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Biden Administration’s Unfinished Health Care Business is an Opportunity

Executive action could advance health equity and give the president important wins

April 14, 2022

Improving access to quality health coverage has long been a top priority for the progressive voters who have been critical to the success of Democrats in Washington. And right now, many are hoping that the Biden Administration will find a way to jumpstart its health care agenda. 


Recent polling and media coverage suggests that to reinvigorate his voters ahead of the midterms, President Biden needs to deliver on health care, with or without Congress. Just last week, he proposed an administrative fix to the “family glitch,” strengthening the Affordable Care Act. Building on that, executive actions on bad Trump-era regulations present an opportunity that can both help improve coverage for working people and give the Biden Administration a political win.


Voters will decide in November on the health care issue


As the Washington Post’s Rachel Roubein outlined in a piece last week, new Pew Research Center polling shows that health care is the #1 issue for Democratic voters, with 74% saying it’s very important to their midterm vote. Health care ranks third for all voters.


Roubein expresses some optimism about what can be accomplished legislatively: “Lawmakers and advocates haven’t given up on passing some sort of health-care legislation, which could include letting Medicare negotiate drug prices or expanding Obamacare’s financial aid for good.” But as Joanne Kenen recently laid out in Politico, the window for achieving the kind of change then-candidate Biden promised on the campaign trail in 2020 is narrowing, citing “sharp divisions in Congress.”


Advance health equity, undo harmful Trump-era policies


Candidate Biden promised to address the lack of health equity in America, a problem that took centerstage during the pandemic. One way to address it without waiting for Congress is tackling Individual Coverage Health Reimbursement Arrangements (ICHRAs) and Short Term Limited Duration Insurance (STLDI) – also known as junk insurance. Rolling these rules back presents an opportunity to level the health care playing field.


As Kenen writes in Politico, “Equity … is also about cost, coverage and quality. And cost, coverage and quality are also about equity.” If the Biden Administration can meaningfully address affordability and coverage issues, they will begin closing the health disparity gap driving frustration with the U.S. health care system – something they and their allies can tout on the campaign trail.


Roll back ICHRAs


Thanks to analysis from Avalere Health, we know that 1.5 million American workers will lose their current health insurance for an ICHRA plan by the end of 2022. The stipend-based system could mean:


American workers deserve the high-quality coverage they earned, not a system that divides workforces into classes, takes the coverage some workers have earned away from them and replaces it with inferior coverage they have to find for themselves on the open market.


Reign in junk insurance

Short-term insurance was always intended to be just that – a coverage option for people in between jobs or in a life transition. But under the previous administration, “short-term” plans were expanded to as long as three years. It means Americans may think they’re covered at a more affordable premium price point, but when a medical emergency arises, they could be stuck with an enormous bill. Access to fewer doctors and high deductibles are characteristic of these junk plans, exposing Americans to painfully high bills once they receive the care they need.


Appropriately redefining short-term to pre-Trump-era levels would drive costs down for many Americans and boost the quality of coverage families depend on.


Bottom line


Biden voters are looking for action on health care as they consider how they’ll vote in November. Congress seems poised for continued stalemate, but the Biden Administration can start advancing health equity now – on their own – by meaningfully addressing the inequity caused by ICHRAs and junk insurance. President Biden already directed his administration to review these two harmful policies with an executive order last year. Following through on fixing them will help American workers facing higher costs and lower quality coverage, and will help the president’s party politically as Election Day approaches.

To learn more about Keep US Covered and its partners’ work to educate policymakers on these regulations and the social determinants of health, visit or follow the campaign on Twitter and Facebook.

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