In December, the final registration period for Obamacare under the Trump administration was completed. Now that the Biden administration has arrived, they are attempting a revision.
The renewed effort reflects the Biden team’s view that, despite a public health crisis and a wave of job losses, the Trump administration has done too little to help people find cover. Although the number of insurance contracts rose slightly compared to the previous year, the growth did not match the increase in demand.
In an ordinance he signed on Thursday, President Biden set a 90-day registration period on Healthcare.gov, the insurance market for 36 states, starting February 15. The White House is planning an outreach campaign with paid advertising and direct marketing.
The 14 states that manage their own marketplaces are likely to follow suit and nationalize the effort. California has already announced that it will do so on Thursday.
“There is no question that this is a better late than never situation for this open enrollment,” said Eliot Fishman, senior director of health policy at Families USA consumer group, who was involved in but not working on the Biden transition this policy.
According to a recent report by the Kaiser Family Foundation, around 15 million Americans are uninsured and eligible for market coverage. Four million of them would qualify for a no-bonus plan.
“The four million people who could get free coverage and instead are uninsured – that just calls out to me for contact,” said Cynthia Cox, vice president of the foundation and co-author of the report.
Many advisors to the Biden administration stress that Obamacare will work better as a safety net when more people understand that it exists. Unlike the self-employed who have signed up for Obamacare plans for years, many of the Americans who lose their insurance have never used the marketplaces or Medicaid. They may need advertisements to inform about the opportunity and professional help in choosing a plan.
Ms. Cox said marketing needs to emphasize not only that sign-ups are possible, but also that people can get financial help buying insurance – and why insurance is worth it. In 2017, the Trump administration cut the program’s advertising budget by 90 percent.
However, it may take time to expand on all of the services that help connect people to coverage. Biden administration officials may be handicapped by the lack of pre-existing networks of outreach staff. State officials say such networks were crucial in getting the word out there during their additional filing deadlines.
The Affordable Care Act already allows people who lose their job or experience a change in income to sign up for insurance outside of the regular open enrollment period. The Biden government will open the marketplaces to all Americans without the need for any documentation to prove their eligibility.
Jan. 28, 2021, 7:16 p.m. ET
States that tried something similar last spring suggest that the extra enrollment time could be an effective way to insure hard-to-reach populations: younger Americans and those who are uninsured despite the expansion of the health insurance law.
“It wasn’t a deluge of people, but we were happy with the kind of people we were attracting,” said Audrey Gasteier, director of policy and strategy for the Massachusetts Health Connector. Last year it had a special registration deadline of almost five months and as a result had 22,800 registrations.
Typically around a quarter of the Konnektors participants are between 18 and 34 years old. That figure, however, was 40 percent for those who signed up during the special enrollment period, suggesting that the pandemic has led so-called Young Invincibles to decide whether health insurance is worth the cost.
“The value of health insurance has skyrocketed for many Americans,” said Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange. “All of a sudden, masks, Clorox wipes, and health insurance became really important.”
Washington also had a higher than usual rate of younger people among the 7,000 who took advantage of this state’s extra enrollment period last spring.
Health insurers tend to oppose expanding enrollment options: restricting enrollments to once a year is seen as an incentive for people to have constant coverage instead of waiting until they get sick to enroll, which increases premiums can. However, the conditions during the pandemic are so varied that the major health insurance lobbies are advocating a new enrollment period this time.
States that have reopened their marketplaces have done so with significant outreach campaigns. Washington and Massachusetts used the state agency that manages unemployment benefits to tell the new unemployed that they may be eligible for health insurance through the market. California doubled its usual marketing budget last year.
They also tapped navigators and registration wizards to find out that the registration deadline remained open – often through Zoom webinars rather than in-person events.
However, the Biden administration has to deal with cuts in Obamacare advertising and face-to-face contact from the Trump era. For example, last year South Carolina and Utah did not receive federal funding for the Health Bill’s aid-based “Navigator” program.
“If you don’t have this infrastructure initially, it will take a long time to set up,” said Kevin Patterson, executive director of Connect for Health Colorado, the state’s insurance market. “It’s getting harder.”
The lack of information about Obamacare isn’t the only reason millions are uninsured. Millions of poor Americans in the 12 states who have not expanded their Medicaid programs cannot get financial help to buy their own insurance.
Experts from right and left also argue that the high cost of health insurance and the deductibles people have to pay even after coverage is what deter many middle-class Americans from buying health insurance. However, it is difficult to improve the affordability of health insurance through action by the executive.
“We have middle-class Americans who want pandemic coverage and can’t afford it,” said Peter Lee, executive director of Covered California marketplace. Mr. Lee strongly supports federal policies to reduce consumer insurance costs.
As part of his recent coronavirus relief proposal, Mr Biden has recommended laws that increase the generosity and breadth of tax credits that help people buy their own insurance. However, changes to these subsidies require action by Congress.