This story was reported and written by our media partner the Virginia Mercury.
DACA populations, the children of undocumented immigrants popularly known as “Dreamers,” are now excluded from enrolling in the Affordable Care Act Marketplace, following the effects of a new U.S. Health and Human Services rule. Meanwhile a recent federal court ruling has paused a few other potential changes to how people can purchase health insurance.
Formally known as Deferred Action Childhood Arrivals, the decades-old U.S. immigration policy grants children of undocumented immigrants protection from deportation and the ability to work in the country. A President Joe Biden-era policy also allowed these populations to be able to enroll in the ACA marketplace, but as of Aug. 25, they are no longer eligible.
The court ruling also eliminated a special enrollment period for low-income people while granting a stay to other pending changes, like stricter eligibility verification for special enrollment periods and requiring enrollees to pay past-due premiums before enrolling in new coverage. This means those changes won’t take effect yet, but the court case is still ongoing.
“We’re still waiting to see what the actual outcome of this court case will be,” said Louise Norris, a health policy analyst with Healthinsurance.org.
While HHS Secretary Robert F. Kenedy Jr.’s rule is meant to eliminate coverage for some, particularly people who might not need to use the ACA Marketplace; the crux of the case had argued that the changes spur eligible people to fall off getting health insurance.
“The marketplace rule was designed to tighten things up and make it harder for people to enroll,” Norris said. “But what the plaintiffs in this case are saying is ‘yes, but also, people will fall through the cracks.”
The case, brought forward by a coalition of various U.S. cities, health care organizations and small businesses, alleges that President Donald Trump’s administration is limiting enrollment opportunities, raising consumer costs and adding administrative burdens in violation of the Administrative Procedure Act.
In tandem, the federal government has handed down a slew of pending administrative changes to states and prompted uncertainties within private health insurance markets through the passage of the “One Big Beautiful Bill Act” (OBBA), which did not address the renewal of tax credits that help lower-income earners purchase health insurance.
Additional eligibility requirements for Medicaid recipients and adjustments to hospital funding mechanisms are looming. Medicaid, the program that helps states provide health insurance to the disabled, pregnant and financially-struggling, also represents a big chunk of federal spending. In order to achieve certain tax cuts and bolster federal spending on immigration enforcement and military efforts, Republicans in Congress zeroed in on Medicaid as a place to trim the national budget. The nonpartisan Congressional Budget Office estimates about 10 billion people nationwide could fall off Medicaid once the changes take effect.
Virginia’s Medicaid director, Cheryl Roberts, told state lawmakers this summer that she expects the extra verification work to be a challenge for various state departments and local governments.
Of Virginia’s roughly 1.9 million people on Medicaid, over 600,000 of them are estimated to be most affected by the changes, she added.
Meanwhile, hospitals argued in a letter to Congress that eventually additional costs they absorb to care for people without insurance will lead to tough choices. Those include potentially reduced services and staff, negotiating higher rates with private insurers — a cost that will be passed on to consumers — or in some cases, hospital closures.
While marketplaces gear up for open enrollment periods towards the end of this year, the lack of renewal of ACA Marketplace tax credits has healthy consumers wondering if they should forego health care next year and hope they don’t get injured or sick.
“It’s sort of like three big puzzle pieces that are all driving premiums higher for next year,” Norris said.
Preemptively, Aetna has already announced it’s pulling out of the ACA Marketplace, though it didn’t say why when theyMercury asked. Norris surmises that a variety of factors are at play for companies as they weigh matters, too.
“These three issues are definitely causing instability in the marketplace,” Norris said, noting how the changes create “hoops” that not everyone can jump through.
Meanwhile, U.S. Rep. Jennifer McClellan, D-Richmond, has emphasized that uninsured people will still need care. That care might be put off until emergencies arise and then it becomes more expensive. She is pressing her colleagues to renew the ACA tax credits and wants to work with others on undoing parts of the OBBA.
“With open enrollment coming, we really need to act quickly,” McClellan said.