As early as Thursday, President Joe Biden is expected to issue executive orders to temporarily reopen the health insurance exchanges, according to The Washington Post, and to address roadblocks encountered when low-income households try to access Medicaid. Although details are thin, the actions would mirror Biden's broader goal of increasing health-care coverage and improving affordability.
"Opening up the marketplace would be useful," said Sara Collins, VP for health-care coverage and access at The Commonwealth Fund. "A many individuals are jobless or losing their jobs and they haven't enlisted."
As for the Medicaid side, significant changes to eligibility requirements for people in the 12 states that have not expanded the program would probably require congressional action, experts say. It's uncertain what might be included in an executive request.
The presidential actions would come as a pending case before the Supreme Court challenges the Affordable Care Act, which authorized the exchanges and the financial assistance that enrollees with canning. A few experts have proposed that Congress could essentially overturn the court challenge through legislation that addresses the tax penalty for noncoverage (setting it to $1) or other means.
Pre-pandemic, approximately 30 million individuals already were without coverage, a number that had been trending upwards for several years. On top of that, an estimated 2 million to 3 million laborers lost business-based health plans last year between March and September, according to the Kaiser Family Foundation.
Most enrollees in the marketplace get sponsorships (technically tax credits), which diminish what they pay in charges. Additionally, they may qualify for assistance with cost-sharing like deductibles and charges on certain plans.
An estimated 4 million uninsured individuals could get an ACA plan with no superior payment and 4.9 million more could get endowments to lessen the expense of such a plan, according to the Kaiser Family Foundation.
The superior appropriations through the exchanges are available to families whose income is from 100% to 400% of the federal destitution level, based on family size. That translates into income from $12,760 to $51,040. For a family of four, it would be $26,200 to $104,800.
The marketplace appropriations that you're qualified for are based on factors that include income, age, and the second-lowest-cost "silver" plan in your geographic area (which may or may not be the plan you select).
Meanwhile, in states that expanded Medicaid, you can qualify for coverage through the program if your income is close to 138% of the federal destitution level. For an individual, that would mean up to $17,609; for a family of four, $36,156. It's also important that if you qualify for Medicaid, you can join at any time.
Biden also has other plans to expand coverage and affordability. His $1.9 trillion Covid upgrade proposal, divulged last week, includes a provision that would restrict the amount paid for health insurance expenses to 8.5% of income.
He also wants to finance COBRA coverage — the option to continue manager-supported insurance after job misfortune — through September. It remains uncertain whether these proposals will be included in any upgrade charge that gets decided on.
Separately, a portion of Biden's health-care proposals faces a daunting task in Congress. The Senate is divided into two halves between Republicans and Democrats, with Vice President Kamala Harris getting the tie-breaking vote. Notwithstanding, many bills need a 60-vote majority to clear the upper chamber.