By Sonja Nesbit

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October 28, 2021 

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With the stroke of a pen, President Biden can make real progress on health equity and coverage goals. Two rules enacted by the previous administration are ripe for executive action. He can do this even as Democrats embark on what might be a lengthy legislative effort tackling other more complicated American health care reforms. These Trump-era rules lower the quality of health coverage, open the door to discrimination in workplace benefits, and promote instability in the Obamacare marketplaces. Reversing these regulations doesn’t require congressional action, and according to late-summer research from top Democratic pollster Cornell Belcher, offers a golden political opportunity for President Biden that would be rewarded by his core supporters with a spike in voter enthusiasm in 2022. 

 

Despite Republicans’ failed efforts to repeal Obamacare, the previous administration was successful putting in place rules that created Individual Coverage Health Reimbursement Arrangements (ICHRAs) – a vehicle for separating workers into classes and slashing their health benefits – and expanded short-term limited duration insurance (STDLI), commonly known as junk insurance, which are still on the books.

 

President Biden rode a wave of support from voters of color, younger voters, and college educated women to the White House. While wide majorities of these voters in key battleground states approve of the job he’s doing, a plurality would like to see more action taken to address high health care costs. In fact, tackling discrimination and bringing health care costs down are among the Biden coalition’s top priorities, according to the poll. Rolling back the two regulations that created ICHRAs and expanded STLDI gives President Biden a chance to deliver on issues that matter to the voters who put him in the Oval Office and gave Democrats the majority in Congress.

 

After learning more about ICHRAs, 65% of Biden voters oppose the policy and 68% would like to see it rescinded over concerns about discrimination. And 68% would like to see the previous administration’s junk insurance expansion rolled back. Importantly, 71% of the Biden coalition report that they would be more motivated to turn out for the mid-term election if ICHRAs were eliminated.

 

Biden voters rightly recognize that ICHRAs and junk insurance harm working Americans and their families.

 

At a time when health care is so important, ICHRAs weaken coverage and promote health inequity. The ICHRA system invites discrimination into the workplace by incentivizing employers to create different classes of employees. Some would receive traditional employer-sponsored health benefits. Others – potentially older workers and workers with health issues, who are more expensive to cover – would be left to shop for their own health insurance plan on the individual marketplace with only a stipend to cover the cost. For people put in an ICHRA plan, it means lower quality coverage, high out of pocket costs if the stipend does not cover what a worker might need, and the headache of finding their own coverage.

 

What’s more, by creating a system that could push workers who are the most expensive to cover into the individual market, ICHRAs threaten the risk pool of the Obamacare marketplaces. This would increase costs for everyone who relies on that coverage. 

 

The previous administration also significantly boosted junk insurance. The regulation changed the definition of “short-term” insurance, which is supposed to fill short gaps in coverage, like when someone is between jobs, to as long as three years. This has flooded the market with low quality insurance plans that cover fewer conditions and saddled working Americans with expensive medical bills. The rule entirely distorts the intent of short-term plans, giving families false confidence that they have coverage only to learn it might not cover what they need when they need it. 

 

That’s why a coalition of health, business and advocacy organizations that care about the quality of care for workers and families recently called on the Biden Administration to reverse the damage in a joint letter. The good news is the current administration knows these two regulations are problematic. Both were included in a January executive order signed by President Biden that directed his team to consider “suspending, revising, or rescinding” them. Our poll shows that the President’s core supporters are ready for action. 

 

This is where good policy is also good politics. Doing away with ICHRAs and reigning in junk insurance are easy wins that will make a real difference in the lives of so many working Americans whose quality coverage is threatened by these ill-conceived policies. If President Biden takes action, his voters will have his back.

 

Sonja Nesbit is a former HHS official and the Executive Director of Keep US Covered, a campaign committed to enhancing quality health coverage and improving care for working Americans.