Proposed Changes Would End Coverage for DACA Recipients, Make Coverage More Expensive and Difficult to Find, and Impose Costs on States

LANSING – Michigan Attorney General Dana Nessel and a coalition of 22 attorneys general sent a letter (PDF) opposing 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 and prohibiting 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 between 750,000 and 2 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 care, driving up costs for everyone. 

“Michigan families are already facing rising prices, and these alarming changes proposed by the Trump Administration would only make health care even more expensive by increasing out-of-pocket costs for everyone,” Nessel said. “Denying Dreamers coverage under the Affordable Care Act doesn’t just hurt them – it leads to more uninsured people in our communities and puts public health at risk. Michiganders deserve better.” 

In 2024, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) released 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 make dramatic amendments to this rule. If allowed to go into effect, the plan would remove access to insurance from DACA recipients, even in the middle of the year, when they are counting on this insurance for their medical care. That harms the states too: if these residents lose access to preventive medical care via their insurance, they may need to seek more expensive emergency room care, harming public health and economic well-being for communities across the state. 

One part of the rule change would force all state ACA exchanges to shorten their open enrollment periods, instead of allowing them to run for longer periods. Open Enrollment for 2025 health insurance in Michigan runs from November 1 through January 15. This timeframe would be shortened under the proposed rule. In 2024, nearly 90% of enrolled Michiganders qualified for a subsidy, with many finding a plan for less than $10 per month.  

An additional amendment to 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. The amendment would 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 sufficient methods to collect past-due payments. 

Joining Attorney General Nessel in signing the letter are the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, the District of Columbia, Hawai‘i, Illinois, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Wisconsin.