In a week when the Biden Administration broke new ground with the historic confirmation of Judge Ketanji Brown Jackson to the United States Supreme Court, the White House also had something of a throwback when Barack Obama visited for the first time since 2017.
Obama’s visit marked 12 years since the former President’s signature healthcare policy achievement—the Affordable Care Act (ACA) known informally as Obamacare—was signed into law.
At the joint appearance with his former boss, President Biden also signed an executive order directing federal agencies to identify opportunities and take steps to expand access to and availability of affordable health coverage.
The new order encourages agencies with responsibilities for Americans’ access to care and coverage to make it easier for people to enroll in and maintain coverage, help people understand their options, strengthen the generosity of benefits, improve access to healthcare providers, protect people from low-quality coverage, and expand eligibility and lower costs for public health insurance programs including the ACA, Medicare, and Medicaid. The order also urges agencies help reduce medical debt, a growing problem for millions of Americans.
At the same time, the Administration proposed a new rule to make it easier for people to afford health insurance. In a quirk of the ACA known as the “family glitch,” workers who are offered health insurance through their job but can’t afford it are eligible for subsidies if they purchase health insurance on the Marketplace. But their family members, would be covered by a family plan if the employer-sponsored insurance were affordable, do not qualify for those same subsidies. The glitch leaves family members without good options; they can’t afford to buy into the employer plan and they can’t get help to buy an Obamacare plan.
The Administration estimates that 200,000 uninsured individuals could gain coverage as a result of this fix and that coverage would become more affordable for another one million. It’s unclear if Congressional action will be necessary to make the proposed rule a reality.
These efforts to improve Americans’ access to health insurance come as millions of Americans face the possibility of losing their coverage when the federal public health emergency (PHE)—instituted at the start of the Covid-19 pandemic and extended several times since then—ends.
For example, the first coronavirus relief package, passed in March 2020, provided federal funds to states that agreed to keep people enrolled in Medicaid during the PHE. The PHE was most recently renewed in January 2022 and is currently set to expire in mid-April if it’s not renewed again. Once the PHE expires, states will lose that additional Medicaid funding and likely seek ways to reduce their Medicaid enrollment.
Another pandemic-era policy that has made health insurance more accessible was the American Rescue Plan, which expanded eligibility for subsidies on Marketplace insurance plans. As a result of this legislation, the Administration says that 9 million Americans have had their premiums lowered by an average of $50 per month. Nearly half of enrollees in Marketplace insurance plans pay no monthly premium.
But several provisions that made coverage more affordable have expiration dates this year; some applied only in 2021.
In the face of these threats to the current coverage rates, the Biden Administration hopes to shore up the ACA and prevent millions of Americans from becoming uninsured due to reduced eligibility or affordability. Obama’s legacy and Biden’s future—not to mention the health and financial well-being of millions of Americana—may be at stake.