UPH Government & External Affairs

Federal Update – April 2021

by | Apr 28, 2021

Tomorrow marks the 100th day that President Joe Biden has been in office. During the beginning of his tenure, the administration has proposed three large legislative packages, signed numerous executive orders, and have overseen the national COVID-19 response efforts. At latest count, roughly 232.3 million vaccine doses have been administered nationally, which translates to 70 doses per 100 people. There have also been hiccups in the transition caused by delays in filling leadership positions (the nominee for CMS Administrator is still awaiting Senate confirmation) and “pauses” and delays placed on regulations and payment reform models while program portfolios are under review. While the first 100 days set a stage, the Administration will ultimately be judged upon results and there are 1,361 days until the next inaugural. The first 100 day legislative packages are outlined below.

Biden Legislative Package #3: American Families Plan. Last night, President Biden gave his first joint address to Congress. Based on an advanced fact sheet for this speech, President Biden outlined the second part of the Administration’s Build Back Better agenda: the American Families Plan. Widely referred to as a “human infrastructure package,” the $1.8 trillion plan focuses on issues like childcare, family leave, tax reform, and education. President Biden’s inclusion of health care policies was very limited. The only detailed health care policy in the plan is a $200 billion investment to make permanent the two-year advanced premium tax credits to individuals who purchase insurance on the Marketplace. These tax credits were expanded in the American Rescue Plan, the latest COVID-19 relief package that was signed into law on March 11, 2021. The plan makes a broad reference to Medicare prescription drug price negotiation and Medicare expansion, while leaving the door open for these to be addressed in other legislative vehicles.

Outside health care, President Biden laid out a vision for Congress that included:

  • $200 billion for free universal pre-school for all three- and four-year-olds;
  • $109 billion for two years of free community college education;
  • $225 billion to support childcare;
  • $225 billion to support 12 weeks of paid family and medical leave;
  • Expanding the child tax credit for working families;
  • Implementing tax reforms focused on the highest income Americans earning an annual $400,000 and above, which would raise about $1.5 trillion over ten years.

Biden Legislative Package #2: American Jobs Plan. The Biden Administration released this first part of its infrastructure package at the end of March. Totaling $2.3 trillion in investment, the American Jobs Plan includes numerous provisions, which impact traditional infrastructure (e.g., jobs, roads and utilities). It also invests $400 billion to support accessible health care provided through home- and community-based services (HCBS) and significant investments in broadband expansion which will help support telehealth. Other health care investments target pandemic preparedness, including shoring up the National Strategic Stockpile, and accelerating research, development and testing of therapeutics and vaccines, and also providing funding to modernize Veterans Affairs hospitals and clinics. Like the American Families Plan, specific legislative language has not been released.

Biden Legislative Package #1: American Rescue Plan. In March, Congress passed and the President signed the $1.9 trillion American Rescue Plan, the sixth round of COVID-19 pandemic relief. The focus on this relief was economic recovery and included support targeting American families – a third distribution of individual stimulus checks, extended unemployment benefits, and tax relief in the form of increased child tax credits and child and dependent care credits.

For notable health care provisions within the American Rescue Plan(ARP), see UnityPoint Health’s ARP Summary. Headlining these efforts are funding for: COVID vaccines, treatment and testing; rural health providers; mental health outreach; state and local government response; Medicaid coverage expansion and support; and premium assistance to expand health care coverage through COBRA and the Marketplace. In most cases, funding will be distributed via existing programs and grant offerings, but others such as the rural provider funding are new allocation streams.

Bipartisan Package: HR 1868 Medicare Sequester Act. Yes, a bipartisan bill passed. On April 13, President Biden signed into law legislation to eliminate the 2% across-the-board cut to all Medicare payments until the end of 2021. In addition, Senator Chuck Grassley’s bipartisan Rural Health Clinic Protection Act was included to protect some rural health clinics from an inadvertent reduction in reimbursement made under the 2021 omnibus appropriations bill. These technical changes to the rural health clinic provisions impacted UnityPoint Clinics in Grinnell, Waverly and Denver.

What’s next? President Biden has now rolled out his infrastructure package, both the American Jobs Plan and the American Families Plan. Outside of the extension of some very specific ACA subsidies, these plans have not addressed major health care issues of the day in detail, such as lowering drug prices, expanding Medicare, or creating a public option. Many items on the UnityPoint Health Federal Agenda  are also not included. Although the infrastructure packages may be limited in scope regarding health care provisions, health care policies are likely to continue to be pushed to the forefront throughout the rest of the year. UnityPoint Health will continue to voice our priorities with Congress, but we do believe there will be at least one legislative vehicle for those types of priorities before the close of 2021.


For addition information on federal legislative, policy and regulatory priorities please contact Cathy Simmons, government and external affairs executive director or Stephanie Collingwood, government and external affairs specialist.