Strengthening Medicaid and the Affordable Care Act

The order directs the Secretaries of Treasury, Labor, and Health and Human Services — along with all other agency heads with ACA or Medicaid authority — to immediately review existing regulations, guidance, waivers, and policies and identify any that are inconsistent with the stated goal of protecting and expanding Medicaid and ACA coverage. Agencies must then consider suspending, revising, or rescinding those actions, including by publishing proposed rules for notice and comment. It also directs the HHS Secretary to consider establishing a Special Enrollment Period for uninsured and under-insured Americans to obtain ACA marketplace coverage in light of the COVID-19 emergency. Two prior executive orders — EO 13765 (directing agencies to minimize the ACA's economic burden) and EO 13813 (promoting healthcare choice and competition) — are revoked outright.

The order does not itself change any regulation, alter any enrollment rule, or grant any new entitlement. Every operative policy change depends on future agency action, which must comply with applicable law and the notice-and-comment requirements of the Administrative Procedure Act. A standard severability clause and a no-private-right-of-action provision limit the order's direct legal effect.

Federal agencies with authority over Medicaid and the ACA — primarily HHS, Treasury, and Labor — are directed to act. Millions of uninsured or under-insured Americans, people with pre-existing conditions, and communities that rely on Medicaid or ACA marketplace coverage are the intended beneficiaries of any resulting policy changes.

If agencies follow through, policies restricting ACA enrollment windows, Medicaid waivers that reduce coverage, and rules limiting financial assistance could be reversed. The Special Enrollment Period, if opened, would let uninsured Americans gain coverage during the pandemic without waiting for the standard annual open-enrollment window.

The order launches a two-track review. On the first track, agencies scan all existing ACA- and Medicaid-related actions for inconsistency with the new pro-coverage policy and then decide — through notice-and-comment rulemaking where required — whether to suspend, revise, or rescind them. On the second track, agencies specifically examine actions that arose from the two revoked EOs and apply the same test. HHS separately decides whether to open a Special Enrollment Period under existing statutory and regulatory authority. No hard deadlines are set; the operative phrase throughout is "as soon as practicable."