Biden Reopens ACA Enrollment, Rescinds Global Gag Rule, Will Reexamine Work Requirements

January 28, 2021
Allison Inserro

The Biden administration will reopen the health exchanges created by the Affordable Care Act (ACA); direct HHS and other agencies to reexamine other health policies, including Medicaid work requirements; and reverse the so-called global gag rule while affirming support for reproductive health.

Using 2 executive orders Thursday, President Joe Biden reopened the health exchanges created by the Affordable Care Act (ACA), directed his administration to reexamine other health policies, including Medicaid work requirements, and reversed the so-called global gag rule while affirming support for reproductive health.

One order will reopen HealthCare.gov from February 15 to May 15, something health policy experts suggested the Trump administration do last year to cope with the loss of health insurance amid staggering job losses created by the coronavirus disease 2019 (COVID-19) pandemic.

In addition, the order directs agencies to review policies put in place during the Trump administration, including CMS Section 1115 demonstrations and waivers that encouraged states to implement work requirements as a condition for receiving health benefits through Medicaid. Advocates for low-income beneficiaries sued states that embraced the concept; in Arkansas and New Hampshire, lower courts ruled against the Trump administration, and the Supreme Court announced in late December 2020 it would hear appeals from the then-administration.

Other aspects of the order tell agencies to reexamine:

  • Policies that could undermine protections for individuals with preexisting conditions or the federal exchanges or other markets for health insurance. This directive is aimed at the previous administration’s expansion of short-term and association health insurance plans, which are not required to cover preexisting conditions. This has become more of a concern during the COVID-19 pandemic.
  • Policies that make it more difficult to enroll in Medicaid under the ACA.
  • Policies that reduce affordability of coverage or financial assistance, including for dependents.

The second order, Protecting Women’s Health at Home and Abroad, will immediately rescind the global gag rule, also referred to as the Mexico City Policy, which bars international nonprofits that provide abortion counseling or referrals from receiving US funding. It also directs HHS to take immediate action to consider whether to rescind regulations under its Title X family planning program.

In the United States and globally, a statement from the Biden administration said, "women, Black, Indigenous and other people of color, LGBTQ+ people, and those with low incomes—have been denied access to reproductive health care."

Last year, for instance, a coalition of 23 states sued the Trump administration over an HHS rule that would end health care discrimination protections within the ACA for LGBTQ people, individuals with limited English proficiency, and women who have had abortions.