We discuss Biden’s American Families Plan proposal, which Biden unveiled in his first State of the Union address last week (spoiler: it’s rather underwhelming) and the industry lobbying that made it happen. Then we discuss the proposal to expand Medicare that came from Reps and Senators – both progressives and moderates – and what it may signify in the fight for Medicare for All.
Today we celebrate Stephanie’s first dose of vaccine and Biden’s first 100 days.
(Spoiler alert: #underwhelming)
While Ben and Stephanie liked the President’s non-healthcare progressive priorities like paid family and medical leave, subsidized childcare for low income families, and increasing taxes on the very wealthy, they’re disappointed in the healthcare vision Biden laid out.
Ben and Stephanie first review the healthcare components of the American Rescue Plan, passed on March 10. This plan included $1,400 payments as well as 100% subsidy of COBRA (the very expensive program that allows employees who have lost their jobs to pay for their past employer’s health insurance plan) premiums. It also removed the income limit on ACA premium subsidies for anyone whose health insurance premium costs more than 8.5% of their income, and increases subsidies for low income households. All of these policies will sunset, or die off later this year or in a few years.
During the State of the Union, President Biden also talked about proposals that aren’t actually in the American Families Plan: a public option, lowering the Medicare eligibility age to 60, extending subsidies to low income people in states without Medicaid expansion, and letting Medicare negotiate drug prices.
The actual American Families Plan only has one healthcare proposal: the ACA subsidies from the Rescue Plan will be made permanent. This will affect about 9 million people, less than 3% of the population, at a time when 30 million have no insurance, and more than 60 million are seriously underinsured. While this expansion will help this small group, it sends more tax dollars to a private, profit-driven insurance industry. Not the big bold reform those of us who believe healthcare is a human right and a public good hoped for.
Coincidentally, back in December America’s Health Insurance Plans (AHIP – the industry lobbying organization) and Blue Cross called on Congress to fully subsidize COBRA and expand subsidies for private ACA plans, as a response to the COVID-19 pandemic. Interesting that this is the exact proposal made by President Biden in the Rescue Plan and Families Plan. Hmm.
Ben and Stephanie also discuss the alternative proposal sent to Biden by members of Congress (Seventeen Democratic Senators and 80 Democratic Representatives), calling for the American Families Plan to include an expansion of Medicare eligibility to age 60, cover hearing, dental, and vision, and introduce a cap on out of pocket expenses. Interestingly, the letter signers include a lot of centerist leadership, not just the typical Medicare for All supporters.
This plan isn’t a clear win for us: we assume Medicare Advantage, the private insurance alternative to traditional Medicare, will continue to siphon taxpayer dollars into private coffers. Also, bringing in 60-65 year olds, we won’t get the cost savings we would get by bringing all Americans in. But bringing more people and some additional benefits into Medicare would help build confidence in public healthcare, potentially making it easier to build a case for Medicare for All.
Ben does some coalition math on this alternative plan: the insurance industry would probably like this plan, because it would take the most expensive people (those 60-65 years of age) out of the private employment-based insurance pool, leaving younger and cheaper policy holders for insurance companies to profit off of. The opposition will come from hospitals and providers, because Medicare pays them less than private insurance does. On the other hand, to win Medicare for All, we want the support of doctors, and the opposition of the insurance industry.
Our next episode will be a M4A mailbag: we’ll take question from listeners, so make sure you’re on the Healthcare-Now email list to submit your question!
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