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

FOR IMMEDIATE RELEASE

March 5, 2021

CONTACT: Kathy Melley, (617) 791-0708, kmelley@communitycatalyst.org

(BOSTON, MA) -- Today, the U.S. Senate begins debate 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 Senate bill includes the House’s critical investments to expand access to health care, advance health equity, help beat the pandemic, and put people across the nation on the path to recovery. Recent polling shows strong support among the public for more reliefThe American Rescue Plan Act is an important step to providing relief that millions of families need nowbut much more work lies ahead to build a fair and just health system.  

Statement of Emily Stewart, executive director of Community Catalyst, the Senate debate on the American Rescue Plan Act. 

“We applaud the Senate for advancing legislation to provide much-needed pandemic relief that prioritizes making health coverage more affordable, available and equitable for people across the country during this critical time. By lowering premiums for people on ACA plans, the Senate bill would help millions gain access to the affordable coverage they need now. Equally important are additional incentives for Medicaid expansion that will give states significantly more funding to expand access to basic health coverage. It is unconscionable that 12 states have refused to expand Medicaid, which disproportionately harms Black and brown people due to unfair and discriminatory barriers to economic security. Community Catalyst will continue to work with local and state partners in those states to push for Medicaid expansion.

“We are also pleased that the Senate bill includes support needed to make distribution of the COVID-19 vaccine more equitable. Implemented properly, these investments will save lives by improving access for Black, Latino and Indigenous people, who have been hardest hit by the pandemic and face vaccine access challenges rooted in the historic underinvestment in their communities. As health advocates, we are deeply disappointed the bill does not boost the minimum wage, as fair wages are one key determinant in any individual or families ability to stay healthy and well.

“The COVID-19 pandemic has exposed all the ways our health system fails our communities and country. The American Rescue Act is a shot in the arm to provide immediate relief. But what must come next is the more essential and harder work of confronting the structural inequities that have both allowed COVID-19 to cause so much harm and put health far out of reach for too many people and families in our country. Community Catalyst urges the Senate to pass the American Rescue Plan Act, and we are committed to pushing for the bigger reforms our country so desperately needs.”

BACKGROUND 

AFFORDABILITY OF COVERAGE 

The Senate American Rescue Plan Act retains House bill provisions to provide 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 Senate bill retains the House bill provisions to eliminate or reduce 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 Senate bill provides for $10 million to cover 100 percent of the premium 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. This is an increase in assistance from the House bill, which only provided 85 percent of premium coverage.  

  • For the taxable year beginning in 2020, the Senate bill retains the requirement that an individual who is deemed to have received excess advance premium tax credit payments must not 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 Senate bill retains the 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 Senate bill retains House bill provisions to provide temporary incentives to expand Medicaid and extend coverage, addressing coverage gaps and extending services to targeted populations. 

  • The Senate bill retains House bill provisions to provide 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 Senate bill retains the House bill provision to give states the option to expand postpartum coverage with full benefits from 60 days to 12 months under Medicaid and CHIP but reduces the length of the provision from seven years to five years. The Senate bill also retains 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. By including increased federal funding for Medicaid home and community-based services (HCBS), the American Rescue Plan takes a significant step toward improving access to a critical benefit at a time when the populations it’s intended to serve need it most. The COVID-19 pandemic has highlighted and increased the need for home-based care, as more than one-third of the nation’s deaths from COVID-19 have been linked to nursing homes and other long-term care facilities. Additionally, most older adults would prefer to age in their home and community, and so increasing access to HCBS would go a long way towards making long-term care in Medicaid more-person centered. Lastly, because HCBS involves services such as non-medical transportation, home-delivered meals and home modifications such as shower “grab-bars” to make someone’s residence safer to live in, HCBS is an important way that the Medicaid program addresses the social determinants of health 

  • 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 Senate bill retains the House bill’s 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 QUALITYOF CARE 

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

  • The Senate bill includes $3 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 $420 million for substance use and mental illness services through the Indian Health Service; $140 million to help health professionals address their own burnout, mental health, and substance use concerns; $100 million for training behavioral health workers; $50 million for community based mental health and substance use disorders providers; $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.  

  • The Senate bill also includes $80 million to integrate and improve mental health services in pediatric care that was not included in the House bill. 

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.  

  • Rising rates of suicidal ideation and emergency department use among children and youth during COVID-19 signal a long-term mental health and substance use crisis, which needs to be addressed in provider’s offices, schools and communities.  

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 Senate Bill retains provisions in the House bill that mandate coverage of COVID-19 vaccines and treatment under certain programs while adding additional funding for vaccination, testing surveillance and early detection efforts.  

  • The 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 percent federal matching rate for these services.  

  • The bill also provides additional funding streams totaling more than $70 billion to address vaccine shortages, improve the testing and tracing infrastructure and to expand the public health workforce.     

The Senate 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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