In response to the Trump administration's plea to the Supreme Court to kill the Affordable Care Act, in the midst of a pandemic with no end in sight, the House of Representatives passed legislation expanding the law on Monday, the first significant expansion in the decade the law has been in effect. It will not, of course, become law because Mitch McConnell won't bring it to the floor and the White House has already promised a veto.
The bill would expand subsidies for people purchasing insurance through the ACA marketplaces, so that more people could qualify for coverage. It would put a financial squeeze on the last hold-out states that have refused the Medicaid expansion by reducing the traditional Medicaid payments they're receiving, but would also incentivize expansion by paying for the entire initial cost of the expansion. It would also allow Medicare to negotiate prescription drug prices, and end the Trump administration's expansion of short-term insurance plans, junk insurance, that don't have to meet all the demands of the ACA's protections and benefits. For example, the plans allowed under Trump's short-term plan expansion don't have to provide coverage for preexisting medical conditions.
House Speaker Nancy Pelosi spoke about the importance of the law and her expansion of it Monday. "As lives are shattered by the coronavirus, the protections of the Affordable Care Act are more important now, more than ever," she said. Noting that both Trump and congressional Republicans keep saying that they intend their as-of-yet totally absent replacement plan for the ACA to cover people with preexisting medical conditions, she said: "Oh really? Then why are you in the United States Supreme Court to overturn them?" She has a point.
This legislation would fix one of the biggest problems for people with higher incomes attempting to buy insurance in the marketplace, the subsidy cliff that puts plans out of reach. It eliminates the existing income ceiling for subsidies, currently 400% of the federal poverty level, or about $51,000 annually for individuals and $105,000 for a family of four. Instead of that cap, the legislation stipulates that no one purchasing on the exchanges would have to pay more than 8.5% of their income to get a plan in the most popular tier. It expands Medicaid, as well, giving new mothers a full year of Medicaid coverage after they've given birth.
In Trump's veto statement, the White House said that the bill "attempts to exploit the coronavirus pandemic to resuscitate tired, partisan proposals." It also said that it would hamper development of new drugs in a way that is "imprudent given the current focus on developing vaccines and therapeutics rapidly to help America and the world combat the coronavirus." That exposes the real concern here: profits to the drug and health insurance industries.