In a move that has sparked significant controversy, the Trump administration has introduced new regulations that will compress the timeframe for enrolling in the Affordable Care Act (ACA), potentially affecting millions of Americans. This decision is now being challenged in court by a group of Democratic mayors.
Last month, the Department of Health and Human Services unveiled modifications intended to reverse the previous administration’s expansion of the ACA’s enrollment period. The Biden administration’s policy had facilitated record-high enrollment numbers by extending the sign-up window, a change that the new rules aim to roll back.
As Congress deliberates a significant bill affecting health care coverage, the new rules are anticipated to leave up to 2 million people without insurance. These regulations have been a longstanding target for Republican President Donald Trump, who has criticized the ACA for its perceived inefficiencies and financial burdens.
Legal action against these changes was initiated by the mayors of Baltimore, Chicago, and Columbus, Ohio, who argue that the new policy will increase the number of uninsured individuals and strain city resources. They contend, “Cloaked in the pretense of government efficiency and fraud prevention, the 2025 Rule creates numerous barriers to affordable insurance coverage, negating the purpose of the ACA to extend affordable health coverage to all Americans, and instead increasing the population of underinsured and uninsured Americans.”
The lawsuit is supported by two advocacy groups, Doctors for America and Main Street Alliance, which have also voiced their opposition.
Significant among the changes are the reduction of the federal marketplace enrollment period to November 1 to December 15 in 2026, stricter income verification processes, and a $5 fee for automatic re-enrollment in certain plans. Additionally, insurers will gain more latitude to deny coverage to those with unpaid premiums, and about 100,000 immigrants brought to the U.S. as children will be excluded from enrolling.
The Department of Health and Human Services defended these measures as “temporary measures to immediately tamp down on improper enrollments and the improper flow of federal funds.”
Democratic mayors assert the introduction of these rules bypassed an adequate public comment period. Skye Perryman, president of Democracy Forward, representing the plaintiffs, remarked, “This unlawful rule will force families off their health insurance and raise costs on millions of Americans. This does nothing to help people and instead harms Americans’ health and safety across our country.”
The current legal challenge does not dispute the Trump administration’s decision to restrict immigrants from accessing ACA coverage.
Under the Biden administration, the ACA saw a surge in enrollment, with records showing 24 million sign-ups, bolstered by tax incentives from the 2022 Inflation Reduction Act. However, the program’s sustainability remains contentious, with critics, including Trump, highlighting its reliance on substantial subsidies.
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