A group of top Senate Democrats is urging the Trump administration to withdraw a proposed rule that would fundamentally reshape the Affordable Care Act marketplace, warning it could cause between 1.2 million and 2 million Americans to lose their health coverage.
The proposed rule, submitted by the Centers for Medicare and Medicaid Services in February, would eliminate requirements that ACA health plan issuers offer standardized plan options and lift restrictions on how many non-standardized plans marketplace issuers can offer. The rule also seeks to allow catastrophic health plans with terms extending up to 10 years.
What the Left Is Saying
Democratic Sens. Tammy Baldwin (Wis.), Chuck Schumer (N.Y.) and Ron Wyden (Oreg.) led 16 colleagues in a letter to CMS Administrator Mehmet Oz demanding the rule be withdrawn. The senators called the proposal 'junk coverage' that would increase deductibles, cover fewer services and kick providers out of networks.
'President Trump told the American people he would protect them from the "big, fat, rich insurance companies, who have made trillions, and ripped off America long enough,"' the letter read. 'Rather than keep this promise, this administration has proposed a rule that CMS' own experts predict will kick 2 million Americans off the health care they have and accelerate the health care affordability crisis.'
The Democrats argued that allowing states to replace their state-based exchanges with private web brokers would make it harder for consumers to compare plans and promote inadequate coverage. They noted that 72 million adults lack dental insurance and said efforts should focus on lowering costs rather than prohibiting essential health services.
'We should be focused on lowering the cost of care and ensuring that insurance companies cannot raise costs, reduce coverage, and take advantage of working families,' the senators wrote. Other signers included Sens. Ed Markey, Dick Durbin, Jeff Merkley, Ben Ray Luján, John Hickenlooper, Angela Alsobrooks, Alex Padilla, Michael Bennet, Chris Van Hollen, Patty Murray, Elizabeth Warren, Richard Blumenthal, Lisa Blunt Rochester and Bernie Sanders.
What the Right Is Saying
The Trump administration has defended the proposed rule as a way to reduce regulatory burden and increase flexibility for insurance issuers. CMS said in its proposal that the changes would 'reduce issuer and HHS burden and regulatory complexity and enhance flexibility for issuers to innovate in plan design.'
The administration argues that lifting standardization requirements would allow insurers to offer more diverse plan options tailored to different consumer needs. The proposal to extend catastrophic health plans to multi-year terms would give consumers longer-term protection against worst-case medical scenarios.
Regarding the elimination of adult dental services from essential health benefits, the administration said this change would follow ACA statutes that require essential health benefits to encompass the scope of typical employee-sponsored plans. The change would align ACA coverage more closely with typical employer-provided insurance.
The rule's supporters say reducing government-mandated plan structures could lead to more affordable options for consumers and greater competition among insurers.
What the Numbers Show
The CMS proposal's own analysis projects average enrollment for 2027 will decrease by 1.2 to 2 million enrollees compared to baseline estimates if the rule is implemented. This projection comes from CMS's own analysts within the agency proposing the change.
Currently, 72 million adults in the United States do not have dental insurance, a figure the Democrats cited in their letter. The ACA mandates essential health benefits that include adult dental services, though many marketplace plans do not include robust dental coverage.
The letter was signed by 17 Senate Democrats, including progressive members like Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts, as well as moderate senators like Michael Bennet of Colorado and Patty Murray of Washington.
The rule would apply to ACA plans offered in 2027, with the public comment period ongoing before final implementation.
The Bottom Line
The proposed CMS rule represents a significant policy shift for the ACA marketplace that divides along partisan lines. Democrats warn it would result in millions losing coverage and promote substandard plans, while the administration says it reduces regulatory complexity and gives states more flexibility.
The 1.2 to 2 million enrollment decrease projected by CMS's own analysts has become the central contested figure in the debate. Democrats cite it as evidence of the rule's harmful impact, while administration officials have not publicly addressed the projection in detail.
The public comment period on the proposed rule remains open. CMS will need to review comments before issuing a final rule, which would take effect for the 2027 plan year if adopted. Senate Democrats have threatened further oversight action if the rule moves forward as proposed.