“Today, I’m about to sign two executive orders that basically, the best way to describe them, to undo the damage Trump has done,” Biden said. “There’s nothing new that we are doing here other than restoring the Affordable Care Act and restoring Medicaid to the way it was before Trump became president.”
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.
Biden’s order calls on the Department of Health and Human Services to reopen enrollment on healthcare.gov, which serves 36 states, to those who need coverage from February 15 until May 15. The agency did so on Thursday.
“As we continue to battle Covid-19, it’s even more critical that Americans have meaningful access to health care,” Biden said.
Soon after the President signed the executive order, California announced it would open its exchange from February 1 to May 15.
Thursday’s executive orders focus on health care. Biden also signed measures aimed at strengthening Medicaid, as well as rescinding the so-called Mexico City Policy — which bans the US government from funding foreign nonprofits that perform or promote abortions — and reviewing the Title X abortion referral restrictions.
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.
Reversing Trump administration directives
As part of Thursday’s executive measures, Biden is directing federal agencies to reexamine a multitude of actions taken by his predecessor.
“He changed and made more inaccessible, more expensive and more difficult for people to qualify for either of those two items, the Affordable Care Act or Medicaid,” he continued.
These include policies that weaken protections for people with preexisting conditions and that undermine the Obamacare exchanges or other health insurance markets.
He also wants agencies to review measures that make it more difficult to enroll in Medicaid and the Affordable Care Act and that reduce affordability or financial assistance, including for dependents.
And the President is asking agencies to look at Affordable Care Act and Medicaid waivers and demonstration projects that the Trump administration approved or put in place that may reduce coverage or undermine the programs, including work requirements.
The agencies will also consider whether additional actions are needed to strengthen and protect access to health care.
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.
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.
A total of about 15 million uninsured people could shop for coverage on the exchanges, Kaiser said.
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 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 appears to have accumulated to more than $1 billion over fiscal years 2018 to 2020, according to Kaiser.
The Centers for Medicare and Medicaid Services, which runs the federal exchange, said Thursday that it will spend $50 million on outreach and education, including advertisements on broadcast and digital platforms. The agency also will conduct an outreach campaign with community groups to raise awareness of the new opportunity to enroll in English, Spanish and other languages.
“The outreach budget for healthcare.gov was slashed dramatically during the prior administration,” the White House official said. “So folks who were uninsured weren’t really given the opportunity to learn about the ability to get coverage. That’s what we’re aiming to rectify during this special enrollment period.”
Many health care moves expected
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’s health care officials are also expected to focus on Medicaid.
These measures run counter to Biden’s promise to expand access to Medicaid so his administration will likely seek to limit or undo these waivers during his term, as well as possibly restore the criteria on waivers’ impact on increasing coverage.
The Department of Health and Human Services is expected to take “a very close look” at the approvals involving work requirements, based on Thursday’s executive order, the White House official said.
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.
This story has been updated with additional developments.