President Biden on Thursday signed an executive order directing HHS to launch a special enrollment period for the Affordable Care Act's federal exchanges and to review policies that make it more difficult to enroll in Medicaid or exchange coverage.

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Biden's latest executive order offers a glimpse at how the president will approach his broader health care agenda of expanding access to affordable health coverage. Biden's previous executive orders have focused on Covid-19 response and relief efforts, as well as addressing inequities in health care.

Executive order to expand access to coverage

The executive order directs HHS to launch a three-month special enrollment period for federally run exchanges that will run from Feb. 15 to May 15. White House officials said the order applies to the more than 30 states that rely on Healthcare.gov, but they expect state-run exchanges to launch their own special enrollment periods. According to Politico, California and Washington state announced plans to reopen enrollment in their state-run marketplaces. Colorado on Thursday also announced it would re-open its exchange for individual health insurance enrollment.

The Biden administration declined to project how many people could enroll in coverage. A new Kaiser Family Foundation (KFF) report estimates 8.9 million uninsured Americans could qualify for subsidized plans, including 4 million who could qualify for a bronze plan with no premium payment. However, those individuals could still be subject to high deductibles, which could pose a barrier to enrollment, Politico reports.

Limited plan options also could pose a barrier to enrollment. KFF data show insurer participation has changed over the years. In 2021, 10% of U.S. counties have just one insurer selling coverage on the exchanges. Forty-six percent of counties have three or more insurers and 44% have two insurers selling exchange plans.

The White House said the special enrollment period will be publicized via increased outreach efforts, which a senior administration official said will involve paid advertising, direct consumer outreach, and outreach from community groups and stakeholders, Politico reports.

In addition, the executive order directs federal agencies to reconsider several policies, including those that could that undermine protections for people with pre-existing conditions, undermine the ACA exchanges or other health insurance markets, or make it more difficult to enroll in Medicaid or exchange plans.

According to Politico, the Biden administration said those policies will include Trump-era Medicaid waiver changes that allowed states to impose Medicaid work requirements, as well as policies that expanded access to association and short-term health plans. Short-term health plans are not required to cover pre-existing conditions or the ACA's essential health benefits, the New York Times reports.

Undoing the rules related to association and short-term health plans could take months, as it will require HHS to write new regulations and go through the rulemaking process, the Times reports. If HHS does overturn the rules, individuals who have enrolled in such plans would not be able to renew them, which the Times reports could leave them without coverage if they can't afford an employer-sponsored or exchange plan.

Biden issues memo aimed at reproductive rights

Biden on Thursday also issued a memo rescinding the so-called "Mexico City Policy" and directing HHS to consider eliminating Trump-era Title X rules.

The "Mexico City Policy," or global gag rule, prohibits organizations that offer abortion care or counseling from receiving foreign aid. Trump signed an executive order to enact the global gag rule shortly after taking office in January 2017. The administration later expanded the policy to include all global health funding, instead of just funding related to family planning. Biden's reversal is in line with the precedent sent by former Democratic presidents.

However, Biden has not yet addressed a domestic rule governing similar funding allocations. HHS in 2019 finalized a rule that requires recipients of Title X family planning funds "to separate their Title X project—physically and financially—from any abortion activities." The rule was challenged in court, and upheld. As a result, Planned Parenthood exited the program. To undo the rule, HHS under Biden would need to go through the rulemaking process to write new regulations, the Times reports (Luthi, Politico, 1/28; Gay Stolberg et al., New York Times, 1/28; Connect for Health Colorado release, 1/28; Kaiser Family Foundation report, 1/27).