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Biden exec order reopens ACA insurance marketplaces: What ASCs need to know

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President Joe Biden issued an executive order to open a special enrollment period for the health insurance marketplace from Feb. 15 to May 15.

All individuals and families eligible for marketplace plans in the 36 states that use the federal marketplace can apply for new coverage or update existing coverage. The administration plans to attract enrollees through paid advertising and direct consumer outreach, according to The New York Times. The states operating on their own marketplaces may also reopen enrollment.

There are around 15 million uninsured Americans eligible for marketplace coverage, according to the Kaiser Family Foundation. The ASC industry could benefit if more of these people are insured, because they'll be able to access needed surgeries.

"Depending on the unemployment rate, insurance coverage and deductibles, and awaiting COVID-19 vaccine administration, patients are slower to schedule surgery," Lori Sylvester, MSN, RN, administrator of Riverside Surgery Center in Columbus, Ohio, told Becker's ASC Review in a recent interview. "We are seeing a slow start to 2021. On a positive note, we are seeing [payers] driving volume to the ASC where it is more affordable, delivers high-quality care and great patient satisfaction."

In addition to the potential expansion of insured Americans, Ambulatory Surgery Center Association CEO William Prentice told the Becker's Healthcare Podcast that CMS, commercial payers and employers are increasingly aware of the role ASCs can play in reducing healthcare costs. "We are seeing things like payers introducing policies to steer patients to the lower-cost setting in ways that could be very beneficial to ASCs," he said.

However, the expanded enrollment and coverage will not necessarily mean greater access if individuals aren't able to stay on long term or pay high deductibles. The administrator of Sinus Center Idaho in Meridian Crystal Baisch told Becker's her center has seen a significant decrease in patient volume because of the expense associated with ACA plans. "Patients can't afford to pay for insurance and use it," she said.

The ACA marketplace premium rates vary by state. Indiana's ACA premium rate increased the most in 2021, at 10.5 percent. By contrast, Maine's rates experienced a 13.1 percent decrease. Take a look at how each state's ACA premium rate is changing this year here.

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