As president, Donald Trump and his Republican allies chipped away at the Affordable Care Act (ACA) and made considerable changes to America’s healthcare system. In the end, however, they struck out on most of the big stuff and never fulfilled their central promise to repeal and replace Obamacare.
Now it’s President-elect Joe Biden’s turn; and in a stunning turn of events, he’ll be entering the White House backed up by Democrats who control both the House and the Senate — but just barely. Biden promised to strengthen and expand Obamacare, but with the balance of power so fragile, that will be easier said than done.
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Virus Response Will Dominate the Early Days
Biden is inheriting the greatest healthcare disaster in modern history, a dynamic that will overshadow everything else in the beginning. He has vowed to administer 100 million vaccines in the first 100 days of his presidency, a monumental challenge and a huge step up from 10.2 million vaccines over 30 days completed by the Trump administration. Experts are already warning to expect slow going in the early days as Biden grapples with challenges in funding, supply, distribution, IT and the workforce, as well as a flurry of frustrating last-minute changes from the outgoing administration.
Quick Executive Actions Could Strengthen Medicaid
According to Health Affairs, Biden’s first 100 days must include efforts to restore “the soul of Medicaid.” The low-income health insurance safety net is the backbone of the ACA, and Biden has made boosting Medicaid the core of his plan to strengthen and restore Obamacare. He’ll likely bypass Congress and use his executive authority to override changes that Trump forced with his own executive power, including:
- Repealing work requirements
- Repealing the block grant initiative
- Ending policies that slashed benefits
- Restoring access to Planned Parenthood services
ACA Subsidies Will Likely Be Available to Higher Earners
Many Americans have been priced out of the federal marketplace because they earn too much to qualify for the subsidies that are the cornerstone of the ACA. In 2021, the income threshold for subsidy eligibility is $51,520 for individuals and $106,000 for a family of four. Those numbers represent 400% of the federal poverty line.
As part of his $1.9 trillion stimulus plan, Biden would cap premium contributions at 8.5% of a family’s income. The idea is to expand Obamacare enrollment by making the ACA economically viable to those just outside that seemingly arbitrary 400% subsidy threshold.
According to The New York Times, a family of four with a household income of $110,000 would currently pay monthly premiums of $1,529 for a midlevel plan. Under Biden’s 8.5% cap, however, that same family would pay $779 per month.
New Tax Credits Could Reduce or Eliminate Premiums for Lower Earners
Biden isn’t only extending subsidies to upper-middle-income earners to bring them into the ACA fold; he’s also expanding subsidies for lower-income enrollees who are already eligible for credits but can’t afford the monthly premiums even with the subsidies. The details of the proposal are not as specific as the higher-income subsidy expansion, but the plan would expand credits to lower-income households to reduce or even eliminate their premium payments.
Did You Know: How Much Is Joe Biden Worth?
None of This Is Guaranteed
According to experts interviewed by NPR, there is a wide consensus that Biden’s administration will have a hard time undoing many of the changes made by the outgoing administration. Most of Trump’s attempts to dismantle the system were done through executive power and will have to be undone on a tedious, case-by-case basis. With a split Senate that Democrats control only through a vice-presidential tiebreaker, passing broad and sweeping legislation will be almost impossible.
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Last updated: Jan. 20, 2021