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Biden to Add 3-Month HealthCare.gov Special Enrollment Period

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President Joe Biden is preparing to sign an executive order that will create a new, three-month HealthCare.gov special enrollment period.

The executive order also could lead to policy changes at and extra federal support for Affordable Care Act (ACA) commercial health coverage access programs and for states’ Medicaid programs.

White House officials said the president will sign the Medicaid and ACA commercial health coverage access executive order this afternoon, along with a reproductive health care access executive order.

Resources

White House officials announced the pending signing of the executive orders in a fact sheet.

The new special enrollment period in the executive order will run from Feb. 15 through May 15, according to the fact sheet.

In the executive order, the president also is asking 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.”

The president is asking agencies to re-examine:

  • Policies that “undermine the Health Insurance Marketplace or other markets for health insurance.”
  • Policies that affect coverage for people with pre-existing conditions, including the after-effects of COVID-19.
  • Medicaid work requirements and other demonstration programs or waiver programs that could affect people’s access to Medicaid or ACA exchange plan coverage.
  • Policies that may reduce affordability of coverage, including dependent coverage.

“For President Biden, this is personal,” according to the fact sheet. “He believes that every American has a right to the peace of mind that comes with knowing they have access to affordable, quality health care.”

The commercial health insurance provisions in the executive order will be of keen interest to agents and brokers who sell individual health coverage.

Both the ACA exchange plan provisions and the Medicaid provisions will be of interest to health insurers, because many commercial health insurers now provide coverage for people with Medicaid through state managed programs.

HealthCare.gov Background

HealthCare.gov is a web-based program that helps people shop for commercial individual health coverage and use federal ACA premium tax credit subsidies to pay for the coverage. It’s part of the ACA public exchange system — a collection of web-based supermarkets for health insurance.

Members of Congress created the ACA public exchange system in an effort to improve the individual health insurance market, by giving people an easy way to buy health coverage. Originally, in 2010, when former President Barack Obama signed the two bills in the ACA statutory package, ACA supporters expected states to run their own exchange programs.

Today, 14 states and the District of Columbia run their own ACA exchange programs. The U.S. Department of Health and Human Services (HHS) set up HealthCare.gov to provide exchange program services in the 36 states without locally run exchange programs.

Since Jan. 1, 2014, the ACA has required health insurers to provide individual coverage without considering the enrollee’s individual health status, and without charging more for enrollees with health problems.

ACA public exchange programs have been using an “open enrollment period” system, or limits on when people can buy individual coverage without showing they have a special reason to be buying health coverage. This new order is an effort to push healthy people to pay for coverage — by raising the possibility that, if they fail to pay for coverage, they could need expensive medical care outside the open enrollment period with no way to sign up for coverage.

States have applied the open enrollment period rules to individual health insurance sales made outside of the ACA public exchange system as well as to on-exchange sales.

Exchange programs had converted on an individual health insurance open enrollment period lasting from Nov. 1 through Dec. 15.

The COVID-19 Pandemic

This year, most states with locally run ACA public exchanges responded to the COVID-19 pandemic by extending signup deadlines past Dec. 15, in an effort to make it easier for people to have health coverage during the pandemic.

HealthCare.gov stuck with its original open enrollment period deadlines, and it stuck with a marketing strategy, developed in 2019, to minimize spending on traditional advertising and support for nonprofit “navigators,” or exchange system navigators. and to rely mostly social media outreach, email-based advertising, and support from commercial health insurance agents and brokers.

The final number of HealthCare.gov signups for 2021 is 7% higher than for 2020 in the states where HealthCare.gov has provided exchange services both this year and last year.

That’s similar, for example, to the 8% signup increase at Connect for Health Colorado, Colorado’s locally run ACA public exchange program. The state provided strong support for both nonprofit navigators and for agents and brokers, and it extended its open enrollment period deadline for 2021 coverage to Jan. 15.

But many ACA program supporters have been calling for HealthCare.gov managers to extend the HealthCare.gov enrollment deadline and improve navigator support.

Peter Lee, the chief executive officer of California’s public exchange program, Covered California, testified in September 2020, during an online hearing organized by the U.S. House Energy and Commerce health subcommittee, that strong marketing support can keep health insurance premiums down, by increasing the odds that relatively healthy people will sign up and pay for coverage.

The Future

The HHS agency in charge of HealthCare.gov and other ACA Medicaid and commercial health insurance access programs is the Centers for Medicare and Medicaid Services.

The president has nominated Xavier Becerra, the California attorney general, to be the next HHS secretary.

He has not yet named a CMS administrator candidate. The current acting administrator is Liz Richter, who began working for CMS in 1990, as an employee working on inpatient hospital payment policy, according to the CMS website.

One question is how the future CMS administrator will see the ACA public exchange program.

— Read COVID-19 Hit Harder Than Expected: Anthem CEO, on ThinkAdvisor.

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