House American Rescue Plan Act Would Extend Affordable Health Coverage to Millions Struggling Amid Pandemic

FOR IMMEDIATE RELEASE

February 26, 2021

CONTACT:        Kathy Melley, (617) 791-070

                         kmelley@communitycatalyst.org

(BOSTON, MA) -- Today, the U.S. House of Representatives will vote on the American Rescue Plan Act of 2021, comprehensive legislation to provide economic relief to people in response to the COVID-19 pandemic’s devastating impact on the country. The need for relief is urgent. With the death toll hitting 500,000 and the economic fallout showing no sign of abating, millions are still struggling to access health care, pay rent and put food on the table. Recent polling shows strong support among the public for more relief now. The House bill makes much-needed investments to help expand access to health care, advance health equity, beat the pandemic, and put people across the nation on the path to recovery.  It’s is an important step to providing relief to millions of families, but there is so much more that needs to be done to address the deep inequities in our nation’s health system.

Statement of Emily Stewart, executive director of Community Catalyst, on today’s House vote on the American Rescue Plan Act.

“The House American Plan Rescue Act would pave the way to more affordable health coverage and care for millions of people across our nation still struggling with pandemic’s impact on their health and economic well-being. By lowering premiums for ACA coverage and creating additional incentives for Medicaid expansion, the House bill would make health coverage more affordable and available at a critical time. This is particularly important for Black and brown people, who are more likely to work in essential jobs that don’t provide employer-based coverage and to live in states that haven’t closed the coverage gap.

“We are also encouraged that the House bill supports more equitable distribution of the COVID-19 vaccine. Implemented properly, these investments will save lives by prioritizing access for Black, Latino and Indigenous people, who have borne the brunt of the pandemic. The bill’s deeper investment in housing, food security, unemployment and financial assistance, including raising the minimum wage, would provide the relief and stability people need to come out of the crisis stronger.

“Even as Congress works to pass this critical legislation, it’s important to remember that the work to build a just and equitable health system is only beginning. The COVID-19 pandemic has exposed all the ways our health system fails our communities and country. The American Rescue Act should be understood for what it is: an immediate relief package. What must come next is the more essential and harder work of confronting the structural inequities that have both allowed COVID-19 to thrive and put health so far out of reach for so many people and families in our country. Community Catalyst urges the House to pass the American Rescue Plan Act, and will keep pushing for the bigger reforms our country so desperately needs.”

BACKGROUND 

AFFORDABILITY OF COVERAGE 

The House American Rescue Plan Act provides temporary premium assistance for Marketplace enrollees as well continuation coverage for enrollees in COBRA while creating special rules for premium assistance reconciliation.  

  • For 2021 and 2022, the House bill eliminates or reduces premiums for millions of Marketplace enrollees. Under this provision, premiums would be eliminated for those below 150% FPL — consistent with current Medicaid law. Premiums would also be lowered for everyone else currently eligible for premium tax credits and a new cap on the total amount of income a person would have to pay would end the “subsidy cliff” under which a small change in income could result a large premium spike.  
  • Through September 31, 2021, the House bill provides for $10 million in premium assistance of 85 percent for COBRA continuation coverage for eligible individuals and families. This subsidy would not count towards an individual’s gross income and would be treated as an advance refundable payroll tax credit.   
  • For the taxable year beginning in 2020, the House bill removes the requirement that an individual who is deemed to have received excess advance premium tax credit payments must be treated as an additional tax liability on the individual’s income tax return for the taxable year. This provision will hold all consumers harmless from income fluctuations in 2020, regardless of income level.  

 The House bill lays out a plan for major improvements in the Affordable Care Act’s affordability scale.   

  • Since its passage, the Affordable Care Act (ACA) has made health care more accessible and affordable for tens of millions of people. But the ACA suffers from a number of shortcomings. High on that list is inadequate premium assistance for millions of low- and moderate-income people.  
  • Evidence that more needs to be done to make premiums affordable comes from both the uninsured — who cite affordability as the biggest barrier to coverage — and from those who get their care on the Marketplace, with over 45 percent of subsidized enrollees in all income brackets reporting some or great difficulty affording premiums. 
  • While low-income people have seen the biggest coverage gains of any income group, they still have highest uninsured rate, and comprise the largest share of uninsured people. Disproportionately, this group is comprised of people of color who have faced years of discrimination in employment and education and who are therefore more concentrated in low-wage jobs without good benefits. 

For the next relief package, Congress must permanently invest in affordability measures that will not only help individuals and families recover from the economic impact of the COVID-19 pandemic, but also provide a more affordable pathway to comprehensive coverage that was out of reach to many even before the pandemic.  

  • The Affordable Care Act has provided better access to health care and greater financial security to tens of millions of people. Yet premium affordability has remained a problem for many. For the first time in over ten years, Congress and the president have an opportunity to build on the foundation created by the ACA. These temporary premium relief measures are a significant first step, but we must work to make them permanent.   

EXPANDING ACCESS TO MEDICAID  

The House bill provides temporary incentives to expand Medicaid and extend coverage, addressing coverage gaps and extending services to targeted populations. 

  • The House bill provides a temporary increase to the state’s base FMAP by five percentage points for two years for states that newly expand Medicaid. Notably, this applies to all eligibility groups, with the exception of the expansion group that would receive a 90 percent enhanced FMAP.  
  • The House bill also targets certain populations by giving states the option to expand postpartum coverage from 60 days to 12 months under Medicaid and CHIP for five years and providing enhanced federal funding for Medicaid home-and community-based services crucial to older adults and people living with disabilities.  

These efforts to expand Medicaid coverage and extend care to underserved populations are a critical step forward in helping individuals and families continue to fight and recover from the impact of COVID-19.  

  • Medicaid serves 75 million people in the U.S., providing health insurance and economic security to children and their families, older adults, people with disabilities, and others.  
  • Medicaid provides critical support to Black and brown people, who face unfair and discriminatory barriers to health and economic security, which the COVID-19 pandemic is exacerbating. Better access to Medicaid has been shown to reduce inequities in coverage and improve health.   
  • There are still 12 states that have not expanded Medicaid to low-income adults as originally envisioned. These individuals would be eligible for Medicaid had their state chosen to expand coverage. People in the Medicaid coverage gap are working people in low-wage jobs, mostly single adults: three quarters are adults without dependent children and nearly 60 percent are people of color. According to Kaiser Family Foundation, of the people who remain uninsured, 29 percent are Hispanic and 23 percent are Black—both groups stand to benefit dramatically from closing the gap. During the pandemic, Medicaid enrollees are more likely to be working essential jobs, placing them at risk for illness. For states that have yet to close the coverage gap, these workers have few if any options to access health coverage when it is needed most.  
  • The health crisis places older adults and people with disabilities at heightened risk; the inclusion of a rate increase for home and community-based services (HCBS) is critical to protect this population, providing options outside congregate care. Over half of direct care workers are people of color, mostly women of color. The inclusion of a rate increase for HCBS services not only supports the health and wellbeing the older adults and people with disabilities who have been hit particularly hard by the COIVD-19 virus but also is a down payment for future policies to support this population and the workforce that serves them. 
  • In the case of birthing people, Medicaid saves lives. Studies have demonstrated the year following the end of a pregnancy to be a concerning period for postpartum people. In fact, one-third of pregnancy-related deaths occur during the first year after the end of a pregnancy, disproportionately Black women. Extending postpartum coverage is a necessary step toward ensuring birthing people can adequately address their medical and behavioral health concerns during this critical period.  

In the next relief package, the Biden Administration and Congress must continue to invest in the Medicaid program as one part of a larger health equity agenda.

  • While the house bill provides a powerful new fiscal argument for states in choosing to close the coverage gap, it falls short in creating a direct federal pathway to coverage for people caught in the coverage gap. First, Congress should provide a 100% FMAP for Medicaid expansion, consistent with the ACA’s original policy. Additionally, Congress should couple this new incentive with a federal fall back option on the Marketplace that ensures access to coverage for all people in the coverage gap. This pairing could affect more than 6 million people according to the Urban institute and significantly improve families’ financial and health security and address a structural inequity of the public coverage system. 
  • The short-term increase in the HCBS rate is an opening to advance a bolder policy agenda that includes deeper investment in and commitment to the HCBS model paired with workforce protections ranging from livable wages to safe workplaces. Community Catalyst will work alongside our coalition partners to amplify the urgent need for these priorities.  
  • The extension of postpartum coverage is a first step, but this important and life-saving postpartum provision cannot be optional for states. As voiced by Black-led reproductive justice groups and recommended by MACPAC, a mandatory benefit with financial support is necessary. We will continue to support advocacy efforts to advance a mandatory rather than optional provision for states that includes financial support.  
  • Congress should provide 30 days of coverage for Medicaid services for people returning to the community after incarceration. This would substantially advance access to quality health care at reentry and facilitate care coordination and connection to community providers, including those treating substance use disorders and mental illness.   

ACCESS TO AND QUALITY OF CARE 

 The House bill invests directly in expanded services for substance use and mental illness.  

  •  It includes $3.5 billion equally divided between Substance Abuse Prevention and Treatment block grants and Community Mental Health block grants, money that goes to all 50 states.    
  • The bill also includes targeted money for specific areas including $100 million for training behavioral health workers, including peers; $50 million for community based mental health and substance use disorders provider; $30 million for harm reduction grants and $15 million plus additional Medicaid funds to help states plan and run community-based mobile crisis intervention services. 

These investments in substance use disorders and mental health services are essential especially during the COVID-19 pandemic, which has worsened substance use disorders and mental illness and exposed the vast shortcomings of the health system, particularly for low income and Black and brown communities.   

  • Drug overdose deaths reached their highest ever, 81,000, from June 2019-May 2020, and numerous surveys show COVID isolation and disruption has driven increases in mental illness. In addition, the pandemic is exacerbating treatment shortages, as COVID restrictions have forced some providers to close. Block grants are a way to get money quickly to all 50 states with flexibility in how states can spend the money, including for prevention, treatment and recovery services. 
  • Life-saving harm reduction services are essential during the COVID-19 pandemic to lower the risk of drug overdose as well as reduce strain on the nation's overwhelmed health care system. 
  • As a part of a workforce development initiative, funding for peer certification and training to assist people with lived experience in building careers in mental health and substance use disorders services is important for building a health workforce that mirrors community demographics and need.  

Going forward, Congress must continue to build substance use and mental health services to meet the growing need, and help end discriminatory insurance practices. In addition, Congress needs to equip schools to meet youth needs when they reopen, with specific focus on services to address the COVID-related increases in youth mental illness and substance use.   

  • Congress must authorize the Department of Labor to assess civil monetary penalties to strengthen parity in mental health and substance use disorders benefits. See H.R.2848, the Parity Enforcement Act of 2019.   
  • Congress must increase funding for the Every Student Succeeds Act (ESSA) Title IV, part A, to help schools address students’ mental health and substance use disorders as they return to in-person learning.     

NATIONAL VACCINE STRATEGY  

The House bill mandates coverage of COVID-19 vaccines and treatment under certain programs while adding additional funding for vaccination, testing surveillance and early detection efforts.  

  • The House bill requires coverage of Medicaid and CHIP beneficiaries for COVID-19 vaccines and treatment without cost sharing for the year following the end of the public health emergency. States can also choose to provide COVID-19 vaccines and treatment to uninsured individuals. In exchange, states will receive 100% federal matching rate for these services. 
  • The house bill also provides additional funding streams totaling $70 billion to address vaccine shortages, improve the testing and tracing infrastructure and to expand the public health workforce.    

The House bill takes critical steps forward in building a robust national strategy to combat COVID-19.  

  • The additional funding for pandemic relief comes at a time when states and local authorities are facing significant shortfalls in their fight against COVID-19. It will be critical to addressing vaccine shortages and boosting public confidence in vaccines, addressing ongoing testing gaps and PPE shortages and improving COVID-19 surveillance efforts.  

Going forward, a national strategy to combat COVID-19 must take additional steps to address equity and disparities in the impact of the virus and the rollout of the vaccine.  

  • HHS must incorporate a role for community-based organizations to engage in conversations about the vaccine and local, state and federal strategies must ensure better vaccine access for communities facing huge challenges due to lack of investment in infrastructure.  
  • Vaccine access initiatives must support access for Black, Indigenous, People of Color (BIPOC) and underserved communities with targeted resources, including for CBOs serving those communities. Federal policymakers must prioritize and help states collect disaggregated data on the impact of COVID-19, which will improve their ability to direct resources where it’s most needed.   

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About Community Catalyst: 
Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for health equity and justice. We partner with local, state, and national advocates to leverage community power so all people can influence decisions that affect their health. Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, state houses and on Capitol Hill. For more information, visit http://www.communitycatalyst.org. Follow us on Twitter @CommCatHealth. 

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