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Trump Administration Finalizes ACA Rollbacks and Ends 'Dreamer' Coverage

Between 725,000 and 1.8 million people will lose coverage when the new rules take effect for the 2026 plan year.

Illustration: Aïda Amer/Axios
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Overview

  • Starting with plan year 2027, federal exchanges will limit open enrollment to Nov. 1 through Dec. 31 and allow states to set their own nine-week windows within that period.
  • The rule rescinds coverage for immigrants who entered illegally as children by overturning a Biden-era policy that was blocked in 19 states.
  • Temporary provisions for plan year 2026 include stricter income verifications and a new $5 monthly premium for consumers automatically reenrolled in subsidized plans.
  • The final rule bans coverage of sex-trait modification as an essential health benefit beginning in 2026 across federal and affected state marketplaces.
  • CMS projects the changes will save $12 billion in 2026 and lower average marketplace premiums by about 5 percent.