Former vice president and presumptive Democratic presidential nominee Joe Biden demanded that the Trump administration reopen enrollment in the Affordable Care Act health insurance exchanges, as millions of Americans—many of them newly unemployed—face the prospect of enduring the coronavirus pandemic without access to healthcare. 

“During this outbreak, when health care coverage is more important than ever, Donald Trump is refusing to give those who have been uninsured access to the best resource we have: the Affordable Care Act’s marketplaces,” Biden said in an exclusive statement to The Daily Beast, in which he called it “critical” that Trump reverse his opposition to reopening the Healthcare.gov federal health care exchange for a special enrollment period.

“This is no time to put pettiness and ideology above helping those who are in the greatest need,” Biden said, calling the spread of the novel coronavirus “the worst public health crisis in generations”—one for which the president failed to prepare the nation, “despite warning after warning.”

Biden’s statement reflects the fervent desire among many Democrats to make health insurance expansion a policy priority as the coronavirus continues to spread across the country and dislodges millions of people from their workplaces. Trump has faced mounting pressure to allow for a special enrollment period so that individuals who don’t have insurance can purchase it.

Last week, Trump told reporters that reopening the exchanges in light of the unique and dire circumstances was “something we’re talking to a lot of people about.” By this week, however, the administration had rejected the idea, dumbfounding health officials, insurers, and various others who’d hoped they would, or expected them to do so.

In meetings at the White House in the time between his stated consideration and his announced rejection of the idea, Trump on multiple occasions had referred to Obamacare as “a failure,” and questioned why the administration should bother helping to prop it up, according to a source with direct knowledge of his private remarks.

And during a press briefing on Thursday, Trump reaffirmed that he was against leaning on Obamacare exchanges to help the uninsured get coverage in light of a growing pandemic. The president told reporters that he had a supposedly “better” idea. 

“We are going to get a cash payment to the people and we are working out the mechanics of that with the legislature,” he said. “So we are going to try and get them a cash payment because just opening it up doesn't help as much, so we're going to work it out… for that certain group of people a cash payment.”

But the term “cash payment” confused even some of the president’s own White House officials—two of whom messaged The Daily Beast while the press briefing was still ongoing that they had no idea what Trump meant by “cash payment” in lieu of enrollment. One senior official joked that they had not, in fact, heard about any proposals floated internally to airdrop “bags of cash” to people who’d just lost their jobs and health insurance. 

When The Daily Beast asked the president Thursday night what he meant by delivering “cash payment” to offset loss of coverage, Trump stared blankly before quickly kicking it over to Vice President Mike Pence to try to explain the confusing new announcement. Pence’s answer, however, related to funding hospital treatment of coronavirus victims, not to any direct cash payments to workers seeking healthcare.

Though Congress has passed three different coronavirus relief bills, lawmakers have not yet approved any legislation to reopen Obamacare’s exchanges or to cover all coronavirus-related health costs for Americans. The crisis, however, has grown only more dire. Individuals who lose employer-based health insurance are allowed to shop for new plans on the Obamacare exchanges, and a handful of states do still have active open enrollment periods.

But of the nearly 10 million Americans who have applied for unemployment benefits in the past two weeks, only 3.5 million are estimated to have lost their insurance along with losing their jobs—meaning that roughly two-thirds of those who lost their jobs lack access to the insurance marketplace during a pandemic. Some of those individuals may qualify for Medicaid, but experts say not everyone will be able to. 

Democratic congressional leaders say they will fight to include such provisions to address lack of access to insurance in a widely-anticipated fourth round of coronavirus-related legislation, which could come as soon as this month.

“We should open it,” said Sen. Chuck Schumer (D-N.Y.), the Senate Democratic leader, when asked about the exchanges by The Daily Beast on a Friday conference call. “This is a crisis; any way we can help people try to get health care, we should do it.”

Schumer also referenced Trump and Pence’s comments about “cash payments,” saying that the “administration is twisting itself into knots to come up with far-fetched theories that don’t get at the real problem.” 

The Daily Beast reached out to a dozen GOP congressional offices to ask if they support opening the exchanges, but none responded. Key GOP lawmakers, however, have done more in recent years to shore up Obamacare than to dismantle it, and the party could warm to special enrollment as a way to ward off more aggressive Democratic health care measures, like Medicaid expansion, that are being proposed as a response to the coronavirus.

The lack of federal help so far has led some states, like Washington, to take their own action. In a statement to The Daily Beast, Washington Gov. Jay Inslee, a former 2020 Democratic presidential candidate, called on leaders to make sure people “get the medical care they need—especially as millions face the possible loss of coverage through their employer.”

“That’s why Washington state’s Exchange just made the decision to extend our special enrollment period for anyone without insurance to get covered through May 8,” Inslee said. “As states grapple with a rapidly evolving public health emergency, the federal government should do the same.”

A similar sentiment was echoed by Michigan Gov. Gretchen Whitmer. Both her state and Inslee’s have become focal points of the coronavirus pandemic, and both have been criticized by Trump in the midst of the health crisis. Last week, Trump bragged about telling Pence, the leader of the coronavirus task force, to skip calling the leaders of those two hard-hit areas. 

“If they don’t treat you right, I don’t call,” Trump said at the time. 

Whitmer said in a statement she would keep working on both the federal and state level, along with the private sector, to boost healthcare access. But she was “disappointed that the Administration is refusing to allow for a special enrollment period under the Affordable Care Act.” 

Thirteen GOP governors’ offices were also asked by The Daily Beast about the Trump administration’s decision, but only one responded with a comment. 

“Ohio is aware of this issue,” a spokesperson for Gov. Mike DeWine said in an email. “Our Ohio Department of Insurance is monitoring the situation closely.”

Advocates for healthcare reform have accused Trump of opposing reopening the exchanges because he is hostile to the Affordable Care Act itself, evidenced by his administration’s continued attempts in federal court to strike down the landmark 2010 legislation.

“President Trump’s calling card is dangerously undermining our health care system with baseless attacks of Medicaid, sabotage of ACA exchanges, and toxic proposed budget cuts to Medicare,” said Kyle Morse, a spokesperson for the liberal PAC American Bridge. “With 3.5 million people losing employer-sponsored health coverage in the middle of a pandemic, Donald Trump’s decision to keep the exchanges closed for business will lead to higher death tolls and medical bills. Uninsured Americans are already being denied care and dying from Coronavirus, Trump’s decision all but ensured that more will follow.”

Biden told The Daily Beast that the president’s continued pursuit of that case would eliminate health coverage for tens of millions of people.

“Trump must also withdraw his support for a partisan lawsuit that would undo the Affordable Care Act and take health coverage away from almost 20 million Americans,” Biden said.