WASHINGTON, DC – U.S. Senators Mazie K. Hirono (D-HI) and Cory Booker (D-NJ), and U.S. Representatives Joaquin Castro (D-TX) and Pramila Jayapal (D-WA) led 117 of their Democratic colleagues in sending a letter to Department of Health and Human Services’ (HHS) Secretary Robert F. Kennedy, Jr. expressing strong opposition to the department’s proposal to reverse Affordable Care Act (ACA) Marketplace eligibility for Deferred Action for Childhood Arrivals (DACA) recipients, a move that would significantly restrict access to affordable health coverage.
“The ACA makes all lawfully present immigrants eligible for marketplace coverage. When the Center for Medicare and Medicaid Services (CMS) first established the regulatory definition of lawfully present immigrants in 2010, it included all deferred action recipients, consistent with longstanding federal policies for Social Security benefits and driver’s licenses under the REAL ID Act. However, in 2012, the agency, without any statutory justification, added an exclusion for DACA recipients. We believe CMS made the wrong decision, arbitrarily excluding hundreds of thousands of immigrant youth from health coverage despite Congress’s intent in passing the ACA to widely expand access to health care,” the lawmakers wrote.
In 2024, HHS finalized a rule correcting this error which resulted in ACA Marketplace and subsidy eligibility being granted to DACA recipients, “Prior to this rule, DACA recipients were nearly five times more likely to be uninsured compared to their U.S. born peers. The proposed regulation would reverse course and tear health coverage away from DACA recipients who have only had eligibility for less than a year.”
The lawmakers highlighted that President Trump has repeatedly recognized the value of DREAMers. In December 2024, President Trump made clear that Congress must “do something about the Dreamers, because these are people that have been brought here at a very young age, and many of these are middle-aged people now, they don’t even speak the language of their country.”
“We agree with President Trump that Congress must pass the DREAM Act to create a pathway to citizenship for DACA recipients. In the meantime, CMS must not enact this proposed rule. Removing ACA eligibility undermines the law’s purpose, contravenes President Trump’s priorities, and jeopardizes the health and stability of hundreds of thousands of immigrant families,” the lawmakers concluded.
In addition to Senators Hirono and Booker, the letter is signed by Senators Michael Bennet (D-CO), Richard Blumenthal (D-CT), Catherine Cortez Masto (D-NV), Tammy Duckworth (D-IL), Dick Durbin (D-IL), John Fetterman (D-PA), Martin Heinrich (D-NM), Tim Kaine (D-VA), Mark Kelly (D-AZ), Andy Kim (D-NJ), Amy Klobuchar (D-MN), Ben Ray Lujan (D-NM), Ed Markey (D-MA), Patty Murray (D-WA), Alex Padilla (D-CA), Jacky Rosen (D-NV), Bernie Sanders (I-VT), Brian Schatz (D-HI), Tina Smith (D-MN), Chris Van Hollen (D-MD), Elizabeth Warren (D-MA), Peter Welch (D-VT), and Ron Wyden (D-OR). In the House, in addition to Representatives Castro and Jayapal, the letter was signed by 94 members.
The full text of the letter is available here and below.
Dear Secretary Kennedy:
We write to express our strong opposition to the Department of Health and Human Services’ (HHS) Notice of Proposed Rulemaking on “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability,” (90 FR 12941) published in the Federal Register on March 19, 2025. Specifically, we oppose the proposed reversal of Affordable Care Act (ACA) Marketplace eligibility for Deferred Action for Childhood Arrivals (DACA) recipients, a move that would significantly restrict access to affordable health coverage.
The ACA makes all lawfully present immigrants eligible for Marketplace coverage. When the Centers for Medicare and Medicaid Services (CMS) first established the regulatory definition of lawfully present immigrants in 2010, it included all deferred action recipients, consistent with longstanding federal policies for Social Security benefits and driver’s licenses under the REAL ID Act. However, in 2012, the agency, without any statutory justification, added an exclusion for DACA recipients. We believe CMS made the wrong decision, arbitrarily excluding hundreds of thousands of immigrant youth from health coverage despite Congress’s intent in passing the ACA to widely expand access to health care.
We were glad this error was corrected in May 2024, when HHS finalized a rule granting ACA Marketplace and subsidy eligibility to DACA recipients. Prior to this rule, DACA recipients were nearly five times more likely to be uninsured compared to their U.S. born peers. The March 2025 proposed regulation would reverse course and tear health coverage away from DACA recipients who have only had eligibility for less than a year.
Allowing DACA recipients access to affordable health coverage was a step in the right direction. Because eighty percent of DACA recipients have health care coverage through their employer, they are particularly vulnerable to losing their health coverage. The 537,000 current DACA recipients have lived in the United States for most of their lives and did not make any choice to enter the U.S. They have over 300,000 U.S. citizen children who are more likely to thrive if their parents have health coverage. Lack of health care coverage and the inability to afford medical costs leads to significant burdens on families, including the accumulation of medical debt, stress around out-of-pocket expenses, and the delaying or forgoing of treatment due to financial constraints. For uninsured parents, this can mean choosing between securing food for the table or receiving needed treatment and medical care to maintain a healthy life and, therefore, providing and supporting their children and family.
President Trump has repeatedly recognized the value of Dreamers. In December 2024, he made clear that Congress must “do something about the Dreamers, because these are people that have been brought here at a very young age, and many of these are middle-aged people now, they don’t even speak the language of their country.” Congress must pass the Dream Act to create a pathway to citizenship for DACA recipients. In the meantime, CMS must not enact this proposed rule. Removing ACA eligibility undermines the law’s purpose, contravenes President Trump’s priorities, and jeopardizes the health and stability of hundreds of thousands of immigrant families.
Sincerely,
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