Joe Biden has signed an executive order to reopen federal health insurance marketplaces in an executive action meant to signal the importance of expanding healthcare, a key commitment during his campaign.
The order is designed to aid people who lost their jobs, and consequently their health insurance, amid the pandemic.
The order will formally reopen HealthCare.gov insurance markets for a special sign-up opportunity geared to people who need insurance during the pandemic.
The marketplaces are one part of the health reform law the Affordable Care Act that Biden helped pass while he was vice-president, best known as Obamacare.
“As we continue to battle Covid-19 it is even more meaningful [that] Americans have access to healthcare,” said Biden, in a brief appearance at the White House as he signed the order. Biden went on to emphasize he was not expanding Obamacare at this time. Biden said the orders would, “undo the damage Trump has done”.
“I’m not initiating any new law, any new aspect of the law,” he said. “Of all times that we need to reinstate access to the affordability of and extent of access to Medicaid is now – in the middle of this Covid crisis,” Biden said.
Biden’s executive order directed federal agencies to, “reconsider rules and other policies that limit Americans’ access to health care and consider actions that will protect and strengthen that access”.
Currently, roughly 11.4 million people use the marketplaces to buy health insurance, according to Kaiser Family Foundation. The marketplaces allow people to buy health insurance as individuals, which before the reforms was extremely difficult, and gives people in certain income brackets federal subsidies to do so. Biden’s executive order will reopen the marketplace from 15 February to 15 May.
Although the number of uninsured Americans has grown because of job losses due to the economic hit of Covid-19, the Trump administration resisted calls to authorize a “special enrollment period” for people uninsured in the pandemic.
Rather than open the window to sign up for healthcare immediately, the White House wants to provide time for the Department of Health and Human Services to mount a marketing campaign, and for insurers to get ready for an influx of new customers.
The previous president, Donald Trump, failed to repeal and replace Obamacare, after he repeatedly vowed to do so. The effort to repeal the law collapsed after a member of Trump’s own party, the late Senator John McCain of Arizona, voted against the effort. Nevertheless, Trump’s administration continued trying to find ways to limit the program or unravel it entirely.
Among Trump’s actions were steep budget cuts to advertising and “navigators” who helped people sign up for the insurance programs. Nearly 1 million people dropped out of the market during the Trump era, and the number of people who lacked insurance entirely grew by more than 2 million.
Further, the Trump administration also approved 13 states’ requests to include harsh work requirements as a prerequisite for people to obtain Medicaid, a government health insurance program for low-income Americans. In the only state that implemented the work requirements, Arkansas, 18,000 people lost health insurance, the Center on Budget and Policy Priorities reported. A supreme court decision on Trump’s final legal challenge to the Affordable Care Act is expected this year.
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, with southern states being the major exception. Coverage is available to people who don’t have job-based health insurance, with the Medicaid expansion geared to those with low incomes. Roughly 158 million people, or nearly 50% of Americans, receive health insurance sponsored by an employer.
Biden’s order would directly affect HealthCare.gov, the federal insurance marketplace currently serving 36 states. The marketplace concluded a successful annual sign-up season in December, with enrollment for 2021 growing by about 7%. Final numbers for this year that include insurance markets directly run by the states will be available soon.
Opening the insurance markets is also likely to result in higher Medicaid enrollment, since people who qualify for that program are automatically referred.
The special sign-up opportunity is only a down payment on health insurance for Biden, who has promised to build on Barack Obama’s health law to push the US toward coverage for all. For that he would need congressional approval, and opposition to the health law still runs deep among Republicans.
The White House press secretary, Jen Psaki, signaled on Tuesday that Biden is also looking at limiting or reversing Trump administration actions that allowed states to impose work requirements for able-bodied low-income adults as a condition of getting Medicaid. Such rules are seen as a way to cull the program rolls.
“President Biden does not believe, as a principle, it should be difficult … for people to gain access to healthcare,” she said. “He’s not been supportive in the past, and is not today, of putting additional restrictions in place.”
Of some 28 million uninsured Americans before the pandemic, the non-partisan Kaiser Family Foundation estimates, more than 16 million were eligible for some form of subsidized coverage through the health law.
Experts agree that number of uninsured people has risen because of layoffs, perhaps by 5 million to 10 million, but authoritative estimates await government studies due later this year.
Source: The Guardian