Trump admin takes aim at Obamacare

Politico

11-03-2025

Presented by the Coalition for Medicare Choices
With Ben Leonard
OBAMACARE IN THE CROSSHAIRS — The Trump administration released its first major health regulation Monday, proposing policies that would limit Obamacare enrollment, Chelsea and POLITICO's Robert King report.
The Centers for Medicare and Medicaid Services' proposed rule, which sets 2026 coverage year policies for the Affordable Care Act, would shorten the annual enrollment period for Obamacare from Nov. 1 to Dec. 15. The previous period stretched to Jan. 15.
The rule would also scrap a Biden-era regulation cleared last year that allowed recipients of the Deferred Action for Childhood Arrivals program — which lets young immigrants who were brought to the U.S. illegally when they were children remain in the country — to enroll in Obamacare. The agency proposes stripping this eligibility as part of President Donald Trump's executive order to end the 'taxpayer subsidization of open borders.'
Why it matters: The proposed rule illustrates how the Trump administration wants to tighten access to Obamacare's insurance exchanges after enrollment surged and reached record levels during former President Joe Biden's administration. It also builds on the Trump administration's decision to cut funding from nearly $100 million to $10 million for nonprofit 'navigators' that help people find insurance plans.
Also in the rule: The administration proposes other changes to Obamacare it says will crack down on improper enrollments, including ending a special monthly enrollment period for people in households earning less than 150 percent of the federal poverty level. The administration's goal is to end a policy that 'allows people to wait to enroll until they become sick instead of promoting continuous enrollment.'
It would also remove 'sex trait modifications,' or gender-affirming care, from a list of essential health benefits that Obamacare plans must cover.
Key context: Directors of state-run Obamacare exchanges have anticipated a rollback of coverage for DACA recipients for months, preparing to have to quickly reverse coverage that was just granted to the group and encouraging them to access health care while coverage is still available. About 500,000 DACA recipients became eligible for coverage under the Biden administration's expansion last year, though CMS estimated at the time that about 100,000 Dreamers would sign up for coverage.
What's next: The Trump administration must still take public comment before it can finalize the rule, a process that can take months.
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In Congress
GOP AGREES TO DOC PAY — House GOP leadership will resolve pay cuts for doctors treating Medicare patients in Republicans' party-line package supporting President Donald Trump's agenda, Ben reports.
In a social media post Monday, Rep. Greg Murphy (R-N.C.), who co-chairs the GOP Doctors Caucus, said that House Speaker Mike Johnson and Majority Leader Steve Scalise would include a fix to the payment cuts — mandated by a formula that lawmakers on both sides of the aisle say doesn't reflect rising costs.
Spokespeople for Johnson and Scalise didn't respond to requests for comment.
Background: Leadership had previously been open to including the provisions in a stopgap spending bill to keep the government funded after this week, but the pay fix was ultimately not included amid broader concerns among GOP leaders that adding more than standard program extensions would open the door to demands for other policies to be attached.
Key context: Supporters of the fix warn the stakes are high for not addressing this issue quickly: Decades of payment reductions in Medicare have put medical practices in difficult financial straits, potentially forcing them to close practices and reduce access to care, doctor groups say. But the price tag of a long-term fix has historically been a barrier to addressing the cuts.
FIRST IN PULSE: MEDICAID CAMPAIGN — Left-leaning advocacy group Protect Our Care is launching a $2 million ad buy targeting key House Republicans on preserving Medicaid, Ben reports.
The purchase, the largest in a $10 million campaign, consists of television, digital and radio ads featuring a 'lifelong' GOP voter and President Donald Trump supporter urging Republicans not to make cuts to Medicaid.
The push comes as Republicans are expected to target the program to help fund Trump's domestic agenda, including tax cuts, border enforcement and energy policy. Moderates have raised concerns about changes leading to cuts in benefits.
Among others, the ads will target several California, New York and Pennsylvania Republicans in swing districts, including Reps. Mike Lawler (R-N.Y.) and Young Kim (R-Calif.).
FREEDOM CAUCUS' PLEA — A group of ultraconservative lawmakers is pleading with moderate Republicans to not get in the way of making massive cuts to Medicaid, Ben reports.
Three prominent members of the House Freedom Caucus said in an op-ed for Fox News on Monday that they're not calling for massive cuts to the safety-net health insurance program but instead calling for reforms that would 'reverse its explosive expansion' that's left Medicaid 'unsustainable.'
Freedom Caucus Chair Andy Harris (R-Md.) and members Chip Roy (R-Texas) and Eric Burlison (R-Mo.) argued in the op-ed that while some colleagues may be 'hesitant' about making changes to Medicaid, many of those changes could be phased in to avoid cuts to benefits and help Republicans achieve necessary savings targets.
Background: Massive cuts to Medicaid would likely be needed to finance Republicans' party-line bill to enact broad swaths of President Donald Trump's domestic agenda. The budget resolution the House adopted last month would instruct the House Energy and Commerce Committee — which has jurisdiction over Medicaid — to find $880 billion in cuts over a decade.
The savings would help to finance the tax, border security and energy bill Republicans want to pass through the filibuster-skirting budget reconciliation process.
'For lawmakers who claim to be on board with cutting the waste, fraud and abuse — and delivering on Trump's historic mandate — this is it,' the Freedom Caucus members wrote. 'Nothing you do in the next two years will come close to the importance of implementing the $880 billion required in savings to programs under the House Energy and Commerce Committee's jurisdiction.'
IN THE STATES
TARGETING mRNA SHOTS — States are introducing more roadblocks to the use of messenger RNA vaccines, POLITICO's Lauren Gardner reports.
Republican policymakers across the country are proposing bills to limit or ban the use of the vaccines based on a mix of medical freedom rhetoric and incorrect assertions of how they work in the body. The proposals represent the latest manifestation of Covid-19 pandemic backlash.
Several bills introduced in the Texas Legislature would ban the administration, manufacture or sale of mRNA vaccines there. Legislation in Kentucky would prohibit the use of mRNA vaccines in children under 18. In Idaho, a GOP state senator has proposed a 10-year moratorium on mRNA vaccine administration.
Why it matters: Some efforts have failed, but public health experts worry that their existence now could be a bellwether for the future.
The efforts come as noted vaccine skeptic Robert F. Kennedy Jr. has taken the reins at HHS and the Trump administration is reportedly weighing whether to pull hundreds of millions of dollars in federal funding to Moderna, the maker of one of the most-used Covid shots, to develop a human bird flu vaccine as that disease spreads among animals and occasionally infects people.
'People laugh at this,' said Dr. Amesh Adalja of the Johns Hopkins Center for Health Security, 'but then five years from now more legislatures are doing it, and it becomes real.'
WHAT WE'RE READING
ProPublica's Annie Waldman and Lisa Song report on certain topics that will get extra scrutiny at the National Cancer Institute under the new HHS secretary.
POLITICO's Meredith Lee Hill reports on House GOP leaders' alarm over the Senate's delay in advancing their budget plan.