Obamacare rule changes could shorten enrollment, limit coverage through Pennie, ACA marketplaces

Apr. 10—Pennsylvania residents may have less time to buy health insurance through Pennie, the state's marketplace for people lacking other access to coverage, and see prices increase as much as fourfold next year.

Congress is nearing a spring deadline to renew a deal that gives tax credits to the vast majority of people who buy insurance through the state-run and federal marketplaces. Monthly premium prices could soar for some people if the so-called enhanced premium tax credits are left to expire at the end of 2025.

At the same time, President Donald Trump's administration has proposed several changes to the insurance marketplaces created under the Affordable Care Act for people who are not eligible for publicly funded programs, like Medicare and Medicaid, and who don't have access to insurance through an employer.

Proposed rule changes would shorten the enrollment period by 30 days in Pennsylvania, end automatic plan renewals, and pull back eligibility for individuals with DACA status, which protects some undocumented immigrants who came to the United States as children from deportation and allows them to work.

Public comment is open through April 11.

The changes are intended to reduce spending on tax credits to people who are no longer eligible for them because of an increase in income and prevent people from being automatically enrolled in coverage they do not want, according to a statement from the U.S. Centers for Medicare and Medicaid Services.

But Pennsylvania's marketplace leaders and enrollment specialists worry that the new rules will limit states' ability to tailor the program to meet local needs.

Pennsylvania and New Jersey both manage their own marketplaces, Pennie and Get Covered New Jersey. The federal healthcare.gov marketplace is for people in states that did not create their own marketplaces.

"Pennsylvania made a very thoughtful, specific decision to take over operation of the marketplace in 2019 so it could be more tailored to Pennsylvania," said Devon Trolley, executive director of Pennie. "The rules really take a lot of that decision-making away."

Here's what to know about the proposed changes:

Shorter open enrollment period

Annual open enrollment is a time when anyone can sign up for a new plan, and people who have a plan can review their coverage and make changes.

The Trump administration has proposed shortening the open enrollment period for the federal marketplace and all state marketplaces to run for 45 days.

Pennie's current enrollment period is 75 days long.

A shorter enrollment period could strain Pennie's ability to provide one-on-one enrollment help to everyone who wants it, Trolley said.

Pennie learned through consumer surveys that people wanted a high level of customer service, with trained specialists to help them elect and enroll in a health plan. The longer enrollment period makes it possible for Pennie to provide that support, she said.

About 40% of the nearly 500,000 people who enrolled in coverage for 2025 did so in the last 30 days of open enrollment.

No automatic plan renewal

Since the marketplaces opened in 2013, people who are enrolled in coverage have their plan automatically renewed every year. The approach is intended to prevent gaps in coverage and help people who are eligible for insurance avoid becoming uninsured.

A change to the rule would require everyone to reapply for coverage every year during the open enrollment period. The Trump administration says the rule change is intended to ensure that people receive the correct tax credit.

Tax credits are based on income. If an individual's income changes during the year, for example they get a raise, they may receive a greater tax credit than they should. They pay back the money when they file their taxes.

About 90% of people who bought a health plan through Pennie received a tax credit for 2025.

No coverage for DACA recipients

Under a rule change by the Biden administration that took effect in January, people with Deferred Action for Childhood Arrivals (DACA) status are eligible to enroll in marketplace plans and qualify for premium tax credits. The move was expected to make health insurance available for about 100,000 people with DACA status.

The proposed rule would eliminate marketplace eligibility for DACA recipients, as the Trump administration moves to accelerate deportations of undocumented immigrants and the DACA program faces ongoing legal challenges.

Looming cuts to tax credits

Though not part of the proposed rule change, a looming deadline for Congress to renew a deal that gives premium tax credits to more people could dramatically affect how much people pay for marketplace plans, said Antoinette Kraus, executive director of Pennsylvania Health Access Network, a nonprofit that helps people enroll in health coverage.

The so-called enhanced premium tax credits have been available since 2021 and make it so no one spends more than 8.5% of their income on a health insurance premium.

For the enhanced subsidies to continue next year, Congress must renew them this spring, when insurers develop proposed prices and submit plans to the government.

If Congress does not renew the expanded financial support, that could result in "unmanageable" premium increases in Pennsylvania, according to Pennie's website.

Pennsylvania residents would pay an average of 82% more for marketplace plans, with some seeing their monthly costs quadruple.

"Any increase, small or large, will put people in a position where they need to make really difficult decisions: Can they pay for health insurance, or can they pay for their mortgage?" Kraus said.

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