Biden’s executive orders reopen ACA exchanges, initiate review,  amid pandemic

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

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Photo: Chris Zúniga via Flickr

President Biden took a big step to aid those who have lost their jobs during the pandemic and their employer-sponsored health insurance ordering the federal marketplaces under the Affordable Care Act to reopen on Feb. 15 for a special three-month enrollment period.

Biden’s orders and his comments are online at WhiteHouse.gov.

“The Biden administration on Thursday (Jan. 28) announced it’s throwing open the doors to the law’s enrollment site, HealthCare.gov, making it easier for the uninsured to get coverage during the pandemic,” Susannah Luthi wrote for Politico. “It is also planning to restore some Obamacare marketing funds that the Trump administration had gutted, and it will soon begin reviewing whether to revoke the previous administration’s changes seen as undermining the health law and Medicaid.”

HealthCare.gov serves most states, and Biden administration officials expect the other dozen-or-so states that oversee ACA enrollment will likely reopen as well, she added. Covered California, the ACA exchange in the Golden State, and the Washington Health Benefit Exchange in that state also plan to reopen enrollment in their state-run marketplaces.

By reopening the ACA’s federal insurance marketplaces from Feb. 15 to May 15, the Biden administration will give millions of Americans an extended chance to buy health insurance, as Amy Goldstein reported for The Washington Post.

“The directive, part of a series of executive actions the president is taking during his first days in office, is a down payment on his pledge to make health care more accessible and affordable and a sign of his determination to rehabilitate the landmark law after four years of Republican battering,” Goldstein wrote. Making health insurance more available is important given that 25 million Americans have contracted the novel coronavirus, she added.

Luthi estimated that 2 million to 3 million Americans have become uninsured due to losing their employer-sponsored health insurance following pandemic-related layoffs.

It’s important to note that Biden also instructed federal agencies to examine rules implemented during the Trump administration that have resulted in limiting Americans’ access to health insurance via such venues as demonstration programs and state-waiver programs under Medicaid and the ACA, Stephanie Armour wrote in the Wall Street Journal.

Once they review the Trump administration’s rules, federal agencies will consider whether to take action, Armour said, noting that such action could lead to the unraveling of initiatives such as Medicaid work requirements and short-term health insurance plans.

“But the process is likely to be long and met with legal battles,” she warned. “Many rules or waivers approved by former President Donald Trump would require going through a rule-making process, public notice or hearings before they could be unraveled.”

Some Trump administration policies have been challenged in court, meaning Biden’s health agencies may need to move quickly before courts can make decisions in these cases.

“States are likely to fight to preserve other Trump administration changes, such as a first-ever block grant in Tennessee that would cap federal funding for the state’s Medicaid program and increase funding based on enrollment,” Armour explained.

Nancy Cook, Sara Hansard and John Tozzi at Bloomberg News went into some detail on Biden’s steps to counteract those of the Trump administration. Enrollment in plans sold in the ACA’s marketplaces declined slightly after Trump promised to repeal the law and the administration cut funding for Obamacare marketing and outreach, they wrote.

The new enrollment period will be available to Americans who need health care coverage, the Biden executive order said without explaining if there would be restrictions. After employers laid off workers during the pandemic, Democrats, health insurers and ACA advocates asked the Trump administration to reopen HealthCare.gov enrollment but were refused, the Bloomberg reporters explained.

“The Trump administration argued that people who lost their coverage in the pandemic could sign up for Obamacare plans using individual special enrollment periods,” they wrote. But the special enrollment process is challenging because it requires applicants to prove their eligibility and is not available to those uninsured for an extended time, they noted.

Sheryl Gay Stolberg and Abby Goodnough in The New York Times noted that Biden also took steps to protect those with pre-existing medical conditions and moved to overturn Trump administration restrictions on the use of federal dollars for clinics that counsel patients on abortion, both in the United States and overseas.

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