Health Provisions in the Build Back Better Bill
We still have about 25 million Americans who are uninsured, and our system of care is vastly over-priced compared to other developed nations which assure universal coverage at half the price of the US system. Build Back Better reduces the numbers of the nation’s uninsured, and reduces the cost of health care, and expands coverage, and increases access to care in very targeted ways. It builds on and enhances the existing public private system of financing and care delivery.
· Subsidies in the ACA’s Exchanges: Build Back Better extends the improved subsidies for Exchange enrollees provided in the American Rescue Plan passed earlier this year. They are as follows: elimination of the cap at 400% of FPL, elimination of premiums for families with incomes below 150% of FPL, an increase in subsidies for all persons buying coverage in the Exchanges and zero premium coverage for people receiving UI (Unemployment Insurance). This will help about 3.6 million people get subsidized coverage, increases coverage for about 2 million uninsured, and reduces premiums and out of pocket for about 12 million Americans already getting Exchange coverage. These changes are effective through 2025, and therefore will need to be reviewed and renewed in 2025.
· Medicare Hearing Benefit: This would add hearing aids and evaluation, rehabilitation, and treatment by audiologists for 62 million Medicare beneficiaries. Projected costs are $35 billion.
· Negotiations for Medicare Prescription Drugs: Negotiated prices apply to 10, then 15, then 20 of the fifty highest cost Medicare covered drugs beginning in 2025. Excluded are new drugs, those with generic or bio-similar competitors. Included quite specifically are all insulin products.
o Inflation Caps for Increases in Drug Prices higher than the CPI
o Out of pocket caps of $35 for insulin products for Medicare patients
o Coverage of adult vaccines at no cost to Medicare patients
· Redesign of the Medicare Part D coverage of prescription drugs: Sets a hard cap of $2,000 on patient out of pocket spending, reduces beneficiaries’ share of premiums, requires manufacturer rebates on high drug prices
· Eliminates the Medicaid Coverage Gap: Twelve, primarily Southern states led by Texas, Florida, and Georgia, have not extended Medicaid coverage to working poor parents and other low income adults. This would cover those 2.2 million or more uninsured adults through the federal Exchanges with no premiums, no deductibles, and nominal copayments; their incomes are less than 100% of the Federal Poverty Level. The ACA offered a 90/10 match for this coverage that has been rejected in these 12 remaining states; this expansion would be at full federal cost, no state match. This fixes a truly egregious and horrendously racist exclusion by the political decision makers in those 12 states.
· Extends Medicaid post partum coverage from 60 days to 12 months after delivery and authorizes maternal health homes.
· Extends Medicaid and CHIP (Healthy Families) coverage for children to 12 months of continuous coverage and permanently reauthorizes the CHIP program for uninsured moderate income children.
· Increases federal Medicaid funding to states for their home and community based services (HCBS) to the frail elderly and disabled: These are services like home health, chore and housekeeping services that help keep people out of nursing homes and other institutional settings. It would increase the federal match to the states by 6% for HCBS, if the states use these funds to reduce waiting lists (over 800,000 seniors), improve quality of care, and increase the workforce to meet family needs (i.e. pay these low wage aides a little more so we can get more people to do this essential work)
· 4 weeks of paid family or medical leave: The US is the only developed nation that does not provide for paid leave of employees; as a result only 1/4th of US workers have paid leave when they are very sick and cannot work, have recently given birth, or are caring for a seriously ill family member. This would be a sliding scale wage replacement --- 90% below $15,000, declining to 53% for wages between $32,000 and $62,000.
The pandemic exposed many of the faults and failures of the US health system – faults and failures many of us were quite simply unaware of, such as the failures of CDC and public health to act in a timely fashion to protect the nation’s health, the extreme levels of political interference in the performance of their duties to preserve and protect the nation’s health, and the rapid spread of lies, disinformation and fear mongering overwhelming the scientific truths about the COVID 19 pandemic, the vaccines and the treatments. But that’s another story for another day.
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Prepared by: Lucien Wulsin
Dated: 11/20/2021