The efforts are part of President Donald Trump’s announced efforts to cut the federal budget and reduce the burden to taxpayers. The budget resolution adopted by the House in February calls for $880 billion in budget cuts for the House Energy and Commerce Committee, which oversees Medicare and Medicaid.
While Trump has denied plans to cut Medicare or Medicaid, analysts say it would be impossible to reduce the committee’s budget without those cuts.
The proposed Marketplace Integrity and Affordability Proposed Rule would revise standards relating to past-due payments, exclude Deferred Action for Chilchood Arrivals (DACA) recipients from certain coverage, change work requirements for eligibility, and remove mandates for insurers to cover gender affirming or sex-trait modifications.
“It’s a clear signal that, certainly, the federal government would not be looking to ensure that coverage is not discriminatory, as it has been doing before,” said Katie Keith, director of the Center for Health Policy and the Law at Georgetown University.
Analysts say the potential changes would shift Medicaid costs away from the federal government and to the states, which have to make up the difference.
The federal government covers 90% of expansion states’ Medicaid budgets, with nonexpansion states receiving a match rate of 50%-77%.
The governors contend that the proposed rules would result in higher insurance premiums and cause low-income residents to abandon healthcare coverage altogether.
The letter, signed by Gov. Pritzker, Gov. Jared Polis of Colorado, Gov. Michelle Lujan Grisham of New Mexico, Gov. Wes Moore of Maryland, and Gov. Tina Kotek of Oregon, is addressed to Peter Nelson, Director of the Centers for Medicare & Medicaid Services.
“Any rule changes for the 2026 plan year, which will be filed for approval in late spring, create a
high risk of destabilizing state health insurance markets, particularly as Congress contemplates
the expiration of enhanced Affordable Care Act (ACA) tax credits and cuts to Medicaid,” the letter reads.
The governors jointly argued against key concerns, such as restricting the state’s ability to set open enrollment periods and determine eligibility for coverage, eliminating options for special enrollments, and changing premium adjustment calculations.
“Once again, it is clear that the Trump Administration will stop at nothing to restrict access to health insurance for Americans,” said Pritzker. “This proposed rule will cause confusion, make it harder to enroll, and limit healthcare access for the most vulnerable Illinoisans.”
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