Obamacare Enrollment Dips Amid Trump Election Fallout and Legal Turmoil

New enrollments under the Affordable Care Act (ACA) are poised to fall significantly short of last year’s record levels, potentially by as many as one million. This decline comes as the Biden administration grapples with significant changes to the program while facing a complex landscape following Donald Trump’s election to a second term.

The situation has been further complicated by new policies aimed at reducing fraudulent enrollments. Additionally, a lawsuit is underway seeking to prohibit immigrants without legal residency from accessing ACA coverage. As of early December, new and returning enrollments on healthcare.gov—a key platform serving 31 states—lagged behind previous figures, with just over 730,000 compared to 1.5 million a year ago.

To mitigate the impact of these challenges, the Centers for Medicare & Medicaid Services has extended the enrollment deadline to December 18. This extension is intended to facilitate access to coverage beginning on January 1, while a later deadline of January 15 applies for plans starting February 1.

The Biden team is also facing uncertainty regarding a directive enabling enrollment for “Dreamers”—individuals brought to the U.S. as children without legal status. Following a December 9 ruling from a North Dakota judge that favored a coalition of 19 states aiming to block this policy, the Biden administration received a temporary stay from the U.S. Court of Appeals for the 8th Circuit on December 16. This stay allows Dreamers to benefit from the ACA while the appeal process unfolds, though a definitive ruling is expected soon.

In its court documentation, the Biden administration contends that a stay is crucial to avoid significant disruptions during the open enrollment period. Without it, rapid adjustments to the marketplace may be necessary, and individuals who have already enrolled could face plan cancellations.

The initial case challenging the Dreamers rule was filed in August in North Dakota and is led by Judge Daniel Traynor, a Trump appointee. Previously, estimates indicated that upwards of 100,000 uninsured DACA recipients might seek coverage, though newly reported figures indicate that only 2,700 have enrolled so far within the suing states.

The Biden administration’s rule, finalized in May, stipulates that those who qualify for DACA are considered “lawfully present” and eligible for ACA plans. Federal lawyers argue that North Dakota has failed to substantiate claims of harm, while the state cites costs associated with DACA recipients living within its borders.

The legal challenges to the ACA rule emphasize concerns about potential administrative burdens and the implications of offering coverage to individuals without permanent legal status. States participating in the lawsuit include Alabama, Florida, Texas, and others.