By Expanding Obamacare, Senate Dems Would Hand Biden Big Health Care Win

Senate Democrats are poised to hand President Joe Biden a significant victory on health care, vindicating the gamble he made as a candidate to support the Affordable Care Act instead of the more progressive proposals backed by his primary rivals.

The passage of a sweeping energy and health care package is not a done deal. Democrats will need every member of their caucus to vote for the measure, including Sen. Kyrsten Sinema of Arizona, a moderate who has bucked her party in the past and has yet to take a position on the proposed legislation.

But if the measure passes in the coming days, it would provide $65 billion in funding for enhanced premium subsidies for Affordable Care Act coverage through 2025. The subsidies were included in the American Rescue Plan, the pandemic aid package that Congress passed soon after Biden took office, but were set to expire at the end of this year.

"It would be extremely significant," Sara Rosenbaum, a health law and policy professor at Georgetown University, said of the health care measure. "The subsidies have made a huge difference. The uninsured numbers have fallen to their lowest levels ever."

Biden was a lonely voice supporting the Affordable Care Act, known as Obamacare, during the Democratic primaries in the run-up to the 2020 election.

Sen. Bernie Sanders of Vermont and other rivals for the Democratic presidential nomination called for replacing the law with some version of a "Medicare-for-All" universal health care system.

Biden argued that it would be easier to build on the existing law rather than trying to replace it with a progressive health care plan that would have little chance of passing in Congress.

The position drew heavy criticism from progressives who viewed it as further proof that Biden was out of step with a party that has shifted to the left since he served in the White House with former President Barack Obama.

Biden 2019 debate
As a presidential candidate, Joe Biden promised to strengthen the Affordable Care Act instead of adopting the health care proposals backed by his progressive rivals in the Democratic primaries. Alex Wong/Getty Images

The issue became a flashpoint in a broader intra-party fight between moderates like Biden, who called for incremental change, and Sanders, Sen. Elizabeth Warren of Massachusetts and other progressives pushing for deeper structural reforms to the federal government.

After clinching the nomination, Biden embraced some of the policies of his Democratic presidential rivals, including on education and climate change, but he never altered his position on health care.

Once in office, Biden signed several executive orders to protect the Affordable Care Act and promote efforts to get more individuals to sign up for marketplace health care plans. In January, the administration announced that 14.5 million people signed up for coverage in 2022.

The COVID relief package expanded Obamacare premium subsidies, and for the first time made people earning more than 400% of the federal poverty level eligible for health care tax credits. It also expanded Medicaid to new mothers and others who weren't previously eligible for the federal and state program, which provides health care coverage for low-income individuals.

The Department of Health and Human Services announced earlier this week that the number of Americans without health insurance coverage had dropped to 8%, an all-time low.

The health care measures Democrats hope to pass now in the Inflation Reduction Act would ensure that Biden expanded the Affordable Care Act throughout his entire first term in office. The bill would also allow Medicare to negotiate for the price of prescription drugs, a change Democrats have sought for decades.

There are several reasons why the health care provisions in the bill, if it passes, may get lost in the shuffle in an election year dominated by the economy and inflation.

For starters, the legislation won't settle the debate over Obamacare on the left once and for all.

"Health care isn't going to go off the table anytime soon as an issue for the progressive wing of the Democratic Party," said Alan Minsky, the executive director of Progressive Democrats of America, a group that endorsed Sanders in 2020.

Kyrsten Sinema
Sen. Kyrsten Sinema (D-AZ) leaves her office to walk to the Senate Chambers in the U.S. Capitol Building on August 02, 2022 in Washington, DC. Anna Moneymaker/Getty Images

The Supreme Court decision in June to overturn Roe v. Wade will likely be the defining health care-related issue for most voters this fall, overshadowing Biden's work on Obamacare.

The bill would also leave some of Biden's health care campaign promises unfulfilled.

Biden called for adding a public option to the Affordable Care Act, but Democrats have not pursued the proposal. The president wanted the states that have not yet expanded their Medicaid programs through the Affordable Care Act to do so under his watch.

But so far the 12 states that held out on the expansion under Obama and former President Donald Trump have held fast, continuing what has been a years-long opposition by Republican governors and state legislatures to Obama's signature domestic achievement.

Republicans in Congress slammed the Democrats' energy and health care plan this week.

"This is an agreement that only Bernie Sanders would love," Senate Minority Leader Mitch McConnell of Kentucky told reporters Tuesday.

Still, McConnell and other Republicans find themselves in the familiar position of opposing a health care law that has survived several challenges over the years in Congress and the courts.

Republicans failed to repeal the Affordable Care Act under Trump. The Supreme Court upheld a challenge to the law last year, handing another blow to opponents who have tried unsuccessfully several times to convince the high court to strike down Obamacare.

Despite the Republican attacks, protections for people with preexisting conditions and other key elements of the law have become popular with a majority of Americans in the years since the law's controversial passage and its messy rollout a decade ago.

Biden understood that as a candidate, and now his support for the Affordable Care Act is paying off, said Rick Ridder, a Democratic consultant.

"He was far more in tune with most voters in the country than other Democrats who were proposing [more progressive] health plans that fit the dynamics of the Democratic primaries," Ridder said.

If Democrats pass their bill, he added, it would be "a victory for Biden, because he laid out what he wanted to do, he told voters how he was going to do it, and he did it."