Updated Proposal Would Help Millions of Americans Access Affordable Coverage and Reduce Health Care Costs Amid COVID-19 Pandemic
Watch and Download Remarks from Bennet and Kaine HERE
The Coronavirus Disease 2019 (COVID-19) pandemic has underscored the need to expand access to high-quality and affordable coverage. Bennet and Kaine’s bill would help achieve universal health care by making coverage more affordable and accessible. The bill also updates previously introduced versions.
“The Affordable Care Act dramatically improved coverage and affordability for health care in America,” said Bennet. “As we continue to face a devastating pandemic where millions of Americans are uninsured or underinsured, we are committed to working with the Biden Administration to strengthen the ACA. Medicare-X is the best way to cover everyone, reduce health costs, and improve the quality of health insurance for all Americans, including those who’ve historically suffered the most from poor access to quality coverage and care. We have a responsibility to create the best health care system possible and achieve universal coverage in our country. We can do that through Medicare-X.”
“With massive job losses, exacerbated health disparities, and increasing health care costs, the COVID-19 pandemic has further reinforced the urgent need for us to expand access to quality, affordable care,” said Kaine. “At a time when health care is a top concern for so many people, we must pass this legislation to offer more Americans, particularly in rural communities, more quality, affordable health care choices and help people get the care they need.”
The ACA expanded health insurance coverage to an additional 20 million Americans, established critical protections for patients with pre-existing conditions, and standardized essential health benefits for all qualified health plans. However, many Americans still face high health care costs and limited options for affordable health insurance. Currently, 10% of counties still have only a single insurer offering health insurance in 2021.
The bill would work within the Medicare framework to establish a Medicare Exchange public option plan in every county in America for individuals and small businesses, providing an additional, affordable option in all communities. It would also build on the ACA and expand premium and cost-sharing support to make all exchange options even more affordable for the uninsured.
Under Medicare-X, the public option would initially be available on the individual exchange in areas where there is a shortage of insurers or higher health care costs due to less competition—including rural communities in Colorado and Virginia. By 2025, the Medicare Exchange plan would expand to every ZIP code in the country and be added as another option on the Small Business Health Options Program Marketplace.
Medicare-X would expand Medicare’s network of doctors and providers and guarantee the essential health benefits established in the ACA, such as maternity care and mental health services. Medicare Exchange plans would expand benefits and provide all primary care services without cost-sharing requirements for plan holders.
Additionally, it would ensure access to affordable prescription drugs by empowering the Secretary of Health and Human Services to negotiate drug prices for Medicare Exchange plans and the Medicare Part D program.
The legislation includes several updates to make coverage affordable for more Americans:
- To better support rural hospitals and providers and increase access to health care for Americans living in rural communities, the proposal would allow for payment adjustments of up to 150% of Medicare fee-for-service rates. Previously, the bill allowed for payment adjustments in rural areas up to 125%.
- On top of the essential health benefits required for qualified health plans under the ACA, Medicare Exchange plans would expand on those benefits and provide primary care services with no cost-sharing for plan holders.
- The bill provides a larger tax premium subsidy for Americans living below 400% of the Federal Poverty Level (FPL). This would help low-income Americans access coverage by making premiums more affordable, including no premiums for those living at and below 150% of the FPL.
- Families earning more than 400% of the FPL would be eligible for the ACA tax credit, helping more middle-income Americans afford quality health insurance. This proposal expands eligibility for the ACA’s premium tax credit to families above 400% of the FPL and makes the tax credits even more generous than in the previous iteration of the bill.
- This proposal now fixes a glitch in the ACA that prevents family members of people who are insured through the health care exchange from receiving a tax credit. This could expand coverage to 2 to 6 million more Americans.
- This legislation would direct the Centers for Medicare and Medicaid Services to study the impact of covering services such as long-term services and support; home- and community-based services; assistive and enabling technologies; and vision, hearing, and dental services. The study would examine the effects on benefits and the costs to beneficiaries. It would also review the implications in the health market and provide recommendations to Congress on potential inclusion of these benefits under Medicare plans.
- This plan would help drive down costs across the entire health care industry by providing additional resources to the Department of Justice and the Federal Trade Commission to take appropriate antitrust enforcement actions and address the root causes of consolidation in the health care market.
The bill text is available HERE. A summary is available HERE.