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:
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:
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.
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 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.
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.