The Build Back Better Act, H.R. 5376 (BBBA), is a framework intended to set the United States on a course to meet its climate goals, create millions of jobs, enable more Americans to join and remain in the labor force, and grow the economy from the bottom up and the middle out. Supported by President Biden and adopted by the House of Representatives on November 19, 2021, the act includes $1.7 trillion in spending across a broad package of social, climate change, revenue, and health provisions, the latter of which is projected to reduce the number of uninsured by 3.4 million individuals. But could these projected health provisions affect your revenue?

In a recent KFF article, Potential Costs and Impact of Health Provisions in the Build Back Better Act, 11 of the major health coverage and financing provisions of the Build Back Better Act are discussed. Here are the highlights from those 11 healthcare-related provisions that could impact your revenue if the bill, which is currently on hold, is ultimately passed in its intended form.

  1. ACA Marketplace Subsidies—Section 137301 would extend the ARPA subsidy changes that eliminate the income eligibility cap and increase the amount of APTC for individuals across the board through the end of 2025. Section 30605 would extend the special Marketplace subsidy rule for individuals receiving UI benefits for an additional 4 years, through the end of 2025. Section 137303 would, for purposes of determining eligibility for premium tax credits, disregard any lump sum Social Security benefit payments in a year, and would be permanent and effective starting in the 2022 tax year. Starting in 2026, people would have the option to have the lump sum benefit included in their income for purposes of determining tax credit eligibility. Section 137302 modifies the affordability test for employer-sponsored health coverage.
  2. New Medicare Hearing Benefit—Section 30901 would add coverage for hearing services to Medicare Part B beginning in 2023. A new defined Medicare Part B benefit could lead to enhanced and more affordable hearing benefits for Medicare Advantage enrollees. Because costs are often a barrier to care, adding this benefit to Medicare could increase use of these services, contributing to better health outcomes.
  3. Lowering Prescription Drug Prices and Spending—Sections 139001, 139002, and 139003 would amend the non-interference clause by adding an exception that would allow the federal government to negotiate prices with drug companies for a small number of high-cost drugs lacking generic or biosimilar competitors covered under Medicare Part B and Part D. The negotiation process would also apply to all insulin products.
  4. Medicare Part D Benefit Redesign—Sections 139201 and 139202 amend the design of the Part D benefit by adding a hard cap on out-of-pocket spending set at $2,000 in 2024, increasing each year based on the rate of increase in per capita Part D costs.
  5. Medicaid Coverage Gap—Section 137304 would allow people living in states that have not expanded Medicaid to purchase subsidized coverage on the ACA Marketplace for 2022 through 2025 with the federal government fully subsidizing the premium for a benchmark plan. People would also be eligible for cost-sharing subsidies that would reduce their out-of-pocket costs to an average of 1% of overall covered health expenses.
  6. Maternal Care and Postpartum Coverage—Section 30721 would require states to extend Medicaid postpartum coverage from 60 days to 12 months, ensuring continuity of Medicaid coverage for postpartum individuals in all states. Section 30722 would create a new option for states to coordinate care for Medicaid-enrolled pregnant and post-partum individuals through a maternal health home model. Sections 31031 through 31048 provide federal grants to bolster other aspects of maternal health care.
  7. Other Medicaid/Children’s Health Insurance Program (CHIP) Changes—Section 30741 would require states to extend 12-month continuous coverage for children on Medicaid and CHIP. Section 30741 would phase out the FFCRA enhanced federal funding to states. Section 30741 also would modify the FFCRA MOE requirement for continuous coverage. Section 30801 would permanently extend the CHIP program.
  8. Other Medicaid Financing and Benefit Changes—Section 30731 would increase the Medicaid cap amount and match rate for the territories. Section 30751 would establish a 3.1 percentage point FMAP reduction from October 1, 2022 through December 31, 2025 for states that adopt eligibility standards, methodologies, or procedures that are more restrictive than those in place as of October 1, 2021. Section 139405 would require state Medicaid programs to cover all approved vaccines recommended by ACIP and vaccine administration, without cost-sharing, for categorically and medically needy adults.
  9. Medicaid Home and Community-Based Services and the Direct Care Workforce—Sections 30711-30713 would create the HCBS Improvement Program, which would provide a permanent 6 percentage point increase in federal Medicaid matching funds for HCBS. Section 30714 would require states to report HCBS quality measures to HHS, beginning 2 years after the Secretary publishes HCBS quality measures as part of the Medicaid/CHIP core measures for children and adults. Section 30714 would require states to report HCBS quality measures to HHS, beginning 2 years after the Secretary publishes HCBS quality measures as part of the Medicaid/CHIP core measures for children and adults. Sections 30715 and 30716 would make the ACA HCBS spousal impoverishment protections and the Money Follows the Person (MFP) program permanent. Sections 22301 and 22302 would provide $1 billion in grants to states, community-based organizations, educational institutions, and other entities by the Department of Labor Secretary to develop and implement strategies for direct service workforce recruitment, retention, and/or education and training. Section 25005 would provide $20 million for HHS and the Administration on Community Living to establish a national technical assistance center for supporting the direct care workforce and family caregivers. Section 25006 would provide $40 million for the HHS Secretary to award to states, nonprofits, educational institutions, and other entities to address the behavioral health needs of unpaid caregivers of older individuals and older relative caregivers.
  10. Paid Family and Medical Leave—Section 130001 would guarantee 4 weeks per year of paid family and medical leave to all workers in the United States who need time off work to welcome a new child, recover from a serious illness, or care for a seriously ill family member.
  11. Consumer Assistance, Enrollment Assistance, and Outreach—Section 30603 appropriates $100 million for state consumer assistance programs (CAPs) over the 4-year period from 2022-2025. Section 30601(d) appropriates $105 million to conduct public education and outreach in non-expansion states so people will learn about new coverage and subsidy options.

While this list of 11 healthcare-related provisions is not meant be exhaustive, they do illustrate how comprehensive the Build Back Better (BBB) strategy is. With the BBB approach integrating disaster risk reduction measures into the restoration of physical infrastructure, social systems and shelter, and the revitalization of livelihoods, economies, and the environment, it’s critical that healthcare providers better understand its potential impact on their industry.