This publication is part two of a two-part series outlining federal changes to the ACA Marketplace. Click here to read part one.
Much of the attention around federal health care cuts has focused on the budget reconciliation law that all four members of West Virginia’s Congressional delegation supported, which we covered in part one of this blog series. In addition to these cuts, there have also been administrative rule changes put in place by the Trump administration that stand to harm West Virginians’ and Americans’ access to health care via the ACA Marketplace. While some of the changes are temporary, they may impact many families beyond 2026 as they deter those who will face difficulty during 2026 from seeking coverage in the years that follow.
This administrative rule, effective August 25, 2025, makes health care harder to obtain by making ACA Marketplace coverage more expensive and less accessible, leaving some out entirely. The changes in the regulation target vulnerable populations, including low-income families, immigrants, and queer folks. Many of these changes will be difficult and confusing for enrollees to navigate without assistance.
In February 2025, before the rule changes and legislation to cut health care programs outlined in this blog series, the Trump administration made significant cuts to the ACA Navigator program. This program, which provides people with free assistance to find the best Marketplace plan for themselves and their families, will lose 90 percent of their funding by the end of August 2025—when several pieces of the new regulations go into effect. Altogether, these changes, alongside the ones in the federal reconciliation law, will make health care difficult to access and have deep impacts on public health outcomes.
Eliminates the income-based special enrollment period for 2026 (effective August 25, 2025; sunsets December 31, 2026): As briefly mentioned in part one of this blog series, the low-income special enrollment period allowed people with incomes below 150 percent of the federal poverty line (about $23,500 for a single person) to enroll in the Marketplace and receive subsidies outside of the open enrollment period without meeting another qualifying life event.
Starting August 25, 2025, and going through December 31, 2026, people seeking Marketplace coverage can no longer qualify based on a low income without another qualifying life event. For plans starting in 2027, states can choose to start offering income-based special enrollment periods again but will no longer be required to. However, a provision of the reconciliation bill states that even if states offer this pathway, enrollees cannot receive subsidies to help cover costs.
Monthly fee for certain enrollees who do not actively reenroll (effective for 2026 coverage; sunsets December 31, 2026): In the past, most people who did not actively reenroll in a Marketplace plan for the following year were automatically enrolled in the same or similar plan. The program utilized recent tax data to update how much their subsidy amount would be, ensuring continuous coverage for many. For coverage in 2026, enrollees whose subsidies cover the full cost of their premiums will face a $5 monthly fee unless they update their information by December 15, 2025. These penalty fees begin on December 15, 2025 and will be charged each month until updated information is provided by the enrollee.
Allows Marketplace insurers to require enrollees repay past-due premiums to enroll (effective August 25, 2025): In the past, insurers were prohibited from requiring people to pay past-due premiums as a condition of enrolling in a plan in the future. This policy helped ensure that past financial instability did not limit access to health care. Starting at the end of August 2025, Marketplace insurers can require people to pay past-due premiums before they receive a new plan with that insurer. There is no limit on how far back insurers can look when applying this policy.
Eliminates eligibility for Marketplace coverage for Deferred Action for Childhood Arrivals (DACA) recipients (effective August 25, 2025): Since 2012, DACA has temporarily deferred deportation for young immigrants who grew up in the United States and allowed them to work. During that period, DACA recipients were able to receive health insurance via the ACA Marketplace and receive income-based subsidies to help them afford coverage. While this policy has faced legal challenges, the regulation passed in June bars DACA recipients from receiving Marketplace coverage. This change is permanent without further regulatory or legislative changes.
On September 1, 2025, DACA recipients across the country will no longer have access to health insurance via the Marketplace, leaving them without any other option if their employer does not offer it. While it is unclear how many West Virginians this regulation will impact, DACA recipients are over three times more likely to be uninsured than the overall US population; this policy will widen this disparity while making health outcomes worse for them.
Shortens open enrollment period (effective during open enrollment starting November 1, 2026): The annual open enrollment period is the time when everyone who qualifies for a plan can enroll in the ACA Marketplace. Currently, it is between November 1 and January 15, though states can extend it beyond mid-January. Starting on November 1, 2026, for coverage starting on January 1, 2027, the open enrollment season will be cut by one month to go from November 1, 2026, to December 15, 2026. A longer open enrollment window ensures that everyone who wants to receive health care via the Marketplace has time to shop for plans and consider the best option for themselves and their family.
Open enrollment for 2026 coverage is unchanged and will occur from November 1, 2025, to January 15, 2026, in West Virginia. Please visit healthcare.gov or acanavigator.com/wv to learn more.
These changes to the ACA Marketplace, in addition to those outlined in the reconciliation bill, stand to make the Marketplace less accessible, less affordable, and more difficult to navigate. This blog touched on several of the key provisions of the regulatory changes, but there are others that target vulnerable populations. These changes, enumerated in a resource from Beyond the Basics, include banning gender-affirming care from being an essential benefit, requiring more verification paperwork with less time to resolve data matching and other issues, making plans more expensive, and creating less generous plans.
Combined, the cuts to the ACA Marketplace and Medicaid are expected to cost West Virginia $1 billion in federal dollars every year. As these dollars disappear, state officials must find ways to fill gaps in the state budget to ensure the same level and quality of care.
Even if a person is not enrolled in either of these programs, a lack of access to health care for those who are stands to impact every West Virginian and community across the state. This legislation and regulation will make health insurance more expensive for everyone, including those enrolled via their employer. It means fewer jobs in the health care sector, the only part of West Virginia’s economy that has grown over the past decade. It means hospital and clinic closures and fewer services, making people travel farther to receive basic health necessities. These barriers, and the coordination it requires to navigate them, will contribute to a lower quality of life and death for many across the state.
Congress still has time to act as the deepest cuts will not occur for at least a year; however, the changes going into effect this month will undoubtedly harm West Virginians in the short-term.
