Biden administration aims to further rebuild ACA with proposed rule


It would lengthen the annual open enrollment period, expand the role of navigators and nix Trump-era guidelines for waivers that were criticized for allowing states to skirt coverage requirements.

The Biden administration is planning to restore key parts of the Affordable Care Act that were pared back by the Trump administration as the current HHS aims to make enrolling in an exchange plan easier and more affordable.

Under a proposed rule released Monday, CMS would lengthen the annual open enrollment period, expand the role of navigators, repeal the option for direct enrollment through private entities and do away with Trump-era guidelines for ACA waivers that were criticized for allowing states to skirt the law’s requirements for adequate coverage.

“These proposed changes would provide consumers greater access to coverage through, for example, greater education and outreach, improve affordability for consumers, reduce administrative burden for issuers and consumers, and improve program integrity,” according to the rule.

ACA plans have seen a surge in enrollment during the ongoing special enrollment period declared for COVID-19. Almost 1.2 million people enrolled from February to the end of May, CMS said. That is in part due to increased financial aid for consumers and a broadening of the pool eligible for assistance under the American Rescue Plan.

That law, the proposal released Monday and other recent actions are part of Biden’s plan to rebuild the landmark law after four years of steady hacking away under former President Donald Trump. The ACA is also on much steadier ground after the U.S. Supreme Court opinion released earlier this month reversing a finding that the individual mandate was unconstitutional and declaring that plaintiffs did not have standing. Experts have warned however, that the challenge will likely not be the last brought against the law.

Under the new proposed rule, open enrollment would run from Nov. 15 to Jan. 15 for the 2022 plan year and beyond, a month longer than it was after Trump’s administration shortened the period from three months to 45 days.

The rule would also create a monthly special enrollment period for people eligible for advance payments of the premium tax credits — those who make 150% or less of the federal poverty level. It notes this might be especially important once the COVID-19 public health emergency ends and states return to determining Medicaid eligibility, potentially kicking people off of the rolls.

About 1.3 million people with low incomes don’t realize they are eligible for a free marketplace plan, according to the Kaiser Family Foundation.

Also, it rolls back Trump-era changes for state innovation waivers, known as Section 1332 waivers, including one that allowed states to use ACA subsidies to pay for plans that might not be compliant with the law’s coverage requirements.

The repeal of the direct enrollment option would remove the ability for exchanges to allow private sector entities like brokers to establish their own websites and platforms for enrolling in ACA plans. CMS said in the proposal that such an option detracts from the administration’s goal of streamlining enrollment and education about ACA plans. Also, no states have expressed interest in implementing direct enrollment.

“Consistent with many public comments received when the Exchange DE option was proposed, we believe that shifting away from or State Exchange websites as the primary pathway to enroll in and receive information about coverage would harm consumers by unnecessarily fracturing enrollment processes among the exchange and possibly multiple direct enrollment entities operating in a state,” according to the rule.

A proposed increase in exchange user fees would help fund the navigator program, building on an announcement in April that CMS was bumping up money going to the program eight-fold to a record $80 million after it was slashed under Trump.

The rule would also repeal a Trump administration requirement that plans send a separate bill to policyholders for the amount of premiums used to cover abortion services, arguing the change was an unnecessary burden for issuers and consumers.

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