Biden order reopens ACA window
Enrollment period to help uninsured in COVID-19 fight
WASHINGTON — 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 President 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 actions were only the first steps by Biden, who has promised to build out former President Barack Obama’s health care law to achieve a goal of coverage for all. While Biden rejects the idea of a government-run system that Sen. Bernie Sanders has pushed for in his “Medicare for All” proposal, his more centrist approach will require congressional buy-in. But opposition to Obamacare runs deep among Republicans.
The most concrete shortterm impact of Biden’s orders will come from reopening HealthCare.gov insurance markets as coverage has shrunk in the economic turmoil of the coronavirus pandemic. That’s an executive action and no legislation is required.
The new “special enrollment period” will begin Feb. 15 and run through May 15, the White House said. It will be coupled with a promotional campaign and a call for states that run their own insurance markets to match the federal sign-up opportunity.
The Biden administration has ample resources for marketing, said Karen Pollitz, a health insurance expert with the nonpartisan Kaiser Family Foundation. The foundation estimates that the Trump administration left unspent about $1.2 billion in user fees collected from insurers to help pay for running the marketplaces.
“The reason it wasn’t spent is the Trump administration spent its time in office cutting services that support consumer enrollment,” Pollitz said. “All the while the user fee revenue was coming in, (but) they were not allowed to spend it on anything other than marketplace operations.”
Created under the Obamaera Affordable Care Act, the marketplaces offer taxpayer-subsidized coverage regardless of a person’s medical history or preexisting conditions, including COVID-19.
Biden also ordered the immediate reversal of a federal policy that bars taxpayer funding for international health care nonprofits that promote or provide abortions. Known as the Mexico City Policy, it can be switched on or off depending on whether Democrats or Republicans control the White House. Abortion-rights supporters call it the “global gag rule.”
The new president’s signing of a growing stack of executive orders is bringing increasing criticism from Republicans and also from some of his allies, especially after Democrats lambasted Trump when he acted on his own. Biden’s team says he’s looking to Congress for major legislation but feels that certain actions are crucial in the meantime.
Some directives he issued Thursday could take months to carry out.
He instructed the Department of Health and Human Services to consider rescinding Trump regulations that bar federally funded family planning clinics from referring women for abortions.
HHS will also reexamine a Trump administration policy that allows states to impose work requirements as a condition for low-income people to get Medicaid health insurance. Work requirements have been blocked by federal courts, which found that they led to thousands of people losing coverage and violated Medicaid’s legal charge to provide medical services. The Supreme Court has agreed to hear the issue.
Such changes cannot happen overnight. Rescinding a federal regulation requires a new regulation, which has to follow an established legal process that involves considering different sides of an issue.
The abortion-related actions brought Biden immediate praise from women’s rights groups, as well as condemnation from social and religious conservatives. Under President Trump, abortion opponents had free rein to try to rewrite federal policy, but now the political pendulum has swung back. Trump’s abortion counseling restrictions led Planned Parenthood affiliates to leave the federal family planning program.
The idea of reopening Obamacare’s health insurance markets in the pandemic has had broad support from consumer, medical and business organizations.