So this is what it looks like when the people in charge of the Affordable Care Act want it to reach as many people as possible.
The U.S. Department of Health and Human Services (HHS) on Wednesday announced that, between mid-February and the end of March, more than 500,000 Americans had signed up for coverage on HealthCare.gov, the federal online marketplace that the Affordable Care Act created for people buying insurance on their own.
That timeframe corresponds with the first six weeks of a “special enrollment period” that the Biden administration created. Normally, enrollment at HealthCare.gov is confined to the last few weeks of the calendar year, as it typically is for employer policies.
People who lose coverage because of unemployment, divorce or other major life events have always been able to get coverage at any time, even if it’s outside the normal enrollment window. But with the pandemic highlighting the importance of health care, and so many people out of work, the Biden administration decided to open up enrollment to all comers again.
“Access to quality, affordable health care is essential — especially as we tackle the COVID-19 pandemic and its aftermath,” HHS Secretary Xavier Becerra said Wednesday.
Initially, the Biden administration had said that HealthCare.gov would be open to general enrollment until May 15. Later, it said the period would extend all the way until Aug. 15.
“It makes a difference to welcome people into ACA health coverage rather than restrict it while also trying to overturn the law altogether.”
The Biden administration has done more than simply make enrollment easier. It has also promoted coverage aggressively, though online and broadcast advertising, in order to reach people who are eligible for deeply discounted insurance but might not know about it. The promotions frequently tout new assistance that is now available because of the American Rescue Plan, the COVID-19 relief program that Democrats in Congress passed and Biden signed in March.
Of the roughly 29 million people who don’t have health insurance today, about 6.8 million now qualify for coverage at HealthCare.gov with zero premiums, according to HHS estimates, while 1.3 million could get policies for less than $50 a month. (More are eligible for free or deeply discounted coverage though Covered California, NY State of Health and other state-run versions of the marketplaces.)
Notably, the 500,000 enrollments HHS reported were all people who signed up before the new assistance was available. (They’ll still be able to get the deeper discounts, as will those who signed up for coverage previously.)
“These are some really impressive numbers, far outpacing what you would typically see outside of the annual open enrollment period,” Sabrina Corlette, a research professor at Georgetown University, told HuffPost. “And this is before the American Rescue Plan’s enhanced premium tax credits have kicked in. I think we can expect the enrollment to grow even more from here.”
Biden’s determination to strengthen and promote the Affordable Care Act represents a sharp break with the approach that former President Donald Trump took toward managing “Obamacare.” He spent the first year of his administration trying to repeal the law and, although that effort failed, he described the law as a “failure” that was “collapsing” and cut funding for promotion.
Trump also had his administration rewrite regulations that propped up alternative forms of insurance, like so-called “short-term/limited-duration” plans, that lacked the Affordable Care Act’s guarantees of coverage for people with preexisting conditions.
Although the actual impact of these changes were mixed, and some may have ultimately boosted enrollment, overall the number of people without insurance crept up while he was president, after reaching historic lows while former President Barack Obama was in charge.
“With the increased premium help in the American Rescue Plan and a new outreach effort, the Biden Administration has an opportunity here to reverse the trend of increasing numbers of people uninsured that we saw in the Trump years,” Larry Levitt, executive vice president at the Henry J. Kaiser Family Foundation, told HuffPost. “It makes a difference to welcome people into ACA health coverage rather than restrict it while also trying to overturn the law altogether.”
Biden, who famously called the Affordable Care Act a “big fucking deal,” has said he wants to keep building on the program ― eventually, allowing people with employer coverage to buy discounted marketplace policies when they are cheaper, and introducing a “public option” that would offer Medicare-like insurance for those people who want it, and by having the federal government negotiate lower drug prices with manufacturers.
Biden can take some steps through regulation. One change, a fix to the so-called “family glitch” that makes it hard for spouses and children of some low-wage workers to get insurance, is now under consideration, according to a recent report by Amy Lotven of Inside Health Policy.
The biggest steps would still require legislation. Democrats in Congress have talked about including some of those measures, starting with prescription drug legislation, in upcoming economic bills. But each of them would entail significant policy tradeoffs and political challenges.
CORRECTION: The original version of this article gave incorrect dates for the end of special enrollment.