Proposed Changes Would End Coverage for DACA Recipients, Make Coverage More Expensive, Difficult to Find, Impose Costs to States
Chicago – Attorney General Kwame Raoul and a coalition of 21 attorneys general sent a letter regarding a raft of proposed changes that would undermine the Affordable Care Act (ACA), making it more difficult and expensive for individuals to enroll in health coverage on federal and state exchanges. Changes would also bar Deferred Action for Childhood Arrivals (DACA) recipients from buying health insurance on the exchanges.
If allowed to take effect, the proposed ACA changes will cause up to two million Americans to lose health insurance coverage in 2026 and will create significant health and economic damage to the states as more people are forced to go without health insurance, driving up costs for everyone.
“These proposed changes to the Affordable Care Act are unnecessary and disturbing,” Raoul said. “Everyone in this country deserves access to lifesaving health services and these changes could cause hundreds of thousands of Americans to be uninsured. I will continue to collaborate with other attorneys general to preserve access to care that saves lives, reduces disparities in health care and improves public health in our communities.”
In 2024, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) published a Final Rule increasing patient access to state and federal exchanges under the ACA. This rule allows DACA recipients, also known as Dreamers, who are allowed to live and work in this country pursuant to deferred action, to purchase affordable health insurance on ACA exchanges.
However, last month, the Trump Administration initiated the process of trying to undo this rule. If allowed to go into effect, the proposal would remove access to insurance on the ACA exchanges from DACA recipients, even if it is in the middle of the coverage year, when they are counting on this insurance for their medical care. In their letter, Raoul and the attorneys general explain this will harm states, too, because if these residents lose access to preventive medical care via their insurance, they may need to seek more-expensive emergency room care. Raoul and the coalition said this would harm public health and economic well-being for communities across Illinois and the nation.
Other proposed changes by the Trump Administration include forcing all state ACA exchanges to shorten their open enrollment periods, instead of allowing them to run for longer periods.
Another part of the rule would allow health insurance plans to deny enrollment to anyone who once missed even a single payment for a health insurance premium, no matter how long ago the missed payment occurred. Raoul and the attorneys general explain the rule does not require insurers to notify their consumers if they implement this policy—meaning consumers could be denied coverage without being aware that their denial is because they owe a past-due premium. In previous rulemaking, the federal government understood that nonpayment could be due to a variety of factors and that insurers currently have methods to collect past-due payments.
Finally, the proposed rule would exclude coverage for gender-affirming care as an essential health benefit, representing a dangerous intrusion into the doctor-patient relationship. The Trump Administration claims, without evidence, that gender-affirming care is rarely covered in employer-based health plans. However, Raoul and coalition explain in their letter that surveys indicate that coverage for these benefits has expanded significantly, with 72% of Fortune 500 companies offering gender-affirming care in 2024.
Joining Attorney General Raoul in sending the letter are the attorneys general of Arizona, California, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington and Wisconsin.
