Obamacare is stronger than ever under Biden, but Manchin could destroy all those gains



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The health provisions in BBB would, in part, extend the expansion of subsidies through 2025. Under these expansions no one purchasing ACA plans has to pay more than 8.5% of household income on premiums, an across the board cap for all enrollees. Households making between 100% and 400% of poverty ($26,500 and $106,000 for a family of four) are eligible for subsidies, and enrollees up to 150% of poverty can get a basic silver-level plan (which covers an average of 70% of claim costs) for free.

If these provisions aren’t extended, according to an analysis from the Commonwealth Fund, about 400,000 people would immediately become uninsured at the end of this year and millions more would have to spend a lot more, possibly driving them out of coverage.

The ARP also provided assistance to many in the Medicaid gap—those people living in states that refused to expand the program under Obamacare who don’t qualify under traditional Medicaid—by extending subsidies down to the 100% of poverty level. Lawmakers had included the extended subsidies in BBB, lasting until 2025, allowing for plans that would cover 99% of allowed benefit costs beginning next year.

As of last fall, the BBB plan had so much to help make health care more affordable and more accessible. It would permanently fund the Children’s Health Insurance Program and require states to keep children in the program for a full 12 months even if the household income rose above the eligibility level for the program during the 12-month period. Families at this income level often teeter in and out of qualifying for the program—this change would ensure stable coverage for kids even as their families’ income fluctuates.

The bill still includes $150 billion to expand home- and community-based Medicaid services for elderly and disabled people, down from the $400 billion Biden originally requested. The funding will raise wages for those home care workers, hopefully growing that workforce and thus shortening the waiting list for these services. The federal government provides matching funds to states for these home- and community-based services, and the bill bumps that matching rate up permanently by 6%. The goal is to have all states provide these services outside of institutions so that people who can be cared for in their homes don’t have to go to nursing homes because it’s the only option available.

It’s still possible that the loss of vision and dental coverage in a Medicare expansion provision will be picked up partially by making that coverage mandatory under Medicaid. That would still leave some elderly people out of coverage—those who don’t qualify for Medicaid but can’t afford the private coverage for those services. But low-income elderly people would have it, so that’s better than what we’ve got now. Coverage for hearing services in Medicare has survived so far, beginning in 2024 and paying for audiology examinations and hearing aids once every five years.

All of this, all these gains, are jeopardized right now by one Democratic senator who has decided to play spoiler. The few million more people who gained health insurance, the many millions more who can afford it more easily could have it yanked away next year if BBB doesn’t pass. Democrats could try to pass these things in stand-alone bills, but they would be filibustered. No way are Republicans going to do anything to help Biden on Obamacare, of all things.


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