The Trump administration is taking aim at "improper enrollments" in Affordable Care Act (ACA) plans in a new rule.
Under a proposed regulation, the Centers for Medicare & Medicaid Services (CMS) said it intends to shorten the current open enrollment period for plans on the individual marketplace by ending it on Dec. 15 rather than a month later in January.
The 2025 Marketplace Integrity and Affordability Proposed Rule also would eliminate the monthly special enrollment period that is available to people who have household incomes at 150% of the federal poverty level. The agency said this special period "currently allows people to wait to enroll until they become sick instead of promoting continuous enrollment that fosters prevention and better health outcomes."
The CMS said that since additional premium subsidies were made available in 2021 following the COVID-19 pandemic, it increased both the "opportunity and incentive for improper enrollments."
The agency cited a report from the Paragon Health Institute that estimates as many as 5 million people were "improperly" enrolled in subsidized coverage in 2023. The CMS also said it began to receive a "dramatic uptick" in complaints from consumers who said they were signed up for coverage without their consent.
Per the Paragon study, the improper enrollments cost the feds $20 billion.
In the press release, the CMS also argued that the expansion of the premium subsidies led to a significant increase in the number of applicants whose submissions did not match federal data sources. In 2022, there were 6.3 million applications with such data-matching issues, an increase of 2.6 million compared to 2020.
The CMS said that these steps to address improper enrollment in the ACA marketplaces would reduce federal spending by $11 billion to $14 billion in 2027.
Beyond changes to the marketplace enrollment processes, the proposed rule also seeks to list "sex-trait modification" to a list of items and services that would not be considered essential health benefits for the 2026 plan year and would revert policies around coverage access for Deferred Action for Childhood Arrivals recipients.
The White House has put a focus on slashing federal spending across the board, including mass layoffs and firings at multiple agencies. Transgender rights and immigration have also been central to President Donald Trump's agenda.