WE OPPOSE TRUMP'S LATEST ATTACK

ON AMERICA'S HEALTHCARE SYSTEM

In February 2026, the U.S. Department of Health and Human Services quietly released a 577-page proposed rule. This proposal will further weaken the health coverage system created under the Affordable Care Act. The Centers for Medicare & Medicaid Services issued it and called for sweeping changes to enrollment procedures, subsidy protections, and eligibility rules starting in 2027. Despite the scale of these changes—and the millions of Americans who could be affected—few people even know these changes are being considered. The rule is buried in a dense federal regulatory filing. Unless finalized later in 2026, it remains technically “proposed,” with public comments accepted through March 13. However, if implemented as written, the changes would reshape the marketplace, push many Americans out of coverage, and increase financial risks for those who remain insured. With these proposed guidelines, an already difficult-to-navigate system will become even harder to navigate, with more red tape and even more hoops to jump through.

One of the most alarming provisions would end automatic re-enrollment. This system has kept millions insured by renewing those who miss deadlines into their plan or a similar one, preventing sudden coverage loss from paperwork errors. Nearly half of marketplace participants were automatically renewed in 2025. The proposed rule would remove this protection, requiring households to repeatedly verify income, residency, and family size before coverage continues—creating a bureaucratic obstacle course. Those with multiple jobs, unstable housing, or language barriers may struggle more. The likely result: not better program integrity, but more people losing insurance because of new administrative hurdles.

The proposal also strips away a crucial financial safeguard tied to premium subsidies. These subsidies are the backbone of affordable marketplace coverage. They are calculated using projected annual income and provided in advance to lower monthly premiums. If a household underestimates income and gets too much subsidy, repayment is currently capped to prevent large tax bills. The new rule would end those caps. Fluctuating income is common for hourly workers, gig workers, and small business owners. Now, these families could face large tax-time repayment demands. Instead of protecting households from financial shocks, the new policy exposes them to unexpected and large repayment obligations. This provision is already scheduled for the 2026 tax year. Many Americans may feel its impact when they file their taxes in 2027.

The rule also cuts the open enrollment period by a month. The new deadline would be December 15, not January 15. This may seem technical, but real-world effects could be significant. About 40 percent of marketplace sign-ups in recent years occurred after mid-December. Removing that window will shut out many people who need more time to choose plans, resolve questions, or recover from holiday expenses. At the same time, the proposal weakens special enrollment protections for lower-income households. People who could enroll year-round during income-based periods would lose premium subsidies if they use those windows. For them, coverage could become unaffordable after sudden changes in income.

Another troubling provision would strip many legally present immigrants of the financial assistance currently enabling their coverage. Beginning January 1, 2027, several groups—including refugees, asylum recipients, and Temporary Protected Status holders—would lose eligibility for marketplace premium subsidies. Assistance would be limited to U.S. citizens and lawful permanent residents, with only narrow exceptions defined by federal law. Without subsidies, marketplace insurance becomes prohibitively expensive, making coverage unattainable for many. Health policy experts warn that many affected individuals will forgo coverage, increasing the uninsured rate, straining hospital resources, and shifting uncompensated care costs onto local health systems.

These changes are more than routine adjustments. They systematically weaken safeguards that have helped millions obtain health coverage since the Affordable Care Act was enacted. The proposal eliminates automatic renewals, exposes families to unlimited subsidy repayments, shortens enrollment periods, and restricts eligibility for some groups. The marketplace could become harder to enter and easier to leave. Even more troubling is the lack of public awareness about these changes. Many Americans may not realize the consequences until they lose coverage, miss a deadline, or get a surprise tax bill.

Press Release: CMS Proposes Regulations to Lower Health Care Costs, Expand Consumer Choice, and Protect Taxpayers (Centers for Medicare & Medicaid Services, 2-9-26)

Fact Sheet: HHS Notice of Benefit and Payment Parameters for 2027 Proposed Rule (Centers for Medicare & Medicaid Services, 2-9-26)

Health Insurance Exchanges 2025 Open Enrollment Report PDF (Centers for Medicare & Medicaid Services)

Comment Instructions/Guidelines: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program (Federal Register, 2-11-26)

Trump administration proposes new Obamacare rules for 2027 with higher deductibles (Reuters, 2-9-26)

HHS Proposes Sweeping Changes For 2027 Marketplace Plans (Part 1) (Health Affairs, 2-11-26)

GOP ‘big beautiful bill’ poised to deliver ‘shock’ to ACA marketplace, health policy experts say (CNBC, 3-6-26)