The 3 big ways Democrats’ social plan would expand health coverage

The measure would expand subsidies for health insurance in two ways, according to Cynthia Cox, director of the Affordable Care Act program at the Kaiser Family Foundation.

(The federal assistance helps reduce health insurance premiums and other costs for private marketplace plans.)

It would preserve a temporary expansion of the subsidies enacted earlier this year by the American Rescue Plan and expand access to low earners who don’t qualify for Medicaid in some states.

Together, the reforms would cost $130 billion, the White House estimates. The provisions would last through 2025. (An earlier version passed by the House would have made them permanent.)

“If it’s passed, then for the next few years almost every American citizen will have access to affordable coverage,” Cox said.

The American Rescue Plan, a pandemic relief law passed in March, made more people eligible for premium tax credits and boosted assistance for those who already qualified.

For example, prior to the pandemic law, Americans didn’t qualify for aid if their income was more than 400% of the federal poverty level (about $51,000 for a single individual or $105,000 for a family of four). New rules got rid of the upper income threshold; they also capped premiums at 8.5% of household income for a benchmark health plan.

The White House estimates extending these reforms would reduce premiums for 9 million Americans, by an average $600 a year per person, and 3 million people who’d otherwise be uninsured would gain insurance.

Additionally, in 12 states that haven’t adopted an expansion of Medicaid under the Affordable Care Act, some low earners currently don’t qualify for Medicaid or marketplace subsidies, making coverage largely unaffordable.

The Build Back Better framework would extend subsidies (premium tax credits) to those in this so-called coverage gap. About 4 million uninsured people in these states would be eligible for such assistance, the White House estimates.

“[They’d] qualify for very significant subsidies on the ACA markets that would essentially make their coverage free,” Cox said.

The legislation would invest $150 billion in home and community-based care for seniors and Americans with disabilities.

Such care is generally designed to let people stay in their home instead of move to a facility. It may include services like skilled nursing, personal care, adult daycare and home-delivered meal programs, according to the Centers for Medicare and Medicaid Services.

Medicaid is largest payer of home and community-based services in the U.S., according to Jennifer Sullivan, director of health and housing integration at the Center on Budget and Policy Priorities.