Included in the $1.9 trillion American Rescue Plan (ARP) that President Biden signed into law last Thursday is an estimated $34 billion to fund the Affordable Care Act’s most significant expansion since Congress passed the ACA in 2010.
The new law is expected to extend health insurance coverage to about 2.5 million uninsured Americans, according to a recent analysis from the Congressional Budget Office.
“The American Rescue Plan will be the biggest coverage expansion in the 11-year history of the Affordable Care Act (ACA),” said a spokesperson for the federal Department of Health and Human Services. Now that the bill is signed into law, HHS will provide additional information about implementation.
As Jessie Hellmann reported for Modern Healthcare, the law includes $34 billion to allow uninsured consumers to get coverage under the ACA, expands eligibility for ACA subsidies for those whose annual income is above 400% of the federal poverty level and raises the ACA subsidies for those with low incomes. Under the ACA, health insurance subsidies technically function as premium tax credits.
At CNBC, personal finance reporter Sarah O’Brien explains that for two years, the ARP removes the cap that the ACA places on income for those who enroll through the federal health exchange (at HealthCare.gov) or a state-based marketplace. That income cap limited the amount of health insurance premium tax credits available to enrollees. Instead, the ARP limits what an individual or family would pay for health insurance to 8.5% of household income. Also, anyone who received too much in tax credits last year will not need to pay back that amount, she said.
Most of the 11.5 million Americans who are already enrolled in exchange-based health plans and receive premium tax credits will be able to recalculate those credits after the new law takes effect.
Soon after the House vote on the bill last Wednesday, the Kaiser Family Foundation (KFF) published a revised version of its 2021 Health Insurance Marketplace Calculator. The revision includes the increased premium tax credits available to those buying coverage on their state’s health insurance exchange.
Journalists can use the calculator to explain to the millions of uninsured consumers how the ARP will help them get covered during the special enrollment period that HealthCare.gov began last month. That special enrollment period runs through May 15, as we reported last month. The federal marketplace serves 36 states. The marketplaces in the remaining states also have opened special enrollment periods, though the dates vary.
The KFF calculator will be useful for showing what consumers might expect to pay for health coverage by entering their age, income, family size and zip code. It reflects the actual cost of health plan coverage in each region and the changes in how the marketplaces calculate tax credits under the ARP, the foundation said.
In an analysis of the bill in the journal Health Affairs, Katie Keith explained that the law could bolster enrollment during the three-month special enrollment period that ends May 15 — but only if the law is implemented quickly.
The Congressional Budget Office has estimated that the ARP will extend coverage to about 800,000 uninsured people in 2021, 1.3 million uninsured consumers next year, and 400,000 uninsured in 2023, she noted.
The bill also will provide subsidies for those who have health insurance coverage under COBRA to about 600,000 uninsured Americans, she added.
COBRA is short for the Consolidated Omnibus Budget Reconciliation Act, which since 1985 has enabled workers and their families to pay for their former health insurance coverage that they may have had through an employer but lost due to a job loss or other circumstances. Consumers are likely to welcome federal assistance to help them pay for COBRA coverage, which can be costly, as Business Insider reported last year.
The Center for Children and Families at the Georgetown University Heath Policy Institute produced a report explaining new provisions in the law to provide more funding for states to expand enrollment in Medicaid and strengthen the Children’s Health Insurance Program. The law also includes funding for extended postpartum coverage to address the maternal mortality crisis, the report said. Other provisions in the law would allow Medicaid programs to cover COVID-19 vaccines and treatments for the uninsured and more financial support for home- and community-based services for those needing long-term care.