Democrats eye big ACA changes in COVID relief bill

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.