The Affordable Care Act’s upcoming open enrollment period is going to look very different this year. It will be the first since 2016 that the official in charge is actively supporting efforts to get people coverage under the landmark law, rather than trying to undermine it.
Centers for Medicare and Medicaid Services administrator Chiquita Brooks-LaSure is planning to leverage temporary subsidy enhancements provided by Democrats in Congress and $1 billion in unspent insurer user fees to carry out more of the mission of the Affordable Care Act, which she helped guide through passage and implementation in her prior government roles.
Under her watch, the agency is quadrupling the number of navigators available to help consumers sign up for policies on the federal exchange, healthcare.gov, as well as for Medicaid and the Children’s Health Insurance Program, or CHIP. It is crafting a more robust outreach campaign — partnering closely with community organizations that work with underserved groups — to inform consumers of the beefed-up subsidies.
CMS also plans to extend the open enrollment period by another 30 days to mid-January, rather than ending it on December 15 as the Trump administration had ordered. And the agency wants to create a special monthly enrollment period to allow low-income consumers to sign up for coverage.
“Now we have just this incredible opportunity to continue to expand on coverage and really focus additionally on health equity,” Brooks-LaSure told CNN, noting that the agency didn’t have as much funding for Affordable Care Act efforts during the Obama administration. “Covid-19 has given us such an opportunity because people are now recognizing the disparities at such a different level.”
The approach stands in sharp contrast to the agency’s operations under the Trump administration, which limited the open enrollment period, slashed marketing efforts and shrunk funding for navigators.
Red state resistance
Brooks-LaSure, nevertheless, faces challenges. While more than 2.6 million people signed up for 2021 coverage on the federal exchange during this year’s special enrollment period, millions more Americans continue to go without insurance — despite the more generous subsides that cap premiums at 8.5% of enrollees’ income and that are available to more people for this year and next.
Also, none of the 12 states that have yet to expand Medicaid — all led by Republicans — has accepted the enhanced federal funding that Congress is offering them to broaden coverage to their low-income adults. About 4 million uninsured Americans would be newly eligible for Medicaid if these states were to expand.
Brooks-LaSure says she remains hopeful, however.
“Even though we haven’t publicly seen a state affirmatively do so that doesn’t mean that states aren’t thinking about it,” she said.
And while a record 80.5 million Americans today have health coverage through Medicaid or CHIP, that’s largely because states have had to keep people enrolled during the coronavirus pandemic under an early congressional coronavirus relief package.
Once the public health emergency is lifted, it will be up to Brooks-LaSure’s agency to oversee states’ transition back to pre-pandemic enrollment and coverage renewal policies, which could significantly shrink the number of people insured under the programs.
CMS last month said states would have a year, instead of six months, from the conclusion of the emergency period to remove ineligible enrollees. Brooks-LaSure also wants to make sure those who qualify for Affordable Care Act’s generous subsidies get shifted to those policies.
New programs
Brooks-LaSure, who served as managing director at professional services firm Manatt, Phelps & Phillips prior to rejoining CMS, could also soon have her hands full with new programs to administer.
Democrats in Congress are currently crafting a $3.5 trillion budget reconciliation bill that may extend the duration of the enhanced Obamacare subsidies, broaden Medicare benefits to include dental, vision and hearing coverage and possibly create a federal Medicaid expansion program to cover residents in the 12 holdout states.
But the administrator isn’t tipping her hand on what she’d prefer lawmakers do.
“We stand ready to implement whatever Congress passes,” she said. “All of my advice is about making sure it’s something we can implement well, and it’s the role of Congress to decide exactly what that looks like.”