Feb 10, 2021 - Health

Democrats eye big ACA changes in COVID relief bill

Illustration of a wrench turn a red cross

Illustration: Sarah Grillo/Axios

Democrats' coronavirus relief proposal includes major changes to the Affordable Care Act, aiming to make health insurance more affordable for the millions of people who have lost their employer-based coverage during the pandemic.

The big picture: These changes would check off a whole lot of moderate Democrats' heath care agenda, at least temporarily. They include some of the biggest changes that President Biden campaigned on.

Driving the news: The House Ways and Means committee will begin considering its portion of the relief package today, and the Energy and Commerce Committee will follow on Thursday.

Details: The Ways and Means legislation would enhance ACA subsidies for two years.

  • People making up to 150% of federal poverty would be eligible for fully subsidized plans, and no one — regardless of their income — would pay more than 8.5% of their income for health insurance.
  • People receiving unemployment would also be eligible for full subsidies for a year.
  • The Energy and Commerce legislation incentivizes states that haven't done so to expand Medicaid.

What they're saying: “Since the enactment of the Affordable Care Act, we have talked about the need to build on and strengthen the policy. We have had virtually no opportunities to make a meaningful contribution toward that end legislatively," said Chris Jennings, a Democratic health strategist.

  • "This is the first real, significant down payment that we’ve been able to secure since the policy’s enactment.”

What we're watching: A large coalition of insurers, employers, hospitals and doctors — groups that often butt heads — support many of the components of Democrats' proposal.

Yes, but: Notably absent from all of this are policies that would meaningfully reduce the actual cost of care.

  • Increasing subsidies just means that the government would shoulder more of the burden, while the U.S's extraordinarily high prices go untouched.
  • Any attempt to control the cost of care would quickly erode any support from the health care industry.

What we're watching: "These subsidy enhancements, along with a new outreach campaign that reverses the 90% cut by the Trump administration, has the potential to supercharge the upcoming reopened enrollment period," said KFF's Larry Levitt.

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