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A shift in federal health-care policy appears to be underway.
As early as Thursday, President Joe Biden is expected to issue executive orders to temporarily reopen the health insurance exchanges and to address roadblocks encountered when low-income households try to access Medicaid. Although details are slim, the actions would reflect Biden’s broader goal of increasing health-care coverage and improving affordability.
“Opening up the marketplace would be helpful,” said Sara Collins, vice president for health-care coverage and access at The Commonwealth Fund. “A lot of people are out of work or losing their jobs and they haven’t enrolled.”
As for the Medicaid side, significant changes to eligibility requirements for people in the 12 states that have not expanded the program would likely require congressional action, experts say. It’s uncertain what would be included in an executive order.
The White House did not respond to a CNBC inquiry.
The presidential actions would come as a pending case before the Supreme Court challenges the Affordable Care Act, which authorized the exchanges and the financial help that enrollees can qualify for. Some experts have suggested that Congress could essentially upend the court challenge through legislation that addresses the tax penalty for noncoverage (setting it to $1) or other means.
Pre-pandemic, roughly 30 million individuals already were without coverage, a number that had been trending upwards for several years. On top of that, an estimated 2 million to 3 million workers lost employer-based health plans last year between March and September, according to the Kaiser Family Foundation.
Most enrollees in the marketplace receive subsidies (technically tax credits), which reduce what they pay in premiums. Additionally, they may qualify for help with cost-sharing like deductibles and premiums on certain plans.
An estimated 4 million uninsured individuals could get an ACA plan with no premium payment and 4.9 million more could get subsidies to reduce the cost of such a plan, according to the Kaiser Family Foundation.
The premium subsidies through the exchanges are available to families whose income is from 100% to 400% of the federal poverty level, based on household size. That translates into income from $12,760 to $51,040. For a family of four, it would be $26,200 to $104,800.
The marketplace subsidies that you’re eligible for are based on factors that include income, age and the second-lowest-cost “silver” plan in your geographic area (which may or may not be the plan you enroll in).
Meanwhile, in states that expanded Medicaid, you can qualify for coverage through the program if your income is no more than 138% of the federal poverty level. For an individual, that would mean up to $17,609; for a family of four, $36,156. It’s also worth noting that if you qualify for Medicaid, you can sign up at any time.
Biden also has other plans to expand coverage and affordability. His $1.9 trillion Covid stimulus proposal, unveiled last week, includes a provision that would limit the amount paid for health insurance premiums to 8.5% of income.
He also wants to subsidize COBRA coverage — the right to continue employer-sponsored insurance after job loss — through September. It remains uncertain whether these proposals will be included in any stimulus bill that gets voted on.
Separately, some of Biden’s health-care proposals face an uphill battle in Congress. The Senate is split 50-50 between Republicans and Democrats, with Vice President Kamala Harris getting the tie-breaking vote. However, many bills need a 60-vote majority to clear the upper chamber.
“Everything got a little bit more likely with the Senate Democratic majority, but it will all still be quite tough, given the numbers,” said Tricia Neuman, executive director of the Medicare policy program at the Kaiser Family Foundation.
She also noted that Democrats’ majority in the House is slimmer than it was pre-election. “That could make it harder to get difficult legislation through the House, much less the Senate,” Neuman said.
The proposals facing a headwind include a public health insurance option, which Biden has floated as an alternative that would operate similarly to Medicare. That is, it would negotiate rates with providers to keep costs down. He also wants to reduce the eligibility age for Medicare to 60 from 65.
U.S. health-care spending grew 4.6% in 2019, reaching $3.8 trillion, or $11,582 per person, according to the Centers for Medicare & Medicaid Services. Out-of-pocket spending grew 4.6% in 2019 to $406.5 billion, a rate of growth that was higher than the 3.8% growth tallied in 2018.