Blog Posts > Build Back Better Would Increase Health Equity
November 3, 2021

Build Back Better Would Increase Health Equity

The US House of Representatives recently introduced its version of the Build Back Better plan. Under the House plan, 7.6 million people across the country would gain health coverage. Furthermore, health care would become more accessible to millions of Americans via increased subsidies on the individual marketplace. This plan aims to make health care accessible and affordable, improve health outcomes, and promote health equity nationally. 

The House Build Back Better plan would permanently close the coverage gap, which refers to people without health insurance in states that opted out of Medicaid expansion under the Affordable Care Act (ACA). In other words: these folks would qualify for Medicaid in a state like West Virginia (which adopted the expansion in 2014), but because they live in one of the 12 states that did not adopt expansion, they do not qualify. According to Congressional Budget Office (CBO) estimates, closing this gap would enroll 4 million more people in Medicaid nationwide. 

While closing the coverage gap would not impact West Virginians, the bill’s impact on the Mountain State would be evident via a permanent expansion of the enhanced premium tax credits included in the American Rescue Plan (ARP) earlier this year. This plan would make health insurance on the individual marketplace more affordable by increasing the amount of money families can receive via the premium tax credit. The previous benchmarks ranged from just over two percent to nearly 10 percent for families whose incomes were below 400 percent of the federal poverty level (FPL). Lower-income families receive the most extensive subsidies, while families closer to the upper threshold contribute a higher portion of their income. Under the ARP, families with incomes below 150 percent FPL are eligible for zero-dollar premium plans. Meanwhile, others between 150 and 400 percent FPL will pay premiums between zero and 8.5 percent of their income.

Alt-text: Table comparing marketplace subsidies before and after the American Rescue Plan, by income level, where individuals can expect to pay less under the new plan.

In addition, the House Build Back Better plan would address the subsidy cliff that exists on the individual marketplace. This cliff refers to the abrupt cutoff from subsidies for incomes above 400 percent FPL, as shown in the table above. Just a few hundred additional dollars above the threshold could result in dramatic increases in health insurance premiums. For example, before the ARP, a single person whose income equaled 399 percent FPL (about $51,390 in 2021 dollars) could receive subsidies that offset costs to equal just under 10 percent of their income. However, a person making 401 percent FPL (roughly $51,650 in 2021 dollars) would be ineligible for any subsidy that would make their health insurance more affordable. By provisionally decreasing premiums — or increasing subsidies — for everyone, including people over the 400 percent FPL threshold, Build Back Better would reach more people in West Virginia and across the country.

Nationally, the CBO estimates that this feature of the Build Back Better plan would benefit 3.6 million Americans. This figure includes the 19,000+ people enrolled in West Virginia’s marketplace in 2021. Experts anticipate that decreased marketplace premiums will also attract additional people to the marketplace. 

Access to affordable health care has never been more urgent. Congress must pass the Build Back Better plan to ensure a healthier, more equitable West Virginia and nation.

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