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With latest executive orders, Biden opens Obamacare enrollment in bid to expand access to health care

The storefront of an insurance enrollment company in Miami encourages people who need health insurance to enroll under the Affordable Care Act, also known as Obamacare.
The storefront of an insurance enrollment company in Miami encourages people who need health insurance to enroll under the Affordable Care Act, also known as Obamacare.NYT

President Biden, seeking to expand access to health care and strengthen the Affordable Care Act, used his executive authority Thursday to order the reopening of enrollment in the health law’s marketplaces and a reexamination of Trump administration policies that undermined protections for people with preexisting medical conditions.

His aim, he said in a brief signing ceremony in the Oval Office, was to “undo the damage Trump has done.”

Biden also moved to protect reproductive rights and expand access to abortion and took a separate executive action to overturn his predecessor’s restrictions on the use of taxpayer dollars for clinics that refer or counsel patients to terminate pregnancies, both in the United States and overseas.

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Taken together, Biden is trying to put a quick stamp on health policies that have been critical to a Democratic resurgence, especially those that back the Affordable Care Act, which he helped secure as President Obama’s vice president. As president, Donald Trump failed to overturn the health law, but he spent four years undermining it with a series of executive actions, including allowing the sale of cheap, short-term and small-business health plans that do not meet the law’s health coverage mandates.

Biden’s first step is to reopen enrollment for health coverage offered through the federal marketplace created under the health law, also known as Obamacare. His intent is to offer coverage not only to those who lost it during the pandemic, but also to those who did not have insurance and now want it, according to a senior administration official who previewed the new policy during a conference call Thursday morning.

The so-called special enrollment period will be Feb. 15 to May 15. The official said the reopening would be accompanied by the kind of robust patient outreach — including “paid advertising, direct outreach to consumers, and partnerships” with community organizations and advocacy groups — that was abandoned by the Trump administration.

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Typically, Americans in the 36 states that rely on the federal marketplace can buy Obamacare insurance only during a six-week period in the fall, a restriction meant to encourage people to hold coverage even when they are healthy. The sign-up period for this year’s coverage ended in mid-December, with enrollments only slightly higher than they were last year. But the Trump administration did little to advertise it.

Once the coronavirus struck, Trump faced pressure to reopen enrollment for the millions of Americans losing their jobs, but he refused.

Biden’s actions take aim at a number of Trump’s policies. In 2018, citing complaints about the price of Obamacare coverage, the Trump administration issued a rule that extended the length of less-expensive short-term policies from three months to up to three years. Such policies do not have to cover preexisting conditions and can exclude common benefits like maternity care, mental health care, or prescription drugs. The former administration also made it easier for small businesses to band together and offer plans that escape some of the requirements of the Affordable Care Act.

Biden has asked federal agencies to reexamine these rules, which could take months to undo. Should the rules be overturned, patients who have such policies would be unable to renew them, which could leave them without insurance if they think coverage is too expensive. Biden campaigned on raising the subsidies for Obamacare plans to make them more affordable.

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Biden’s executive actions on abortion put him in the center of the nation’s long-running culture wars. Like his Democratic predecessors, Obama and President Bill Clinton, he will immediately rescind the global gag rule — often called the “Mexico City Policy” — which bars international nonprofit organizations that provide abortion counseling from using US tax dollars.

The rule has been riding a philosophical seesaw for decades — in place when a Republican occupies the White House and overturned when a Democrat moves in.

Biden is also directing the Department of Health and Human Services to “take immediate action,” his administration said, to consider whether to rescind the so-called domestic gag rule — a regulation imposed by the Trump administration that prohibits family planning clinics that receive federal funding from counseling patients about abortion. Such a change would likely require the department to write new regulations, a process that could take months.

The president’s Obamacare directive will also instruct federal agencies to review policies — including waivers that allowed states to impose work requirements — that discourage participation in Medicaid, the public health insurance program for the poor and disabled. Enrollment in Medicaid has grown substantially during the coronavirus pandemic, in part because people who have lost jobs and their health insurance have turned to Medicaid for coverage.