Biden expands window to try and keep millions more low-income Americans insured

President Joe Biden is widening a critical window for low-income Americans to join Obamacare, in a move aimed at reinforcing a central element of his reelection bid: That he presided over a historic expansion of health care coverage.

Tens of millions of people eliminated from Medicaid would now have until Nov. 30 to sign up for new coverage under a plan to be announced Thursday by the Department of Health and Human Services and first shared with POLITICO — an extension from the July 31 deadline initially set for the special enrollment period.

The new timeline will apply to all those seeking coverage through HealthCare.gov, with officials encouraging state-run insurance marketplaces to adopt the change as well.

The move aims to minimize the number of people losing health insurance coverage in the run-up to the November election as a result of a nationwide purge of state Medicaid rolls. The mass disenrollments are happening for the first time since the pandemic, prompted by the expiration last April of a Covid-era policy meant to prevent vulnerable people from losing coverage amid the health crisis.

More than 19 million people have since been kicked out of the Medicaid program to date, exceeding the administration’s original projections that about 15 million would lose coverage overall. The vast majority of those Americans have lost their insurance for procedural reasons, not necessarily because they were newly ineligible.

It’s a process that’s resulted in the biggest reshuffling of the health insurance landscape since the passage of Obamacare itself. And it’s raised fears that a notable portion of those dropped from Medicaid will end up going uninsured, denting a record of expanding health coverage that Biden has hailed as a key piece of his presidential legacy.

Biden has touted Obamacare’s record-high enrollment on the campaign trail, an achievement spurred in part by legislation that Democrats passed in 2021 expanding the law’s subsidies. He’s vowed to widen health access even further in a second term, while slamming GOP rival former President Donald Trump for suggesting he’d try once again to “terminate” Obamacare.

But the Medicaid unwinding process means the nation’s overall uninsured rate is likely to tick up from its current lows, health experts project. Biden health officials have sought to ease that impact by urging states to direct people toward Obamacare — where they can purchase individual policies — as well as to lengthen the overall disenrollment process and allow more time for people to submit the paperwork needed to keep them on Medicaid.

Just 2.4 million — or 15 percent — of those cut from Medicaid had enrolled in Obamacare through HealthCare.gov at the end of last year. And only some states have taken advantage of all the flexibilities that HHS has offered. Florida, which boasts one of the largest Medicaid populations, has refused to take up any of them. It has disenrolled roughly 1.4 million people, according to data compiled by health policy nonprofit KFF, arguing that its main focus is restoring its program's normal operations and ensuring access only to those who qualify.

Texas, another GOP-led state with large enrollment in the safety net program, has so far terminated coverage for 2.1 million recipients — more than half of its Medicaid population. State officials have said they're working closely with the federal government to manage the process, and that the number of disenrollments comes after the program ballooned in size during the pandemic.

Biden health officials have insisted there’s only so much they can do to limit coverage losses, since Medicaid is administered by individual states. In the states that have accepted federal help with their unwinding, the administration said, the rate of Medicaid recipients who had their coverage auto-renewed has surged.

But the decision to extend the deadline for finding new Obamacare plans represents a fresh effort to prevent more people from going uninsured, and an acknowledgment that the disenrollment process is taking longer than anticipated.

The shift also means the new deadline will overlap with the Nov. 1 start of Obamacare’s annual open enrollment, eliminating what would have been a three-month gap between the end of the special sign-up period and the beginning of the general process for anyone seeking Obamacare plans. That change, officials hope, will make for a smoother transition that ensures more people stay enrolled.

In tandem with the extended deadline, HHS' Centers for Medicare and Medicaid Services said it's also issuing a series of new guides aimed at further aiding states in renewing Medicaid recipients' coverage and providing resources for organizations that help people navigate the renewal process.