How the Build Back Better Bill Would Help Millions of Uninsured Patients Waller Lansden Dortch & Davis, srl


[co-author: Ellie Martin]

The House narrowly passed the Build Back Better bill on November 19 with a vote of 220 to 213, after a one-night delay. The $ 1.75 trillion social spending bill includes the ability for Medicare to negotiate drug prices, new hearing benefits for Medicare beneficiaries, and extended Affordable Care Act grants. The bill is yet to be passed by the Senate, and Senate Democrats are expected to make revisions.

With respect to Medicaid, the Build Back Better Act aims to close the coverage gap and significantly expand coverage – particularly in “red states” which have so far refused to take advantage of the matching funds available under it. of the Affordable Care Act. States that have rejected the expansion of Medicaid have a larger coverage gap that includes many individuals and couples living below the poverty line who do not have children or disabilities.

While the law does not technically expand Medicaid, as only federal funds will be used to subsidize Medicare, the law will cover the Affordable Care Act premiums for people who are not eligible for the Medicaid program. their state or other form of subsidized health insurance. The White House reported that the Affordable Care Act premium tax credits would cover up to 4 million uninsured Americans who do not qualify for Medicaid. For example, a valued 120,000 Tennessee residents who fall within the Medicaid coverage gap could receive support under the Build Back Better Act.

Other Medicaid changes under the law include a requirement that states extend postpartum coverage to 12 months and an option to coordinate care through a maternal nursing home model. States would also be required to provide 12 months of continuous coverage for children under the Children’s Health Insurance Program (CHIP).

The Build Back Better Act was also drafted to reduce the prices and expenses of prescription drugs. The law would allow the federal government to negotiate prices with drug companies for a small number of high-cost prescription drugs covered by Parts B and D of Medicare. The negotiated prices will apply to a maximum of 10 drugs in 2025 and will increase up to 20 drugs per year. The law would also impose a tax penalty on manufacturers who increase the price of their drugs faster than inflation. Insurers, including Medicare Part D, would not be required to charge more than $ 35 per month for insulin. Starting in 2024, Medicare Part D would have a cap of $ 2,000 on personal expenses.

The law would add hearing services coverage to Medicare Part B, starting in 2023. Hearing aids would be available once a year, every 5 years, for people diagnosed with severe or profound hearing loss. Part B of Medicare should also cover hearing rehabilitation and treatment services provided by qualified hearing care professionals and audiologists.

Waller will continue to monitor the legislation and report on developments. Medicaid’s supportive arrangements in particular have the potential to have a profound impact on patients and providers in non-expanding states. The Build Back Better Act could provide a lifeline for many community hospitals in these areas.


Comments are closed.