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KHN’s ‘What the Health?’: All About Budget Reconciliation

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President Joe Biden has said he still wants a bipartisan bill to provide the next round of covid relief. But in case that doesn’t happen, House committees this week got down to work on a budget reconciliation bill that could pass the Senate with a simple majority. Proposals cover not just covid-related issues, but also some significant changes to the Medicaid program and the Affordable Care Act.

Meanwhile, the Centers for Disease Control and Prevention has issued new guidance for mask-wearing. But the guidelines are confusing for many, highlighting the rapidly changing science around the virus that leaves many laypeople uncertain about how best to proceed.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s podcast:

  • The Biden administration Wednesday told the Supreme Court it was reversing the federal government’s official support of Republican states’ challenge to the Affordable Care Act. The case was argued in November 2020, so it is unclear what, if any, impact the change of administration position might have.
  • More interesting than the expected administration announcement on the ACA lawsuit is the question about how Congress will respond if parts of the law are overturned by the justices. Democrats have not added any remedies into the reconciliation bill moving through Congress now, but they will have options they could implement instead.
  • Regarding the relief bill, there doesn’t appear to be much progress on a bipartisan compromise. Using the highly technical and limited option of a reconciliation bill to get the president’s funding plans through, however, may curb some efforts that Democrats had in mind for using the procedure on broader health care packages in the future.
  • One proposal in the relief plan would dramatically change how premium subsidies are determined for people who buy insurance on the ACA marketplaces. Instead of pegging the amount of subsidy to the federal poverty level, a subsidy would be determined based on the cost of the insurance and the family’s income. That will help higher-income middle-class families and those who live in high-cost regions.
  • Another proposal would make changes in Medicaid funding for states that agree now to expand their eligibility for adults. But in many of those states, resistance to expansion runs deep and even additional federal funding may not change minds.
  • The Medicaid proposal would also expand the time that low-income women can remain on the program when they are pregnant and after delivering a baby. That may help to cut maternal mortality rates in the country.

In honor of Valentine’s Day, the panelists chose their favorite #healthpolicyvalentines from Twitter. KHN is also selecting its own assortment, to be published Friday.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Washington Post’s “’Oh, We’re Still in This.’ The Pandemic Wall Is Here,” by Maura Judkis

Joanne Kenen: The New Yorker’s “Inside the Worst-Hit County in the Worst-Hit State in the Worst-Hit Country,” by Atul Gawande

Paige Winfield Cunningham: The Atlantic’s “Frustration Is Spreading Faster Than the Vaccine Is,” by Anne Applebaum

Sarah Karlin-Smith: HuffPost’s “Delay Second Doses? A Guide to the Latest COVID-19 Vaccine Debate,” by Jonathan Cohn

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

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