President Biden’s FY22 Budget Would Advance Health Equity by Improving Health Coverage Access and Affordability

FOR IMMEDIATE RELEASE

May 28, 2021

CONTACT: Kathy Melley, (617) 791-0708

kmelley@communitycatalyst.org

(BOSTON, MA) -- Today, President Joe Biden released his fiscal year 2022 budget, which proposes many crucial and historic investments to help people get back on their feet from the pandemic and promote long-term economic and health security and prosperity. This includes making the 2-year ACA premium assistance increase permanent; investments to address racial disparities in maternal mortality; increased funding for home and community-based services and support for the workers who provide that essential care; and funding for paid family leave and child care. While there are still many details to work out, the President is clear that he will work with Congress to expand access to and improve health coverage, including by closing the Medicaid coverage gap. This must also include reducing high out-of-pocket and prescription drug costs. Additionally, in recognition of the critical need to improve equitable access to abortion, the President omits the Hyde amendment, a discriminatory policy that denies abortion coverage to people with low-incomes. For decades, the Hyde amendment has significantly undercut access to abortion for millions of low-income pregnant people, particularly women and LGBTQ+ people of color – people who already face unfair and discriminatory barriers to care. Community Catalyst applauds the reproductive justice leaders who have led the way in pushing for repeal of Hyde.

Statement of Emily Stewart, executive director of Community Catalyst, in response to President Biden’s proposed budget:

“As the country emerges from the pandemic, we cannot return to the way things were. We applaud President Biden for recognizing this reality in his budget by renewing his commitment to affordable coverage and care for all, especially the critical need to close the Medicaid coverage gap that unjustly denies millions access to affordable health coverage. This includes many essential workers, who are disproportionately Black and brown people working in low-wage jobs without benefits due to longstanding unfair and discriminatory barriers to economic security. We look forward to working with the Biden administration and Congress to help all people and families across the nation gain access to high-quality, affordable health care and what they need to be healthy and free.”

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BACKGROUND

AFFORDABILITY OF HEALTH COVERAGE

President Biden’s budget includes $200 billion to make the 2-year improvements in the Affordable Care Act’s (ACA) affordability scale permanent, significantly lowering the cost of premiums for millions of low- and moderate-income people getting coverage through ACA Marketplace plans.

  • The American Rescue Plan Act included temporary provisions that eliminate or reduce premiums for millions of Marketplace enrollees through an increase in premium support tax credits. Under this provision, premiums are eliminated for those below 150% FPL — consistent with current Medicaid law. Premiums are lowered for everyone else currently eligible for premium tax credits and a new cap on the total amount of income a person would have to pay would end the “subsidy cliff” under which a small change in income could result a large premium spike.   
  • The increased ACA tax credits have lowered the cost coverage for 3.7 million more people and made coverage free or nearly free for more than 40 percent of people who are uninsured.  
  • While low-income people have seen the biggest coverage gains of any income group, they still have highest uninsured rate, and comprise the largest share of uninsured people. This is especially true for Black and brown people, who face discrimination in employment and education. As a result, they are more likely to work in low-wage jobs without good benefits like health coverage.

The President’s commitment to making the premium tax credits permanent is an important step toward making health coverage more affordable, but we can’t stop there. In addition to reducing premiums, we need to reduce high out-of-pocket costs – from deductibles to prescription drug prices – that are putting health coverage and care out of reach for too many people.

  • Despite the progress afforded by the ACA and the American Rescue Plan, millions are forced to make choices between basic needs and health care— from seeing a doctor to affording prescriptions to managing a chronic illness. One in four persons taking a prescription drug reported skipping doses or cutting pills in half due to affordability issues.
  • Recent polling shows that reducing health care costs is a top priority for voters, regardless of political affiliation. 
  • To lower out-of-pocket costs and prescription drug prices, Congress should pass the S. 499, the Health Insurance Affordability Act (Sen. Jeanne Shaheen) and H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (Rep. Frank Pallone).

EXPANDING ACCESS TO MEDICAID BY CLOSING THE MEDICAID COVERAGE GAP

President Biden is proposing a new federal premium-free option that would extend affordable health coverage to millions of people in the Medicaid “coverage gap,” which shows a firm commitment to addressing deep inequities in access to coverage and care. Expanding the affordability of health coverage and care for people in the Medicaid coverage gap is critical to advancing health equity and racial justice.

  • In June 2012, the Supreme Court ruled that the Medicaid expansion had to be optional for states. This created a “coverage gap” in states because assistance to purchase health insurance on the ACA Marketplace is not available for people with incomes below the poverty line. As of May 2021, 38 states have closed the coverage gap.
  • There are still 12 states that have not expanded Medicaid to more than 4 million low-income adults as originally envisioned. These individuals would be eligible for Medicaid had their state chosen to expand coverage. 
  • People in the Medicaid coverage gap are working people in low-wage jobs, mostly single adults: three quarters are adults without dependent children and nearly 60 percent are people of color who face unfair and discriminatory barriers to economic security. According to Kaiser Family Foundation, of the people who remain uninsured, 29 percent are Hispanic and 23 percent are Black—both groups stand to benefit dramatically from closing the gap. During the pandemic, Medicaid enrollees are more likely to be working essential jobs, placing them at risk for illness. For states that have yet to close the coverage gap, these workers have few if any options to access health coverage when it is needed most.  
  • There is broad support for expansion among the public. In the most recent KFF Health Tracking Poll that assesses public views on the Medicaid program, it was found that a large majority of the public has a favorable view of the program and believes it works well for low-income people covered by the program.
  • Research shows better access to Medicaid has been shown to reduce inequities in coverage and improve health.   
  • Medicaid serves 75 million people in the U.S., providing health insurance and economic security to children and their families, older adults, people with disabilities, and others.  
  • Medicaid provides critical support to Black and brown people, who face unfair and discriminatory barriers to health and economic security, which the COVID-19 pandemic is exacerbating.

IMPROVING ACCESS TO ABORTION

President Biden has omitted from his budget the Hyde amendment, which has been attached to Congressional spending bills since the 1970s to bar low-income people from using their Medicaid coverage to obtain abortion careThis presents a clear step forward in undoing a discriminatory and harmful law.

  • Reproductive justice organizations have long called for an end to the Hyde amendment because it discriminates against low-income women and LGBTQ+ people of color. This move is particularly necessary as more judicial challenges to Roe v. Wade and legislative attacks on reproductive justice are on the horizon. 
  • Prior to Roe v. Wadein 1972 alone, approximately 50,000 women traveled more than 500 miles to obtain a legal abortion in New York City, including some from states as far away as Arizona and Idaho. Inadequate access to safe and legal abortion is not only time-consuming, but economically burdensome to those who require care. 
  • Access to safe and legal abortion isn’t just a reproductive rights issue – it’s an equity issue. In every Southern state except Florida, more than half of women of reproductive age live in a county with no abortion clinic. Plus, Black women disproportionately reside in states with abortion restrictions. Data frequently do not reflect the experiences of transgender and non-binary people, so researchers, lawmakers, and advocates do not have a complete understanding of abortion access for people who are not women but can get pregnant. 
  • Women of color, trans and non-binary people, people with disabilities, and young people are already less likely to be able to pay for abortion care out of pocket, travel to access abortion care, or pay the additional costs associated with delays in abortion access. In fact, nearly 50 percent of abortion patients have incomes below the federal poverty level. 
  • Delaying this lifesaving care, leads to adverse health outcomes and, often, medical debt. Specifically, delaying or denying abortions has been found to increase the likelihood of certain mental health conditions, serious complications during pregnancy and even interpersonal violence. According to ANSIRH’s Turnaway Study, people denied an abortion are more likely to struggle with unemployment and poverty.

About Community Catalyst:

Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for health equity and justice. We partner with local, state and national advocates to leverage and build power so all people can influence decisions that affect their health. Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, state houses and on Capitol Hill. For more information, visit http://www.communitycatalyst.org. Follow us on Twitter @CommCatHealth. 

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