$1.9 trillion pandemic relief bill also carries big boost for health care coverage

brooks-lasure-150x150With millions of Americans now eligible to seek affordable health insurance on Obamacare exchanges newly re-opened to them, even more consumers will want to see if Congress’ impending action on the $1.9 trillion coronavirus pandemic response plan pushed by President Biden further expands coverage options.

The Democrats in Congress have made clear that they hope to get Biden’s financial package passed and in place by mid-March, when earlier approved pandemic plans, notably for unemployment insurance and other economic aid, are set to expire.

Their vote margin is so narrow, however, that they may need to rely on so-called budget reconciliation paths to pass the “American Rescue Plan,” a measure that includes an array of Democratic initiatives, notably those involving their plans to improve the access and affordability of health care, especially with greater coverage of the aged, poor, children, as well as the chronically physically and mentally ill.

The plan goes beyond what Biden already could do by executive order — allowing millions of poorer, middle-class, and recently unemployed Americans to seek policies, often with significant subsidies, on ACA exchanges opened for a special enrollment period.

As the Vox news site explained:

“The Covid-19 relief package … could expand health care coverage to millions of people, the most significant step in the last 10 years toward patching up some of the holes in [Obamacare].The ACA led to a historically low uninsured rate in the US — 8.6% in 2016 — but the number of uninsured Americans started ticking up again during the Trump administration, rising to 9.2% by 2019. Then millions of people lost their insurance (along with their jobs) during the coronavirus pandemic. The Covid-19 relief plan is trying to move the rate back in the other direction. The most effective provision would be a two-year expansion of the ACA’s premium subsidies, which Americans can use to purchase private health insurance on the marketplaces the law established. The House version of the Covid-19 relief bill would increase the size of the subsidy for those already eligible for assistance (people making between 100% and 400% of the federal poverty level). It would also extend subsidies for people earning more than 400% of the poverty level, ensuring that nobody would pay more than 8.5% of their income for health coverage.

“This would provide help to one of the populations left out of the ACA: the roughly 2.6 million people who make too much money to qualify for subsidies and are currently uninsured. Based on prior estimates of such a proposal, somewhere between 4 million and 5 million people would be expected to gain coverage as a result of expanding the subsidies. The Biden administration has already opened ACA enrollment to everybody until May 15, which would give people an immediate opening to take advantage of the new benefits.”

Don’t underestimate the math in this proposal. Do consider that it would be a boon to middle-class and gig workers, a sizable and growing group that has been hit hard by coverage costs, which were neither supported by employers (the source of health insurance for most Americans who work in “regular” jobs) nor helped by the government, specifically the ACA.

A major boost for the neediest

For even more vulnerable and poorer people, the Biden proposal also could be a big deal. That’s because it would up the ante with increased federal support for a dozen states that have declined to expand Medicaid. As Vox explained this element of the Democrat-supported measure:

“Under the Covid-19 relief bill, if a state expanded Medicaid now, it would receive a 5% bump in federal funding for its traditional Medicaid population for the next two years. Because many more people are covered by traditional Medicaid than by the expansion, that funding bump would be expected to more than cover the 10% share states are asked to pay for Medicaid expansion under the ACA. It’s a new way to sweeten the expansion deal, which already comes with a permanent 90% federal match for expansion enrollees, for the holdout states.”

As the independent, nonpartisan Kaiser Health News Service also reported:

“Medicaid, the half-century-old health insurance program for the poor and people with disabilities, and the related Children’s Health Insurance Program cover more than 70 million Americans, including nearly half the nation’s children. Enrollment surged following enactment of the health law, which provides hundreds of billions of dollars to states to expand eligibility to low-income, working-age adults. However, enlarging the government safety net has long been anathema to most Republicans, many of whom fear that federal programs will inevitably impose higher costs on states. And although the GOP’s decade-long campaign to ‘repeal and replace’ the health law has largely collapsed, hostility toward it remains high among Republican voters.”

The Biden Administration will need to steer any further Medicaid expansion, notably in big states like Florida and Texas, with great political skill, KHN reported.

It has shown a flash of this already, likely side-stepping for now a running court battle with conservative states that had sought to curtail Medicaid enrollment and usage by imposing draconian requirements on benefit recipients. These efforts included forcing them to seek work (even if it was crystal clear they lacked the physical or cognitive capacity to do so) and to report frequently on their efforts to do so (even if they were too poor, for example, to have the needed computers and online access).

A new leader at Medicare, Medicaid agency

After a bit of back-and-forth, the administration has found a seasoned and respected leader for the Centers for Medicaid and Medicare Services (CMS), which has vital roles in overseeing not only the two pillars of the U.S. social safety net but also nursing homes and other long-term care facilities.

As the Washington Post reported:

“President Biden has selected Chiquita Brooks-LaSure [shown above] to lead [CMS. She] served in the Obama administration as a senior CMS official who helped implement the Affordable Care Act’s coverage expansion and insurance-market reforms. She also worked on Capitol Hill as a Democratic staff member for the House Ways and Means Committee, building ties with then-Rep. Xavier Becerra, Biden’s choice to lead the Health and Human Services department and who sat on the committee at the time … If confirmed by the Senate, she would run the $1 trillion agency that oversees Medicare and Medicaid — vast public health insurance programs for older Americans and for the poor. The agency also is responsible for large parts of the Affordable Care Act, including the insurance marketplaces through which millions of Americans buy coverage.”

The news site Politico reported on the importance of the CMS appointee’s strong and important working relationship with nominee Becerra:

“Biden’s team has been mindful of avoiding a personality clash between two of the administration’s most high-profile health care jobs, said one source familiar with the discussions.Trump’s last HHS secretary, Alex Azar, and his CMS administrator, Seema Verma, infamously sparred over department priorities and personnel decisions, disrupting work on the previous administration’s health agenda.”

By the way, Brooks-LaSure will be the first African-American woman to serve in the top CMS role, and Becerra will be the first Latino HHS secretary, if confirmed.

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.

For too many years now, political partisans, notably in the GOP, have hijacked the national conversation about health care into a fierce, counter factual battle over health insurance alone. Republicans have in almost theological fashion insisted that health care is a privilege, not a right, and that the federal government should have next to zero role in this vital area of Americans’ lives.

Health insurance is not the alpha and omega. It has become a crucial way for all of us — one unfortunate blink away from catastrophic illness or injury — to share the bankrupting burdens of medical services, and, in times of dire and persistent need to benefit from a shared, collective altruism.

Voters have rejected politicians’ efforts to improve the access and affordability of health care, notably with expanded health insurance via the ACA. GOP resistance has arguably cost the party its hold on the House, Senate, and White House. Americans have made clear in the last several campaigns that they want help with soaring medical costs, and they do not want to pay more than any other western industrialized nation for health care that has poorer outcomes.

Lots of posturing and political rhetoric will flow in the days ahead, as the Biden plan comes up for important congressional votes. Democratic progressives may sigh and say they want a single payer system, aka the Medicare for All so thoroughly discussed in the presidential campaign. Naysayers may look at the Biden health measures and note that they may require revisiting as soon as in two years.

Political circumstances change, post haste, these days. But it is getting harder and harder for opponents to argue against the increasingly entrenched idea that, in the world’s wealthiest nation, health care is a right, not a privilege, and improving its quality, access, safety, and affordability are all good goals that we must press on to get done.

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