New enrollments in the Affordable Care Act (ACA), popularly known as Obamacare, appear to be well below—up to a million fewer—than those recorded in 2023, especially due to problems with the program facing the outgoing Administration of President Joe Biden.
Donald Trump’s re-election for a second term has generated uncertainty about the future of the health law. Additionally, the government implemented complex rules to reduce fraudulent enrollment and is fighting a lawsuit that seeks to prevent a group of immigrants without legal residency from purchasing coverage in the health insurance markets.
So far, the number of new enrollees and re-enrollees using healthcare.gov, the federal website used by 31 states, is well below last year. At the beginning of December, new registrations were just over 730,000, compared to 1.5 million in the same period in 2023.
To give consumers more time to enroll, the Centers for Medicare & Medicaid Services (CMS) extended the deadline to purchase coverage that begins January 1 to December 18. (The January 15 deadline is for the one that would start on February 1).
Also at stake is a rule issued by the Biden Administration that allows, for the first time, Dreamerspeople brought to the country as children without papers, can register in the health insurance markets and obtain subsidies.
On December 9, a federal judge in North Dakota ruled in favor of 19 states seeking to block this directive from the Biden Administration.
On the 16th, the Democratic president’s team obtained a temporary suspension, but the fate of this option remains to be seen.
If prevailing, the decision in this case, Kansas v. United States, would effectively prohibit those who have qualified for the Deferred Action for Childhood Arrivals (DACA) program from enrolling in or receiving subsidies for ACA plans in all 19 states. According to attorneys following the case, it does not appear to affect enrollment or coverage in other states.
A final decision on the temporary suspension is expected any time. If granted, it could allow Dreamers continue to sign up while the government’s appeal of the district court’s decision is heard, which is unlikely to happen before Trump takes office.
In its court papers, the Biden Administration argues that not granting a suspension would be highly disruptive in the middle of the open enrollment period, causing the federal government to incur costs to readjust its marketplace to reflect the change and notify those who have already signed up. They have registered that their plans have been cancelled.
The original case was filed in August in the United States District Court for the District of North Dakota and is being heard by District Judge Daniel Traynor, nominated in 2019 by then-President Trump.
Previously, the federal government estimated that about 100,000 uninsured people out of a total of half a million DACA recipients could sign up for coverage in 2025. In its new writing, the government says that 2,700 have signed up in states that filed the demand and that use the federal market.
The Biden Administration’s rule, finalized in May, clarified that those who qualify for DACA would be considered “lawfully present” for purposes of enrolling in ACA plans, which are open to citizens and those called “lawfully present” immigrants.
Federal lawyers argue that North Dakota has not shown it would be harmed by the rule, so it has no standing to bring the case. The state argued that it incurs costs for approximately 130 DACA recipients living there, and that it would not incur those expenses if they were prohibited from enrolling in the ACA and therefore decided to leave the country.
For its part, the federal government argued that an exodus is unlikely. The legal brief also questioned North Dakota’s estimate that it incurs costs of $585 to issue driver’s licenses to DACA recipients and about $14,000 annually to educate at least one DACA member or dependent.
All states challenging this rule argue that it will cause administrative and financial burdens as more individuals register, and that it will encourage more people to remain in the United States illegally.
The plaintiff states are: Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas and Virginia.
This story was produced by KFF Health News, the national newsroom focused on in-depth treatment of health issues that is one of the main programs of KFFthe independent source for health policy research, polling and journalism.
