President Biden has increased the access and affordability of health care for millions of Americans, issuing executive orders to reopen Obamacare exchanges and review rules or practices that targeted the aged, poor, sick, and chronically ill or mentally ill and hindered them from benefiting from Medicaid.
These were fast, early actions that Biden campaigned on and said that voters wanted him to take with urgency, as he did.
Allowing a “do over” of ACA enrollment will be a boon for millions of the pandemic jobless, many of whom may have lost employer-provided health insurance (which covers more than 150 million Americans, or most of us) and could not afford the daunting prices of so-called COBRA policies. That coverage requires consumers to may their own share of health insurance, plus the big chunk their employers cover, as well as an administrative fee.
At least one analysis of the Biden order says that it will affect 15 million Americans, including 4 million of the uninsured who could get free coverage with an ACA “bronze” (limited) plan and 5 million more people who could get subsidies for that same policy, health policy analysts estimate. (See Kaiser Family Foundation map, above, on where bronze plans would be available under Biden order).
Many consumers have struggled with confusion about health coverage as the coronavirus pandemic caused the economy to collapse, leading to under- and un-employment at levels not seen in decades. Workers, at first, thought they would retain coverage because they thought they were getting furloughed, not laid off. Some workers have been called back, as public health protective measures have alternately relaxed and tightened.
In keeping with their obsessive opposition to the ACA, which they failed to repeal, officials in the previous administration shrugged at calls for the federal government to assist the big numbers of the jobless by allowing a special enrollment period in Obamacare, as Biden ordered.
Indeed, in the last four years, the previous administration pulled major funding for advertising, marketing, and public outreach about insurance on ACA marketplaces.
Instead, President Trump and his allies promoted short-term or so-called skinny policies as one of their Obamacare alternatives. That type of insurance, exempted from ACA requirements (such as ensuring insurers do not bar coverage due to patient pre-existing conditions), comes with lower monthly premiums. But complaints had escalated about skinny policies because consumers found that when they needed them most, when sick or injured, the insurance offered them little or no coverage.
Under Biden’s executive orders, the skinny policies will be reviewed and will not enjoy federal support, casting their future in doubt, especially as individuals need to renew the insurance.
Because his predecessor skimped on ACA support, Obamacare enrollment has declined slightly in the last four years and the number of uninsured has risen, as it had not before for a while, by more than 2 million. Still, with the ACA requiring that fees be collected to support Obamacare, the new administration may have as much as $1 billion to spend on advertising, marketing, and outreach to do so.
As for Medicaid, Biden’s predecessor also had made this federal program an object of scorn. In the name of fiscal rectitude, the 45th president and his minions worked with states to experiment with draconian regulations aimed at reducing the program’s cost and number of aid recipients. They, for example, were required to seek work while on Medicaid and document their efforts to do so — even though it may have been clear that they were physically or cognitively incapable. Conservative states also were eager to convert their funding from a robust federal allocation to a supposedly less costly and less generous block grant system, in which further cuts could be made.
Biden has ordered his government, notably the Centers for Medicaid and Medicare Services (CMS), not to toss his predecessors initiatives but to review them. That may seem a distinction without a difference.
It also may indicate that the 46th president, unlike the 45th, will abide by laws and regulations, notably those affecting federal rules, policies, and practices. His predecessor and his people found themselves reversed often by courts, including by judges appointed by the 45th president, for failure to adhere to legal procedure.
Biden reviews, on the other hand, may have the same effect, while lessening legal bases for challenge. Which is not to say that the new president’s moves will be obstacle free.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Although health insurance has dominated the national political discussions for more than a decade now, it is not the alpha and omega of health care concerns for Americans. It is an invaluable way for all of us, as we are a blink away from catastrophic illness or injury, to share risks and attempt to avoid getting crushed by all-too-common bankrupting medical costs.
But in the world’s wealthiest nation, where we spend more on health care than any of our western industrialized peers and get poorer outcomes in return, we could do well to deal well with health insurance and advance to other equally pressing health care problems. With Medicaid, it simply is unacceptable that the many cannot provide basic, reasonable care for the least — and not stigmatize them for needing help.
Biden, as a key architect of Obamacare, is an ACA enthusiast and declined as a candidate to embrace for now a single-payer program, ala the much-discussed Medicare for All proposals. But if he can reverse the rising number of the uninsured and boost enrollment of Obamacare — not only among the lower- and middle-class but also some higher-paid gig workers who just miss out on federal subsidies — who knows? The ACA will, in 2024, will have lasted four presidential terms and will be ever tougher for Republicans to kill or to persist in their campaigning to do so, right?
