By Sabrina Corlette and Rachel Swindle

In the past few years, the Affordable Care Act (ACA) marketplaces experienced significant enrollment growth, contributing to historically low uninsured rates. This is largely attributable to enhanced premium tax credits enacted in 2021 and to marketplace efforts to reduce barriers to coverage, including the expansion of open-enrollment and special-enrollment opportunities.

In March, the Trump administration released a draft regulation that would limit those enrollment opportunities and increase paperwork requirements for consumers to prove their eligibility for coverage and tax credits. Those policies are slated to be codified in the budget reconciliation package pending before Congress. The administration argues that the current policies have prompted less-healthy people to enroll (this is known as adverse selection), which led to an increase in premiums. However, there is limited evidence that expanded open- and special-enrollment periods have led to adverse selection. In fact, data from several state-based marketplaces suggest that reducing administrative burdens around enrollment and conducting robust consumer outreach can both grow enrollment and improve the health of marketplace risk pools. In a recent article for the Commonwealth Fund, Sabrina Corlette and Rachel Swindle assess the impact of shortened and limited enrollment opportunities. You can read the full article here.