SIDE BY SIDE: What Open Enrollment Looks Like Under President Biden After Four Years of Trump Sabotage

On Monday, the Centers for Medicare & Medicaid Services (CMS) opened the Affordable Care Act Marketplace for enrollment as Americans continue to face the health and economic consequences of the coronavirus pandemic. This move ensures that everyone—including those who lost employer coverage and those who were uninsured before the crisis—can get covered beyond the standard open enrollment period. The Trump administration refused to take this important step despite pleas from health care experts, health insurers and lawmakers. 

Open enrollment under President Biden will look significantly different from the past four years. In 2017, Trump cut the outreach and advertising budget for enrollment by 90 percent. Funding for advertising and outreach remained at diminished levels for the 2021 enrollment period, even as millions lost coverage as a result of the pandemic. The Trump administration also cut the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days. This was on top of ongoing efforts to dismantle the ACA, which undoubtedly created confusion among consumers. Unsurprisingly, millions lost coverage under Trump even before the pandemic. 

The Biden administration, on the other hand, is spending five times more on education and outreach during this special enrollment period than Trump spent for the standard enrollment period. The Biden administration has also pledged to prioritize reaching groups that historically have experienced lower access to health coverage and greater disparities in health outcomes. President Biden is also leading the charge to pass the American Rescue Plan which includes key provisions to expand coverage and lower health care costs for American families.


Trump’s PlanPresident Biden’s Plan 
Efforts to expand health coverage during the pandemicNone 

Trump instead pursued harmful waivers to reduce Medicaid enrollment, including block grants and work requirements, in the middle of the pandemic. 

Opened a special enrollment period

Biden directed the HHS to examine policies that undermine the Affordable Care Act and Medicaid. Additionally, the Biden administration announced it would end Medicaid work requirements as part of its efforts to remove enrollment barriers.

Funding for education, outreach & advertisingCut funding for outreach and advertising to just $10 million for the standard enrollment period Dedicating $50 milion for the special enrollment period alone 
Duration of enrollment period45 days90 days for the special enrollment period in addition to the standard enrollment period later this year
Efforts to enroll hard-to-reach populations, including communities of color & non-English speakersNone — the Trump administration stopped engaging with partner groups, such as the Latino Affordable Care Act Coalition, women’s groups, medical organizations, and churches. CMS will collaborate with community partners to reach groups that historically have experienced lower access to health coverage and greater disparities in health outcomes.

THEN/NOW: February 15, 2017 vs February 15, 2021

What a difference a new administration makes. For four years, Donald Trump and his Republican allies waged a war on America’s health care. President Biden opening a special enrollment period four years to the day of Donald Trump trying to tear apart the ACA marketplaces is a prime example of the stark differences between these two administrations.

THEN:Trump Administration’s New Health Rule Would Reduce Tax Credits, Raise Costs, For Millions of Moderate-Income Families.” “The Trump Administration’s new proposed rule on health care would raise premiums, out-of-pocket costs, or both for millions of moderate-income families…If finalized as proposed, the rule would reduce the amount of health care that marketplace plans have to cover. As a result, the rule would force millions of families to choose between higher premiums and worse coverage.” [Center on Budget and Policy Priorities, 2/15/17

NOW: President Biden To Open Up The Federal Health Insurance Marketplace For Three Months. “The move is in stark contrast to the Trump administration’s approach. As covid-19 took hold last spring and the economy imploded, health experts pleaded with the Trump administration to open up the federal marketplace so people could buy insurance to protect themselves during the worst public health emergency in a century…The Biden administration is promising to spend $50 million on outreach and education to get the word out about the new special enrollment period. That’s critical, experts said. [Kaiser Health News, 2/16/21

ACA Special Enrollment Period Begins to Provide Relief to Americans Battling Pandemic

Robust Outreach and Education Campaign WIll Reach More Americans with Information About Affordable Coverage Options

Washington, DC — Today, the Centers for Medicare & Medicaid Services (CMS) opened the Affordable Care Act Marketplace for enrollment, as Americans continue to face the health and economic consequences of the coronavirus pandemic. President Biden enacted the special enrollment period with a January executive order. The Marketplace opens today and will remain open through Saturday, May 15. According to CMS, 9 in 10 current Marketplace enrollees receive financial help, and 75 percent of consumers can find a plan for $50 or less. CMS will also launch outreach efforts including broadcast, radio, and digital advertising to let people know they may be eligible for subsidies. These outreach efforts will prioritize reaching groups that historically have experienced lower access to health coverage and greater disparities in health outcomes. In response, Protect Our Care Chair Leslie Dach issued the following statement:

“President Biden is delivering on his health care promises. For four years, Republicans waged a war on America’s health care. President Biden is doing the opposite. Thanks to the President’s actions, millions of Americans will now be able to buy affordable quality health insurance for themselves and their families. This is so important during this pandemic, when millions have lost their job or can no longer afford their insurance and where every American is worried about their access to health care. The President’s announcement of a $50 million marketing campaign will mean more Americans know that affordable health insurance is now within their reach. This move comes on the heels of a historic week for health care, where the House Democrats strengthened the already substantial health care provisions proposed by President Biden in the American Rescue Plan. It’s clear President Biden and Democrats are using every tool at their disposal to build on the strong foundation of the Affordable Care Act to lower costs and expand coverage.”

American Rescue Plan Includes Critical Medicaid Expansion Measures

Watch Protect Our Care’s Video Explainer Here

Washington, DC — House Democrats released parts of their American Rescue Plan Tuesday night, which would incentivize the 12 remaining holdout states to expand Medicaid under the Affordable Care Act. If these states expanded Medicaid, nearly 6 million could gain coverage. The House Energy and Commerce Committee will consider the bill this week. In response, Protect Our Care Chair Leslie Dach issued the following statement:

“Congressional Democrats are taking decisive action to expand health care coverage to Americans when they need it the most — in the middle of a pandemic when millions have lost their jobs or their health insurance. After years of Republican led sabotage, lawsuits and attempts at repeal, House Democrats are delivering on their promise to lower health care costs, improve care, and expand coverage. This is a historic week in the fight for better health care. Medicaid expansion has played a vital role in reducing racial disparities in health care access and has served as a critical safety net for millions. Providing increased financial incentives for states to expand Medicaid could expand coverage to six million more Americans. The bill also works to reduce racial inequities by addressing the maternal mortality crisis, by enabling states to expand Medicaid coverage to new mothers 12 months postpartum. For far too long states with Republican governors like Texas, Georgia, and Florida have refused to expand Medicaid and have instead chosen to deny their constituents the affordable quality health care they deserve. Now, they will have no more excuses.”

HEADLINES: President Biden Delivers on Campaign Promise to Expand Access to Health Care

On Thursday, President Biden signed executive orders to reopen for a special enrollment period to help people get coverage and remove barriers to enrolling in Medicaid. These executive orders build on the strong foundation of the Affordable Care Act just as Americans who are facing an ever-worsening public health crisis need help the most. Coverage shows President Biden is committed to delivering on his health care promises and reversing the health care sabotage agenda of Trump and Republicans. These executive orders are important first steps to making sure Americans have more affordable health coverage and access to better care. 

Washington Post: Biden Reopens ACA Enrollment for Three Months in Opening Bid to Extend Health Coverage. “The directive, part of a series of executive actions the president is taking during his first days in office, is a down payment on his pledge to make health care more accessible and affordable and a sign of his determination to rehabilitate the landmark law after four years of Republican battering. Those goals have taken on more urgency as 25 million people have been infected with the coronavirus and millions of others have lost jobs.” [Washington Post, 1/28/21

New York Times: Biden Moves to Expand Health Coverage in Pandemic Economy. “President Biden on Thursday ordered the Affordable Care Act’s health insurance marketplaces reopened to give people throttled by the pandemic economy a new chance to obtain coverage, and he took steps to restore coverage mandates that had been undermined by his predecessor, including protecting those with pre-existing medical conditions. Thursday’s orders also took aim at Trump-era restrictions on Medicaid, especially on work requirements imposed by some states on poor people trying to obtain coverage.” [New York Times, 1/28/21

  • New York Times: “Perhaps No Policy Is as Important to [Biden] as the Affordable Care Act, Which He Helped Secure as President Barack Obama’s Vice President.” Mr. Biden used Thursday’s appearance at the White House to begin shoring up health care programs and policies that have been critical to a Democratic resurgence. Perhaps no policy is as important to him as the Affordable Care Act, which he helped secure as President Barack Obama’s vice president. President Donald J. Trump tried and failed to overturn the law, then weakened it with executive actions and rules, including making it easier for people to buy cheap, short-term plans that are not required to cover pre-existing medical conditions. [New York Times, 1/28/21

AP: Biden Opens ‘Obamacare’ Window For Uninsured As COVID Rages. “President Joe Biden on Thursday ordered government health insurance markets to reopen for a special sign-up window, offering uninsured Americans a haven as the spread of COVID-19 remains dangerously high and vaccines aren’t yet widely available. Biden signed an executive order directing the insurance markets to take new applications for subsidized benefits, something Donald Trump’s administration had refused to do.” [Chicago Tribune, 1/28/21]

USA Today: Biden Signs Executive Action to Reopen Obamacare Enrollment Amid COVID-19, End Gag Rule. “President Joe Biden on Thursday took initial steps to expand health care coverage and reverse some of the policies of former President Donald Trump, including directing that people be given a new chance to sign up for government-subsidized care and lifting restrictions on abortion and family planning services.” [USA Today, 1/28/21

The Hill: Biden Signs Health Care Executive Actions to ‘Undo The Damage’ Caused by Trump. “President Biden on Thursday signed two executive actions focused on health care, describing the directives as a necessary effort to ‘undo the damage’ done by former President Trump…The president repeatedly insisted Thursday that the directives did nothing but reverse the Trump administration’s policies and restore the policies of the Obama administration.” [The Hill, 1/28/21

CNN: Biden Signs Executive Order to Reopen Affordable Care Act Enrollment. “It’s Biden’s first move toward delivering on his campaign promise to bolster the landmark health reform law that he championed as vice president. And it comes as more Americans could be facing the loss of coverage because of the pandemic-fueled economic downturn.” [CNN, 1/28/21

Modern Healthcare: Biden to Reopen ACA Marketplace, Revisit Work Requirements. “President Joe Biden on Thursday ordered HHS to create a special enrollment period to allow people to sign up for a health plan through Affordable Care Act marketplaces and reexamine policies like Medicaid work requirements that make it more difficult for individuals to access or afford coverage.” [Modern Healthcare, 1/28/21

The Upshot: Biden’s Obamacare Do-Over: Another Chance to Sign Up, This One More Publicized. “In December, the last Obamacare enrollment period under the Trump administration closed. Now that the Biden administration has arrived, it’s trying a do-over. The renewed effort reflects the Biden team’s view that the Trump administration did too little to help people find coverage, despite a public health crisis and waves of job losses. Although insurance sign-ups were up a bit compared with last year, the growth did not match the increase in need.” [New York Times, 1/28/21

New York Times: Biden’s Health Care Moves. “Biden’s orders still matter, because Trump’s actions mattered. Biden will try to strengthen protections for people with medical conditions. He will also create a new three-month sign-up period for Obamacare, starting next month, aimed partly at people who lost their jobs during the pandemic. The most recent sign-up period was in the fall.” [New York Times, 1/29/21

  • New York Times: “Perhaps Most Significant, the Biden Administration Plans to Promote the Sign-Up Period Heavily.” “Perhaps most significant, the Biden administration plans to promote the sign-up period heavily, through advertisements, email and other outreach, according to my colleague Margot Sanger-Katz, who’s been covering Obamacare for most of its existence. ‘Biden’s people think the Trump people bungled the regular enrollment period,’ Margot told me.” [New York Times, 1/29/21

The Health 202: Will Now Be Open During Tax Season.“This special sign-up period could help the Biden administration start reversing incremental declines in ACA enrollment. Over the course of the Trump administration, the number of people buying coverage on gradually eroded. Biden, who has made boosting marketplace enrollment a top goal, said yesterday that ‘basically the best way’ to describe his action is that it is intended “to undo the damage Trump has done.” [Washington Post, 1/29/21

  • The Health 202: “Biden’s Health Care Order Puts Medicaid Work Requirements Under the Microscope.” “Biden’s health-care order puts Medicaid work requirements under the microscope. Biden’s executive order on health care also directs federal agencies to reexamine rules that have made it more difficult for people to enroll in Medicaid or that could undermine protections for people with preexisting conditions.” [Washington Post, 1/29/21

Talking Points Memo: Biden Signs Exec Order ‘Restoring the Affordable Care Act’ After Trump’s Sabotage Attempts. “During its first two years, the Trump administration gutted money for advertising and for community groups that helped people enroll, seeing such an effort as wasteful. Biden’s executive order to reopen enrollment for a three-month period, extending from  Feb. 15 and May 15, may help people who have lost coverage in the past year due to the pandemic. Enrollment will be open, however, to those seeking health insurance for any reason, in any of the 36 states that use” [Talking Points Memo, 1/28/21]

HEADLINES: Biden Moves to Reverse Trump’s Health Care Sabotage, Expand Health Care Access

Ahead of President Biden signing executive orders today to increase access to affordable health care, coverage shows these actions are a repudiation of Trump and Republicans’ years-long war on health care. These are the first steps President Biden is taking to deliver on his promises to build on the Affordable Care Act by reopening for a special enrollment period to help people get coverage and removing barriers to enrolling in Medicaid, as Americans continue to face the coronavirus pandemic.

Politico: Biden Takes First Step Toward Bolstering Obamacare. “President Joe Biden is taking the first step toward rebuilding Obamacare, ushering in a new era for the health care law after a decade of Republican attacks. The Biden administration on Thursday announced it’s throwing open the doors to the law’s enrollment site,, making it easier for the uninsured to get coverage during the pandemic. It is also expected to restore Obamacare marketing funds that the Trump administration had gutted, and it will soon begin the process of reversing the previous administration’s changes seen as undermining the health law and Medicaid.” [Politico, 1/28/21

CNN: Biden Will Sign Executive Order to Reopen Affordable Care Act Enrollment. “President Joe Biden will reopen enrollment on the federal Affordable Care Act exchanges on Thursday as part of a series of executive actions related to health care, taking a step to help uninsured Americans that former President Donald Trump rejected. It’s Biden’s first move toward delivering on his campaign promise to bolster the landmark health reform law that he championed as vice president. And it comes as more Americans could be facing the loss of coverage because of the pandemic-fueled economic downturn.” [CNN, 1/28/21

The Hill: Biden to Take Action on ACA Marketplaces, Medicaid. “President Biden will direct federal agencies this week to reopen the ObamaCare marketplaces and roll back the Trump administration’s changes to Medicaid in a repudiation of his predecessor’s health care policies. Biden’s executive orders are expected to set the stage for his presidency by reinforcing his belief that the federal government should make it easier — not harder — for people to get health care.” [The Hill, 1/27/21

Associated Press: Biden to Open ‘Obamacare’ Markets for COVID-19 Relief. “Fulfilling a campaign promise, President Joe Biden plans to reopen the insurance markets for a special sign-up opportunity geared to people needing coverage in the coronavirus pandemic. [Associated Press, 1/27/21

New York Times: Biden Plans to Reopen Obamacare Exchanges in Many States. “The Biden administration plans to reopen enrollment in many of the Affordable Care Act marketplaces, both to help those who may have lost health insurance during the pandemic and to offer coverage to those who did not have any and now want it. The move will be announced on Thursday as part of an executive order describing administration policies on shoring up health insurance coverage, according to three people familiar with the details.” [New York Times, 1/27/21

ABC News: Biden to Expand Affordable Care Act Enrollment Amid COVID-19 in New Executive Order. “President Joe Biden will tackle the issue of health care Thursday with two executive actions aimed at expanding enrollment for the Affordable Care Act amid the COVID-19 pandemic, and addressing reproductive health, according to the White House. The actions continue a series of executive moves by Biden in his first week in office, setting an ambitious tone for his administration on a number of policy areas.” [ABC News, 1/28/21

HuffPost: Biden Administration to Reopen Obamacare Enrollment, Start Undoing Trump Sabotage. “President Joe Biden on Thursday will announce a series of executive actions on health care, including one designed to boost health insurance enrollment through the Affordable Care Act and one designed to undo President Donald Trump’s attempts at undermining the law.” [HuffPost, 1/28/21

Biden Delivers on Election Promise to Improve and Expand Health Care Access and Reverse Trump’s Health Care Sabotage

Executive Orders Will Start Special Enrollment Period, Remove Barriers to Medicaid

Washington, DC — Today, President Biden will sign executive orders to start to roll back Republicans’ years-long war on health care and increase access to affordable health care by reopening for a special enrollment period to help people enroll in Affordable Care Act health plans and removing barriers to enrolling in Medicaid as Americans continue to face the coronavirus pandemic. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“President Biden pledged to build on the strong foundation of the Affordable Care Act and use his executive authority to reverse Trump’s sabotage, and he began fulfilling that promise today. Today’s executive actions are a critical first step in rolling back Republicans’ war on health care and increasing coverage. Reopening the ACA marketplace means nearly 9 million people will be eligible for free or subsidized health insurance coverage. Recent polling shows people think coverage is more expensive than it actually is. There is an estimated $1 billion in unspent funds from the Trump administration that can be used to promote this special enrollment period. As Americans continue to battle the COVID-19 pandemic, which has cost millions of Americans their jobs and health insurance, they need coverage more than ever. Additionally, by removing barriers to Medicaid enrollment implemented by the Trump administration, President Biden is making sure vulnerable populations can access the care they need. Between today’s executive actions and including provisions to make health care more affordable in his American Rescue Plan, President Biden is delivering on his promises and making sure Americans can get the coverage they need.”

As Health Care Takes Center Stage, Protect Our Care Releases Agenda to Lower Costs, Improve Care and Reduce Inequities

Protect Our Care Says Key Health Care Measures Must Be Included As Congress Considers COVID Relief and Budget Reconciliation 

Read the Agenda Here

Washington, DC — Today, Protect Our Care released a health care agenda detailing steps President Biden and the Democratic-controlled Congress should take to improve Americans’ health care. The agenda lays out both administrative and legislative actions to expand coverage, lower costs, strengthen protections and address inequities in care. The agenda comes as the Biden administration prepares to sign executive orders related to health care, presses forward with the American Rescue Plan, which includes key health care affordability provisions, and Congress prepares to move forward on budget reconciliation if Republicans fail to agree to the rescue plan America needs.   

“Protect Our Care’s health care agenda lays out common sense measures in line with what Democrats, including President Biden, have run and won on when it comes to health care. These provisions will increase coverage and lower costs, and they are even more important as Americans battle the pandemic. President Biden has put health care front and center since taking office by prioritizing critical executive orders that make sure more Americans can get covered and remove barriers to enrolling in Medicaid. We look forward to working with President Biden and Democratic leaders in Congress to move our common agenda forward,” said Protect Our Care Executive Director Brad Woodhouse

“President Biden’s American Rescue Plan includes strong provisions to reduce the cost of health insurance for millions of Americans and get millions more covered. Polling shows that large majorities of Republican voters support these provisions, and Republican members of Congress should support them too. And if Republicans refuse, any COVID relief budget reconciliation plan should include them. That’s what Americans want and expect. Americans cannot afford to wait any longer,” said Protect Our Care Chair Leslie Dach.

After Four Long Years, Donald Trump’s War on American Health Care Ends Tomorrow

Joe Biden’s Inauguration Will Mark a New Beginning on Health Care: Better Coverage, Lower Costs and an End to the Pandemic 

Washington, DC — On Wednesday, Joe Biden will be sworn in as the 46th President of the United States, closing President Trump’s dark chapter of health care sabotage and his colossal failure to address the worst public health crisis in over a century. At noon tomorrow, Americans can breathe a sigh of relief as President Biden will immediately launch a national plan to end the pandemic and put in place an administration that will fight for better, more affordable health care for every American. 

“Four years ago, President Trump’s first act as president was an Executive Order directing his cabinet to begin dismantling the Affordable Care Act. Four years later, the ACA is here to stay, and President Trump is out of a job, along with the congressional majorities he came in with,” said Protect Our Care Executive Director Brad Woodhouse. “Since taking office, Trump has seized every opportunity to attack health care and the Affordable Care Act. From trying to eliminate protections for pre-existing conditions, to throwing people off of Medicaid and completely failing to respond to the pandemic, Trump has been a disaster for American health care. Trump’s four year war on health care will end after costing the Republicans the White House and both chambers of Congress and with the ACA more popular than ever.”

“After Joe Biden is sworn in tomorrow, people will go to bed knowing better health care is on its way,” said Protect Our Care Care Chair Leslie Dach. “Voters elected Joe Biden because he will build on the successes of the Affordable Care Act by expanding coverage, improving care, addressing inequities and lowering costs. With Speaker Pelosi and Majority Leader Schumer at his side and Democratic majorities in both Houses of Congress, President Biden will deliver on his promises and deliver better health care for tens of millions of Americans.”

Protect Our Care Praises Biden’s ‘American Rescue Plan’

Along with Delivering Relief to Americans and Fixing Problems with the Vaccine Distribution Rollout, Biden’s Ambitious Plan Will Make Health Care More Accessible and Addresses Racial Disparities

Washington, DC — Following President-elect Joe Biden’s release of his ‘American Rescue Plan,’ Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“We commend President-elect Biden for putting forth a package to address the disaster he will inherit from Donald Trump and his failed leadership. It will take time to fill the steep hole this administration has left us in, but delivering relief into the hands of Americans, fixing Trump’s disastrous vaccine distribution rollout, and getting resources to states and localities are vital to rescuing our nation from a pandemic that has gone on far too long and been far too costly to the American people. Importantly, this package includes crucial provisions to expand health care coverage, make accessing health care more affordable and address racial disparities in coronavirus treatment and outcomes.

“During the entirety of this pandemic, President Trump and Republicans refused to lift a finger to help people get covered or make health care more affordable. In fact, the Trump administration is before the Supreme Court right now trying to rip coverage away; but President-elect Biden is doing the right thing by working to preserve and expand health care coverage and end the pandemic. Congress should move quickly to provide this much needed relief for Americans.”