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The Health 202: Biden will reopen for buying insurance plans

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with Alexandra Ellerbeck

President Biden plans to bolster the Affordable Care Act, after his predecessor spent four years trying to peel back the 2010 health-care law.

His first move: To reopen the federal-run insurance website amid the coronavirus pandemic.

The president is expected to announce a special sign-up period for Obamacare on Thursday.

The move, coming among a new batch of health-focused executive actions, may allow those who were eligible for ACA coverage at the end of last year — and who didn’t sign up then — to enroll for a limited time period. This special enrollment period could last 30 days, 45 days or maybe even 60 days. 

The idea is to make it as easy as possible for anyone who lacks health insurance — because of the pandemic or otherwise — to get covered throughout 2021. Normally, people can only sign up during a six-week window in November and December.

“The next few months will be tough, and keeping the marketplaces open for anyone who is uninsured will offer a critical safety net,” Joel Ario, who helped run during the Obama administration, wrote for Health Affairs.

Another enrollment period isn’t crucial but could make it easier to sign up for coverage.

In one sense, it doesn’t really matter whether Biden reopens 

That’s because people who lost their workplace coverage already qualify for signing up outside the regular, end-of-the-year enrollment period. Losing insurance provided through a job is one of several events that qualify a person to buy an ACA plan throughout the year, in what’s known as a special enrollment period. Other reasons include getting married or having a baby.

But for someone to take advantage of a special enrollment period, they must show documentation that they qualify — like uploading a copy of an unemployment notice, for example. That’s an extra hoop people don’t have to jump through during the regular enrollment window.

By broadly reopening, Biden could make the enrollment process easier, at a time when millions of Americans are grappling with job and wages losses, said Charles Gaba, a Detroit-based analyst who crunches ACA data and has also raised money for Democratic candidates.

“If it’s open-ended, you enroll like normal,” Gaba said.

People took advantage of existing exemptions to sign up last year.

According to Gaba, there were around 188,000 more plan selections on by late June than normal — a reflection of the widespread job losses and economic recession caused by pandemic lockdowns. The Trump administration cited this figure in arguing that opening enrollment broadly was unnecessary.

But Gaba argues that enrollment might have been even higher if the administration had created a special enrollment period specifically related to the pandemic.

This is precisely what nearly a dozen states running their own insurance marketplaces have done.

Some opened up their marketplaces last spring, during the first wave of layoffs. Others lengthened their sign-up period far beyond Dec. 15. For example, enrollment lasts until the end of January in California, New Jersey and Washington, D.C. It extends through some or all of March in New York, Massachusetts and Maryland.

Yet marketplace enrollment hasn’t really increased.

According to a final enrollment snapshot, sign-ups on remained stable from 2020 to 2021. And the number of new consumers actually declined, by 3.6 percent.

That’s partly because employer-sponsored coverage didn’t decline as much as one might expect, given the job losses. While employment rates fell 6.2 percent from March to September, enrollment in workplace plans decrease by 1.5 percent over the same time period, according to an analysis by the Kaiser Family Foundation. One reason could be that losses were concentrated among lower-wage workers, who are less likely to be offered employer-sponsored coverage to begin with.

Additionally, people who lose their jobs more often qualify for Medicaid, which covers people under 133 percent of the federal poverty level, depending on the state. Enrollment in the program expanded considerably last year, growing 8.6 percent between February and September.

“If someone has virtually no income, then they’re going to go on Medicaid instead of the exchanges,” said Cynthia Cox, a vice president at KFF.

But for Biden, the move is also about signaling a renewed support for the ACA.

Whereas President Trump loved to cast the law as a failure, Biden is famously known for calling it “a big, [expletive] deal” when it passed. Throughout his campaign, he promised to strengthen and expand the law.

Reopening will be just one of many changes to the ACA being eyed by the new administration. Biden is also expected to restore previously slashed funding for advertising and enrollment assistance, roll back Trump’s expansion of some leaner plans and tweak marketplace rules to make subsidies more generous.

Ahh, oof and ouch

AHH: Biden is aiming for a more ambitious vaccine target.

“For weeks President Biden has emphasized that his goal for rolling out the coronavirus vaccine was an easy-to-remember 1 million shots a day, or 100 million vaccinations in his first 100 days. On Monday, he suggested a much faster clip, saying he could envision 1.5 million vaccinations per day,” The Washington Post’s Annie Linskey reports.

“I think we may be able to get that to 1.5 million [shots] a day, rather than 1 million a day. But we have to meet that goal of a million a day,” Biden told reporters.

Biden also said he expected anyone who wanted to get a vaccine to be able to get one by the spring and that the U.S. should be well on its way to herd immunity by the summer.

President Biden on Jan. 25 said anyone who wants a coronavirus vaccine will be able to get one by "this spring." (Video: The Washington Post)

Biden is facing pressure to commit to a more ambitious vaccine target. His advisers characterized the vaccine rollout under Trump as a “huge mess,” but critics say his target of 100 million doses doesn't go far beyond the vaccine rollout he inherited. The U.S. was already vaccinating nearly 1 million people a day by the end of Trump’s tenure. 

“Even with vaccine shortages and bottlenecks in delivery, the pace needed to meet Biden’s goal — 1 million doses administered per day — was achieved last Friday and on four other days of the previous eight, according to Washington Post data. The accelerating speed of the program also arguably undercut assertions by some Biden advisers that they were left no plan at all by the Trump administration,” Annie writes. 

Still, some officials have been reluctant to raise expectations. Rochelle Walensky, the new director of the Centers for Disease Control and Prevention, has said that supply could be a constraint when it comes to meeting a more ambitious target.

OOF: New coronavirus variants continue to spread throughout the United States.

The first U.S. case of a highly transmissible Brazil coronavirus variant, known as P.1, was identified in Minnesota and involved a resident who had recently traveled to Brazil, The Post’s Joel Achenbach reports

There’s a lot researchers don’t know about the P.1 variant, but they are worried that it appears to be driving a surge of infections in the Brazilian city of Manaus, despite the fact that the city had already been hard-hit by the coronavirus and many residents were thought to have natural immunity. One research study estimated that some three-quarters of the Manaus population had already been infected. 

“It is fair to say that P.1 is the object of very, very serious attention and concern among epidemiologists. We don’t know why it has been so successful in Manaus,” said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

The Brazil variant is one of three that have drawn particular attention from virologists. Two others were first identified in South Africa and the United Kingdom. The U.K. variant is already spreading throughout the United States, with some experts warning that its heightened transmissibility could make it the dominant strain in the country by the spring. The South Africa variant has not been identified in the United States.

Although scientists originally said that they did not expect the new variants to cause more severe cases, some preliminary evidence suggests the U.K. variant may be more deadly in addition to more transmissible. 

Moderna released new data suggesting that its vaccine is effective against the U.K. and South Africa variants, although the it produced a somewhat diminished antibody response against the latter. The company said it intends to develop a new vaccine specifically targeted against the South Africa variant as a precaution.

OUCH: Biden rejected blaming teachers unions for closed schools, but not all parents agree.

“COVID-19 vaccinations are rolling out. Studies have shown in-school transmission of the virus is low. Thousands of schools have successfully brought kids back in person, while kids who stayed home have struggled,” USA Today’s Erin Richards reports. “Yet many parents are realizing their children may never see their teachers in person this year. A growing number blame their local teachers union, even as President Joe Biden and his administration make in-person instruction a priority.”

A new report from the Center on Reinventing Education at the University of Washington finds that nearly 3 out of 4 urban districts only offer online instruction. In Chicago Public Schools, the nation’s third largest district, the teachers union voted on Monday to continue working from home, effectively defying the city’s reopening plan. Some cities, like Baltimore, are forging ahead with reopening, despite protests from the teachers union. 

Biden had made reopening schools a central part of his coronavirus response plan, proposing an additional $130 billion in federal money to help schools reduce class sizes, improve ventilation and buy protective gear. He has rejected blaming teachers unions for the fact that classrooms have not yet opened. 

“If you are anti-union, you can say it is all because of teachers,” Biden said. “If you want to make a case, though, [that] it is complicated, you say, what do you have to do to make it safe to get kids in schools?”

Marc Lipsitch, a professor of epidemiology at Harvard University, told USA Today there is growing consensus among experts that schools should be the last to close and the first to open. 

But while studies suggest that schools have not contributed to major outbreaks in places with mild to moderate community transmission, the research is less conclusive about reopening in places with high rates of infection.

The Biden administration

Biden is tapping nurse Susan Orsega to serve as the nation’s acting surgeon general.

“Orsega, a career-commissioned officer in the U.S. Public Health Service corps and a longtime infectious-disease specialist, would be among the first nurses to serve in the role of surgeon general, which is often referred to as ‘the nation’s doctor,’” The Post’s Dan Diamond reports.

Sources said the announcement of Orsega’s selection could come as soon as Thursday. She would serve pending the confirmation of Vivek H. Murthy, Biden’s surgeon general nominee who held the same role during the Obama administration. His Senate confirmation hearings have not yet been scheduled.

“Frequently viewed as the nation’s spokesperson on public health matters, the surgeon general oversees the U.S. Public Health Service, more than 6,000 uniformed public health personnel who work in various parts of the federal government, but has limited ability to make policy. In her current role, Orsega oversees the corps’s personnel, operations and readiness,” Dan writes.

Vice President Harris is expected to get her second coronavirus shot today.

Sources tell Dan that Harris is getting her second dose of Moderna’s coronavirus vaccine at the National Institutes of Health on Tuesday.

Harris and her husband Doug Emhoff received their first doses of the vaccine on Dec. 29 at United Medical Center in Washington, D.C. They received those shots on camera as part of an effort, they said, to build public trust in the vaccines.

Vice President-elect Kamala D. Harris received the Moderna coronavirus vaccine at United Medical Center in Southeast Washington on Dec. 29. (Video: The Washington Post)

In other coronavirus news

Chick-fil-A staff helped guide gridlocked traffic at a drive-thru coronavirus vaccine site in South Carolina.

The popular restaurant chain is known for its efficient drive-through lines.

“No business can master a drive-thru like Chick-fil-A, and a restaurant manager is getting high praise for using the company’s method to help workers at a COVID-19 vaccination site after a computer glitch caused a traffic gridlock,” Fox News 11 reports.

Mount Pleasant Mayor Will Haynie said he was alerted to a traffic back up at a vaccination site being held at a local church. He called Chick-fil-A Manager Jerry Walkowiak for help, “knowing the company had a great reputation for mastering the art of drive-thru.” The mayor credited Walkowiak with reducing the wait time from an hour to 15 minutes.

Elsewhere in health care

Biden reversed a Trump-era ban on transgender people serving in the military. 

The executive order repeals a 2019 Defense Department rule that effectively amounted to a ban on thousands of transgender people in the military. Under Trump, transgender troops were only allowed to serve if they had not received a diagnosis of gender dysphoria, hadn’t transitioned and didn’t need to, and could meet standards for their biological gender including for grooming and uniforms.

“According to Defense Secretary Lloyd Austin, the new regulations will permit recruits who meet entry standards to serve in their self-identified gender, and will ensure that the military pays for medically necessary care related to gender transition," The Post’s Missy Ryan, Samantha Schmidt and Matt Viser report. “The new order will also halt steps to force transgender personnel out of the military.”

President Biden on Jan. 25 signed an executive order lifting the ban on transgender people serving openly in the U.S. military. (Video: The Washington Post)
Biden is nixing Trump’s plan to ease opioid-treatment prescriptions.

The Biden administration is planning to halt a last-minute plan that would make it easier for physicians to prescribe an opioid treatment drug, known as buprenorphine. 

“The Trump plan had been hailed by physicians as loosening requirements they said had slowed their response to the nation’s worsening opioid crisis. Then-presidential candidate Joe Biden also criticized the prescribing rules and vowed to lift them if elected president. But some legal experts warned that the Department of Health and Human Services lacked the authority to issue guidelines that allowed physicians to avoid requirements mandated by Congress,” The Post’s Dan Diamond and Lenny Bernstein report.

The new plan, announced by Trump on Jan. 14, would have exempted doctors from undergoing a day’s training before they could prescribe buprenorphine to treat opioid use disorder. Advocates have said that rule creates bureaucratic barriers for a lifesaving medicine.

The news comes as the CDC reports that a record 81,230 Americans have died of drug overdoses in the 12 months ending last May. The death rate increased as the coronavirus pandemic disrupted daily life.

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