New Biden health care orders begin to unspool Trump policies

President Joe Biden will act Thursday to get more people health insurance in the middle of the raging coronavirus pandemic, a down payment on his pledge to push the U.S. toward coverage for all.

The White House said he would sign an executive order reopening the HealthCare.gov insurance markets, something the Trump administration refused to do. He’ll also move to start reversing other Trump administration policies, including curbs on abortion counseling and work requirements for low-income people getting Medicaid.

Biden has promised to build on former President Barack Obama’s health law to achieve his goal of health insurance coverage for all Americans, while rejecting the single government-run system that Independent Vermont and former Democratic presidential campaign rival Sen. Bernie Sanders pushed for in his “Medicare for All” proposal. But Biden will need congressional approval for his more centrist approach, and opposition to “Obamacare” still runs deep among Republicans.

The most concrete short-term impact of Biden’s orders will come from reopening HealthCare.gov insurance markets as coverage has shrunk in the economic turmoil of the coronavirus pandemic. That new “special enrollment period” will begin Feb. 15 and run through May 15, the White House said. It will be coupled with a promotional campaign and a call for states that run their own insurance markets to match the federal sign-up opportunity.

Created under the Obama-era Affordable Care Act, the marketplaces offer taxpayer-subsidized coverage regardless of a person’s medical history, or preexisting conditions, including COVID-19.

Biden will also immediately reverse a federal policy that bars taxpayer funding for international health care nonprofits offering abortion counseling or referrals. Known as the Mexico City Policy, it can get switched on and off depending on whether Democrats or Republicans control the White House.

Other instructions Biden plans to issue Thursday could take months to carry out. He’s directing the Department of Health and Human Services to:

• Formally consider whether to rescind Trump regulations that bar federally funded family planning clinics from referring women for abortions. The ban on referrals led to Planned Parenthood clinics leaving the program. Rescinding a federal regulation requires a new regulation, which has to follow an established legal process to deter court challenges.
• Reexamine a Trump administration policy that allows states to impose work requirements as a condition for low-income people to get Medicaid health insurance. Work requirements have been blocked by federal judges, who found that they led to thousands of people losing coverage and violated Medicaid’s legal charge to provide medical services. The Supreme Court has agreed to hear the issue.
• Review policies that could undermine protections for people with health problems, such as a Trump administration rule that facilitated the sale of short-term health insurance plans that don’t have to cover preexisting medical conditions.
• Explore ways to make health insurance more affordable, including by fixing what’s called the ACA’s “family glitch.” Under that clunky provision, an entire family can be denied subsidized premiums if the head of household has access to employee-only coverage at work that’s deemed to be affordable. Fixing it would probably require legislation.

The abortion-related actions will bring Biden immediate praise from women’s rights groups, as well as condemnation from social and religious conservatives. Under President Donald Trump, abortion opponents got free rein to try to rewrite federal policy, and now the political pendulum is swinging back.

Biden also campaigned on repealing longstanding federal prohibitions against taxpayer funding for abortion, but a change of that magnitude to a group of laws known as the Hyde Amendment would require congressional approval.

Many of the regulatory and policy changes Biden is asking health officials to undertake aren’t likely to happen overnight because hastily written policies can be more easily overturned in court, as the Trump administration found out. Time and again, federal judges ruled that Trump officials ran roughshod over legal requirements for regulators, such as demonstrating they’ve considered different sides of an issue.

Biden’s nominee for health secretary, California Attorney General Xavier Becerra, has not yet been confirmed by the Senate, but the White House said that will not stop health agencies from immediately going to work on the president’s directives.

The idea of reopening Obamacare’s health insurance markets in the pandemic has had broad support, including from consumer groups, professional medical associations, insurers and business organizations.

Although the number of uninsured Americans has grown because of job losses in the coronavirus economy, the Trump administration resisted calls to reopen HealthCare.gov. Failure to repeal and replace Obamacare as he repeatedly vowed to do was one of the former president’s most bitter disappointments. His administration continued trying to find ways to limit the program or unravel it entirely. A Supreme Court decision on Trump’s final legal challenge to the Affordable Care Act is expected this year.

The Obama-era health care law covers more than 23 million people through a mix of subsidized private insurance sold in all states and expanded Medicaid adopted by 38 states, with Southern states being the major exception. Coverage is available to people who don’t have job-based health insurance, with the Medicaid expansion geared to those with low incomes.

Of some 28 million uninsured Americans before the pandemic, the nonpartisan Kaiser Family Foundation has estimated that more than 16 million were eligible for some form of subsidized coverage through the health law. Because of the ACA’s financial assistance, many are eligible for zero-premium coverage, and that’s expected to be a major selling point in the Biden administration’s promotional pitch.

Experts agree that number of uninsured people has risen because of layoffs in the coronavirus economy, perhaps by 5 million to 10 million, but authoritative estimates await government studies due later this year.