Everything You Need to Know About Biden’s HealthCare Plan

We explain Joe Biden’s “Protect and Build” ObamaCare plan (AKA the Biden Plan to Protect & Build the Affordable Care Act).The goal of Biden’s healthcare reform plan is to keep most key parts of ObamaCare, improve them, and add in a public option.

The plan also reverses some Tump era healthcare changes (mostly in terms of healthcare rights).

Important expansion items focus on expanding coverage, increasing assistance, cracking down on fraud and abuse (especially with drug companies), and expanding healthcare rights.

Key ideas include a public option styled after Medicare, negotiating drugs for Medicare, allowing consumers to buy drugs from other countries to drive costs down, expanding assistance to above 400% of the poverty level to offer assistance to more Americans and to avoid the current tax credit “subsidy cliff,” and more.

This plan should be compared to the Republican “Repeal and Replace” plan and to Bernie’s “Medicare-for-all” plan.

With that all in mind here is the short version of Joe’s plan, you can see a more complete list of ideas on his website.

The Biden Plan to Protect & Build the Affordable Care Act

Below is our shorthand version of Biden’s plan. Some bullet-points are unchanged. Otherwise the aim is to provide a short and simple version of the plans with less jargon and only the key points pointed out.

I. Expanding Coverage:

  • A public health insurance option like Medicare. This is Biden’s answer to Medicare-for-all. Instead of expanding Medicare, the plan includes a public option for both individuals and small employers. A public option was initially going to be included in the ACA but it wasn’t able to pass, this is a good example of taking the next logical step to build on ObamaCare. Here instead of everyone getting Medicare like Bernie’s plan, people have the choice to buy into a public plan that is styled after Medicare (for example in how it will negotiate, see below about Medicare negotiating drug prices, and coordinate with healthcare providers to reduce costs).
  • Expanding tax credits to expand affordable coverage. The Biden plan not only increases the value of tax credits (capped at 8.5% of income and based on a Gold and not Silver plan), it also expands tax credits to those making above 400% of the poverty level. Previously the cut-off meant that families who went over 400% of the level got no assistance or owed back tax credits, this caused real issues for middle class families. This plan solves some very real affordability issues.
  • Expanding coverage to low-income Americans. Today governors and state legislatures in 14 states still haven’t expanded Medicaid. That means over 4.8 million adults that should have been covered under ObamaCare aren’t. Biden’s plan covers them by offering premium-free access to the public option for those 4.9 million individuals who would be aren’t eligible for Medicaid. The remainder of those covered under expansion can also be moved to the public option instead if the state decides to do this. Further, people will be automatically reenrolled if eligible when they go to access certain services like public schools and SNAP.

II. Addressing complexity.

  • Stopping “surprise billing.”  The plan stops “surprise medical billing” (billing that occurs when a person accidentally accesses out-of-network care). The plan does this by barring health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization).
  • Breaking up “big healthcare.” The Biden Administration will  use its existing antitrust authority to address the concentration of power in healthcare that is driving up prices for consumers.
  • Lowering costs and improving health outcomes by partnering with the health care workforce. The Biden Administration will partner with health care workers and accelerate the testing and deployment of innovative solutions that improve quality of care and increase wages for low-wage health care workers, like home care workers.

III. Drug Reform

  • Negotiating Drug Prices. Like with Bernie’s plan, and like Trump even said he would do, Biden’s plan allows Medicare to negotiate with drug companies. This would help lower the cost of Medicare and the cost of the public options noted above.
  • Limiting launch prices for drugs. In some cases drug manufacturers are unfairly pricing drugs. The plan creates a board to recommend a reasonable price for a new drug, based on the average price in other countries (a process called external reference pricing) or, if the drug is entering the U.S. market first, based on an evaluation by the independent board members. This reasonable price will be the rate Medicare and the public option will pay. In addition, the Biden Plan will allow private plans participating in the individual marketplace to access a similar rate.
  • Limiting price increases for all brand, biotech, and abusively priced generic drugs to inflation. As a condition of participation in the Medicare program and public option, all brand, biotech, and abusively priced generic drugs will be prohibited from increasing their prices more than the general inflation rate. The Biden Plan will also impose a tax penalty on drug manufacturers that increase the costs of their brand, biotech, or abusively priced generic over the general inflation rate.
  • Allowing consumers to buy prescription drugs from other countries. To create more competition for U.S. drug corporations, the Biden Plan will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe.
  • Terminating pharmaceutical corporations’ tax break for advertisement spending. Drug corporations spent an estimated $6 billion in 2016 alone on prescription drug advertisements to increase their sales, a more than four-fold increase from just $1.3 billion in 1997. Currently, drug corporations may count spending on these ads as a deduction to reduce the amount of taxes they owe.
  • Improving the supply of quality generics. Generics help reduce health care spending, but brand drug corporations have succeeded in preserving a number of strategies to help them delay the entrance of a generic into the market even after the patent has expired. The Biden Plan supports numerous proposals to accelerate the development of safe generics, such as Senator Patrick Leahy’s proposal to make sure generic manufacturers have access to a sample.

IV. Expanding HealthCare Rights

The plan increases healthcare rights, especially for groups that saw their healthcare rights slip from the Obama-era into the Trump-era. The plan does this by:

  • Expanding access to contraception and protect the constitutional right to an abortion. The Affordable Care Act made historic progress by ensuring access to free preventive care, including contraception. The Biden Plan will build on that progress. Vice President Biden supports repealing the Hyde Amendment because health care is a right that should not be dependent on one’s zip code or income. And, the public option will cover contraception and a woman’s constitutional right to choose. In addition, the Biden Plan will:
    • Reverse the Trump Administration and states’ all-out assault on women’s right to choose. As president, Biden will work to codify Roe v. Wade, and his Justice Department will do everything in its power to stop the rash of state laws that so blatantly violate the constitutional right to an abortion, such as so-called TRAP laws, parental notification requirements, mandatory waiting periods, and ultrasound requirements.
    • Restore federal funding for Planned Parenthood. The Obama-Biden administration fought Republican attacks on funding for Planned Parenthood again and again. As president, Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information and reverse the Trump Administration’s rule preventing Planned Parenthood and certain other family planning programs from obtaining Title X funds.
    • Just as the Obama-Biden Administration did,President Biden will rescind the Mexico City Policy (also referred to as the global gag rule) that President Trump reinstated and expanded. This rule currently bars the U.S. federal government from supporting important global health efforts – including for malaria and HIV/AIDS – in developing countries simply because the organizations providing that aid also offer information on abortion services.
  • Reducing our unacceptably high maternal mortality rate, which especially impacts people of color. Compared to other developed nations, the U.S. has the highest rate of deaths related to pregnancy and childbirth, and we are the only country experiencing an increase in this death rate. This problem is especially prevalent among black women, who experience a death rate from complications related to pregnancy that is more than three times higher than the rate for non-Hispanic white women. California came up with a strategy that halved the state’s maternal death rate. As president, Biden will take this strategy nationwide.
  • Defending health care protections for all, regardless of gender, gender identity, or sexual orientation. Before the Affordable Care Act, insurance companies could increase premiums merely due to someone’s gender, sexual orientation, or gender identity. Further, insurance companies could increase premiums or deny coverage altogether due to someone’s HIV status. Yet, President Trump is trying to walk back this progress. For example, he has proposed to once again allow health care providers and insurance companies to discriminate based on a patient’s gender identity or abortion history. President Biden will defend the rights of all people – regardless of gender, sexual orientation, gender identity – to have access to quality, affordable health care free from discrimination.
  • Doubling America’s investment in community health centers. Community health centers provide primary, prenatal, and other important care to underserved populations. The Biden Plan will double the federal investment in these centers, expanding access to high quality health care for the populations that need it most.

Additionally, Biden will put forward plans to tackle health challenges affecting specific communities, including access to health care in rural communities, gun violence, and opioid addiction.

V. Tax Reform

The Biden Plan also gets rid of the 20% long term capital gains tax, increases the top tax rate, and cuts out loopholes that lets some people avoid paying taxes and capital gains. Getting rid of the long term capital gains tax would for example freed up $127 billion in fiscal year 2019 alone to put toward healthcare.