The new changes to federal health programs will reverse years of progress and jeopardize access to care to some Californians who need it most. The law creates barriers that are designed not to improve the system — but to discourage people from enrolling at all.

While we’ve heard a lot about how this will hurt Medicaid, there’s another big part of the health care system that’s also at risk: Covered California, our state’s health insurance marketplace. That’s where people buy health care coverage if they don’t get insurance through their employer. Think landscapers, caregivers, hairdressers, truckers, and freelance and part-time employees— people who work hard but don’t have insurance through their job. It’s also the place middle-class people turn to, including real estate agents, small business owners, early retirees not yet eligible for Medicare, and people between jobs who need a safety net. And for entrepreneurs launching a business, Covered California is often the only way to get coverage— both for themselves and for their employees.

In California, nearly 2 million people depend on Covered California for health care. The need is such that enrollment rose for the fourth consecutive year in 2025. But this new legislation adds hurdles that will shorten the enrollment period and add frustrating and unnecessary paperwork.

Here are some of the major hurdles deliberately created by the new law:

Gives less time to enroll in coverage or switch health plans: Enrollment time will be shortened by a month. That might not sound like much. But it means longer wait times for help and more confusion when everyone’s scrambling at once to apply.

Eliminates the low-income special enrollment period: Under previous Affordable Care Act rules, individuals with incomes below 150 percent of the federal poverty level could enroll in coverage year-round and receive premium tax credits and cost-sharing reductions. This amounts to an income of no more than $23,475 for a single person. The new law eliminates these subsidies for those who enroll through special enrollment periods, regardless of income. As a result, affected individuals would have to pay the full premium and out-of-pocket costs if they miss the regular open enrollment window.

Creates mountains of red tape: Starting Jan. 1, 2028, new applicants will be required to provide proof of eligibility because marketplaces will not be able to rely solely on a third-party data source. Instead, consumers will need to proactively verify and submit information about their household income and family size, immigration status, eligibility for other coverage, place of residence, or any other information determined necessary by the Department of Treasury.

Automatic reenrollment will also come to an end on Dec. 31, 2027. To make things worse, any enrollee or applicant encountering a data matching issue between what they self-reported and the federal data base will have to resolve the discrepancy prior to receiving benefits. This process, referred to as a data matching issue or DMI, is a manual one and can take months to resolve. In fact, more than half of income DMIs take over 60 days to resolve.

Prohibits many lawfully present immigrant groups from receiving financial assistance: As of August 2025, recipients of the Deferred Action for Childhood Arrivals program will no longer be eligible for ACA Marketplace coverage or premium subsidies, reversing a previous policy update. Victims of human trafficking and domestic violence, as well as refugees with asylum or with temporary protected status will also lose their subsidies. This will very likely force thousands of individuals to discontinue their enrollment, leaving them without access to critical preventive and primary care.

Does not renew the enhanced premium taxes credits: The Affordable Care Act’s enhanced premium tax credit— set to expire at the end of 2025— has made health insurance policies through the marketplace more affordable for eligible applicants. According to estimates from KFF, on average, health insurance premiums for ACA enrollees could rise by more than 75 percent. Of the more than 24 million Americans who signed up for insurance through the marketplace this year, 90 percent received a subsidy. For everyday Americans, losing this subsidy will simply make health coverage unaffordable.

The loss of this support may cause many of the low- and middle-income working individuals and families to forgo health insurance due to lack of affordability.

Health insurance is already complicated enough. Why make it harder for people to get the care they need and deserve? If a state knows someone is eligible for tax credits, why make them fill out paperwork to tell states what they already know? Why force new parents with low incomes to wait for their child’s Social Security card to arrive to cover their child, or pay hundreds of dollars up front for the coverage that newborns especially need?

Part of the problem is that lawmakers are relying on the complexity of the new rules to make people give up buying coverage through the marketplace. In fact, the nonpartisan Congressional Budget Office estimates that when combining the law’s effects with that of the expected expiration of the ACA’s enhanced premium tax credits, 16 million more people will be uninsured in 2034 than would otherwise be the case. In California, 1.8 million people may be uninsured by the combined effects.

Californians deserve a health care system that works for them — not one that pushes them out with bureaucratic burdens and budget games. These are people building better lives for their families. They need our support, not more red tape.

Martha Santana-Chin is the CEO of L.A. Care Health Plan, the largest publicly-operated health plan in the nation serving nearly 3 million Angelenos.