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Joe Biden’s health care plan is built upon the Affordable Care Act (also called ACA or “Obamacare”). It is not a direct copy, however. Joe Biden’s health plan starts with the ACA, and builds up from there. The purpose is to make sure everyone can afford good health insurance coverage.

Building on the Affordable Care Act

Making it More Affordable

Right now, families and individuals that make between 100% and 400% of the federal poverty index may receive a tax credit to help them pay for premiums on ACA insurance purchased through the Marketplace. The dollar amount eligible families and individuals receive was designed to ensure that families don’t have to pay more than a certain percentage of their income on health insurance premiums.

The dollar amount of of the tax credit that eligible families and individuals receive was based on a silver plan. But, that amount is still too high for some eligible families or individuals to pay for.

Another problem hits families that make more than 400% of the federal poverty level (which is about $50,000 for a single person and $100,000 for a family of four). These people don’t qualify for financial assistance in the form of a tax credit that can be used to pay for their ACA health insurance premiums. This makes ACA plans too expensive for them to afford.

Joe Biden will fix this problem by eliminating the $400,000 cap on tax credit eligibility. Doing so would allow individuals and families who make more than 400% of the federal poverty level to be eligible for tax credits that they can use on an ACA plan from the Marketplace.

The Biden Plan is also going to increase the size of tax credits by basing them on a gold plan – the most generous plan on the Marketplace – instead of the silver plan. Doing so gives more people the ability to afford more generous coverage.

Expanding Medicaid

The Affordable Care Act expanded Medicaid eligibility for low-income Americans. Unfortunately, governors and legislators in some states, including Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin and Wyoming, still refuse to expand Medicaid eligibility.

Some states have tried to implement work requirements in order for low-income people to be eligible for Medicaid. On March 27, 2019, U.S. District Judge James Boasberg blocked Kentucky from implementing their work requirements and Arkansas from continuing its program. At the time, more than 18,000 Arkansas enrollees had lost Medicaid coverage since that work requirement mandate began.

Judge Boasberg said that the approval of work requirements by the Department of Health and Human Services “is arbitrary and capricious because it did not address… how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

In February of 2020, residents of Kentucky and Arkansas brought an action to the U.S. Court of Appeals for the District of Columbia. Their argument was that Secretary of Health and Human Services Alex Azar “acted in an arbitrary and capricious manner when he approved Medicaid demonstration requests for Kentucky and Arkansas” (referring to the work requirements).

Joe Biden believes that access to affordable health insurance shouldn’t depend on the politics of the state that you happen to live in. The Biden Plan will ensure that people who are eligible for Medicaid – but aren’t getting it due to the politics of their state government – will get Medicaid coverage.

The coverage will come through the premium-free public option, which will cover the full scope of Medicaid benefits. States that have already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option (as long as those states continue to pay their current share of the cost covering those individuals).

Biden’s plan will ensure that people making below 138% of the federal poverty level get covered. They will automatically be enrolled in the premium-free public option when they interact with certain institutions (such as public schools), or other programs for low-income people (such as SNAP).

What is the Public Option?

Biden’s Plan includes something for people that don’t like “Obamacare”. It is called the public option. It is similar to the premium-free public option that people who are eligible for Medicaid would receive. Those who make too much money to be eligible for Medicaid can purchase a public option health insurance like Medicare.

To be clear, the public option is not a “Medicare for All” plan. In my opinion, it might serve as the basis upon which a true “Medicare for All” plan could be built up from. At the start, however, the public option plan will require people to pay for it.

The good news is that, just like with the Medicare we know today, the public option would reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It will better coordinate among all of a patient’s doctors to improve efficacy and quality of care. Primary care will be covered without any co-payments.

Whether you’re covered through your employer, buying your health insurance on your own, or going without coverage altogether, Biden will give you the choice to purchase a public health insurance option like Medicare.

Small businesses that find themselves struggling to afford health insurance coverage for their workers could find relief though the public option plan.

Vox has an article that was written by Matthew Yglesias in July of 2019 that provides a good explanation of why Biden’s public option plan would be a great choice for many people:

…Medicare pays lower unit prices than almost any private health insurance plan because it’s such a big program that it’s able to drive a very hard bargain. Biden is promising to unleash that same bargaining power on behalf of a public option available to all Americans — which should generate an insurance option that is cheaper for patients and stingier to providers. That’s why the Partnership for America’s Health Care Future — a joint venture of the American Medical Association, the American Hospital Association, and a bunch of other health industry groups — don’t like it. Industry likes the idea of government-subsidized health care but hates the idea of government-orchestrated bargaining over prices.

But that’s why Biden’s proposal would be a much bigger deal than the hypothetical ACA public option. By using Medicare purchasing power, the public option would deliver lower premiums, which would make it a very attractive option for all kinds of people who currently have private insurance. Nobody would be “forced” onto the public plan, but in practice lots of people would opt for it…

Lowering the Cost of Prescription Drugs

Companies that make prescription medications currently do not have to negotiate with Medicare over drug prices. This causes the cost of medications to be too high for many people who are covered by Medicare (including seniors and people with disabilities).

Biden’s plan will change that by repealing the existing law that explicitly bars Medicare from negotiating lower prices with drug corporations. Remove that law, and pharmaceutical companies will have to negotiate lower prices with Medicare.

The result will be much lower costs on prescription drugs for people who are currently covered by Medicare. It will also benefit those who chose to purchase Biden’s public option.

In addition, Biden’s Plan will limit launch prices for biotech drugs that have little to no competition. Under the Biden Plan, the Secretary of Health and Human Services will establish an independent review board to asses the value of biotech drugs.

The board will recommend a reasonable price, based on the average price in other countries. This is called external reference pricing. In short, it means finding out what a medication costs outside of the United States, and negotiating with pharmaceutical companies for a reasonable price. This will lower the cost of prescriptions for people who use Medicare or the public option. Biden’s Plan will also allow private “Obamacare” plans that participate in the individual Marketplace to access a similar rate.

Biden’s Plan will also allow consumers to buy prescription drugs from other countries. Personally, I think this is a fantastic idea! It would force pharmaceutical companies to lower their costs in order to compete with the less expensive medications from outside of the United States.

Biden’s Plan also will improve the price of generic medication by accelerating the development of safe generics. This could be done via The CREATES Act that would ensure that generic manufacturers have access to a sample of a brand name drug.

But Wait, There’s More!

Here are more things that Biden will do to protect people’s access to health care:

  • Stop “Surprise Billing”: Would put an end to unexpected medical bills that consumers get stuck with because they had no way of knowing that a specialist at a hospital who treated them was not part of their insurance company’s network. Biden’s plan would bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider they see (for example, during a hospitalization). California passed a law in 2017 that banned “surprise billing”.
  • Expand Access to Abortion: Biden’s supports repealing of the Hyde Amendment. That controversial amendment was passed in 1976 (just a few years after Roe v. Wade). It barred federal Medicaid funds from being used for abortion – except for instances in which the woman’s life would be endangered by carrying out the pregnancy. The Hyde Amendment prevents low-income pregnant people who want an abortion from obtaining one because they can’t use Medicaid to pay for it.
  • Reverse the Trump Administration and states assault on women’s right to choose: Biden will work to codify Roe v. Wade and his Justice Department will do everything in its power to stop state laws that prevent pregnant people from getting abortion.
  • Biden will rescind President Trump’s “Mexico City Policy”. It is also called the “Global Gag Rule” because it prevents global health organizations that provide help for malaria and HIV/AIDS in developing countries from providing that aid if they also offer information on abortion services.
  • Restore Federal Funding to Planned Parenthood: Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information. Biden will reverse the Trump Administration’s rule preventing Planned Parenthood and other family planning programs from obtaining Title X funds. Those funds are used to provide contraception, treatment of STIs, preventative services (screening for breast and cervical cancer), pregnancy tests and counseling, and educational programs.
  • Reduce the Maternal Mortality Rate: Biden will institute a strategy that California came up with in which “crash carts” are used in hospitals to ensure that doctors can save the life of a person who has a hemorrhage while giving birth (or after giving birth). The maternal death rate for Black women is more than three times higher than the rate for non-Hispanic white women. The “crash carts” halved California’s maternal death rate.
  • Defending Health Care Protections for All, Regardless of Gender, Gender Identity, or Sexual Orientation: Biden will overturn the Trump Administration rule that removed the “ObamaCare” nondiscrimination protections for sex and gender identity. It was released during Pride Month and targeted people who are LGBTQ+. It allowed doctors, receptionists, janitors, and anyone else working in a health care office to deny care to people who were LGBTQ+, and to people who were seeking contraception or abortion.
  • Expanding Access to Mental Health Care: Biden will continue to make efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.

Key Things to Know About Joe Biden’s Health Care Plan is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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