President Biden Opens the Door to Health Care Coverage and Protections for Millions

Provides access to free or low-cost coverage for up to 9 million people and strengthens Medicaid  

FOR IMMEDIATE RELEASE 

January 28, 2021 

CONTACT: Kathy Melley (617) 791-0708  

(BOSTON, MA) -- Today, the President Biden announced a series of executive orders to expand access to affordable health coverage and undo the harm of Trump administration policies designed to cut people off from health care, particularly Black and Brown people, low-income families, women, and LGBTQ+ people. The executive order adds a special enrollment period from February 15 - May 15 that will help up to 9 million people get free or low-cost coverage through the ACA marketplace; and takes steps to reverse harmful Trump administration guidance under the Medicaid program, including work requirements and block grant policies. The Administration would also take steps to undo Trump administration’s harmful policies that undercut people’s access to sexual and reproductive health care, including abortion. 

Statement of Emily Stewart in response to the Biden Administration’s action today on health care and sexual and reproductive health care. 

“Today, President Biden unlocked the doors to health care for millions of people across the country. This is a major step toward addressing the pandemic, which has underscored how important it is for people to have health coverage, particularly for Black and Brown people who have borne the brunt of the crisis and already face unfair and discriminatory barriers to coverage and quality care. By reopening and reinvesting in the ACA Marketplaces and strengthening Medicaid, the Biden Administration has reasserted the central purpose of these foundational health programs, which is to provide access to affordable health coverage for those who need it most. 

“We also applaud the administration’s review of the domestic gag rule, which has undercut people’s access to sexual and reproductive health care. This action is especially important for   low-income, Black, Latinx, and indigenous people who have been hurt the most by the Trump administration’s dangerous policies. Everyone everywhere should be able to control their own bodies, and that must include access to affordable sexual and reproductive health care. 

“The Biden Administration’s actions today are a strong step forward, but there is much more to do to make health care more accessible, affordable and equitable in our country. Community Catalyst and our partners across the country look forward to working with the administration on a bold agenda to advance health equity and build a health system that works for everyone.” 

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BACKGROUND 

ACA SPECIAL ENROLLMENT PERIOD: 

President Biden’s executive order establishes a Special Enrollment Period (SEP) to expand access to health coverage now 

  • The Biden Administration will reopen the ACA Marketplace for three months, allowing people who have been impacted by COVID-19 to gain subsidized coverage the security of health coverage now. 

  • The federal Marketplace will be open from February 15 – May 15, 2001. The federal Marketplace covers 38 states. This action does not affect state Marketplaces, a number of which established a SEP during the pandemic to help families remain financially secure and access coverage. Today’s action extends an essential protection to people who live in the 38 federal Marketplace states.  

President Biden’s action to open ACA enrollment is a major part of COVID relief.  

  • The ACA Marketplaces are a key entry point for consumers to gain access to health care, currently providing over 9 million people with health coverage. As people lose their jobs – and their health insurance – as a result of the COVID-19 pandemic, the ACA marketplaces are a critical way for people to find affordable coverage.   

  • President Biden’s action is focused on re-building ACA Marketplaces, which were under constant attack by the Trump administration. The Trump Administration executed a multi-year effort to deter ACA enrollment, halving the open enrollment period from 3 months to 45 days, zeroing out funding for advertising to promote sign-ups, and slashing funding for consumer assistance, resulting in far fewer navigators across the country and less help for consumers looking for guidance. As a result, enrollment in the ACA Marketplaces steadily declined between 2016 and 2020. The only exception was the recent 2021 Open Enrollment period, in which the pandemic drove ACA enrollments up 6 percent – an indication of the intense need as a result of the COVID-19 pandemic.  

The ACA SEP will open the door to affordable coverage for 9 million people.  

  • According to the Kaiser Family Foundation, up to 9 million people in America could gain access to free or subsidized coverage, including a disproportionate number of Black and Brown people. According to the KFF analysis, those who stand to gain from a SEP include Latinx people, those who are high school educated, part time or unemployed workers and young adults (19-34).  

  • Adding a SEP is critical to boosting coverage as people continue to experience COVID-related job loss and the loss of employer-sponsored coverage (ESI). Providing additional opportunities for frontline workers, who are heroes in the fight against COVID, to access coverage is vital to community health. Frontline workers, as well as others who lack ESI, are disproportionately Black and brown people, so opening the SEP is an important part of centering equity in this administration’s COVID response.   

Going forward, the ACA SEP must be matched with a strong investment in consumer assistance.  

  • In order to ensure the SEP helps those most in need of coverage, the Biden-Harris administration must restore Navigator program funding through the ACA’s user fees and return to funding significant outreach and advertising efforts about the marketplace and enrollment. Navigators are critical and tasked with providing culturally and linguistically appropriate support through the enrollment process. According to this recent Kaiser Family Foundation report, the Trump administration stockpiled over $1.2 billion in revenue designed to support consumer assistance, outreach activities and healthcare.gov. This accumulated set of resources should be swiftly deployed to help consumers now by restarting the consumer assistance programs, marketing and outreach plans and investments in technology that help consumers navigate health coverage selection – no easy task for anyone. 

  • The Biden Administration must provide additional resources to support multilingual enrollment assistance. Non-English- speaking people and their families face barriers accessing needed assistance; targeted support for multi-lingual support is critical to helping people access coverage as many people are distrustful of government support as a result of the Trump administration’s public charge policy specifically and their attacks on immigrant communities more broadly. 

  • The Biden Administration must work with Congress to fund consumer assistance programs (CAPs) that serve as vital resources to consumers across states. The Consumer Assistance Program Grants (CAP Grants) are intended to work in coordination with Navigators to provide accurate information to consumers in making their health care coverage decisions and in supporting consumers with appeals, network queries and more. CAPs are essential to protecting consumers from harm while also supporting coverage access. 

  • Rescind regulations that encourage consumers to buy junk plans, including short-term, limited duration plans and association health plans. 

MEDICAID:  

President Biden’s executive order takes steps to rollback dangerous Trump administration guidance imposing burdensome work requirements and allowing states to cut benefits.  

President Biden’s action on Medicaid is critical for protecting quality coverage for millions.  

  • Medicaid serves 75 million people in the U.S., providing health insurance and economic security to children and their families, older adults, people with disabilities, and others. 

  • Medicaid was designed to serve as a safety-net for families when the unthinkable happens, providing free or low-cost quality health coverage to people who become sick or lose their jobsMedicaid provides critical support to people of color, who face unfair and discriminatory barriers to health and economic security, which the COVID-19 pandemic is exacerbating. Better access to Medicaid has been shown to reduce inequities in coverage and improve health 

Work requirements and block grants are designed to impede access to coverage, and they must be stopped 

  • By rescinding these failed policies, the administration is also communicating to states and policymakers that we must focus on ways to expand coverage for the many who still need it, including between 2-4 million people currently in the Medicaid coverage gap, disproportionately Black and Brown people who face longstanding barriers to coverage to due systemic racism. 

  • Work requirements cause people to lose health coverage. 2018 Trump Administration guidance allowed states to apply for waivers in order to impose work requirements in Medicaid as a condition of eligibility, limiting consumer access to needed coverage and care. While 11 states received CMS approvals from the Trump administration for waivers involving work requirements, Arkansas was the only state to implement them and disenroll people from the program. After implementing this policy, 18,000 Arkansans lost their Medicaid coverage and the overall uninsured rate increased. This increased uninsured rate was coupled with an increase in unemployment, thereby illustrating that the state’s work reporting requirements primarily caused individuals to lose their Medicaid coverage, rather than find employment or private insurance.  

  • Block Grants are designed to incentivize cuts in benefits. Days before the end of the Trump administration’s term, CMS approved Tennessee’s 1115 waiver proposal to opt-in to block grants, which would cap federal Medicaid funding “in exchange for less federal oversight and the ability to impose reductions in coverage, benefits, payment rates, and access to care to keep costs below the cap.”  

  • Tennessee’s block grant serves as an example of a harmful Trump-era Medicaid waiver. In early 2020, the Trump administration encouraged states to apply for such waivers in an effort to reshape the Medicaid program to be more restrictive. Tennessee’s block grant waiver, in particular, has no benefit for low-income residents because in Tennessee, where uninsurance affects 1 in 3 adults in the coverage gap and Tennessee’s Medicaid program is already as restrictive as legally possible, Tennessee would be less likely to improve their Medicaid program to make health care more accessible and equitable.    

Going forward, the Biden Administration and Congress must significantly invest in the Medicaid as a part of a larger health equity agenda.   

  • The Medicaid program is at the cornerstone of our nation’s health system and there are a range of changes, administrative and legislative, that must be made in order for the program to advance equitable coverage and care for individuals and families with low incomes.  

  • That work must start with an increase in the Medicaid FMAP as a part of the COVID relief packages. Increasing the Medicaid FMAP is essential to shoring up the program in the face of the COVID-19 pandemic, particularly as states face budget shortfalls. Increasing the FMAP in COVID relief is a priority of a range of stakeholders, including the National Governor’s Association, medical societies like the National Medical Association, and local, state, and national consumer advocates.  

  • The Biden Administration should also prioritize working with Congress to close the coverage gap for populations left behind in the ACA, disproportionately Black people located in the South who do not have coverage because of policies rooted in systemic racism.  

  • This should include restoring the 100 percent FMAP for late entrants to taking up Medicaid expansion, coupled with a federal fall back option on the Marketplace that ensures access to coverage for all people in the coverage gap. This pairing could affect more than 6 million people according to the Urban institute and significantly improve families’ financial and health security and address a structural inequity of the public coverage system. 

  • In fact, there are still 12 states that have not expanded Medicaid to low-income adults as originally envisionedThese individuals would be eligible for Medicaid had their state chosen to expand coverage. People in the Medicaid coverage gap are working people in low-wage jobs, mostly single adults: three quarters are adults without dependent children and nearly 60 percent are people of color. According to Kaiser Family Foundation, of the people who remain uninsured, 29 percent are Hispanic and 23 percent are Black—both groups stand to benefit dramatically from closing the gap. During the pandemic, Medicaid enrollees are more likelyto be working essential jobs, placing them at risk for illness. For states that have yet to close the coverage gap, these workers have few if any options to access health coverage when it is needed most. 

  • Additional improvements should include a removal of the 5 year bar for legally residing immigrants that impedes health care access for children and families.  

SEXUAL AND REPRODUCTIVE HEALTH: 

The Biden Administration took critical action to begin the process of rescinding the Title X gag rule.  

  • The executive order today directs U.S. Department of Health and Human Services to review the Title X gag rule. This action is the first step in repealing the rule, which has taken away sexual and reproductive health care from people across the country. 

The Title X rule jeopardizes care for 1.6 million people.  

  • The rule forced out key providers like Planned Parenthood (which previously served 40% of Title X patients) and prohibited providers still in the program from giving patients comprehensive care  and people lost care as a result. People with low-incomes, Black and Brown people, LGBTQ+ people were harmed the most. 

Going forward, the Biden Administration's HHS must act swiftly to both rescind the Title X rule and take additional action to expand access to care under Title X and other programs. 

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About Community Catalyst 
Community Catalyst is a national non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit www.communitycatalyst.org. Follow us on Twitter @CommCatHealth. 

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