President Joe Biden is expected to reopen enrollment on the federal Affordable Care Act exchanges on Thursday as part of a series of executive actions related to health care, taking a step to help uninsured Americans that his predecessor rejected.
It will be Biden’s first move toward delivering on his campaign promise to bolster the landmark health reform law that he championed as vice president. And it comes as more Americans could be facing the loss of coverage because of the pandemic-fueled economic downturn.
Open enrollment on the federal exchanges, which the Trump administration cut in half to six weeks, ended on December 15. But Biden has the power to reopen sign-ups, which will allow the uninsured to select policies, under a special enrollment period.
Former President Donald Trump refused to do so last year, despite heavy lobbying from elected officials of both parties and the health care industry. Eleven states that run their own Obamacare exchanges, along with the District of Columbia, allowed their uninsured residents to obtain coverage outside the usual time frame.
Biden has turned to executive actions in his first days in office to swiftly start putting in place his agenda and to wipe out that of his predecessor.
He has signed 33 measures in his first six days, including mandating masks on federal property, reversing Trump’s ban on transgender Americans joining the military, providing additional nutrition assistance and accelerating the manufacturing and delivery of supplies for vaccination and testing.
On Tuesday, his actions focused on equity, including creating a police commission and promoting equitable housing policies. Wednesday is scheduled to center on combating climate change, according to a draft calendar document viewed by CNN.
Thursday’s focus is set to be on health care. Biden is also expected to sign measures strengthening Medicaid, as well as rescinding the Mexico City Policy on abortion and review the Title X abortion referral restrictions.
Augmenting the Affordable Care Act
Increasing the number of insured Americans by strengthening the Affordable Care Act was at the heart of Biden’s health care campaign promises. However, his two main measures — creating a government-run public option and increasing Obamacare’s federal premium subsidies — will require Congress and face plenty of opposition.
Reopening enrollment is a much easier lift, though it’s unclear how much impact it will have.
Anyone who loses job-based health insurance coverage is already eligible to sign up on the exchanges within 60 days of becoming uninsured. Enrollment in the first five months of 2020 jumped 46% compared to the same period the year before, the Trump administration said in June.
Also, more people have appeared to hold on to job-based coverage than expected, while those who have lost their employment and most of their income have turned to Medicaid. Between February and August, Medicaid enrollment jumped by more than 5.8 million people, or 9.1%, according to federal data released in late December.
During the most recent open enrollment period, overall Obamacare sign-ups for 2021 coverage increased when comparing the 36 states participating on the federal exchange both this year and last year — the only time that happened under Trump. But the number of new consumers for 2021 slid somewhat.
Making the changes work
The key to reopening enrollment will be publicizing it and providing help for people to sign up, according to a recent Kaiser Family Foundation discussion with navigators who assist those looking for coverage on the exchanges. They also say the period should last more than six weeks.
The Trump administration slashed advertising by 90% and deeply cut funding for enrollment assistance — two measures Biden is expected to reverse. Unspent revenue from exchange user fees appear to have accumulated to more than $1 billion over fiscal years 2018 to 2020, according to Kaiser.
Just over half of consumers who looked for coverage during the open enrollment period for 2020 coverage encountered difficulties, and nearly 5 million folks sought in-person help but couldn’t get it, according to a Kaiser Family Foundation analysis released Monday.
Many health care moves expected
Thursday’s measures will likely be the first of many efforts to bolster the Affordable Care Act and roll back Trump administration health care actions.
Among Biden’s top priorities will likely be saving the law itself from being declared unconstitutional by the Supreme Court. The justices are currently considering a case brought of a coalition of Republican state attorneys general — and backed by the Trump administration. It revolves around Congress reducing the penalty for not having health insurance to zero several years ago, which the states argue rendered the individual mandate unconstitutional and the entire law invalid.
The case will continue even if the Justice Department under Biden withdraws, because it originated with Texas and other Republican-led states. But the President could work with the new Democratic majority in Congress to short circuit the GOP states’ legal argument — by setting the penalty at a $1, for instance.
Biden will also likely want to reverse various measures the Trump administration put in place to chip away at the Affordable Care Act. These include broadening the duration of short-term health plans to a year, and, more recently, allowing Georgia to stop using the federal exchange, healthcare.gov, and shift to a private sector model instead. The Centers for Medicare and Medicaid Services went a step further in recent weeks, establishing a pathway for all states to do this for 2023.
Biden’s health care officials are also expected to focus on Medicaid.
The Trump administration made many historic changes to the health insurance program for low-income Americans, in line with Republicans’ long-standing wish list. Officials allowed states to introduce work requirements and just approved Tennessee’s request to shift its federal Medicaid funding to a type of block grant.
The Supreme Court recently agreed to consider the approval of work requirements in Arkansas and New Hampshire, which were voided by lower courts.
These measures run counter to Biden’s promise to expand access to Medicaid so his administration is expected to seek to limit or undo these waivers during his term, as well as possibly restore the criteria on waivers’ impact on increasing coverage.
Also, Congress has limited states’ ability to trim their Medicaid rolls during the public health emergency. The Biden administration may want to continue some of those provisions after it ends.