Reconciliation: Extended ACA Subsidies and Medicaid Expansion Against Growing Medicare Benefits

Congress has turned its attention to a budget reconciliation package (H.R. 5376, Build Back Better Act).  After tough intra-party negotiations, Democrats are now contemplating legislation with between $1.5 and $2.0 trillion. The pressure to limit the bill’s expenditures may pit congressional Democrats against each other over health-related provisions, such as expanding Medicaid to low-income adults in all states, extending American Rescue Plan Act marketplace subsidies, and expanding Medicare benefits to include vision, dental, and hearing. Although these issues may be addressed, health care is not the focus of the bill.
 
During PCC’s Oct. 19 Policy and Advocacy meeting, Jennifer Bell from Chamber Hill Strategies provided insight on the status of the reconciliation bill as it relates to health provisions. Bell expects activity to likely center around strengthening the Affordable Care Act and expanding Medicaid coverage. There are also several critical healthcare provisions that are not included in the current reconciliation negotiations, including telehealth.
 
Democrats feel there is an opportunity to make significant progress and feel tremendous pressure to deliver on campaign promises with this reconciliation package. However, debates have grown as Democrats consider cutting funding for Medicare Advantage to pay for portions of the bill. Additionally, according to Bell, there is a real possibility that the package could fail as deadlines rapidly approach and a lack of trust and sense of urgency stall necessary action on expiring provisions, which include surface transportation funding, the debt ceiling, and the child tax credit.