New Biden Executive Order Aims To Build On Coverage Gains – healthaffairs.org
On April 5, 2022, President Biden signed a new executive order on continuing to improve access to affordable, quality health coverage. His stated priorities include further expanding the availability of affordable health insurance, improving the quality of coverage, strengthening benefits, and helping more Americans enroll in quality coverage. President Biden issued the executive order on the same day as a proposed rule to fix the family glitch was issued and was joined at the signing ceremony by Vice President Harris, former President Obama, members of Congress, and several Cabinet officials. (The proposed rule on the family glitch is discussed in detail in a separate article.)
The Greatest Hits?
President Biden’s new executive order builds on a prior executive order signed in January 2021. This prior order rescinded several Trump-era orders, directed the Department of Health and Human Services (HHS) to consider establishing a broad special enrollment period for HealthCare.gov (which it promptly did), and directed agencies to reassess rules and policies that undermine access to Affordable Care Act (ACA) and Medicaid coverage.
In fact, much of the new executive order is dedicated to touting the changes that have been made under this prior order. Section 1 of the new executive order lists the various actions taken by the Biden administration to strengthen the ACA and Medicaid. These include but are not limited to:
This list also includes the proposed rule to fix the family glitch that is noted above and could be finalized for the 2023 plan year.
The executive order emphasizes the positive impact that the American Rescue Plan Act has had, in the administration’s view, on access to coverage through enhanced marketplace subsidies, options for states to extend postpartum Medicaid coverage, and new incentives for states to expand their Medicaid programs, among other policies. Democrats in Congress had plans to expand or extend many of these programs in the Build Back Better Act. But progress has stalled on Capitol Hill, and President Biden used the executive order signing ceremony to call on Congress to act. He specifically urged Congress to extend the enhanced marketplace subsidies, close the Medicaid coverage gap, and allow Medicare to negotiate prescription drug prices.
What’s In The New Executive Order?
In terms of overall policy, President Biden’s new executive order reiterates the goals of his prior order: to protect and strengthen Medicaid and the ACA and to make quality health care accessible and affordable for every American. The executive order cites data about how there is still work to do, particularly in states without Medicaid expansion, and emphasizes the need to address issues such as underinsurance, medical debt, and patient enrollment in coverage that does not meet their needs. Agencies should continue to review existing agency policies under the prior executive order and make changes where relevant.
Beyond that, the executive order directs certain agencies—those with responsibility for health coverage—to identify ways to expand affordable coverage, improve quality, strengthen benefits, and increase enrollment. As part of this process, President Biden wants the agencies to examine policies or practices that will 1) make it easier for consumers to understand their coverage options, select a plan, enroll, and maintain that coverage; 2) strengthen benefits and improve access to providers; 3) improve the comprehensiveness of coverage and protect consumers from low-quality coverage; 4) expand eligibility and lower costs for coverage through the marketplaces, Medicaid, Medicare, and other programs; 5) help improve linkages between the health care system and other stakeholders to address “health-related needs;” and 6) help reduce the burden of medical debt.
These policies are broad and do not give much specific insight into what actions the agencies will prioritize. Further, the agencies are asked generally to “examine” these issues rather than take any concrete action. Of course, how quickly an executive order can be implemented depends on the underlying policy that is being directed. Changes that are largely operational can be made swiftly while changes that require new rules or revisions to existing rules require notice-and-comment rulemaking processes that take months.
That said, some of these efforts may already be in process or contemplated. To “protect consumers from low-quality coverage,” federal officials could issue a rule to limit short-term limited duration insurance. This would not be a surprise since such a rule was included in the unified agenda for 2021 and is expected later this fall. Helping improve linkages between health care and “health-related needs” could refer to addressing the social determinants of health, which has been an area of interest for HHS and some states through the Medicaid program. Making it easier for consumers to understand their coverage options might include new standardized marketplace plan options that HHS proposed, but has not yet finalized, for the 2023 plan year.
Some of these efforts may be informed by recent requests for information. HHS recently issued a request for information on ways to develop and implement a comprehensive access strategy for Medicaid and CHIP, to improve health outcomes, advance health equity, and address disparities in access to coverage and care. Comments on this request are due on April 18. HHS also requested information on ways to advance health equity and climate health in its proposed 2023 payment notice. Both could be sources of information to examine the types of policies and practices noted above and make regulatory changes in response.
