Senate Democrats released a white paper outlining a series of proposals intended to expand health coverage in response to the COVID-19 pandemic, including expanding advance premium tax credit eligibility, providing a financial incentive for non-expansion states to expand Medicaid, and reversing various final rules and guidance related to the ACA marketplace promulgated by the Trump administration. The white paper also consists of proposals addressed in the House-passed HEROES Act (H.R. 6800) – including subsidizing COBRA coverage, prohibiting cost-sharing for COVID-19 treatment, and establishing a Special Enrollment Period.
For most proposals, the white paper points to specific bills introduced by Senate Democrats. However, they do not specify how COBRA coverage would be subsidized. Instead, the white paper references a letter (sent April 16, 2020) led by Sen. Dick Durbin (D-IL), noting COBRA premium subsidies made available under the American Recovery and Reinvestment Act of 2009 (ARRA) were not enough for many individuals to retain coverage.
ARRA provided a subsidy to eligible individuals that covered 65 percent of the COBRA premium, leaving individuals to pay 35 percent of the premium to their former employers. The subsidy was available from September 1, 2008 to May 31, 2010. To be eligible, individuals had to be temporarily terminated or experienced a reduction in hours that affected eligibility for health coverage and lacked access to another form of group health insurance. The subsidy began phasing out at $125k for single filers ($250k joint filers) and was entirely phased out at $145k for single filers ($290k for joint filers).
In the HEROES Act, House Democrats propose providing 100 percent COBRA subsidies through January 2021 for those who are laid off or furloughed. The lack of specificity in the white paper, as well as considerations discussed in Sen. Durbin’s letter, indicate that Senate Democrats may be open to an approach that does not fully subsidize COBRA subsidies, provided it ensures continuity of care.
Additionally, Senate Democrats call for no cost-sharing for COVID-19 treatment for all individuals, as well as a Special Enrollment Period during the public health emergency – which were also included in the HEROES Act.
Below is a summary of the legislation noted in the white paper
- Improving Health Insurance Affordability Act of 2019 (S. 961), introduced by Sen. Jeanne Shaheen (D-NH) – The legislation would restructure the income tiers for advance premium tax credits by raising the cap from 400 percent to 800 percent of the poverty line, as well as increase the value of tax credits.
- Health Insurance Relief for Unemployed Individuals and Families (S. 3696), introduced by Sens. Ben Cardin (D-MD), Chris Van Hollen (D-MD), Michael Bennet (D-CO), Sherrod Brown (D-OH), Ed Markey (D-MA), and Shaheen – The legislation would temporarily suspend repayment of excess advance premium tax credits for 2020 and 2021. Additionally, the bill would exempt the $600 weekly federal unemployment benefit from annual income during the public health emergency. The weekly add-on payment would not be counted towards an individual’s income when determining eligibility for advance premium tax credits.
- MORE Health Education Act (S. 455), introduced by Sens. Shaheen, Gary Peters (D-MI), and Tim Kaine (D-VA) – The legislation would appropriate $100 million for fiscal year 2020 and each subsequent fiscal year to support outreach, education, and ACA enrollment assistance to individuals.
- States Achieve Medicaid Expansion (SAME) Act of 2019 (S. 585), introduced by Sens. Mark Warner (D-VA), Doug Jones, and Kaine – The legislation would provide a financial incentive to states that have not expanded Medicaid by providing 100 percent federal financing for the first three years. The Federal Medical Assistance Percentage (FMAP) would then fall to 95 percent in year 4, 94 percent in year 5, 93 percent in year 6, and 90 percent for each subsequent year (same phased federal match rate for other states that had expanded Medicaid).
- No Junk Plans Act (S. 1556), introduced by Sens. Tammy Baldwin (D-WI) and Jones – The legislation would overturn the Trump administration’s final rule, “Short-Term, Limited-Duration Insurance,” which extended the maximum duration of short-term plans from three months to 36 months. The bill would also prohibit the promulgation of similar rules.
- Protecting Americans with Pre-existing Conditions Act (S. 466), introduced by Sens. Warner, Cardin, Shaheen, and Baldwin – The legislation would nullify the Trump administration’s guidance, “State Relief and Empowerment Waivers,” which relaxed guardrails for Section 1332 waivers. The bill would also prohibit the promulgation of similar guidance.