Federal ACA Marketplace Enrollment Lagging

It’s open enrollment season for the Affordable Care Act — and there are ongoing challenges.

First up, enrollment.

New and returning sign-ups through healthcare.gov — the federal marketplace that serves 31 states — are well below last year’s rate. New enrollments were just over 730,000 in early December, compared with 1.5 million at the same time last year.

To give consumers in those states more time to enroll, the Centers for Medicare and Medicaid Services extended the deadline to Wednesday to sign up for coverage that starts Jan. 1. (Open enrollment itself ends in most states on Jan. 15, for coverage that would begin Feb. 1.)

Meanwhile, the Biden administration is seeking to put on hold an order by a federal judge in North Dakota who ruled in favor of 19 states that challenged a rule allowing — for the first time — enrollment in ACA coverage by “dreamers,” people brought to the United States as children without immigration paperwork.

The Dec. 9 ruling effectively barred those who qualified for the Deferred Action for Childhood Arrivals (DACA) program in the 19 states from enrolling in or getting subsidies for ACA plans. It does not appear to affect enrollment or coverage in other states, lawyers following the case have said.

On Monday, the U.S. Court of Appeals for the 8th Circuit granted a temporary stay of the order at the government’s request. A final decision, expected any day, could extend the stay while the court hears the appeal.

The Biden administration argues that North Dakota hasn’t proved it would be harmed by the rule — and that not granting a stay would be disruptive. The Dec. 9 order would cause the federal government to incur financial costs if it has to retool the marketplace to reflect the change and notify those who have already enrolled that their plans are canceled, the administration argued.

The original case was filed in August in U.S. District Court in North Dakota and is being heard by District Judge Daniel Traynor, who was nominated in 2019 by then-President Donald Trump.

Previously, the federal government estimated that about 100,000 uninsured people out of a half-million DACA recipients might sign up for 2025 coverage. In its new filing, the government says 2,700 have enrolled through the federal marketplace, and an unknown number in states involved in the litigation that run their own state-based marketplaces.

The Biden administration rule, finalized in May, clarified that those who qualify for DACA would be considered “lawfully present” for the purpose of enrolling in plans under the ACA.

All the states challenging the ACA rule say it will cause administrative and resource burdens as more people enroll, and that it will encourage additional people to remain in the United States when they don’t have permanent legal authorization.

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