Healthcare as Stimulus and Infrastructure?

By Dr. Christopher Peters

Between last fall’s election and inauguration day, many of us were speculating about what health care changes we could expect under President Joe Biden. Nearly three months into his presidency, the picture still is not crystal clear.

Since President Biden’s inauguration, the administration has reversed some of the healthcare policy decisions enacted under the Trump administration. This has included attempting to boost enrollment in Affordable Care Act (ACA) marketplace plans through advertising and outreach. It also opened a special ACA marketplace enrollment period, which began on February 15th and will run until May 15th. And, it has rolled back Trump era regulations which made it more difficult for some low-income Americans to obtain coverage under Medicaid.

All of these changes were expected. However, the likelihood that President Biden will be able to fulfill his campaign promise for “Bidencare”, to include a public option for Medicare and reducing the Medicare eligibility age to sixty, remains low. Nonetheless, President Biden and the thin Democrat majority in Congress haven’t given up.

The recently passed $1.9 trillion COVID relief bill, the American Rescue Plan Act, is best known for additional stimulus checks and expanded unemployment assistance. This legislation contained a number of healthcare provisions, too, though many of these escaped the headlines. Some of these provisions include a two-year increase in subsidies for those who purchase coverage through the ACA marketplace, increasing the income cap to make more Americans eligible for ACA coverage, and reducing the percentage of their income that participants would have to pay toward ACA premiums.

Beyond ACA changes, the American Rescue Plan Act completely subsidizes premiums for COBRA coverage for workers who have lost their jobs. It also provides states the option to extend Medicaid coverage for low-income women following childbirth. And, in an attempt to lure the twelve states who have resisted expanding Medicaid coverage, President Biden has increased the federal match for expanded coverage. Finally, there is additional funding for behavioral health, including block grant programs for substance abuse and mental health treatment.

President Biden’s newest policy proposal, an infrastructure bill known as the American Jobs Act, is estimated to cost $2 trillion over the next eight years. The Administration argues that the plan will be paid for by increasing the corporate tax rate to 28%, reversing the current rate of 21% that was lowered as a result of the Tax Cuts and Jobs Act of 2017. While much of this proposal is focused on traditional infrastructure projects, a sizable portion, $400 billion, addresses healthcare-related issues. It would seek to increase access to care for the elderly and disabled, expand access to long-term care services under Medicaid, and increase pay for workers who care for the elderly.

The American Rescue Plan Act was passed by Congress through a process known as budget reconciliation. Utilizing reconciliation required no Republican support, and it received none. It is not yet known whether the narrowly-controlled Democrat Congress will pursue budget reconciliation to pass President Biden’s infrastructure proposal too, but given recent public denouncements by Republican leaders in Congress, I suspect that might be their only politically viable option.

While reconciliation may indeed be the only viable option for additional health care reforms to become law, it is certainly not the most desirable option. Our healthcare system is in dire need of real reform in a timely fashion. The Medicare Trust Fund, for example, is projected to be exhausted by 2024, just a little over three years from now.

Healthcare reform is incredibly complex and requires honest discussion, public deliberation, and political compromise. With the decision-making process confined to the Biden administration and a few members of congressional leadership, discussion and deliberation are circumvented. Reforming and expanding healthcare through inclusions in stimulus spending and infrastructure bills, especially through the budget reconciliation process, avoids the need for political compromise in order to see the necessary reforms enacted.

Such maneuvers are not, of course, unique to the Biden administration or the current Democrat Congress. They have happened during the presidential administrations of Donald Trump, Barack Obama, and George W. Bush, when they each briefly enjoyed unified government. Political machinations such as these are a symptom of our polarization and our deeply dysfunctional political system.

It seems increasingly likely to me that we will not be able to create a healthy healthcare system until we first heal our broken political system.


Dr. Chris Peters is a Contributing Scholar to TEF Iowa, a 9-year Army Medical Corps veteran, a surgeon, and a small-business owner in Coralville. He was also the Republican candidate for U.S. Congress in Iowa’s 2nd District in 2016 and 2018. Most importantly, Chris has been happily married to Julie for 26 years, is the proud father of three adult sons, Cole, Jake, and Caleb, and is the delighted grandfather to Jake’s son, Liam.