Affordable Care Act Update: Subsidies, Navigator Funding, Special Enrollment Period

The newly installed Biden Administration and the ongoing turbulence of the pandemic have resulted in a flurry of recent changes in the world of the Affordable Care Act—all as an impending Supreme Court decision on its very existence looms in the background. 

Many Americans lost jobs due to the pandemic, and with them their health insurance. Kaiser Family Foundation estimates that roughly 2 to 3 million Americans lost employer sponsored health coverage between March and September 2020. Hoping to offset these losses, President Biden instituted a special ACA enrollment period that started Feb. 15 and will run until May 15.

According to CMS, over 200,000 Americans have enrolled in health plans during the first two weeks of this special enrollment period—more than three times as many that enrolled during the same two weeks in 2019 and 2020 respectively.

But more enrollment time isn’t the only ACA modification in the works. The House Ways and Means Committee has proposed ACA changes that would increase subsidies and expand the pool of people eligible for them. According to an analysis by Health Affairs, which is supportive of the proposal, the changes could mean an additional 2.4 million insured Americans. 

Of course, none of these ACA modifications will be maximally effective if people don’t know about them. And during the Trump years, navigators had their funding slashed nationally by 84%. This week, CMS announced $2.3 million in funding for navigators to help with the current special enrollment period—”nowhere near what they need,” according to KFF’s Karen Pollitz. CMS did promise to “increase funding significantly” in advance of the normal fall enrollment period, but didn’t give a specific number. 

But all of this hangs in the balance as the Supreme Court prepares to rule on Constitutionality of the ACA. And if it goes away, it could mean a worsening of America’s racial health disparities so starkly highlighted by the pandemic. Nathalie Huguet, the lead author of a recent Oregon Health & Science University study on COVID-19, the ACA, and racial health disparities said, 

If COVID-19 is considered a pre-existing condition and health insurance coverage of pre-existing conditions is curtailed, the situation would be made worse, and health disparities could increase.

And on the topic of COVID-19, CMS announced recently that in accordance with a Biden executive order, private group plans must fully cover testing for the virus—even for asymptomatic patients. But the elimination of the ACA would have effects far beyond the pandemic. 

KFF recently released the results of a 2020 survey which found 63% of OBGYNs reported their patients increased use of contraceptives since the implementation of the ACA’s contraceptives coverage requirement. But still, over 90% of respondents said contraceptive affordability was a burden for their low income patients. 

Additionally, as of Jan. 1, OBGYNs and primary care physicians may screen women ages 13 and up for anxiety, under the ACA. Sayres Van Niel, a part of the U.S. Department of Health and Human Services’ Women’s Preventive Services Initiative (which proposed the screenings in 2019) said of their implementation, 

It legitimizes the fact that anxiety is a very serious condition that needs treatment and has huge consequences for people, and for women’s lives particularly. It’s not that it’s only in women. It’s just that it’s twice as prevalent in women.

According to statistics cited in The Lily’s story about the screenings, 40% of women experience anxiety—and only 20% of the women that go through it seek treatment. 

Read the press release from Oregon Health & Science University’s study on how revoking the ACA could impact racial health disparities. And for more on that see Health Payer Intelligence’s analysis of how the elimination of the ACA could worsen disparities. 

Read The Washington Post’s story on CMS’s modest bump to navigator funding.