The Commonwealth Fund  |  May 17, 2021

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Issue: Federal officials have significant flexibility in implementing the Affordable Care Act and can adopt different positions based on an administration’s preferred policy goals. The Biden administration has pledged to use its executive authority to strengthen and expand access to marketplace coverage and Medicaid.

Goals: Identify high-priority federal administrative policy changes related to the Affordable Care Act and Medicaid.

Methods: Analysis of nine key publicly available recommendations to the Biden–Harris presidential transition team made by patient and consumer advocates, health insurers, hospitals, physicians, state marketplace officials, and state insurance commissioners.

Key Findings and Conclusions: Health care stakeholders have offered broad support for a range of federal administrative policy changes to increase access to affordable, comprehensive health insurance and promote health equity. Top recommendations included increasing funds for outreach and enrollment, fixing the family glitch, limiting short-term plans and association health plans, and revisiting policies on state innovation waivers. Stakeholders also emphasized the need for policies that streamline enrollment and eligibility processes and help people gain and maintain coverage. These recommendations offer a framework for the Biden administration to adopt policies consistent with its goal of increasing access to coverage.

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