Affordable Care Act Access to be Expanded

President Biden issued an executive order today that will expand access to the Affordable Care Act (ACA) and create a special enrollment period for ACA sign-ups from February 15 to May 15.

The non-profit Kaiser Family Foundation said earlier this week that nearly 15 million uninsured persons would be eligible to get ACA plans based on current rules. That’s roughly half of Americans without health insurance, although this number is rising because of pandemic-related job losses.

The order’s language, quoted below, is likely to lead to eased ACA access rules and reduced consumer out-of-pocket expenses. It directs federal health agencies to re-examine:

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

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

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

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

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

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

Kaiser said its estimates excluded those already eligible for Medicare and Medicaid as well as impoverished people who make too little money under current rules to afford ACA marketplace plans.

Kaiser, as quoted below, said three groups would be affected:

4.0 million uninsured people could get a free bronze plan (with a $0 premium payment, after accounting for subsidies). . . . People in this group would clearly benefit from getting Marketplace coverage rather than continuing to go without coverage.

4.9 million uninsured people could purchase Marketplace coverage for a reduced premium, partially covered by a subsidy. Although subsidies for this group do not cover the full premium, they may significantly lower the premium and/or out-of-pocket liability. Even so, some people in this group may still find Marketplace coverage unaffordable or unattractive due to high deductibles.

6.0 million uninsured people are eligible to buy Marketplace plans but are ineligible for financial assistance. Of this group, 2.6 million (43 percent) have incomes that would qualify them for a subsidy, but their unsubsidized premium is not high enough to merit financial assistance under the current ACA subsidy structure. The remaining 3.4 million (57 percent) people in this group are ineligible for subsidies because their income exceeds 400 percent of poverty. People in this final group are often priced out of coverage under the ACA’s current subsidy structure.