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The Health 202: will now be open during tax season

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with Alexandra Ellerbeck

Aligning Obamacare enrollment with tax season would be a no-brainer, tax experts have long argued.

Now it’s actually happening, with President Biden’s order yesterday to reopen the federal health-care marketplace from Feb. 15 through May 15.

“President Biden signed an executive order Thursday to reopen the Affordable Care Act’s federal insurance marketplaces for three months to give Americans who need coverage during the coronavirus pandemic an extended chance to buy health plans,” our colleague Amy Goldstein reports.

“The action represents the first step the new administration is taking to fulfill a major part of the president’s campaign agenda to make health insurance and health care more accessible and affordable — goals that have taken on more urgency as 25 million have been infected with the coronavirus and millions of others have lost jobs,” Amy adds.

Biden cited the pandemic, not tax season, as the reason for the special sign-up period.

But the timing will give tax preparers — used by more than half of low-income taxpayers — a new opportunity to potentially help uninsured Americans to access health coverage. 

Filing taxes can be a prime moment for enrolling in health coverage. Many people who are both uninsured and poor file their taxes early in the year, to collect refundable tax credits. And people are more likely to buy a health plan with some money on hand to pay the premiums, instead of during the holidays, when funds might be running low. Tax preparers can also help calculate the insurance subsidies someone might be eligible for, since those subsidies are based on income.

“For many people-especially those eligible for subsidies—the tax filing season is a perfect time to enroll and tax preparers are a great way to connect them to plan options,” the Tax Policy Center’s Howard Gleckman wrote back in 2013.

Back when the Affordable Care Act was being rolled out, popular tax firms including Jackson Hewitt and H&R Block asked the Obama administration to give them a role in helping sign up people. Because the insurance subsidies are calculated based on income, tax preparers argued they were well-positioned to help people understand what assistance they’d be eligible for.

But the Obama administration mainly relied on nonprofit groups to assist with enrollment. And it stuck with the original plan to hold the sign-up period in November and December.

This special sign-up period could help the Biden administration start reversing incremental declines in ACA enrollment.

Over the course of the Trump administration, the number of people buying coverage on gradually eroded. Biden, who has made boosting marketplace enrollment a top goal, said yesterday that “basically the best way” to describe his action is that it is intended “to undo the damage Trump has done.”

During the special enrollment period, people won’t have to prove they had a major life change to quality — something that is typically required for anyone to enroll outside the regular six-week enrollment period.

It's unclear exactly how many more people will avail themselves of the new opportunity to sign up. Sign-ups could be modest, considering federal subsidies won't be any more generous than they currently are. Charles Gaba, who has crunched ACA data for years, estimates they could reach 400,000. A White House official told Amy they don't have a forecast for how many people might sign up, noting that “there are millions of uninsured people who can benefit from the ACA.”

Sarah Kliff, investigative reporter for the New York Times:

Charles Gaba:

An advocacy group with ties to Democrats:

The order affects people in three dozen states that use, the federal marketplace. But many of the states running their own marketplaces — including California, Minnesota, Washington, New Jersey and Colorado — also announced a special enrollment period lasting until May 15.

Covered California is extending enrollment through May 15:

“The unusual extra sign-up time will be accompanied by a resumption of federal aid for paid advertising, other outreach efforts and community groups that help people figure out how to sign up,” Amy reports. “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 declined to say how much money the Department of Health and Human Services will devote to outreach and enrollment help, or whether it will match what the previous administration cut. 

Ahh, oof and ouch

AHH: Biden’s health-care order puts Medicaid work requirements under the microscope.

Biden’s executive order on health care also directs federal agencies to reexamine rules that have made it more difficult for people to enroll in Medicaid or that could undermine protections for people with preexisting conditions.

A White House official said the administration would take a “very close look” at waivers granted under the Trump administration allowing states to impose work requirements for Medicaid recipients, Amy reports. These requirements compel people to work or look for a job to qualify for safety-net insurance.

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

The Supreme Court is set to hear appeals related to work requirements in Arkansas and New Hampshire, which were struck down by lower courts. Arkansas’s work requirement has been blamed for causing 18,000 people to lose their health insurance.

Biden’s order also directed HHS to review policies that could undermine protections for people with preexisting conditions, including complications related to covid-19.

OOF: Biden took aim at abortion restrictions.

A second order, in the form of a presidential memorandum, sought to undo Trump-era restrictions on abortions both in the United States and overseas. The order rescinds the Mexico City policy, which forbids nonprofit groups in other countries from receiving U.S. foreign aid if they perform abortions or provide information about them, Miriam Berger reports.

The Mexico City policy — named for the location in which it was signed —  has been the subject of partisan whiplash since it was drafted in 1985 during the Reagan administration. Two Democratic presidents, Bill Clinton and Barack Obama, have rescinded it, and two Republican presidents, George W. Bush and Trump, have put it back in place. The Trump administration went a step further by expanding the order to cover all global health aid, not just aid aimed at family planning.

“The decades of Washington-imposed whiplash have left sexual and reproductive health and rights programs around the world scrambling to secure funding — or needing to adjust the services they provide,” Miriam writes.

The memorandum also orders HHS to review a rule instated by the Trump administration that cuts off Title X funding, which supports family planning, for domestic organizations

Biden’s orders on abortion come on the eve of the annual “March for Life” — an antiabortion march that will be held virtually this year because of the coronavirus pandemic. In place of the annual march, some churches and organizers are planning smaller local events across the country.

OUCH: Two federal reports describe lacking safety measures as U.S. officials met American evacuees from Wuhan, China.

As the evacuees touched down at a California military base a year ago, fleeing the epicenter of the coronavirus outbreak, they were met by U.S. health officials with no virus prevention plan or infection-control training, Dan Diamond reports.

Later, those officials were told to remove protective gear when meeting with the evacuees to avoid “bad optics." Days after those initial encounters, they departed California aboard commercial airline flights to other destinations.

“Those are among the findings of two federal reports obtained by The Washington Post, supporting a whistleblower’s account of the chaos as U.S. officials scrambled to greet nearly 200 evacuees from Wuhan at March Air Reserve Base in Riverside County, Calif., in the early morning of Jan. 29, 2020,” Dan writes. 

The handling and quarantining of those evacuees and the resulting whistleblower complaint prompted internal reviews by the Health and Human Services Department and an investigation overseen by the Office of Special Counsel.

The “most troubling finding” is that the government’s handling of the Wuhan evacuees “increased the risk of infection transmission not only to deployed [government] personnel, but also to the American public as a whole,” Special Counsel Henry Kerner wrote in a letter to Biden yesterday.

More in coronavirus

New York severely undercounted coronavirus deaths in nursing homes.

New York Attorney General Letitia James issued a report claiming that the state had undercounted coronavirus-related deaths of nursing home residents by the thousands. Just hours later, state Health Department officials made public new data that added 3,800 deaths to the state’s covid-19 tally, representing nursing home residents who had died in hospitals.

“The findings do not change the overall number of Covid-19 deaths in New York — more than 42,000, the most of any state — but the recalculation in the number of nursing home deaths illustrates how unprepared the nursing home industry was in the first and deadliest weeks of the pandemic,” the New York Times’s Jesse McKinley and Luis Ferré-Sadurní report.

New York’s health commissioner, Howard Zucker, disputed the accusation that officials had undercounted nursing home deaths, pointing out the state’s website made it clear that the nursing home count only included people who died in facilities.

The attorney general’s report gives credence to theories the state may have intentionally played down the number of nursing home-related deaths to deflect criticism of policies during the pandemic.

Gov. Andrew Cuomo (D) has faced harsh criticism over a March 25 directive ordering nursing homes to accept and readmit patients who tested positive for the coronavirus. While the attorney general’s report acknowledges the directive was aligned with federal guidance, it says it “may have put residents at increased risk of harm in some facilities.”  Cuomo also codified immunity protections for health-care providers in the state budget, a move that some critics say may have prompted some facilities to make riskier decisions.

A coronavirus variant first seen in South Africa has been identified in South Carolina.

The report of the new, highly transmissible virus in the United States came just hours before biotech company Novavax reported that its coronavirus vaccine was highly effective at preventing illness — except against the South Africa variant, Carolyn Y. Johnson and Joel Achenbach report.

“The Novavax vaccine was highly effective — 89 percent — in a trial where the variant first identified in the United Kingdom, known as B.1.1.7, was highly prevalent. But its efficacy dropped to 49 percent in a smaller and less definitive South Africa trial, where the vast majority of infections were from a different variant that is spreading there, known as B. 1.351,” Carolyn and Joel report.

Some scientists cautioned against too closely comparing the trials in the United Kingdom and South Africa. Others pointed out that a 50 percent efficacy rate could still be a powerful tool in combating the virus’s spread.

Still, the fact that viruses with new mutations may be less susceptible to some vaccines is troubling news that has galvanized a vaccine makers' effort by to create booster shots targeted at the new strains.

The South Carolina case confirms all three of the major coronavirus “variants of concern” identified by international scientists are now present in the United States. Earlier this week, officials in Minnesota identified the P.1 strain, which shares several mutations with the South African strain, is linked to a disastrous outbreak in the Brazilian city of Manaus. 

The World Health Organization team investigating the coronavirus's origins has finally been released from 14-day quarantine in Wuhan.

“The WHO-led investigation of the virus’s origins in China, mooted since the earliest days of the pandemic, had already been long-delayed amid disagreements about the nature of the inquiry,” Adam Taylor reports.

“Geopolitical rivalry complicated the matter further, as U.S. officials in the Trump administration suggested repeatedly that the virus could have leaked from a lab in Wuhan, while Chinese officials claimed that the virus may not have originated in China at all,” he writes.

EcoHealth Alliance President Peter Daszak, a member of the international team:

Even after their two-week quarantine, the investigators will be subject to regular health checks and should avoid gatherings, under China’s health policies.

Some public health experts have questioned whether the team will get adequate access to complete the investigation, but WHO Director General Tedros Adhanom Ghebreyesus suggested there has been progress.

Vivek Murthy says getting everyone vaccinated “will take well into the summer and probably into the latter part of this year."

Murthy, who is awaiting Senate confirmation as Biden’s pick for surgeon general, said he doesn't expect to have the whole country vaccinated by June.

“We have confidence that the supply would significantly ramp up over the course of spring into early summer,” Murthy said during a Washington Post Live interview. "But the real question I think that we're all focused on is how to translate that supply into people's arms, and I don't think that we'll be at a place where we've got the whole country vaccinated by the beginning of this summer.”

Murthy’s tone of caution — characteristic of Biden administration members —  contrasts sharply with promises from President Trump’s top vaccine officials, who repeatedly promised there would be enough doses by June for every American who wants them.

Vivek H. Murthy, the nominee for surgeon general, said in a Washington Post Live interview that he believes vaccines in the United States will be in a better place "from a supply standpoint as the year rolls on." (Video: Washington Post Live)
There’s growing reason to be optimistic about the vaccine rollout.

Despite a litany of complaints the rollout wasn’t fast enough — and some legitimate confusion about who can get a vaccine and where — the daily rate of immunizations has been growing steadily for the past month.

According to The Washington Post’s tracker, at least 21.1 million people in the United States have received at least one vaccine dose, with more than 47 million doses distributed. About 1.2 million people are getting a coronavirus vaccine shot every day — a figure well above the threshold the Biden administration would need to maintain to achieve its goal of 100 million shots in 100 days.

Yet administration officials are tempering Biden’s suggestion he’d like to raise the goal to 1.5 million doses per day. The goal is still 100 million shots, Murthy said. But that's a floor “not a ceiling.” 

“We need to, and fully intend, to blow past that goal and hopefully to do much better,” he said.

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