By Stephanie Armour 

President Biden is set to sign executive orders Thursday directing the government to re-examine Trump-era health-care policies, which could lead to the unraveling of initiatives like Medicaid work requirements and short-term health plans.

But the process is likely to be long and met with legal battles.

Many rules or waivers approved by former President Donald Trump would require rule-making, public notice, or hearings before they could be unraveled. Some policies are already enmeshed in legal proceedings, which means the Biden administration in some cases would need to move swiftly to take action before court decisions are made.

States are likely to fight to preserve other Trump administration changes, such as a first-ever block grant in Tennessee that would cap federal funding for the state's Medicaid program.

Mr. Biden is likely to stop short in the executive orders of calling for the policies and waivers to be gutted. The orders are expected to call for federal agencies to re-examine rules and policies that limit access to health care, including demonstrations and waivers under Medicaid and the Affordable Care Act. Agencies will then consider whether to take additional action.

The orders will also temporarily reopen enrollment under the ACA from Feb. 15 through May 15 and Mr. Biden will rescind a rule that bars international nonprofit groups from getting federal funding if they provide abortion counseling or referrals. He will also direct the Department of Health and Human Services to consider whether to rescind regulations that barred family planning groups from getting federal funds if they refer patients for abortion.

But his sweeping call to review decisions that could limit access to health care marks the start of a tougher battle that is likely to spur political conflict between the Biden administration and Republicans.

Medicaid work requirements were a long-held goal of conservatives, but the mandates had never been approved until the Trump administration. The Supreme Court is slated to hear arguments over the legality of federal approvals for work requirements that were adopted in Arkansas and New Hampshire. The decision could help determine how much authority HHS has in crafting waivers in Medicaid.

The Biden administration could try to move quickly to end work requirements that were granted in Medicaid, a federal-state program for low-income and disabled people. Fast action could potentially make the Supreme Court case moot.

But 12 states have already had their requirements approved and could challenge any effort to take them away. The new administration in some cases has to follow certain procedures--including hearings--which could take time, and there are legal questions as to how quickly the Biden administration could move to make any changes.

The Trump administration also allowed the proliferation of short-term health plans and association health plans, which provide insurance that doesn't comply with the ACA consumer protections. Both are entangled in lawsuits and the D.C. Circuit Court of Appeals has upheld the expansion of short-term health plans.

The Biden administration can still move to weaken or reverse the regulations that gave rise to the plans. But the action could be tough politically, since the short-term plans have become more widespread because they are generally inexpensive compared with ACA-compliant plans. Trying to take away plans that millions of consumers now have could prompt a backlash, so it is possible the Biden administration could opt instead to limit future enrollments, according to legal and health policy analysts.

The review means a host of policies will be up for grabs, pitting Democrats who believe the federal government should do more to provide health coverage and access against Republicans who say the initiatives often amount to federal overreach, hinder state authority and spur overspending of taxpayer dollars.

Mr. Biden has designed his health policy agenda on expanding health coverage during a pandemic that has had a disproportionate impact on people who have lower incomes and in communities of color.

Health-insurance coverage rates increased for all racial and ethnic groups between 2010 and 2016, with the largest increases occurring after implementation of the ACA, but the coverage gains began stalling and reversing for some groups starting in 2017 and 2018, according to the Kaiser Family Foundation.

Write to Stephanie Armour at stephanie.armour@wsj.com

 

(END) Dow Jones Newswires

January 28, 2021 05:44 ET (10:44 GMT)

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