- House Democrats voted on a bill designed to lower drug prices and strengthen the Affordable Care Act.
- While the bill won't become law, the goal was to highlight Republican opposition to the healthcare law ahead of the 2020 elections.
- The bill included a provision that would let the government regulate drug prices and use those savings to pay for expanding healthcare coverage.
- But the bill didn't touch on other Democratic priorities, including a public option.
- For more stories like this, sign up here for our healthcare newsletter Dispensed .
House Democrats passed a bill Monday that would pour more funding into the Affordable Care Act and force drug companies to lower their prices.
The bill, the Patient Protection and Affordable Care Enhancement, doesn't have any chance of becoming law in this Congress because it won't be taken up by the Republican-controlled Senate. House Democrats instead set it up as a messaging move ahead of the 2020 election as a way to cast themselves as the party that wants to help more people get healthcare coverage at a lower cost in the middle of a pandemic.
The bill cleared the House with a 234-179 vote along party lines. Part of Democrats' goal was to put the a spotlight on Republicans up for re-election, who have voted to repeal the ACA, knowing they would vote against Monday's measure. It also was aimed at drawing a contrast with the Trump administration, which is fighting to have the healthcare law thrown out in court.
Democrats are hoping to repeat their winning strategy from the 2018 midterms, when they picked up 41 seats and gained control of the House. That year, they campaigned heavily on the ACA and bashed Republicans and the Trump administration for wanting to repeal it.
The healthcare law, signed by former President Barack Obama more than 10 years ago, brought insurance coverage to more than 20 million people and prohibited insurers from turning down sick people for coverage or charging them more.
The Democrats' Affordable Care Enhancement Act is a 154-page bill that builds off that law. It would let the government regulate drug prices and then use the savings to pay for increasing health-insurance coverage.
Here's what we learned after combing through the bill's text :
Medicaid for more people
The bill would create incentives for more states to expand Medicaid to low-income people. Before the ACA, states varied in who qualified for Medicaid, but the program generally covered pregnant women, people with disabilities, and nursing-home care.
The ACA hoped to make states more uniform by allowing anyone who made under 138% of the federal poverty level to qualify (which translates to about $12,760 for one person). A Supreme Court decision made the provision optional, however. As a result, 14 states haven't expanded the coverage.
The expansion bill would let states get more funding from the federal government to expand Medicaid for poor people, even if they didn't do it until years later.
Under current law, if states expand now, the federal government kicks in 90% of funding. In 2016, when the expansion started, states received 100% of the expansion funding from the federal government for the first couple of years.
If all states expanded, more than 4 million people would be added to Medicaid, according to the Kaiser Family Foundation . About 2 million of these people are currently uninsured.
Another provision for Medicaid was included in the legislation. Under current law, women are allowed to be enrolled in Medicaid for up to 60 days after they give birth. The legislation passed Monday extended that timeline to up to a year post-birth.
This idea has been gaining steam as a way to reduce the number of women who die during pregnancy or childbirth, as well as those who have serious complications. US data shows that as many as 900 women die from childbirth or pregnancy-related causes every year, and 65,000 have serious complications.
More subsidies for private insurance
Another way that the ACA covers people is through "marketplaces" where they can buy government-subsidized private health insurance.
Generally, people get government subsidies if they make under 400% of the federal poverty level — or under about $49,960 a year for one person.
That cutoff means health insurance isn't affordable for millions of people who make more money. The Democrats' bill would make subsidies more generous. Anyone making above 400% of the federal poverty level would pay no more than 8.5% of their income on health insurance.
More generous subsidies would go to people making less than that amount as well. Anyone making less than 150% of the federal poverty level would pay $0 in premiums, though in most states, people would have Medicaid if they make under 138% of the federal poverty level.
More money to get the word out about the ACA
The bill put more funding into advertising the ACA and helping people enroll, reversing cuts made by the Trump administration.
The Trump administration cut ACA outreach to $10 million a year from the $100 million the Obama administration spent. It also cut spending on "navigators," which are nonprofits that help people pick out health-insurance plans, from $62.5 million to $10 million.
Democrats would restore funding for both programs to $100 million each a year.
Curbing short-term plans
The Trump administration expanded the availability of what are known as "short-term plans" as a way to let customers get around the high costs of ACA plans. For some people, short-term plans are less expensive than ACA plans, but that's because they limit what's covered.
Democrats would overturn the Trump administration's rule in their bill. They have blasted short-term coverage as "junk insurance" because the plans allow insurers to deny sick people coverage.
The bill will be paid for through savings on drug costs
The Affordable Care Enhancement Act payed for the healthcare-expansion measures through a version of the Elijah E. Cummings Lower Drug Costs Now Act , a bill Democrats passed in December that would allow the government to negotiate the price of up to 50 prescription drugs.
The bill also penalizes pharmaceutical companies that don't comply with government negotiation and caps what seniors pay for their medicines.
According to the Congressional Budget Office, the negotiation provision would save the government $528 billion over a decade. The Affordable Care Enhancement Act is similar to the bill Democrats passed in December but left out a provision that would have let Medicare pay for vision, dental, and hearing aids.
The bill avoids some high-profile issues
The House bill avoided a few high-profile healthcare issues that have played prominently on the campaign trail, including proposals that would reshape US healthcare more broadly.
Former Vice President Joe Biden, who is running against President Donald Trump for the White House in November, has said people should have the option to buy into a government "public option" if they prefer it over private insurance. He has also suggested letting people buy into Medicare at age 60, which is five years earlier than the current age of eligibility.
These types of provisions, which have gained steam among congressional Democrats, were not included in the legislation.
"Right now what we are really trying to do is address the affordability issue and have more access," said Rep. Frank Pallone, who supports a public option and chairs the Energy and Commerce Committee. He said the provisions currently in the bill were "the easiest way right now" to achieve those goals.
"I would definitely want to see a public option," he added.
The plan was also not in line with the goals of House Progressives, who favor a "Medicare for All" approach that would enroll everyone living in the US into a government plan. The caucus pushed Democratic leaders for a change to the bill before the vote that allowed Deferred Action for Childhood Arrivals recipients to get health insurance on the marketplaces.
This article has been updated with details of the bill's passage.
Via PakApNews