Biden opens ACA window for uninsured as COVID
By Ricardo Alonso-Zaldivar
The Associated Press
January 28, 2021
WASHINGTON (AP) ó 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 arenít
yet widely available.
Biden signed an executive order directing the HealthCare.gov
insurance markets to take new applications for subsidized
benefits, something Donald Trumpís administration had refused to
do. He also instructed his administration to consider reversing
other Trump healthcare policies, including curbs on abortion
counselling and the imposition of work requirements for
low-income people getting Medicaid.
"Thereís nothing new that weíre 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 predecessorís attack on womenís health."
The actions were only the first steps by Biden, who has
promised to build out former President Barack Obamaís healthcare
law to achieve a goal of coverage for all. While Biden rejects
the idea of a government-run system that senator 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 short-term impact of Bidenís orders will
come from reopening HealthCare.gov insurance markets as coverage
has shrunk in the economic turmoil of the coronavirus pandemic.
Thatís an executive action and no legislation is required.
The new "special enrollment period" will begin February 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
"The reason it wasnít 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 Obama-era Affordable Care Act, the
marketplaces offer taxpayer-subsidized coverage regardless of a
personís medical history or preexisting conditions, including
Biden also ordered the immediate reversal of a federal policy
that bars taxpayer funding for international healthcare
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 presidentís 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. Bidenís team says heís
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
He instructed the Department of Health and Human Services (HHS)
to consider rescinding Trump regulations that bar federally
funded family planning clinics from referring women for
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 Medicaidís legal charge to provide medical services.
The Supreme Court has agreed to hear the issue.
And Biden directed HHS to review Trump policies that could
undermine protections for people with health problems, such as a
rule that facilitated the sale of short-term health insurance
plans that donít have to cover preexisting medical conditions.
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.
Former Trump health policy adviser Brian Blase said the Biden
administration has to take care it doesnít throw out some
policies intended to help solidly middle-class people who donít
qualify for financial assistance under Obamaís law.
"Obamacare plans are generally only attractive to people who
receive large subsidies to buy them," said Blase. He cited a
Trump policy that allows employers to provide tax-free money for
workers to buy individual plans.
The abortion-related actions brought Biden immediate praise
from womenís 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. Trumpís abortion
counselling restrictions led Planned Parenthood affiliates to
leave the federal family planning program.
Biden campaigned on repealing longstanding federal
prohibitions against taxpayer funding for most abortions, but
that was not part of Thursdayís orders. A change of that
magnitude to a group of laws known as the Hyde Amendment would
require congressional approval.
Bidenís nominee for health secretary, California attorney
general Xavier Becerra, has not yet been confirmed by the
senate, but the White House said that will not stop health
agencies from immediately going to work on the presidentís
The idea of reopening Obamacareís health insurance markets in
the pandemic has had broad support from consumer, medical, and
business organizations. The main insurer trade group, Americaís
Health Insurance Plans, applauded Bidenís move.
As the number of uninsured Americans grew because of job
losses in the pandemic, the Trump administration resisted calls
to reopen HealthCare.gov. Failure to repeal and replace
Obamacare was one of the former presidentís most bitter
disappointments. His administration continued trying to find
ways to limit the program or unravel it entirely. A Supreme
Court decision on Trumpís final legal challenge to the
Affordable Care Act is expected this year.
Experts agree that the number of uninsured people has risen
because of layoffs in the coronavirus economy, but authoritative
estimates await government studies due later this year. While
some estimates cite 5 million to 10 million newly uninsured
people, the nonpartisan Congressional Budget Office (CBO) says
its analysis suggests a smaller number.
Nonetheless, the CBO projects that nearly 32 million
Americans are uninsured and of those, about 2 in 3 are eligible
for some kind of subsidized coverage.
The Obama-era healthcare law covers more than 23 million
people through a mix of subsidized private insurance sold in all
states, and expanded Medicaid adopted by 38 states.