The Affordable Care Act in the Biden Era: Identifying Federal Priorities for Administrative Action

Federal officials have significant flexibility in implementing the Affordable Care Act and can adopt different positions based on an administration’s preferred policy goals. The Biden administration has pledged to use its executive authority to strengthen and expand access to marketplace coverage and Medicaid.

In a new issue brief for the Commonwealth Fund, Katie Keith analyzed publicly available recommendations to the Biden–Harris presidential transition team made by patient and consumer advocates, health insurers, hospitals, physicians, state marketplace officials, and state insurance commissioners to identify high-priority federal administrative policy changes related to the Affordable Care Act and Medicaid. The analysis shows that health care stakeholders support a range of federal administrative policy changes to increase access to affordable, comprehensive health insurance and promote health equity. A majority of stakeholder recommendations urged the Biden administration to:

  • Increase marketing, outreach, and enrollment assistance
  • Authorize a COVID-19 emergency enrollment period
  • Reverse funding cuts and regulatory changes to the navigator program
  • Increase oversight of direct enrollment entities
  • Rescind Medicaid work requirement guidance and waivers
  • Fix the family glitch
  • Reverse the methodology for the premium adjustment percentage
  • Limit the duration of short-term plans to no more than three months
  • Restrict association health plans
  • Reverse the public charge rule
  • Reverse changes to the Section 1557 rule
  • Rescind Section 1332 waiver guidance and/or implementing regulations
  • Allow more flexibility for the use of Section 1332 waivers

As discussed in the issue brief, the Biden administration has already taken action on some, but not all, of these top priorities. These recommendations offer a framework for the Biden administration to adopt policies consistent with its goal of increasing access to coverage.

You can read the full issue brief here.

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