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How the Build Back Better bill would help millions of uninsured patients

The House narrowly passed the Build Back Better bill on Nov. 19 with a vote of 220 to 213, after an overnight 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 subsidies. The bill will still have to pass the Senate, and Senate Democrats are expected to make revisions.

With regard to Medicaid, the Build Back Better Act aims to close the coverage gap and dramatically extend coverage - particularly in “red states” that have so far declined to take advantage of the matching funds available under the Affordable Care Act. States that have rejected Medicaid expansion have a larger coverage gap that includes many individuals and couples living below the poverty line who do not have children or a disability.

Although the Act would not technically expand Medicaid, as only federal funds will be used to subsidize health insurance, the Act would cover the Affordable Care Act premiums for individuals who do not qualify for their state Medicaid program or another form of subsidized health insurance. The White House has reported that the Affordable Care Act premium tax credits would provide coverage for up to 4 million uninsured Americans who do not qualify for Medicaid. For example, an estimated 120,000 Tennesseans who fall into the Medicaid coverage gap could receive support under the Build Back Better Act.

Other Medicaid changes under the Act include a requirement that states extend postpartum coverage to 12 months and an option to coordinate care through a maternal health 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 with the purpose to lower prescription drug prices and spending. The Act would allow the federal government to negotiate prices with drug companies for a small number of high-cost prescription drugs covered under Medicare Part B and Part D. The negotiated prices will apply to up to 10 drugs in 2025 and will increase to up to 20 drugs per year. The Act would also impose a tax penalty on manufacturers who raise their drug prices faster than inflation. Insurers, including Medicare Part D, would be required to charge no more than $35 per month for insulin. Beginning in 2024, Medicare Part D would have a $2,000 cap on out-of-pocket spending.

The Act would add coverage of hearing services to Medicare Part B, beginning in 2023. Hearing aids would be available once a year, every 5 years, for individuals diagnosed with severe or profound hearing loss. Medicare Part B would also be required to cover hearing rehabilitation and treatment services by qualified hearing aid professionals and audiologists.

Waller will continue to monitor the legislation and report on developments.  The Medicaid support provisions in particular have the potential to have a profound impact on patients and providers in non-expansion states.  The Build Back Better Act could provide a lifeline to many community hospitals in these regions. 


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