With New Executive Order, President Biden Gives Uninsured Americans More Health Insurance Options

President Joe Biden signs healthcare executive actions in the Oval Office of the White House

President Biden is making it easier for millions of uninsured Americans to sign up for health insurance. Through an executive order signed today, the federal health insurance Marketplace, Healthcare.gov, will reopen for a special enrollment period from February 15 through May 15, 2021. 

Thirty-six states use the federal Marketplace to offer health insurance. Enrollment is typically available during open enrollment or within 60 days of a qualifying life event such as losing a job. The six-week open enrollment period for 2021 coverage ended December 15, 2020. The new executive order will allow uninsured Americans to enroll even if they are outside of the 60-day window after losing their job

David Cutler, professor of economics at Harvard University, thinks the executive order is a great idea. 

“It sends a signal that the government is interested in making medical care work for people,” Cutler said. 

Under normal circumstances, according to Cutler, the concern with special enrollment periods is the risk of “non-random selection”—that only people with the greatest health needs will enroll. Such a phenomenon drives up insurers’ costs because the people who sign up tend to be sick or need more services than people in the general population. In turn, consumers can face higher rates in the future. 

The pandemic may reduce those concerns. According to Cutler, the sheer number of people displaced from health insurance, independent of their health status, and greater concern about health in general may drive a more representative population to enroll, whether they are sick or not.  

A second aspect of the executive order, and key to broadening enrollments, is the resumption of federal funding for advertising and outreach to encourage consumers to sign up.

“Advertising and community outreach and support for consumers is critically important for successfully increasing the number of uninsured people who get enrolled for health insurance coverage,” said Dr. SreyRam Kuy, surgeon and former chief medical officer for Louisiana Medicaid. 

According to Kuy, when Louisiana expanded Medicaid in 2016, effective outreach, along with collaboration, was essential to enrolling uninsured people.

The President’s order comes on the heels of new jobless claims which were slightly better than expected but still reflect persistent economic harm from the pandemic. This week, nearly 850,000 Americans filed new unemployment claims and 4.77 million filed continuing claims.

It’s not clear exactly how many of these people need health insurance. Though some people who lose their jobs find alternate coverage through another job, Medicaid, or a Marketplace, high unemployment puts more people at risk of becoming uninsured. Before the pandemic, just under half of Americans—nearly 160 million—got their health insurance through a job. 

Estimates of the number of Americans who have lost access to job-based health insurance vary. The Commonwealth Fund calculated that as many as 15 million people might have lost health benefits through an employer. 

According to a recent survey, nearly one-third (29%) of respondents reported losing health insurance at some point during 2020 and more than half of those had not yet gotten new coverage. 

The new order should help close the gap for people living in states that rely on the federal Marketplace. 

Another 14 states plus the District of Columbia operate state-based Marketplaces and have discretion to voluntarily follow the federal special enrollment period or create their own. 

Washington announced today that it will open for the federal special enrollment period. 

Other states had already announced plans to extend open enrollment through the end of January. Maryland created a special enrollment period through March 15, 2021 and Massachusetts extended open enrollment through March 23, 2021.

States that operate their own Marketplaces have some of the highest rates of unemployment and overall job losses. These hard-hit states may choose to follow the federal lead and ease access to health insurance for their residents who are struggling.

Full coverage and live updates on the Coronavirus