ACA 2.0

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Last Friday I took an in-the-weeds look at the healthcare provisions of the pared-down (but still hugely significant) Build Back Better Act.

Well, as the long-gestating legislation finally heads into the endgame this week, there's been a last-minute rush to add to & change some provisions of the bill before it actually gets voted on, and earlier today, the House Rules Committee released a revised/updated version of the bill, including a handy comparison version which shows exactly what legislative language has changed since the prior version.

Many of these changes are either simple grammatical or wording tweaks to make sure it all passes legal muster, while others simply provide clarification. Other changes involve simply increasing or decreasing the amount of federal money which would be allocated to one program or another.

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UPDATE 11/19/21: The revised Build Back Better Act passed the House of Representatives this morning, so I'm re-upping this for a few days. It now moves to the Senate where it will likely be tinkered with a bit more; if it passes there, it will then move back to the House for one more final vote before hopefully being signed into law by President Biden. Make sure to also read about some additional revisions to the bill made after I wrote this post.

The legislative text of the updated Build Back Better (BBB) bill is now available, and as I suspected, for all the understandable disappointment about what isn't part of it any longer, there's a lot more healthcare-related stuff in there than most people think. A lot of it gets kind of wonky or may seem like "small potatoes" to most folks, but pretty much everything in it would make a huge positive impact on those it benefits.

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A couple of hours ago, the Biden White House posted a completely updated version of what's being described as a "framework" for his Build Back Better policy agenda, which has been significantly pared down from the more ambitious version last spring. There are three main reasons for this: Congressional/Senate Republicans as a whole; Senator Joe Manchin of West Virginia; and Senator Kyrsten Sinema of Arizona.

There's still no way of knowing whether or not this version of Biden's #BBB agenda will pass either, but assuming it does, here's what will make the final cut:

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Regular readers may have noticed that I haven't checked in on the status of #BidenCare (aka #ACA 2.0) since way back in early August. There's several reasons for this: At first I was swamped with my COVID vaccination/case/death rate project; then, more recently, I had to scramble to get my annual Rate Change project up to date.

Both of these have indeed monopolized my time, but the main reason is simply that President Biden's Build Back Better (BBB) plan (which ACA 2.0 is a part of) has gotten bogged down over the past few months due to infighting and intransigence by a handful of "moderate/centrist" Democrats in the House but especially by two Democratic Senators in particular (Joe Manchin of West Virginia and Kyrsten Sinema of Arizona).

(Needless to say, I'm not even mentioning any Republicans in either the House or Senate, since not a single one of them is willing to support the bill.)

It seemed a bit pointless to write up a lengthy, in-depth analysis of the latest developments on the bill when what does or doesn't have a serious shot at making the final cut kept changing every few days.

ACA 1.5

Welp. Back in March, I wrote a 3-part series about what types of healthcare policy improvements/upgrades might be in the offering now that Democrats have taken control of the White House, (just barely) retained control of the House of Representatives and (just barely) taken control of the Senate (mostly).

Given the razor-thin margins in both the House and especially the Senate, I was already cautioning people to pare back expectations for the 117th Congressional Session. No, Medicare for All wasn't gonna happen. No, Medicare for America wasn't gonna happen. I already knew that even President Biden's own less-dramatic federal Public Option was unlikely to happen.

At the time, however, it did seem like at least a few Big Ticket items might make the cut, hopefully including:

President Biden, Vice-President Harris, Speaker Pelosi

As expected, the healthcare section of President Biden's first address to a joint session of Congress (technically not a State of the Union, but close enough) included a call for making the subsidies expanded under the American Rescue Plan permanent as part of the American Families Plan.

Also as expected, he did not call for other major healthcare reform priorities to be baked into the #AmFamPlan.

He did, however, spend significant time calling for those other priorities to be passed separately from the AFP...considerably more than he did on the subsidies themselves.

Before I get into the proposed healthcare policies: Early on in the speech, Biden gave a shout-out to his Administration for the success of the current, ongoing COVID Special Enrollment Period:

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After weeks of anticipation and jockeying for policy priorities to be included by various advocacy groups, President Biden is set to formally roll out the American Families Plan at a speech to a joint session of Congress this evening...the first such speech of his administration, falling just ahead of his 100th day in office.

The first half of Biden's larger "American Infrastructure Plan" is the "American Jobs Plan" which addresses "hard" infrastructure like road & bridge construction/repairs, green energy investment, broadband access, overhauling our clean water system and so forth.

The #AmFamiliesPlan comprises the second half, and includes the following:

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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:

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