News: Under Trump, Dreamers' health care is uncertain

Tuesday, January 7, 2025

Under Trump, Dreamers' health care is uncertain

Jan 07, 2025

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By Ben Leonard and Chelsea Cirruzzo

With help from Daniel Lippman

Driving The Day

Immigrant rights supporters gather at the U.S. Capitol

Dreamers' health care access may be cut short under a Trump administration. | Pablo Martinez Monsivais/AP

DREAMER DEBACLE — Undocumented immigrants who entered the U.S. as children were able to enroll in Obamacare for the first time in 2024, but the incoming Trump administration throws the future of the policy into flux, POLITICO’s Kelly Hooper reports.

It’s a political reality that state officials have contended with since the November election. Some Affordable Care Act exchange directors are preparing to quickly roll back health coverage that was recently extended to thousands of immigrants in their states, while others are urging residents to get the care they need while it’s still available.

“What we have done is really focused our messaging around what’s here right now,” said Jessica Altman, executive director of Covered California, the state exchange. “If you haven’t been to the doctor, if you need to fill a prescription, if there is care you’ve been putting off, you can enroll, and you can get it right now.”

Background: Recipients of the Deferred Action for Childhood Arrivals policy — which protects certain undocumented immigrants who came to the U.S. as children from deportation — had been ineligible for any federally funded health insurance until last year, when the Biden administration expanded Obamacare eligibility to the group, also known as “Dreamers.

Though data shows most Dreamers are working, are in good health and could be receiving health insurance through an employer, the group continues to have a high uninsured rate.

Key context: While President-elect Donald Trump hasn’t commented specifically on the expansion, he tried to scrap DACA in his first term and has promised mass deportations of undocumented immigrants who have committed crimes in his second term. The president-elect has recently signaled a softer stance toward Dreamers, saying “in many cases, they become successful,” and “we’re going to have to do something with them.”

The Trump transition team didn’t respond to a request for comment on whether the administration would roll back the policy.

Even so: The policy is already in flux in 19 Republican-led states that challenged the Biden administration’s rule, arguing it would increase costs and encourage more people to remain in the U.S. without permanent legal authorization. A Trump-appointed federal judge in early December temporarily barred Dreamers from enrolling in ACA coverage in those states.

Amid the uncertainty, some states that run their own Obamacare marketplaces are preparing for the policy to be fully reversed. In Maryland, the state exchange has pulled back its marketing of Obamacare plans to Dreamers since Trump was elected, said Michele Eberle, the executive director of the Maryland Health Benefit Exchange.

“After the election, we were concerned — when we only have so many marketing dollars to go around — about really encouraging people to get coverage and then having to take it away,” she said.

WELCOME TO TUESDAY PULSE. Senate HELP Chair Bill Cassidy sat with VP-elect JD Vance at Congress’ certification of Trump’s win Monday. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

Health Costs

Folded hands on top of medical bills.

Credit reports will no longer be able to include medical debt. | Jacquelyn Martin/AP

NEW PRIVACY RULES FOR MEDICAL DEBT — The Consumer Financial Protection Bureau finalized a rule on Tuesday that will ban medical debt information from appearing on credit reports.

The rule, POLITICO’s Alfred Ng reports, is part of the agency’s efforts to improve financial data privacy, as debt collectors are known to rely on credit reports to track people who owe medical bills.

“People who get sick shouldn’t have their financial future upended. The CFPB’s final rule will close a special carveout that has allowed debt collectors to abuse the credit reporting system to coerce people into paying medical bills they may not even owe,” CFPB Director Rohit Chopra said in a statement.

The agency first proposed the rule in June, arguing that such information was inaccurate and ineffective predictors of a person’s ability to repay loans.

Trump Transition

TRUMP TARIFF LATEST — President-elect Donald Trump’s vow to enact across-the-board tariffs has rattled some in the health care industry, who fear they could raise consumers’ costs and threaten hospitals’ bottom lines.

He’s looking to focus them on key sectors to strengthen domestic manufacturing, including “critical medical supplies” like needles and pharmaceutical materials, according to The Washington Post. Trump denied that report, saying it “incorrectly states that my tariff policy will be pared back.”

Trump has pitched the tariffs as a way to spur domestic investment and bring more jobs back to America, all without creating inflation, and has the support of some domestic manufacturing groups like the American Medical Manufacturers Association. Trump’s push for tariffs comes amid a broader push to boost domestic manufacturing and keep adversaries out of supply chains.

But economists have told POLITICO the policies could lead to inflation and companies passing costs to consumers. Companies have said they could also shake up pharmaceutical supply chains, which are complex and increasingly reliant on countries like China for key supplies, companies warn.

“The biggest impact is going to be ... forcing some of these biotech companies to change the supply chain,” said Alex Guillen, global life science and pharma director at supply-chain firm Tive Inc., saying companies may look to move production elsewhere. “Every time there is a change in the supply chain ... There is a huge cost."

Other types of firms have concerns, too. Casey Hite, CEO of durable medical equipment provider Aeroflow Health, said tariffs could reduce consumer choice for medical devices and raise costs.

“There may be alternative approaches to tariffs that wouldn’t burden US companies with absorbing these costs,” Hite said. It's a complex issue that requires careful consideration.”

In Congress

GUTHRIE TALKS RECONCILIATION — Changes to Medicaid and site-neutral payment policy were among the health care options for reconciliation discussed at a recent House GOP retreat, new Energy and Commerce Committee Chair Brett Guthrie (R-Ky.) told POLITICO.

The reconciliation process, which skirts the Senate filibuster and would allow Republicans to pass budget-related legislation without Democrats, is expected to be central to President-elect Donald Trump’s agenda, including on border, energy and tax policies.

Republicans need ways to pay for their priorities, including extending Trump-era tax cuts.

House Republicans met Saturday in Washington to discuss options. Guthrie said he presented potential health care provisions, including changes to Medicaid.

“[Health care] will be a big part,” Guthrie said. “Not just because it generates savings because it’s reconciliation — that’s what our instructions are going to be. We also need to do it in a way that makes it sustainable for our states. States pay a big portion.”

Guthrie also said lawmakers discussed establishing site-neutral policies that would ensure Medicare pays the same rate for care regardless of where it’s provided.

“The question would be is that in reconciliation or do we look at it in other terms, or to what level do we do site-neutral?” Guthrie said.

CARTER MAKES HEALTH PACKAGE PLEDGE — Rep. Buddy Carter (R-Ga.), the new chair of the House Energy and Commerce Committee’s Health Subcommittee, tells POLITICO that he hopes to get a health care package done “as soon as possible” after President-elect Donald Trump and Elon Musk helped kill it last month.

That package included significant new regulations for pharmacy intermediaries, a longer-term extension of eased telehealth rules in Medicare and the commercial market and hospital at-home care, and measures to avert pay cuts for doctors in Medicare.

“We’re going to make sure it happens,” Carter said. “My hope is we’ll be able to put it together and rush it through as soon as possible. If they want to use it in reconciliation as a pay-for, then so be it.”

Musk and Trump railed against the stopgap measure in December, though not directly about its health care provisions, leading Republicans to significantly narrow the legislation that extended government funding through mid-March. Lawmakers will have to act quickly to avoid a shutdown and expiration of several health care programs.

Names in the News

Drew Gonshorowski is now Nebraska’s Medicaid director. He was previously a senior research fellow at the Paragon Health Institute.

Jay Gulshen will be chief counsel for the House Energy and Commerce Committee’s Health Subcommittee. Most recently he was senior adviser for E&C on Medicare Part B and D issues.

Greg Perry has been appointed director general of the Global Self-Care Federation. He was previously at the International Federation of Pharmaceutical Manufacturers and Associations.

Jasmine Yunus is now campaign counsel at the Government Accountability Project where she represents government and private-sector whistleblowers, Daniel reports. She previously was a litigation fellow at the Center for Reproductive Rights.

WHAT WE'RE READING

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