A Rules Change Would Open the ACA to ‘Dreamers’

It’s that time of year again: open enrollment for Affordable Care Act insurance — a period that runs from tomorrow to Jan. 15 in most states, a bit longer in some, and shorter in Idaho.

One of the biggest changes this time around: a new rule from the Biden administration that opens enrollment to Deferred Action for Childhood Arrivals recipients. DACA is a federal program offering some protection from deportation and providing work authorization to some people brought to the country as children by family members lacking permanent legal residency.

While the rule could allow an estimated 100,000 DACA recipients to sign up for health insurance in 2025, its fate is uncertain. That’s because it’s being challenged in federal court by Kansas and 18 other states, including Virginia, New Hampshire, North Dakota, and several others in the South and Midwest.

Separately, 19 states and D.C. filed a brief in support of the Biden administration rule that allows DACA recipients to enroll in ACA plans. Those states, led by New Jersey, include many on the East and West Coasts, including California, New York, Oregon and Washington.

The plaintiff states argue that the rule will cause management 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 the proper paperwork. The lawsuit, filed in U.S. District Court for the District of North Dakota in August, seeks to postpone the rule’s effective date and overturn it, saying the expansion of the “lawfully present” definition by the Biden administration violates the law.

ACA plans are open to American citizens and lawfully present immigrants. Now the group often dubbed “Dreamers” will qualify as lawfully present for the purpose of enrolling and applying for tax credits to help cover premiums.

“More than one third of DACA recipients currently do not have health insurance, so making them eligible to enroll in coverage will improve their health and wellbeing, and help the overall economy,” Health and Human Services Secretary Xavier Becerra said in a May news release.

On Oct. 15, the district court heard arguments in the case, and a ruling might come soon, said Zachary Baron, a legal expert at Georgetown Law, who helps manage the O’Neill Institute’s Health Care Litigation Tracker.

But that hearing also launched a flurry of related motions and orders. For instance, U.S. District Judge Daniel Traynor ordered the federal government to provide North Dakota with the names of 128 DACA recipients in the state, under seal, to calculate any financial costs associated with complying with the Biden administration rule in order to determine whether the case should be heard there. The state has until Nov. 12 to respond. The federal government sought to squelch the order, but Traynor denied the request Monday.

And there could be more back-and-forth.

Once Traynor issues a final ruling in the case, it could be appealed by either side, delaying resolution of the lawsuit possibly into next year, when the outcome of Tuesday’s presidential election might also play a role. A new administration, for example, could issue new rules to change or reverse decisions made by the Biden administration.

Find more here on sign-up season, including deadlines, projected premium increases and scams.

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Julie Appleby:
jappleby@kff.org,
@Julie_appleby