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To boost coverage, Biden to reopen ACA marketplaces

The Affordable Care Act is in far better shape as 2021 gets underway than those who spent four years desperately trying to tear it down.
Image: The website in Washington on Oct. 31, 2018.
The website in Washington on Oct. 31, 2018. Health insurance sign-ups for the Affordable Care Act are down with just a few days left to enroll in most states.Pablo Martinez Monsivais / AP file

Throughout the Trump era, the Republican administration took a variety of steps to undermine the Affordable Care Act. It was not time well spent: the first year of Donald Trump's term was dominated by a failed effort to repeal "Obamacare"; Democrats regained the House majority after heavily emphasizing the issue in the 2018 midterms; and all GOP officials have to show for their efforts is a higher national uninsured rate.

Four years ago at this time, the conventional wisdom was that the ACA's days were numbered, and the law stood little chance of surviving a full-scale Republican attack. And yet, here we are: the Affordable Care Act is in far better shape as 2021 gets underway than those who desperately tried to tear it down.

What's more, as the Washington Post reports, President Joe Biden is poised to put the ACA on even stronger footing, with new executive actions.

Under one order,, the online insurance marketplace for Americans who cannot get affordable coverage through their jobs, will swiftly reopen for at least a few months, according to several individuals inside and outside the administration familiar with the plans. Ordinarily, signing up for such coverage is tightly restricted outside a six-week period late each year.

Note, last spring, as the coronavirus crisis first started to intensify, the Trump administration considered creating a special open-enrollment period, but the White House balked, to the surprise of nearly everyone involved in the process. As Politico reported, the decision appeared to be largely political: Team Trump didn't want to turn to "Obamacare" to help people in a crisis.

The Post's new report added:

Another part of Biden's scheduled actions, the individuals said, is intended to reverse Trump-era changes to Medicaid that critics say damaged Americans' access to the safety-net insurance. It is unclear whether Biden's order will undo a Trump-era rule allowing states to impose work requirements, or simply direct federal health officials to review rules to make sure they expand coverage to the program that insures about 70 million low-income people in the United States.

When it comes to health care policymaking, this is very likely to be the start of Democratic efforts, not the end. While dramatic changes along the lines of a Medicare-for-all system are out of reach for now, Biden and his congressional allies have plenty of meaningful options.

The New York Times recently reported, "A series of tweaks bolstering the Affordable Care Act stands the best chance of passage. Legislators could make insurance subsidies more generous, get coverage to low-income Americans in states that haven't expanded Medicaid, and render moot a pending Supreme Court lawsuit that aims to overturn the entire law."

Watch this space.