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House Democrats want Obamacare expansion in coronavirus bill

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  • Even though Congress isn’t returning to Capitol Hill until April 20, political fights are already brewing over the next steps to respond to the coronavirus pandemic. 
  • House Democrats want a future recovery and infrastructure bill to include a special enrollment period for the Affordable Care Act, so that more people can buy health insurance amid the coronavirus pandemic.
  • They also want more people to get financial help buying insurance, and they want to push more states to expand Medicaid.
  • Republicans oppose boosting the Affordable Care Act, a law they failed to undo in 2017 and that the Trump administration has sought to wipe out in court. 
  • Visit Business Insider’s homepage for more stories.

House Democrats want to use a future coronavirus recovery bill to expand Obamacare, as a step to relieve the public from the health and economic tolls of the coronavirus pandemic.

The push could add a divisive component to a recovery bill already contentious with Republicans, who’ve long campaigned against the Affordable Care Act.

Lawmakers aren’t planning to return to Capitol Hill until April 20, but House Democrats already have begun planning for a recovery bill. Speaker Nancy Pelosi told reporters Thursday that Democrats would push to include a special enrollment period for the Affordable Care Act, the formal name for Obamacare, as part of that package, which will otherwise largely focus on infrastructure.

But Democrats want to go much further in bolstering Obamacare as part of that package, a top senior Democratic aide confirmed to Business Insider. Among the changes are boosting the amount of money the federal government pays toward private health insurance premiums and incentivizing more states to use Obamacare’s expansion of Medicaid, a government program that covers low-income people.

The changes would help the millions of people who are likely to lose their health insurance when they’re laid off from jobs thanks to the coronavirus. About 3.5 million people who lost their jobs in the last two weeks also likely lost health insurance they got through work, according to the Economic Policy Institute.

A broader analysis from Health Management Associates found that a coronavirus-driven downturn could result in roughly 23 million people losing their employer-provided health insurance. Many of those people would get covered through Medicaid, but about 5 million would wind up uninsured.

Though bolstering Obamacare has the support of health insurers, it’s a nonstarter for House Republicans. The party has demonized the healthcare law since its passage in 2009 — failing in 2017 to repeal it — and the Trump administration is siding with a lawsuit aimed at wiping it out entirely. 

House GOP aides said they hadn’t been looped into discussions about the infrastructure package, and one called it “premature.”

“Republicans and Democrats seem to be on two different timelines with two different ideas of what this is supposed to be,” another senior GOP aide told Business Insider. Republicans first want to see how the three other bills they passed play out and how to plug any gaps, including whether they will need to boost funding for hospitals. 

Pelosi indicated all week that the recovery bill would be the fourth package to come from Congress, but on Friday she reversed those plans, saying it would come after Congress fills gaps in bills it already passed. 

The party will have trouble bringing Republicans along with the recovery plan. While Democrats can pass a bill in the House without their support, they need the GOP-controlled Senate onboard with a recovery plan so the bill can reach President Donald Trump’s desk. 

While Trump has called for Congress to pass an infrastructure package, Senate Majority Leader Mitch McConnell is skeptical. 

“I’m not going to allow this to be an opportunity for the Democrats to achieve unrelated policy items that they would not otherwise be able to pass,” McConnell said Tuesday on “The Hugh Hewitt Show.”

The debate over a special enrollment period 

Whether to re-open the Obamacare marketplaces has become a frequent line of questioning during Trump’s White House briefings. Doing so would allow more people to buy private health insurance from “marketplaces,” where the federal government picks up some — or all — of the tab for premiums depending on people’s income. 

Generally speaking, people can enroll in coverage during what is known as “open enrollment,” which happens at the end of every year. But there are exceptions. For instance, people who lose their health insurance automatically qualify for a special enrollment period. That means that many of those laid off in recent weeks can enroll without the government making any changes. 

Democrats want a special enrollment period so even more people could join Obamacare. People who were uninsured at the start of this year would be allowed to enroll, as would those who bought short-term plans, which offer lower premiums to some customers but can deny coverage for pre-existing illnesses.

“Without quality health coverage, a coronavirus hospitalization could cost patients tens of thousands of dollars,” Pelosi said Thursday on a call with reporters. 

Roughly 11.4 million people are enrolled in the Obamacare marketplaces, though that number is likely to grow because 11 states and the District of Columbia, which run their own marketplaces, created special enrollment periods. Healthcare.gov is the federal exchange that most states use and that Democrats want to open up. 

This week, the White House closed the door on the idea of opening the marketplaces. On Thursday, Trump indicated the federal government would use some of the funds set aside for hospitals in the $2 trillion coronavirus stimulus, called the CARES Act, to directly pay for treatment for the uninsured. 

A GOP spokesperson from the House Energy and Commerce Committee said there were other ways for people to get coverage — including by enrolling in Medicaid in some states and by signing up for short-term plans — and that the primary goal should be to keep people on health coverage they get at work. 

“Let’s focus on providing this support and reassuring the public, and steer clear from false promises designed to open a back door to a government-run healthcare system,” the spokesman said. 

Even with a special enrollment period, millions of people would be locked out of coverage 

But House Republicans aren’t open to a special enrollment period or to expanding Obamacare.

“I think it’s very contentious,” one senior GOP aide told Business Insider, saying such provisions in a bill would make it “very difficult to find common ground.” 

Democrats are pushing for an Obamacare expansion on top of a special enrollment period because not everyone finds the plans affordable. By law, people who make less than roughly 400% of the federal poverty level, or $51,040 a year for an individual, qualify for premium help.

But the rest have to pay the full cost of the insurance, which prices millions of people out. The Democratic plan would address that issue by funneling more government funding into the marketplaces, extending who qualifies for help. 

A second Obamacare gap Democrats want to fix would let more people enroll in Medicaid by boosting federal dollars to states that haven’t tapped into the provision. Under the way Obamacare was originally written, all states were set to expand Medicaid to low-income people, but a Supreme Court decision made the provision optional. As a result, 14 states don’t allow the coverage, and uninsured rates are higher in those states.

Have you struggled to sign up for healthcare coverage after a job loss tied to the coronavirus pandemic? If you are willing to tell your story, please email senior healthcare reporter Kimberly Leonard at [email protected].

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