$1.9-trillion Biden law takes major steps to reshape U.S. health and health care

The Biden Administration’s $1.9 trillion coronavirus pandemic relief law, called the American Rescue Plan, tackles one of the leading concerns expressed by American voters in repeated recent political campaigns: our health and health care. Foes have denounced it as wasteful and unfocused. But it arguably offers common sense federal responses to the worst public health catastrophe in a century.

The Biden measure gives a huge boost to battling the coronavirus itself, providing almost $60 billion for “vaccine and treatment development, manufacturing, distribution, and tracking, as well as Covid-19 testing and contact tracing,” according to media reports.

The Biden package, as the president promised, also expands health insurance coverage under the Affordable Care Act, albeit for at least two years. As the New York Times reported:

“The American Rescue Plan broadens the subsidies available under the Affordable Care Act for comprehensive health insurance — increasing them for people who are already eligible, and providing new assistance for people with incomes previously too high to qualify …The changes mean small adjustments for some Americans and very substantial ones for others. For anyone earning around $19,000, subsidies will now be generous enough to sign up for a typical plan with no monthly payment. For someone earning over $51,000, new subsidies could lower premiums by as much as $1,000 a month in the country’s most expensive markets.”

For those who do not get their coverage at work or whose income may be so low that they qualify in most states for help under the Medicaid program for the poor, it may be more than worth checking out New York Times articles on the enhanced ACA coverage, notably how to qualify and seek affordable options.

As for Medicaid, the Biden bill includes significant financial enticements for the states that have declined so far to expand this coverage program to do so.

The measure also includes help for the jobless who choose to maintain their employer health coverage under the pricey option dubbed COBRA, which forces employees to pay not only their share of a workplace policy but also cover the company’s considerable contribution.

Securing a better future for children

A portion of the ARP that is attracting considerable and positive attention seeks to provide greater help to the nation’s poor children. Here is how the New York Times described the bare bones of what the bill provides:

“For 2021, the bill would temporarily expand the child tax credit, which is currently worth up to $2,000 per child under 17. Under the legislation, the tax credit would be as much as $3,600 for children up to age 5 and as much as $3,000 for children 6 to 17. The bill would make the full value of the credit available to low-income people who are currently ineligible or receive only a portion. And for the second half of this year, it would have the federal government send advance payments of the credit to Americans in periodic installments, akin to a guaranteed income for families with children. The legislation would also expand the child and dependent care tax credit for 2021, and it would expand the earned-income tax credit for workers without children for this year as well.”

That may seem straight-forward enough. It has its own drama, though, providing huge hope for uplifting young Americans at a time when every boost can have significant lifetime benefits, advocates say. Here is how the Vox news site explained it, also quoting New York Times reporting:

“’Though framed in technocratic terms as an expansion of an existing tax credit, it is essentially a guaranteed income for families with children, akin to children’s allowances that are common in other rich countries,’; New York Times reporter Jason DeParle, the de facto dean of poverty journalism in America, wrote about the plan. According to an analysis by the Center on Budget and Policy Priorities, a center-left think tank, the child allowance on its own will cut child poverty by about 40% in 2021.”

Biden has signaled that he will push to make this part of the ARP permanent. Sen. Mitt Romney has offered a competing proposal, and the Republican’s very entry into this area of federal activity indicates a major political shift in what had been battleground in recent years, as often disagreeing New York Times commentators Paul Krugman and David Brooks both have noted.

The help with child credits and childcare, combined with the direct payments, food assistance, as well as support on housing and evictions, and heating and utility costs, will be significant for families, helping them get back or stay at work, uplifting them, advocates say.

It will be a boon for the working poor and middle class — which is what Biden and the Democrats targeted with their pandemic response, they say. This is confirmed by the New York Times graphic analysis (shown above) of who benefits from the ARP.

But Biden faces major political obstacles as he pursues any further parts of his agenda. That is because his rescue plan received zero GOP votes in the House and Senate.

A huge divide —  by politics and economics

Republicans, among other reasons, have suddenly turned into deficit and spending hawks — this after four years in which their control of Congress and the White House ran up record red ink, along with failing to effectively deal with the pandemic that has killed more than 530,000 Americans and infected almost 30 million. (Those figures are likely undercounted). Republicans have gotten aboard for an early $2-trillion coronavirus package and a belated $900-billion aid program.

After falling from political control of the nation’s capital, they somehow no longer can see that, as the progressive Center for Budget Policy and Priorities reported, based on U.S. data:

  • 7 million people either met the official definition of “unemployed” (meaning they actively looked for work in the last four weeks or were on temporary layoff) or lived with an unemployed family member in February.
  • Nearly 7 million children 22 million adults — 11% of all adults in the country — reported that their household sometimes or often did not have enough to eat in the last seven days, according to Household Pulse Survey data collected February 17-March 1.
  • Adults in households with children were likelier to report that the household did not get enough to eat: 14%, compared to 8%t for households without children. And 10%-15% percent of adults with children reported that their children sometimes or often did not eat enough in the last seven days because they could not afford it.
  • An estimated 13.5 million adults living in rental housing — nearly 1 in 5 adult renters — were not caught up on rent, according to data collected February 17-March 1.
  • Nearly 81 million adults — 35% of all adults in the country — reported it was somewhat or very difficult for their household to cover usual expenses in the past seven days, according to data collected February 17-March 1.

Meantime, the Washington Post reported this:

“The pandemic has been a boom time for America’s richest billionaires. The wealth of nine of the country’s top titans has increased by more than $360 billion in the past year. And they are all tech barons, underscoring the power of the industry in the U.S. economy. Tesla’s Elon Musk more than quadrupled his fortune and jockeyed with Amazon’s Jeff Bezos for the title of world’s wealthiest person. Facebook’s Mark Zuckerberg topped $100 billion. Google co-founders Larry Page and Sergey Brin gained a combined $65 billion.”

These figures are important to know because, as voters may well wish to recall, Republicans, after failing to strip tens of millions of Americans of health care by killing Obamacare in the first year of the Trump presidency, turned instead to tax cuts. At a time when the economy was sound, the GOP gave wealthy corporations and the richest of plutocrats in this country more than $2 trillion in tax cuts. Combined with a lack of fiscal rectitude during the 45th presidency, the nation is bleeding red ink.

While assailing Democrats for the ARP which tries to help ordinary folks, the GOP has come up with another give-away to a speck of the wealthiest. Republicans want to repeal the estate tax, which, as the Los Angeles Times reported:

“That’s a tax paid by 2,500 of America’s 153 million tax filers, all of whom are (or were) among the richest Americans. Also, 100% of those on whom the tax is levied are dead when the bill arrives. To owe any tax at all, an estate has to be worth more than $11.7 million … Currently the top tax rate is 40%, kicking in at $1 million of taxable assets. But the estate tax is subject to an exemption of the first $11.7 million for each spouse, meaning that the effective exemption for a married couple is $23.4 million … the average estate subject to the tax was worth $30 million…”

Really? In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

The pandemic, combined with unacceptable displays of excessive use of force by law enforcement, has laid bare the huge social and economic inequities that persist in the county and especially the $3-trillion-plus U.S. health care system. We cannot allow our problems to fester and grow any worse than they are now. We cannot be a nation riven, with the super rich exploiting and living in a separate and unequal world from the poor and middle class. We have much work to do to rebuild not just what the country looked like before the pandemic but something far fairer and better.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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