Democrats won the tiniest of majorities in the U.S. Senate this week, but that one-vote majority will have a large impact on health care.
For the first time in a decade, Democrats will control the White House and both houses of Congress. Democrats’ small Senate majority won’t be sufficient to enact Biden’s more ambitious health policy proposals, like creating a government-run plan called "the public option" which can negotiate with providers. But it will allow Congress to vote on proposals to make Affordable Care Act policies more affordable, which Biden has championed.
Democrats have long agreed that ACA premiums and deductibles are too high. But with Republicans in control of the Senate, the focus was on repealing Obamacare, not fixing it.
Democrats will now be able to consider proposals that Republican leaders rejected, such as increasing subsidies for those who already receive them, those who earn between 100% and 400% of the poverty level ($26,200 to $104,800 for a family of four.)
They will also be able to expand subsidies to those who find coverage unaffordable but are currently ineligible for assistance because they earn more than 400% of the poverty level, which Biden says is necessary.
Biden’s plan would insure people who live in states without Medicaid expansion — like North Carolina — by enrolling them in his new, public option. It’s unlikely Congress will pass that new plan.
But Kaiser Family Foundation Vice President Cynthia Cox says Congress could instead vote to provide subsidies to make insurance free or very low cost for those earning less than the poverty level.
This is an expensive way to extend coverage though, Cox says. “It’s cheaper to cover people though Medicaid than through private insurance, but barring other options to expand Medicaid to this group, this is the politically simple way to do it,” she said.
Earlier this year, House Democrats passed a bill which would have created more financial incentives to induce states to expand Medicaid. It’s possible they could try reintroducing that legislation again instead of expanding subsidies.
In order to expand on Obamacare, Congress must first preserve it. Republicans are suing to overturn the law, saying it’s unconstitutional after they voted to remove the penalty for those who refuse to buy insurance. The Supreme Court is set to rule on the case later this year.
But health policy analysts expect a Democratic Congress to void that lawsuit by reimposing a small penalty or eliminating the individual mandate altogether.
Biden has said COVID-19 is his top health care priority. He wants 100 million vaccines to be administered during his first 100 days in office. He also said Congress will need to appropriate more funding for this. So, expect a Democratic Congress to approve more money for things like COVID testing, vaccine distribution and assistance to the states.