The Republican Study Committee (RSC) issued a primer about the health care agenda the Biden administration and congressional Democrats are pushing to “increase costs, reduce health care quality, and choices.”
The primer, “10 Ways Democrats are Killing Your Health Care,” outlines steps already underway to tighten the federal government’s grip over health care.
The HSC primer notes that the $1.9 trillion American Rescue Plan enacted earlier this year expands market-distorting Obamacare subsidies—in the form of premium tax credits—for all previously covered individuals and removes the existing income cap to extend subsidies to individuals making an indefinite amount of money. It subsidizes health care coverage for the rich while increasing health care costs for all Americans in the aggregate.
Restricting Choice of Care
A January 28 Biden executive order instructed federal agencies to revoke a Trump-era executive order increasing consumer access to less-costly insurance plans. Specifically, the Trump-era order was designed to expand access to short-term, limited-duration insurance (STLDI) by increasing the allowable coverage period for STLDIs. Since the plans are exempt from Obamacare mandates, they are often targeted by the Left. Such plans typically have broader networks than those burdened by Obamacare regulations, the RSC notes.
Biden’s executive order also took steps to revoke a Trump-era rule that expanded the use of health reimbursement accounts (HRAs). An HRA is a type of account-based, employer-provided group health plan that provides reimbursement for medical care expenses incurred by the employee and certain family members.
Trump’s HRA rule also created individual coverage HRAs, which allowed employers to reimburse employees’ individual market premiums under certain conditions. The rule also created “excepted benefit” HRAs which could be used in STLDIs. The HRA rule could have dramatically changed the individual market, leveling the playing field between employer-sponsored insurance and individual policies using HRAs and expanding health care choices for individual employees.
The executive order instructed federal agencies to “review for potential recission, demonstrations, and waivers…that may reduce coverage or otherwise undermine Medicaid or the ACA.” The RSC notes this is a direct order to reject Section 1332 waivers, which the Trump administration sought to use to expand access to health care choices.
Section 1332 waivers permit states to seek exemptions from specific federal health insurance regulations. States that use a 1332 waiver to waive a limited number of Obamacare’s most burdensome regulations see significantly reduced premiums compared with states that do not.
The Biden administration eliminated the Trump-era Association Health Plan (AHP) rule. AHPs allow groups of individuals of small employers to band together to purchase coverage. The rule was designed to broaden the definition of “employer” to include “working owners” such as sole proprietors, the self-employed, and independent contractors. AHPs have been shown to increase choice and reduce premiums, the RSC notes.
By gaining recognition as a “large” employer under the Employment Retirement Income Security Act, AHPs avoid some of the costliest, most burdensome regulations mandated by Obamacare. This option, which, could have allowed such plans to be offered across state lines, is now foreclosed by the Biden administration.
Expanding Medicaid, Removing Requirements
Expanding Medicaid to the able-bodied harms the integrity of the program for those who need it most, the primer points out. Instead of focusing on reforms to the Medicaid program, Democrats have sought to use it as a stepping-stone to a single-payer system. In the American Rescue Plan, they promoted a 5 percent bump in the Federal Matching Assistance Percentage (FMAP) rate while shaming states that have not expanded Medicaid coverage.
Noting that Medicaid work requirements could lead to higher earnings and better health outcomes for able-bodied people, the RSC says the Biden administration appears determined to put an end to them. Although Trump-era work requirements have been challenged in court, the RSC says the Biden administration would prefer to punish states that recognize the intersection of employment and health.
With the Obamacare individual mandate effectively eliminated under the Tax Cuts and Jobs Act of December 2017, the Biden administration is encouraging states to enact their own state-based individual mandates.
Blocking the Rebate Rule
In a move widely regarded as a win for the Pharmaceutical Benefit Managers (PBMs), the Biden administration has set its sights on the Trump “rebate rule” that would require manufacturer rebates made under Medicare Part D and Medicaid managed care to be provided at the point of sale, allowing patients to benefit directly from the rebate. The rebate rule would have cracked down on the opaque practices of the PBMs, the RSC points out.
Finally, the RSC concludes the Biden administration is using COVID-19 as a reason to extend the ACA Special Enrollment Period (SEP) to August 15. Such open-ended SEPs could lead to higher premiums by encouraging people not to buy insurance until they are sick.
“Thus, far, the Biden administration is largely engaged in saber-rattling. But they have made the direction in which they want to move health care policy very clear,” said John Goodman, president of the Goodman Institute for Public Policy Research and co-publisher of Health Care News. “That direction will lead to fewer consumer choices and higher consumer prices.”
Bonner R. Cohen, Ph.D., (email@example.com) is a senior fellow at the National Center for Public Policy Research.
“10 Ways Democrats are Killing Your Health Care,” The Republican Study Committee, 2021