President Biden’s Executive Order Marks New Era for ACA

Jennifer Berman JD, MBA – CEO of MZQ Consulting

On January 20, 2017, the date of his inauguration, former President Trump issued an the first of several executive orders directing the federal government to “minimize the economic burden” of the Patient Protection and Affordable Care Act (ACA).  Last week, on Thursday January 28, 2021, President Biden signed his own executive order intended to strengthen the ACA. 

This new order included directing the federal agencies to review all existing guidance relating to Medicaid and the ACA to identify and change:

  • Any policies and practices that may undermine protections for individuals with pre-existing conditions (including COVID-19);
  • Any demonstrations or waivers (or policies regarding such demonstrations or waivers) that may reduce coverage under Medicaid or the ACA;
  • Any policies or practices that may undermine health insurance market (include the individual, small and large group markets);
  • Any policies or practices that may present unnecessary barrier to individuals and families attempting to access health coverage, including for  mid-year enrollment; and
  • Any policies of practices that may reduce the affordability of coverage or financial assistance for coverage, including for dependents.

This Executive Order highlights the changes we can expect to the rules and enforcement surrounding the ACA over the next four years.  The order also has the impact of repealing the executive orders issued by President Trump that restricted the applicability of the ACA.  Several of the rules adopted under President Trump’s executive orders are now likely to change.  These include:

  • The creation of individual coverage health reimbursement arrangements (ICHRAs);
  • The expansion of short-term limited duration health insurance plans;
  • The “new” association health plan rules (which are still being challenged in federal courts); and
  • The IRS safe harbor that loosened the distribution requirements for IRS Form 1095-Bs.

While many of the actual changes that will result from Biden’s Executive Order will take months to materialize, one big change is taking place quickly.  In response to the Executive Order, CMS immediately announced that the federal health insurance marketplace will have a new open enrollment period from February 15, 2021 – May 15, 2021.  This new open enrollment period is intended to make it easier for people to enroll in coverage in light of the pandemic.  The change only applies to the federal exchange; however, CMS is strongly encouraging that states maintaining their own health exchanges allow for such a mid-year open enrollment period as well.

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