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President-elect Biden’s health care approach

January 19, 2021

Topics: Quote of the Day

An increase in subsidies could drive millions to enroll in Obamacare marketplaces, experts say.

By Sarah Kliff
The New York Times, January 16, 2021

Tucked into President-elect Biden’s $1.9 trillion stimulus plan is a one-sentence provision that could drive billions in federal subsidies to help people afford to buy health insurance.

The proposal would do two things: make upper-middle-income Americans newly eligible for premium subsidies on Obamacare marketplaces, and increase the financial help that already goes to lower-income enrollees. Taken together, some experts expect these changes to drive more sign-ups for Healthcare.gov plans after they fell in the Trump era.

Mr. Biden’s plan tackles one of the Affordable Care Act’s biggest weaknesses: affordability. Surveys of uninsured Americans and those with Healthcare.gov plans routinely find that affordability of premiums ranks as a top complaint.

The affordability challenges are a result of how drafters wrote the health law. They limited premium subsidies to those earning less than 400 percent of the federal poverty line: $51,520 for an individual and $106,000 for a family of four in 2021.

The Biden plan would create a new cap — 8.5 percent of an individual or family’s income on premium contributions — for midlevel health plans. This policy would mostly affect higher-earning Americans who do not currently qualify for subsidies.

The Biden proposal also describes a second policy that appears to be aimed at increasing subsidies for those who already qualify.

NYT Reader Comment:

By Don McCanne, M.D.

It is our private insurance industry that is charging us exorbitant amounts to take away coverage through high deductibles and other cost sharing and through narrow provider networks, while at the same time they are placing a tremendous administrative burden on the professionals and hospitals that provide the care – an administrative burden that we also pay for.

A well designed, single payer, improved Medicare for All is what we need, not more of the administratively burdensome private insurance industry that Biden wants to pay for with even more of our taxes. By condemning Medicare for All, he is missing the opportunity to finally fix our system so it works for everyone.



By Don McCanne, M.D.

When affordability is a problem, Biden wants to spend even more through our taxes and give it to the private insurance industry – the source of our profound administrative waste, along with the administrative burden they place on the delivery system.

The private insurance industry is selling us services we don’t want – deductibles and other cost sharing, maintenance of narrow networks, prior authorization administrative costs, while ducking out on paying for surprise bills and other denied benefits.

The tragedy is that a well designed, single payer, Medicare for All program would eliminate the costs of these excessive and unwanted administrative services, but Biden has ruled this out. What is the matter with him? Everyone could be covered at a lower cost if we would just get rid of the private insurers. That is our money they are holding onto, and for that we are giving them up to 15% when our traditional Medicare takes less than 2%? Exorbitant profits for the industry when it is us who are paying the bills.

It doesn’t make sense. We are paying more but getting less, and now Biden wants to give the insurers even more – not exactly the way private markets are intended to work.

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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