Biden just took his first step to expand health coverage

Eight days into his administration, President Joe Biden took a small step to expand health coverage during the Covid-19 pandemic — one that Donald Trump refused to take last year.

In an executive order Biden is signing Thursday, the president directs the US Department of Health and Human Services to open a special enrollment period on HealthCare.gov, allowing Americans to sign up for a new health insurance plan subsidized by the federal government. From February 15 to May 15, people who are uninsured can log on to the federal website and choose a health plan. (HealthCare.gov serves most states but not all; Biden officials said they expected the states that run their own insurance marketplaces to also open up enrollment.)

“These actions demonstrate a strong commitment by the Biden-Harris Administration to protect and build on the Affordable Care Act, meet the health care needs created by the pandemic, reduce health care costs, protect access to reproductive health care, and make our health care system easier to navigate and more equitable,” the White House said in a statement announcing the order.

Health insurance companies and Democrats in Congress had urged Trump to allow a special enrollment period last spring, when the pandemic was worsening. But the previous administration ultimately decided against it.

So Biden’s order signals a shift in the federal government’s willingness to use the Affordable Care Act during an emergency. But exactly how many people will be helped by this opportunity to buy new health insurance as a result is more of an open question.

Biden administration officials did not have a specific projection. The normal enrollment period just ended in mid-December. Anybody who loses their job or has a child is already eligible to enroll after one of those major life changes. It’s fair to ask who Biden’s special enrollment period is supposed to be for.

The new administration seems to have one specific target in mind: Americans who are eligible for federal assistance to buy coverage through the ACA but never learned about their options. That could represent some of the several million people who have lost their health insurance during the Covid-19 pandemic. It could also include some of the 30 million or so people who were already uninsured before the current economic crisis.

The Biden administration is planning an ad blitz around the special enrollment period, though officials did not put a dollar figure on their efforts. ACA outreach and advertising had been cut dramatically under President Trump, another way in which Biden’s actions represent a new direction for federal health policy.

There are, in theory, a lot of people to reach. About 40 percent of uninsured Americans in 2018 were eligible for government assistance through the ACA, a Commonwealth Fund survey found. More than half of the uninsured gave one of three reasons for their lack of health insurance: They didn’t think they could afford it, they didn’t think they were eligible for coverage, or they weren’t aware of the marketplaces. A Kaiser Family Foundation study estimates 4 million people are eligible for free coverage through the law.

It remains to be seen whether another two-month sign-up window, even one supported by a new ad campaign, gets through to them. But this was also one of the few easy steps Biden could take to try to expand health coverage.

Otherwise, Biden has a long way to go in reversing Trump’s actions on health care or advancing new policies of his own. Much of it will require going through the complicated rulemaking process, and new policies to expand coverage will likely depend on Congress to act. That will take time. Experts told me before Biden took office that the new administration would have to be diligent when issuing new regulations, because Republican judges are likely to be skeptical of any executive actions from Biden.

The executive order Biden will sign Thursday starts the process by officially directing federal agencies to review the Trump policies that could lead to people losing coverage. Medicaid work requirements are one policy specifically called out for scrutiny, one that Trump’s lieutenants had desperately sought to preserve before leaving power.

In as many ways as he can, Biden is trying to signal a break from Trump.