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Biden reopens ACA enrollment for three months in opening bid to extend health coverage

On Jan. 28, President Biden signed two executive orders expanding access to affordable health care and reversing restrictions on abortion access. (Video: The Washington Post)

President Biden ordered Thursday the reopening of the Affordable Care Act’s federal insurance marketplaces for three months to give millions of Americans who need coverage during the coronavirus pandemic an extended chance to buy health plans.

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. Those goals have taken on more urgency as 25 million people have been infected with the coronavirus and millions of others have lost jobs.

Biden also instructed officials to remove barriers to Medicaid erected under President Donald Trump. These are concrete steps, but health experts said their importance lies primarily in indicating the direction he wants to take the nation’s health-care system. Since his campaign, the president has made clear that he believes the perennially divisive ACA should be further anchored in American life — and used as a springboard for expanding access to affordable coverage.

President Joe Biden issued 19 executive orders in his first week, far more than previous presidents in that period. (Video: The Washington Post)

During a brief signing ceremony, Biden described the action in unusually direct terms, as a way to “to undo the damage Trump has done,” saying his predecessor had made the ACA plans “more inaccessible, more expensive, and more difficult for people to qualify for.”

The president also began Thursday to rewrite federal policy surrounding reproductive rights. He rescinded one federal rule Trump had reinstated that forbid family-planning aid to international organizations that refer women for abortions. And he instructed federal health officials to review another Trump-era rule that has been financially damaging to Planned Parenthood.

Later in the day, the Department of Health and Human Services announced a special enrollment period from Feb. 15 to May 15 through, the online marketplace for people who cannot get affordable health benefits through a job.

The order affects people in three dozen states that rely on the federal marketplaces, allowing those consumers to buy a health plan or to update a previous application for coverage. The action does not directly affect residents of states that run their own ACA insurance exchanges, but a White House official predicted that those states — many of which reopened their marketplaces early in the pandemic — will follow suit.

For the past few years, Americans who qualify for ACA health plans have been required to sign up during six weeks late each year, except if they could prove they had a major life change, including the loss of a job. The new enrollment period will not require such proof, the White House official said, speaking on the condition of anonymity before the president’s remarks.

In a ceremony lasting less than five minutes, Biden said that his actions were moored in the law that he and President Barack Obama championed. “There’s nothing new that we’re doing here,” he said, “other than restoring the Affordable Care Act and restoring Medicaid.”

“As we continue to battle covid-19, it’s even more critical that Americans have meaningful access to health care,” he added.

The White House indicated that the administration planned to boost federal aid for advertising, outreach and contracts with community groups that help people figure out how to sign up. The Trump administration, during its first two years, slashed most of the funding for such efforts, saying there was no evidence they were effective.

The White House official declined to say how money will be spent. But the Centers for Medicare and Medicaid Services, which oversees ACA enrollment, said the agency plans to spend $50 million on increasing public awareness of the sign-up period. That sum approximates what the Obama administration spent in the first years of, which debuted the fall of 2013, but it is about half the $101 million for outreach in the final year of Obama’s tenure.

An estimated 15 million uninsured people in the United States could qualify for the ACA health plans, according to the Kaiser Family Foundation, a health-policy research organization. Nearly 9 million of them would be eligible for a federal financial subsidy for their monthly premiums, the estimates show.

Biden “is moving fast to do what he can to invigorate the ACA,” said Larry Levitt, Kaiser’s executive vice president, but he called the actions “a very partial step.”

Levitt noted that Biden’s broader health-care goals — which would require the consent of Congress — include making ACA plans more affordable by expanding premium subsidies to people well into the middle class and increasing financial help to those already receiving subsidies.

“There’s a risk in reopening enrollment without increasing subsidies,” Levitt said. “It will be hard to get more people to sign up without the coverage being any more affordable.”

Jennifer M. Haley, an Urban Institute research associate, concurred, pointing to research suggesting that cost is the most common barrier people cite for not exploring or buying a marketplace health plan.

Even some federal health officials questioned the practical effect of Biden’s actions on enrollment in the ACA’s private plans, though they said they regard it as a symbolic statement of faith in the law. Two HHS officials said analyses of Biden’s order, such as projections of health-insurance enrollment changes, had not been circulated to the relevant teams — a change from the Obama and Trump administrations, when the White House often laid groundwork for its actions involving the ACA days or weeks in advance.

I think it’s more of a gesture [by Biden] to look like they’re doing something immediately,” said one health official, speaking on the condition of anonymity because they weren’t authorized to discuss the president’s actions.

The officials noted that sign-ups that ended last month for marketplace coverage — about 8.3 million in the states using — did not grow from the previous year, despite the economic and insurance losses from the pandemic.

But they predicted that the additional sign-up opportunity could produce a spike in Medicaid enrollment, because low-income Americans who visit the ACA marketplace are often steered to the safety-net health program.

The directive was welcomed by America’s Health Insurance Plans, the industry’s main trade group, which has been pressing since early in the pandemic for the government to give people more time to enroll through the federal marketplaces. The American Medical Association also praised the actions, as did the Federation for American Hospitals, which represents for-profit hospitals and health systems.

Predictably, congressional Democrats supported the moves, while some Republicans accused the president of overreaching.

As expected, other parts of the president’s order will direct federal agencies to review federal rules to ensure they promote access to health care.

The one Trump administration policy mentioned in the order involves Medicaid work requirements — a rule inviting states to ask for federal permission to compel some people to work or prepare for jobs to join the safety-net insurance program. Federal courts have ruled against such requirements, but a case trying to reinstate the idea is before the Supreme Court.

Asked during a briefing whether federal health officials will withdraw permission the last administration gave several states for work requirements, perhaps before the high court rules, the White House official did not answer directly but said, “HHS is expected to take a very close look at those waivers.”

Biden also issued a presidential memorandum that the White House is characterizing as “protecting women’s health at home and abroad.” A major feature of the order will rescind the “Mexico City policy,” which forbids nonprofit groups in other countries from receiving U.S. federal family planning aid if they provide abortion counseling or referrals.

Another part of that memorandum instructs HHS to “take immediate action to consider” whether to remove regulations under the Title X program that supports family planning. The White House official said that directive is focused on a 2019 Trump administration rule, hostile to Planned Parenthood, that blocks organizations that provide abortions or referrals from receiving funds through Title X; the action has been challenged in courts.

Dan Diamond and Annie Linskey contributed to this report.