The Biden Administration's Health Care Reforms
During the Democrat national primary, President Biden appeared to be the most conservative candidate when it came to health care reform. He eschewed a government-run, single-payer system, or “Medicare For All,” that most of his opponents supported. Instead, he advocated for simply expanding Obamacare, since according to him, the Affordable Care Act has been working so well.
In point of fact, the ACA has been a failure based on the goals set by the Obama Administration. Rather than provide universal health insurance coverage, as was promised, it has insured only 20 million people, or 40 percent of those uninsured when it became law in 2010. Half, or 10 million people, were placed in the poor-quality Medicaid entitlement nationally. Eighty percent were placed in the Medicaid expansion in Washington state.
Americans were also told that Obamacare would bring down the ever-rising cost of health care and families would save $2,500 per year on health insurance. The exact opposite has occurred, with insurance premiums continuing to increase and government spending on health care continuing to rise.
Then there was the promise that “if you liked your doctor, you could keep your doctor.” Unfortunately, that was not true for thousands of Americans.
So, what is the Biden Administration now proposing to expand Obamacare? The details still need to be worked out and some of this will require legislation, but the goals are more taxpayer subsidies in the exchanges and a greater expansion of Medicaid.
Subsidies in the ACA exchanges are now available to anyone earning up to 400 percent of the federal poverty level, which for a family of four is $106,000 in 2021. The proposal is to increase the subsidy to anyone earning up to at least 500 percent of the FPL, or $132,500 in 2021.
Medicaid financing has always been shared between the federal and state governments. The matching in the original or traditional Medicaid is roughly 60 percent federal and 40 percent state money. Under the expansion in the ACA, the federal government paid 100 percent for the first three years, then gradually decreased its contribution to 90 percent starting in 2020.
To date, 12 states have not expanded Medicaid as allowed under Obamacare. Their main argument is that the expansion population is young and healthy and would crowd out traditional Medicaid enrollees who are sicker and more needy. As an incentive to these states, however, the Biden Administration would make the federal match more attractive by potentially using the 100 percent contribution for an unspecified period of time.
As a final non-legislative move, the Biden Administration has increased funding by millions of taxpayer dollars for outreach and marketing to promote and encourage enrollment in the Obamacare exchanges.
After the failure of major health care reform in 2017, the Trump Administration used executive orders to expand access and offer more health care choices. Several of these orders (the expansion of association health plans, short-term limited duration plans, and health reimbursement arrangements) are now under threat of being overturned by the Biden Administration using executive orders.
The overriding goal of the political left is a complete government-run health care system in the U.S. The proposals of the Biden Administration are simply incremental actions to achieve that goal.