WASHINGTON — President Biden directed his administration Thursday to reverse actions by the Trump administration that Biden said had hurt women’s access to reproductive healthcare and made it harder for people to enroll in Affordable Care Act (ACA) health insurance and in Medicaid.
The executive orders and memorandum that Biden signed are “to undo damage [former president] Trump has done,” said Biden. “There is nothing new that we’re doing here other than restoring the Affordable Care Act and restoring Medicaid to the way it was before Trump became president — he made more inaccessible, more expensive, and more difficult for people to qualify for either of those two items,” said Biden.
“The second order I’m going to be signing changes what the former president has done … reversing my predecessor’s attack on women’s health access. As we continue to battle COVID-19, it’s even more critical Americans have meaningful access to healthcare.”
Opening Up ACA Enrollment
The first of these orders authorizes the Department of Health and Human Services to open a “special enrollment period” from Feb. 15 to May 15 for the Affordable Care Act’s health insurance exchanges. “This Special Enrollment Period will give Americans that need health care coverage during this global pandemic the opportunity to sign up,” the White House said in a fact sheet.
The president also is instructing federal agencies to reconsider rules that limit healthcare access, including:
- Policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19
- Medicaid and ACA waiver and demonstration programs that might reduce coverage, including Medicaid work requirement programs
- Policies that make it more difficult to enroll in Medicaid and the ACA
- Policies that reduce affordability of coverage or financial assistance, including for dependents
FamiliesUSA, a healthcare consumer group, praised the orders on the Affordable Care Act and Medicaid. “Comprehensive health insurance and extending Medicaid will help keep families healthy and ensure they don’t experience a financial catastrophe when they get sick,” said Frederick Isasi, executive director of FamiliesUSA, in a statement. “We applaud President Biden and his team for putting families first and giving them a new opportunity to get the best health and health care they deserve.”
The American Medical Association (AMA) also was pleased. “The AMA supported passage of the Affordable Care Act, and we are pleased by the Biden Administration actions today to bolster access,” AMA president Susan Bailey, MD, said in a statement. “Opening the ACA exchanges provides a crucial lifeline at a time when people are losing insurance because of job layoffs as a result of the pandemic. We also applaud the Administration’s move to eliminate barriers to Medicaid enrollment, which will repair holes in the health care safety net. Taken together, these actions will restore coverage to patients who are victims of the economic fallout of the pandemic.”
The American Academy of Family Physicians (AAFP) signaled its approval of the Medicaid order. “The AAFP has previously condemned waivers allowing states to opt-out of marketplace participation, thereby complicating the enrollment process, increasing the burden on consumers and making it more confusing to sign up – all factors that lead to loss of coverage,” AAFP president Ada Stewart, MD, said in a statement.
Rescinding the Mexico City Policy
On the reproductive healthcare front, the president issued a memorandum to rescind the “global gag rule” — also called the Mexico City Policy — which bars international non-profits that provide abortion counseling or referrals from receiving federal funding.
The memorandum also directs the Department of Health and Human Services to consider whether to rescind regulations under its Title X family planning program. Title X, passed in 1970 as an amendment to the Public Health Service Act, provides funds for family planning, including contraception, to healthcare clinics nationwide; most of the clinics’ clients are low-income.
In February 2019, the Trump administration issued a rule stating that health clinics that offer abortions would no longer receive federal family planning funds if there is no “clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning.” The same rule also bans providers from offering abortion as a method of family planning, or directly referring patients to abortion providers, and removes a requirement that all Title X providers offer abortion counseling. In August 2019, Planned Parenthood, which had battled the rule in court and had served 40% of the 4 million patients cared for in the program, withdrew from Title X, calling the rule “unethical and dangerous.”
Reactions Split Along Familiar Lines
Not surprisingly, pro-reproductive rights groups said they were pleased about Biden rescinding the global gag rule. “The Global Gag Rule (GGR) has always been a cruel policy aimed at women, girls, families, and LGBTQ+ communities around the world,” Serra Sippel, president of the Center for Health & Gender Equity (CHANGE), a nonprofit organization that works to protect and promote sexual and reproductive health and rights, said in a statement. “Trump’s expansion of the GGR in 2017 was just another element of his administration’s crusade against women … CHANGE applauds President Joe Biden for keeping his promise to rescind this disastrous policy during his first days in office.”
The groups also applauded the Title X program memorandum. “The Title X program is there to help ensure that every person — regardless of where they live, how much money they make, their background, or whether or not they have health insurance — has access to basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams,” Jamila Perritt, President & CEO of Physicians for Reproductive Health, said in an email to MedPage Today. “Restoring federal funding for reproductive health organizations is a critical first step for the Biden Administration to undo the harm of the Trump administration’s restrictions on the Title X family planning program.”
But not everyone was happy. “As practitioners of women’s healthcare, we were deeply troubled to hear the news that President Biden reversed the Mexico City Policy as well as reinstating federal funds for organizations that perform or refer for abortions under the Title X program,” Christina Francis, MD, chair of the board of directors at the American Association of Prolife Obstetricians and Gynecologists (AAPLOG), said in a statement.
“Abortion is not healthcare, as evidenced by the fact that 85% of ob/gyns do not perform abortions,” she continued. “By forcing U.S. taxpayers to finance abortions in other countries, the administration is exporting its own ideas of reproductive health into sovereign nations that may not even have cultural acceptance of this practice – a form of ideological neocolonialism … AAPLOG calls for a return to policies that protect women and their children from the harms of abortion and that do not require US citizens to be financially complicit in them.”