The option for people to choose a health insurance plan through the Affordable Care Act returned as of February 15, as part of an extended enrollment period put into place by the Biden administration. The goal: to get as many uninsured Americans covered as soon as possible, pandemic or no.

In January, President Biden signed an executive order to reopen the federal health insurance marketplace for three months, due to the “exceptional circumstances” presented by the pandemic. The move arrived in concert with Biden’s $1.9 trillion stimulus package to address the COVID-spurred public health crisis and economic downturn. The market will remain open until May 15. 

Upon formally reopening the enrollment period, the President said in a statement that the decision will “take big steps to lower health costs and expand access to care for all Americans, including those who have lost their jobs.” But because the extension is happening outside the regular enrollment period — which ended December 15 — getting the word out in a big way will be crucial to its success.

To that end, the federal government plans to spend $50 million on outreach and communication to boost awareness in the 36 states that participate in ACA markets. The effort will also attempt to share more information about the ACA in general.

It goes without saying that this represents a major shift from the Trump administration’s approach over the course of the last four years. When the pandemic first hit, the administration did not choose to open up the federal marketplace beyond the normal enrollment period. Additionally, it slashed the original ACA marketing budget of $100 million by 90% in 2017 — and attempted to restrict and undermine the ACA in numerous other ways.

The Biden administration is essentially trying to accomplish two main goals with the new open enrollment, said Coalition for Healthcare Communication executive director Jon Bigelow. The first, not surprisingly, is “for those people who lost their jobs in the COVID-19 pandemic, to get more of them into the Affordable Care Act.”

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The second, Bigelow added, was to provide Biden with an opportunity to jumpstart the ACA expansion process, which he has consistently ranked among his major health-policy goals.

“It’s an attempt to get more people in general into the Affordable Care Act, and to use the COVID-19 pandemic as an excuse to bring back the marketing budget more broadly,” Bigelow explained. “And it’s an attempt to bring back the navigator program in the hope that some of the other millions of people who are eligible would come into the plan.”

Even prior to the economic upheaval of COVID-19, the number of uninsured Americans had been rising since 2016. Among the 30 million Americans who are currently uninsured, around 15 million are eligible for the ACA. Up to nine million of that sum qualify for federal financial assistance, like subsidized or free coverage.

But whether extending the open enrollment period will have the intended effect of boosting the number of people signing up for ACA coverage is anyone’s guess. The enrollment period last November saw a lower number of enrollees than expected.

Additionally, some ACA support groups and navigators expressed concern that they may not have enough funding to manage a second enrollment period. Several noted that they spent much of their federal grant money during last fall’s enrollment.

The money carved out for communications, then, is seen as crucial for raising public awareness – even though the Biden administration hasn’t yet outlined the details around the anticipated marketing campaigns.

Bigelow stressed that the effort will be important to clarify the ongoing confusion around the ACA. “It’s confusing to sort through even for experts, so I can imagine what it’s like for someone who does not know anything about the health insurance system, particularly if English is not your first language,” he said.

The first take, Bigelow added is to make people aware of their options. “People need to learn how subsidies are set, what are the differences between bronze and silver plans and what they are getting for their money,” he continued. “The impact of the marketing campaign would be that the more people who know about health insurance – and especially know that it would be highly subsidized or free for them – why wouldn’t they sign up?”

Assuming the latest open enrollment period results in a boost of Americans purchasing plans through the ACA, Bigelow believes it could also have a halo effect on the pharmaceutical industry.

“Specifically when it comes to the pharmaceutical industry, the ACA is a positive thing because it has brought millions more people into the healthcare arena,” Bigelow explained. “That’s one way of looking at it: The number of people who are on insurance provided through the ACA today is equivalent to the population of Australia. That entire population has been added to the pharma market.”