Boom: Pres. Biden orders HC.gov enrollment re-opened for 3 months starting 2/15 & much more!

I wrote about this a few days ago, but today it'll be official:

President Biden to Sign Executive Orders Strengthening Americans’ Access to Quality, Affordable Health Care

The Biden-Harris Administration will open a Special Enrollment Period for Americans to sign up for health coverage and roll back attacks on the Affordable Care Act, Medicaid, and access to reproductive health care

Strengthening Medicaid and the Affordable Care Act.

This Executive Order takes critical steps to reverse attacks on and strengthen Medicaid and the Affordable Care Act, so they can continue to provide access to life-saving care for millions of Americans. Based on this Executive Order, it is expected that the Department of Health and Human Services (HHS) will open HealthCare.gov for a “Special Enrollment Period,” from February 15, 2021 – May 15, 2021. This Special Enrollment Period will give Americans that need health care coverage during this global pandemic the opportunity to sign up.

And there you have it: Biden is re-opening the federal ACA exchange, HealthCare.Gov, for a full 3 month period starting February 15th. This is actually longer than I expected...I was figuring either 30 or 60 days, not 90.

Earlier this week I gave a rough projection of perhaps 400,000 additional Americans enrolling in on-exchange policies via HC.gov with a 60-day COVID-19 "no reason needed" SEP. Making it 3 months doesn't necessarily mean 600,000 extra enrollees, however; it's not a straight linear scale for a number of reasons, some of which David Anderson laid out yesterday.

Even so, it'll be interesting to see how many additional enrollments this generates.

Beyond fully re-opening HC.gov, however, today's executive order also includes some other provisions which are likely even more important in terms of how much they impact both ACA enrollment and healthcare coverage and affordability in general:

The President will also direct 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.

Agencies are directed to re-examine:

  • Policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19;

This sounds like it refers to the notoriously bad "reinterpretation" of ACA Section 1332, which is set to allow states to effectively ignore large parts of the ACA's patient protection guidelines and to even abandon any official ACA exchange altogether. It may also refer to Trump's XO which allowed #ShortAssPlans to flood the market by not only allowing non-ACA compliant so-called "Short-Term, Limited Duration" plans to be neither, but also heavily encouraged states & regulators to push them.

  • Demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements;

Again, this sounds like it's a pushback against Trump/Verma's 1332 waiver "definitions" and also finally puts a well-deserved nail in the coffin of Medicaid work requirements.

  • Policies that undermine the Health Insurance Marketplace or other markets for health insurance;

This sounds like it refers to the Trump Administration massively slashing the marketing and outreach budgets for HealthCare.Gov, among other things.

  • Policies that make it more difficult to enroll in Medicaid and the ACA; and

I'm not entirely sure what this specifically refers to, but it could be about reversing the Trump Admin's slashing of HC.gov's Navigator/assister program budget.

  • Policies that reduce affordability of coverage or financial assistance, including for dependents.

HUGE!! This sounds very much like the Biden Administration has decided to tackle the ACA's infamous Family Glitch via regulation instead of (or, more likely, in addition to) waiting on Congress to finally eliminate it via formal legislation. My colleague Louise Norris estimates that between 2 - 6 million Americans are locked out of ACA exchange subsidy eligibilty due to this stupid drafting error in the original ACA.

  • As part of their reviews, agencies will consider whether to take additional actions to strengthen and protect access to health care.

He's also expected to announce another important XO (or perhaps it's part of the same one?) regarding reproductive healthcare and family planning services in general:

Protecting Women’s Health at Home and Abroad.

Across the country and around the world, people — particularly women, Black, Indigenous and other people of color, LGBTQ+ people, and those with low incomes — have been denied access to reproductive health care. President Biden is also issuing a Presidential Memorandum to protect and expand access to comprehensive reproductive health care.

The memorandum reflects the policy of the Biden-Harris Administration to support women’s and girls’ sexual and reproductive health and rights in the United States, as well as globally. Like memoranda issued by President Clinton and President Obama before him, it immediately rescinds the global gag rule, also referred to as the Mexico City Policy, which bars international non-profits that provide abortion counseling or referrals from receiving U.S. funding. In recognition of the additional work necessary to protect access to reproductive health care, President Biden’s memorandum also directs the Department of Health and Human Services to take immediate action to consider whether to rescind regulations under its Title X family planning program.

It's important to note that while some of the items above will go into effect immediately, and the COVID-19 SEP is supposed to go into effect on 2/15, many of the provisions will take months to be finalized and implemented, and some may not actually be implemented until January 2022.

Even so...this is excellent news and an excellent start by the Biden Administration.