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How the $1.9 trillion COVID relief bill will bolster the Affordable Care Act

A key part of the COVID aid bill creates the most significant changes to the Affordable Care Act since it was passed more than 10 years ago, including larger subsidies to buy insurance, reducing deductibles and more money for Medicaid expansion. The CBO estimates the changes would cost more than $90 billion in the next two years. Julie Rovner, of Kaiser Health News, joins Judy Woodruff to discuss.

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  • Judy Woodruff:

    A key part of the COVID relief bill creates the most significant changes to the Affordable Care Act since it was passed more than 10 years ago, among other changes.

    Some important provisions include providing larger subsidies to buy insurance, reducing deductibles, covering the entire costs of COBRA, the insurance extension program for those who recently lost a job, and giving states more money to expand Medicaid.

    The Congressional Budget Office estimates these changes could cost more than $90 billion over the next two years.

    Julie Rovner of Kaiser Health News watches this closely, and she joins me now.

    Julie, thank you so much for joining us.

    So, let's first talk about the ACA, the parts that affect the ACA. How does that money reach people? Tell us how it works.

  • Julie Rovner:

    Well, it basically boosts subsidies by about $35 billion. Now, this is temporary. It's just two years, but it will particularly help people at the very top and very bottom of the eligibility threshold for the law.

    People at the top, right now, if you earn more than four times the poverty level — that's about $50,000 for an individual — you basically get no help. There's this cliff where you suddenly have to pay everything yourself.

    They'd change that, so you would only have to pay 8.5 percent of your income. That could dramatically reduce premiums for people at that cutoff threshold by as much as half. Then people at the bottom would also get larger subsidies, so that people up to one-and-a-half times poverty, about $19,000 for an individual, would basically have access to a zero premium silver plan.

    That's that middle-level plan. So, they're pretty significant increases.

  • Judy Woodruff:

    It sounds very significant.

    And, Julie, I want to ask you about Medicaid. There's enticements in here, as we mentioned, for states that have so far chosen not to expand Medicaid. How would that work?

  • Julie Rovner:

    There's a dozen states that have not expanded Medicaid under the Affordable Care Act, including some really big ones, like Texas and Florida.

    Basically, what they would do is encourage these states by giving them a larger share of federal funding for their current Medicaid populations, not the expansion population. Again, it would be temporary. It would be two years, in the hopes that maybe that sort of financial relief would encourage some of these states to go ahead and expand Medicaid eligibility upwards a little bit.

  • Judy Woodruff:

    And then, Julie, I'm ticking these off. As we mentioned, there's yet another provision here to help people who have been laid off from their jobs continue to receive this employer-paid health insurance, the so-called COBRA provision.

  • Julie Rovner:

    That's right.

    COBRA dates back to 1986. And it allows people to continue their employer coverage when they lose their jobs, but they have to pay the entire premium themselves, which can be many, many hundreds and sometimes thousands of dollars a month.

    So this is a very short-term provision that said, if you have been laid off or if you have had your hours cut so that you can't — you don't qualify for coverage anymore, the federal government will pay 100 percent of your COBRA premium, but only for as much as six months.

  • Judy Woodruff:

    And you were telling us, Julie, efforts are being made to make some of these changes, instead of being just two years, to be permanent?

  • Julie Rovner:

    Well, certainly, they will expire in two years. And, clearly, there will be a political fight. I imagine Democrats will want to continue them. And I imagine Republicans won't, and they're going to argue — they're going to basically decide who's going to take the political hit there.

  • Judy Woodruff:

    And, Julie, one other thing I want to ask you about,

    Republicans were aiming some of their criticism today, among many others, at this COVID relief bill at what they say is a provision that would require $36 billion worth of cuts to Medicare. How do we understand that?

  • Julie Rovner:

    Well, this was actually a provision that was last put in by Democrats in 2010 to keep the deficit from exploding, and it says, if you don't pay for new spending, then we will cut Medicare.

    And so that is, in fact, true. Now, Congress can and has in the past waived this, so again, another political fight about whether they will lets Medicare cuts take place or whether they will actually vote to waive those cuts.

  • Judy Woodruff:

    But we will see is what you're saying on that last one?

  • Julie Rovner:


  • Judy Woodruff:

    All right, Julie Rovner, covering all these health care changes in this new piece of legislation.

    Thank you, Julie.

  • Julie Rovner:

    Thank you.

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