This morning, healthcare reform advocacy organization Protect Our Care held a webinar in which they went over the results of a new national survey of 1,200 Americans conducted a couple of weeks ago called, simply enough, "Next Steps on Healthcare: What Voters Want".
For the most part, none of the results are terribly surprising:
Lowering the cost of healthcare and expanding affordable health insurance coverage is a top priority for a large majority of voters.
There's strong support across the board for three major healthcare proposals:
Lowering the cost of health insurance for people who purchase coverage on their own
Giving Medicare the power to negotiate with drug companies for lower prices
Giving low-income Americans who are uninsured the opportunity to obtain health insurance at little or no cost
Several of the questions were more about the framing of the issues--that is, which specific types of messaging work best.
As I noted last night, the healthcare provisions of the upcoming American Families Plan could be in jeopardy, due primarily to (wait for it) the liberal and progressive wings of the Democratic party squabbling over whether to pass ACA 2.0 or to beef up Medicare instead. Aside from the fact that this is likely a false choice (there seem to be several options available to pay for both, or at the very least to pay for large portions of each), this has also led to various factions of Democrats to move more assertively to ensure their priorities are included.
The New Democrat Coalition (NDC) consists of 94 mainstream House Democrats, including many of those who first took office after the 2018 midterms to help flip control of the House.
The Biden Administration's first major bill was, of course, the American Rescue Plan, which actually consisted of perhaps a dozen smaller bills which were debated and passed out of a bunch of different House/Senate committees individually before being merged together into the larger package bill.
The next major legislative effort in the works is supposed to be an even larger omnibus infrastructure bill, broken into two major sections: "The American Jobs Plan" and "The American Families Plan". The "Jobs Plan" is supposed to include so-called "hard infrastructure". Here's the summary of the major bullets according to the White House website:
The Urban Institute has come out with a brand-new analysis which projects the impact of making the ACA subsidies which have been expanded & enhanced temporarily under the American Rescue Plan permanent. In other words, this is what they expect the real-world impact would be if Congress were to finally #KillTheCliff and #UpTheSubs permanently (as opposed to for just 2021 - 2022), as I and other healthcare activists been pushing for for years now.
So, the American Rescue Plan includes two important provisions whch I've been fighting for for years: #KillTheCliff and #UpTheSubs. The only downside is that, for now at least, these ACA enhancements are only included for two years (including 2021...the beefed-up & expanded subsidies are retroactive to January 1st of this year).
As a reminder (this is like the 20th time I've posted a table like this), here's the official ACA subsidy formula compared to the improved formula under the American Rescue Plan (ARP):
Note: The Federal Poverty Level (FPL) is 15% higher per household in Hawaii and 25% higher in Alaska.
...there's also another small but critical detail included in the table above which escaped my attention last summer in H.R. 1425.
Take a look at the first line of Rep. Underwood's 2019 version (H.R 1868):
Over 100.0 percent up to 133.0 percent
Now take a look at the first line under both H.R. 1425 and H.R. 369:
Up to 150.0 percent
Notice the difference? I'm not talking about the "up to 150%" part. I'm talking about the removal of the "Over 100.0 percent" part.
If this were to pass the House & Senate and be signed into law by President Biden using this exact language, it would apparently eliminate the Medicaid Gap...albeit with a couple of major caveats.
UPDATE 4/13/21:An earlier version of this post had misinterpreted Linda Blumberg's estimate how much S.499 would cost--I thought that the $350 billion estimate was the gross projected 10-year cost without taking into account the impact of eliminating Silver Loading, but it turns out that it's the net cost after taking that into account as well. My apologies for such a bone-headed error.
Having said that, there's still the possibility of up to $196 billion in additional savings elsewhere, so it's still worth discussing the relative costs of both proposals and seeing whether both, or at least parts of both, could still be worked into the American Families Plan. I've significantly reworked the the wording of the post accordingly.
The White House is expected to roll out the health care priorities for its two-part infrastructure package sometime this Spring, and the health piece potentially could move separately now that the Senate parliamentarian has agreed Democrats have another shot passing their priorities through a simple majority. While there appears to be consensus that the bill will expand, or make permanent, the Affordable Care Act tax credits from the American Rescue Plan, other policies are less clear and will likely depend on the amount of offsets lawmakers can glean from drug-pricing measures.
Pelosi: Drug Pricing May Pay For Health Care Pieces Of Infrastructure Bill
House Speaker Nancy Pelosi (D-CA) said everything is on the table for the next legislative package that is expected to focus on infrastructure improvements and include health care provisions like a permanent increase to the Affordable Care Act tax credits — and she said the package likely will be paid for by tackling prescription drug prices.
...Pelosi said including House Democrats’ drug pricing bill, H.R.3, would pay for $500 billion of the cost of the infrastructure bill, part of which could be used to boost ACA tax credits and make ACA coverage more affordable. The savings also could also be used for other health-related efforts, she said. For example, House Energy & Commerce Chair Frank Pallone (D-NJ) has been working with Rep. Jim Clyburn (D-SC) to expand community health centers and to improve broadband services, which would support telehealth.
Sen. Mark Warner's Health Care Improvement Act of 2021 (S.352)
Sen. Michael Bennet & Sen. Tim Kaine's re-introduced "Medicare X" Act (S.386, I believe)
Sen. Jeanne Shaheen's Improving Health Care Affordability Act (S.499)
Of the three, the one which seems most likely to actually have a shot at passing both the House and Senate and being signed into law by President Biden during the 2021 - 2022 legislative session is Sen. Shaheen's S.499, which would:
