Biden Signs Executive Orders That Could Dramatically Increase Number of Insured in the U.S.
On Thursday, January 28, President Joe Biden signed a number of executive orders related to healthcare and health insurance, which could impact the U.S. healthcare delivery system in a number of ways. As the Associated Press’s Ricardo Alonso-Zaldivar wrote on Thursday, “President Joe Biden on Thursday ordered government health insurance markets to reopen for a special sign-up window, offering uninsured Americans a haven as the spread of COVID-19 remains dangerously high and vaccines aren’t yet widely available. Biden signed an executive order directing the HealthCare.gov insurance markets to take new applications for subsidized benefits, something Donald Trump’s administration had refused to do. He also instructed his administration to consider reversing other Trump health care policies, including curbs on abortion counseling and the imposition of work requirements for low-income people getting Medicaid.”
“There’s nothing new that we’re doing here other than restoring the Affordable Care Act and restoring Medicaid to the way it was before Trump became president,” Biden said as he signed the directives in the Oval Office. He declared he was reversing “my predecessor’s attack on women’s health.”
The orders could potentially add many thousands of Americans to the health insurance exchanges and also to state Medicaid programs, some of which had been burdened with complex, frustrating rules around work requirements forcing individuals receiving Medicaid to work or to document their searching for work; those work rules will now begin to be dismantled.
As the fact sheet for the executive orders, entitled “FACT SHEET: President Biden to Sign Executive Orders Strengthening Americans’ Access to Quality, Affordable Health Care,” explained, “After four years of attempts to strip health care from millions of Americans, President Biden will sign two executive actions that will begin to restore and strengthen Americans’ access to quality, affordable health care. The Biden-Harris administration will re-open enrollment to the Health Insurance Marketplace, take additional steps to strengthen Medicaid and the Affordable Care Act, and protect women’s health. These actions demonstrate a strong commitment by the Biden-Harris Administration to protect and build on the Affordable Care Act, meet the health care needs created by the pandemic, reduce health care costs, protect access to reproductive health care, and make our health care system easier to navigate and more equitable.”
The core of the orders, insofar as the U.S. healthcare delivery system is concerned, is the “Strengthening Medicaid and the Affordable Care Act.” As the fact sheet notes, “This Executive Order takes critical steps to reverse attacks on and strengthen Medicaid and the Affordable Care Act, so they can continue to provide access to life-saving care for millions of Americans. Based on this Executive Order, it is expected that the Department of Health and Human Services (HHS) will open HealthCare.gov for a “Special Enrollment Period,” from February 15, 2021 – May 15, 2021. This Special Enrollment Period will give Americans that need health care coverage during this global pandemic the opportunity to sign up.”
Further, “The President will also direct federal agencies to reconsider rules and other policies that limit Americans’ access to health care, and consider actions that will protect and strengthen that access.
Agencies are directed to re-examine:
Ø Policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19;
Ø Demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements;
Ø Policies that undermine the Health Insurance Marketplace or other markets for health insurance;
Ø Policies that make it more difficult to enroll in Medicaid and the ACA; and
Ø Policies that reduce affordability of coverage or financial assistance, including for dependents.
Ø As part of their reviews, agencies will consider whether to take additional actions to strengthen and protect access to health care.”
The leaders of the Washington, D.C.-based Association for Community Affiliated Plans (ACAP), which represents 78 health plans nationwide that serve “more than 20 million people enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and other publicly sponsored health programs,” immediately expressed praise for the executive orders. “We commend President Biden for creating a special enrollment period for the federal Marketplaces. The pandemic led to financial difficulties and changes in health coverage for millions, which did not stop at the end of open enrollment,” ACAP CEO Margaret A. Murray said in a statement posted to the association’s website. “Consumers deserve time to thoughtfully consider and select the plan that best meets their needs—we thank President Biden for taking a long-overdue action. We are encouraged by the directive to review regulations that undermine protections for pre-existing conditions and policies that threaten the stability of the Marketplace. Reversing the 2018 rule expanding the use of short-term limited-duration insurance plans would help accomplish both these goals,” Murray said.
“In two years,” she added, “junk insurance plans have created havoc for consumers, promising access to affordable, comprehensive coverage only to leave them holding a stack of unpaid bills when they need to access said coverage. When allowed to compete directly with ACA-compliant plans, junk insurance plans erode consumer protections and send premiums spiraling higher. We urge the Administration to reverse this rule. We also applaud the President’s action to slow down the approval of work requirements for the Medicaid program. ACAP has long maintained that Medicaid helps people who work stay on the job – a job shouldn’t be a requirement for Medicaid. Work requirements add another layer of red tape and administrative burden to an enrollment process that’s complex enough as is.”
