Trump Proposes Rule That Would Cut ACA Enrollment by Over a Million

Trump administration proposes major ACA changes

The Trump administration has proposed a new rule that would weaken the Affordable Care Act and likely reduce enrollment by over a million people. The policy was announced last week in the dense, annual "Marketplace Integrity and Affordability Final Rule" for 2027.

This yearly document allows an administration to adjust how the ACA functions. While the Obama and Biden administrations used it to expand the law's reach, the Trump administration is using it to pursue a long-standing Republican goal of scaling it back.

The rule would shift costs to consumers

The proposed changes would roll back requirements on what health insurance plans must cover. It would also encourage a shift toward plans with lower monthly premiums.

Those lower premiums come with a significant trade-off: much higher out-of-pocket costs for consumers when they need care. The administration's own analysis estimates the changes would result in 1.2 to 2 million fewer people enrolling in ACA marketplace plans by 2027.

This is not a full repeal, which Republicans attempted in 2017, but it represents a substantial reduction in the law's coverage.

The proposal faces hurdles before taking effect

The rule is not final. The administration must now allow for a public comment period, which could lead to modifications or delays. Major insurance companies may request more time to adjust to the substantial changes.

Any final rule is also likely to face legal challenges. A similar Trump administration proposal was blocked by a lawsuit last year.

The policy also arrives amid significant political pressure over health care costs. Recent Republican actions have already made coverage more expensive for many Americans.

• Last year, Trump and GOP allies cut over $1 trillion from federal health programs, including the ACA.
• Weeks ago, they allowed extra financial assistance for marketplace customers, passed by Democrats, to expire.

Higher costs are already hurting enrollment

The combined effect of these policies is making health insurance more expensive for people who buy plans on HealthCare.gov or state-run marketplaces. There are clear signs this is having an impact.

Enrollment in ACA plans is already down by more than a million people this year. The rising cost of care is a primary concern for voters and is becoming a central political issue.

The proposed rule, if enacted, would accelerate this trend by making comprehensive coverage less affordable and accessible for millions of Americans.