ExecutiveOrdersEO
EO 14009Executive OrderBiden · D

Executive Order 14009

Strengthening Medicaid and the Affordable Care Act

HealthcareHealthcareEconomy & LaborEconomy & LaborCivil RightsCivil Rights

In simple terms

This executive order directs federal agencies to review and potentially reverse Trump-era regulations that weakened the Affordable Care Act (ACA) and Medicaid, establishes a special enrollment period for ACA marketplace coverage during COVID-19, and revokes two previous executive orders aimed at undermining the ACA. It mandates examination of policies affecting pre-existing condition protections, Medicaid waivers, marketplace barriers, and affordability of coverage.

Federal Register Open PDF 86 FR 7793

Record & deadlines

  1. Signed

    Signed by the President

  2. FR published

    Published in the Federal Register · 86 FR 7793

    Federal Register PDF

  3. Agency review of existing regulations orders guidance and policies for inconsistency with ACA/Medicaid strengthening policy

  4. Consideration of suspending revising or rescinding inconsistent agency actions and publishing proposed rules

  5. Consideration of additional enforcement actions

  6. Identification and review of agency actions related to revoked EOs 13765 and 13813

Key directives

  • Secretary of HHS shall consider establishing Special Enrollment Period for uninsured and under-insured through Federally Facilitated Marketplace
  • Agency heads shall as soon as practicable review all existing regulations orders guidance policies related to Medicaid and ACA for inconsistency with strengthening policy
  • Agency heads shall examine policies undermining pre-existing condition protections including COVID-19 complications
  • Agency heads shall examine demonstrations and waivers reducing Medicaid or ACA coverage
  • Agency heads shall examine policies undermining Health Insurance Marketplace or individual small group large group markets
  • Agency heads shall examine unnecessary barriers to Medicaid or ACA coverage including mid-year enrollment
  • Agency heads shall examine policies reducing affordability of coverage or financial assistance for dependents
  • Agency heads shall consider suspending revising or rescinding inconsistent actions and publish proposed rules as applicable
  • Agency heads shall consider additional actions to enforce strengthening policy
  • Revoke Executive Order 13765 (January 20 2017) and Executive Order 13813 (October 12 2017)
  • Identify and review agency actions arising from revoked EOs 13765 and 13813 for potential suspension revision or rescission

Who is ordered

Prior policyRollback

  • revokeExecutive Order 13765 of January 20, 2017 (Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal)
  • revokeExecutive Order 13813 of October 12, 2017 (Promoting Healthcare Choice and Competition Across the United States)
  • otheragency actions inconsistent with strengthening Medicaid and ACA policy
  • otheragency actions related to or arising from Executive Orders 13765 and 13813

Related orders

What to expect

Immediate

  • Revocation of Executive Orders 13765 and 13813
  • Consideration of Special Enrollment Period for Federally Facilitated Marketplace
  • Launch of agency review of existing regulations and policies

Near term (90d)

  • Agency heads to review all existing ACA/Medicaid-related regulations orders guidance and policies
  • Identification of agency actions inconsistent with strengthening ACA/Medicaid
  • Consideration of suspending revising or rescinding inconsistent actions
  • Examination of Medicaid demonstration and waiver policies

Long term

  • Potential rulemaking to revise or rescind identified inconsistent agency actions
  • Implementation of additional enforcement actions to strengthen ACA and Medicaid
  • Structural shift toward expanded coverage and reduced barriers

Risks & tensions

  • 'As soon as practicable' language creates uncertainty on actual completion timelines; no hard deadlines specified
  • Special Enrollment Period is discretionary ('shall consider') not mandatory
  • Rulemaking process for revising rescinding actions faces potential legal challenges and delays
  • Revocation of prior EOs may not automatically reverse underlying regulatory changes already finalized
  • State-level Medicaid waivers and demonstrations may resist federal pressure to revise
  • Political and judicial opposition to ACA expansion could constrain implementation
Executive Order 14009: Strengthening Medicaid and the Affordable Care Act · Executive Orders