Biden reopens ACA enrollment, will revisit Medicaid work requirements
CONTINUING HIS MARCH to undo several Trump-era policies, President Joe Biden last week took steps aimed at expanding access to insurance coverage.
In a widely anticipated move, Biden signed an executive order directing HHS to create a special enrollment period to allow people to sign up for a health plan through Affordable Care Act marketplaces. HHS will allow individuals to enroll in coverage through HealthCare.gov from Feb. 15 to May 15. Ordinarily, signing up for an exchange plan is tightly restricted outside a six-week period late each year.
The Trump administration refused to create a special enrollment period during the pandemic, despite requests from providers, insurers, consumer groups and Democrats to do it. A number of states reopened their own exchanges shortly after the crisis began to alleviate concerns people without insurance would be reluctant or unable to access care during the COVID-19 pandemic.
The Kaiser Family Foundation found that opening the exchange would extend coverage options to 15 million people, 4 million of whom would qualify for a free plan under the ACA and 4.9 million eligible for subsidies to lower the cost of their coverage. The majority of those uninsured are disproportionately young adults, Latinx and hold a high school diploma or less, KFF said.
Ceci Connolly, CEO of the Alliance of Community Health Plans, noted that states that reopened their exchanges for special enrollment periods earlier in the pandemic did not see significant changes to their risk pools. Experts had worried that higher-risk, sicker individuals would enroll in large numbers, while lower-risk, healthier people wouldn’t.
Still, Connolly said the executive order would force insurers to accept more beneficiaries than they originally planned, adding some uncertainty into their risk pools. The announcement comes as the industry reckons with how costs related to the pandemic and consumers’ deferred care from the previous year will play out in 2021, she said. Insurers that serve as the only option in an area’s exchange will be disproportionately impacted by the extended enrollment period and uncertainty over COVID-19 costs, she said. KFF found that 10% of counties have a single insurer offering in 2021.
L.A. Care Health Plan essentially acts as a public option for the nearly 2.4 million members it covers in Los Angeles County, representing 23% of the city’s population. The payer serves as the largest publicly operated health plan in the U.S. and offers the cheapest exchange plan in the region, CEO John Baackes said.
Since its exchange plans represent just 4% of the not-for-profit’s overall business or about 100,000 enrollees, Baackes doesn’t expect the extension to have a huge impact on the bottom line. But the federal government should look to California as a model for how to properly operate the ACA. He said California kept its open enrollment available for triple the amount of time the federal exchange was open, reinstated the tax penalty for consumers lacking coverage and made subsidies available for those earning 400% above the federal poverty line. Biden also directed federal regulators to take another look at waivers granting states the ability to impose work requirements on Medicaid beneficiaries.
Former CMS Administrator Seema Verma made Medicaid work requirements central to her effort to modify the program. Proponents argued the waivers would encourage people to work and ensure people didn’t receive benefits if they didn’t qualify for them. Of the 13 states CMS approved for a work requirement, Arkansas was the only state to completely implement its experiment. A federal court struck down the demonstration after seven months, and a federal appeals court agreed. A Health Affairs study found that more than 18,000 people, or nearly 1 in 4 people covered by the waiver, lost their coverage, with profound adverse effects on their finances and medication adherence.
According to the Center on Budget and Policy Priorities, it’s “unavoidable” for Medicaid work requirements to cause large coverage losses, even among people who are working or should be eligible for exemptions. ●
President Biden directed federal regulators to take another look at waivers granting states the ability to impose work requirements on Medicaid beneficiaries.
A little more than a month into the COVID-19 vaccination effort in long-term care facilities, only 8% of residents and staff have received the second dose of the vaccine, according to newly released federal data.
As of Jan. 24, 2,567,019 doses of the COVID-19 vaccines had been administered to staff and residents in long-term care facilities, according to the Centers for Disease Control and Prevention. Only 201,293 of those vaccinations were second doses. The federal Pharmacy Partnership for Long-Term Care Program, which pairs nursing facilities with either Walgreens or CVS for vaccine administration, has distributed more than 4.5 million COVID-19 vaccine doses so far.
The CDC stopped releasing the vaccine distribution numbers in mid-January and has not replied to Modern Healthcare inquiries about the decision.
Dr. Mike Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine, said industry experts predicted that vaccination in their facilities would be slow. “All of the issues we were worried about with nursing homes have happened. The nursing home rollout has been delayed and has taken longer than initially planned,” Wasserman said.
Wasserman served on the National Academies' Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, which made recommendations to the federal government on how to proceed with long-term care vaccination.