WASHINGTON — The Democrats’ social spending and climate change bill would put the United States back on a path to reducing its persistent pool of uninsured people, with estimates ranging from 4 million to 7 million Americans gaining health coverage.

Those getting covered would include about one-third of uninsured Black Americans, according to an analysis by the Urban Institute and the Commonwealth Fund, nonpartisan research groups that support the goal of expanding health insurance. Other estimates from the Congressional Budget Office and the center-right American Action Forum project a similar overall trend.

With the legislation, the number of uninsured people under age 65 would drop from about 28 million to less than 24 million in a decade, according to the budget office, which provides nonpartisan analysis for Congress. That 28 million starting point is roughly in line with the current count of uninsured people, so the nation would see a holding pattern if lawmakers do nothing.

Even with former President Barack Obama’s Affordable Care Act, nearly 9 percent of Americans remain uninsured. But now, by building on that health law, President Biden is trying to drive the numbers lower, a few percentage points at a time.

Left-leaning Democrats who favor guaranteed government health insurance for all are promoting the piecemeal progress under Biden nonetheless.

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Sen. Elizabeth Warren, D-Mass. Patrick Semansky/Associated Press

“The best approach to getting universal coverage is through a single-payer system, but we should not overlook how powerfully important the provisions in the Build Back Better agenda are,” said Massachusetts Sen. Elizabeth Warren, referring to Biden’s signature legislation proposal. “We have a historic opportunity to make a real difference in people’s lives … and we should do that.”


Final specifications of Biden’s package are being worked out, but numerous Democrats say the health insurance provisions have broad backing within their party. The changes include an extension of temporary financial subsidies for “Obamacare” plans in Biden’s coronavirus relief bill, coverage for low-income people in a dozen mainly Southern states where Republicans blocked Medicaid expansion, and a formula tweak for what’s deemed affordable workplace coverage.

“These policies would definitely reduce the number of uninsured in ways you could see clearly,” said economist Jessica Banthin, lead author of the Urban-Commonwealth analysis.

Republicans are trying to brand the Democrats’ plan as wasteful. Citing a budget office cost estimate of $553 billion over 10 years, House Republicans say that would work out to $14,200 per person covered, or about twice the annual premium for employee-only coverage at work.

“There’s nothing affordable about Democrats’ plan,” Rep. Kevin Brady of Texas, the top Republican on the House Ways and Means Committee, said in a statement.

But such criticism overlooks the fact that Republicans don’t agree among themselves on a strategy to continue expanding health insurance coverage. Most believe it’s not the role of government to guarantee coverage for all, particularly for people who are able to work.

Under President Donald Trump, Republicans tried and failed to repeal the Obama health law, and that would have made more than 20 million Americans uninsured. Trump never delivered on his own promise of “insurance for everybody.”


What’s more, a good deal of the cost in the Democrats’ latest bill involves their Medicaid workaround, which would not be happening if GOP-led states such as Texas, Florida and Georgia had joined the 38 others that expanded the program under the Obama law.

In the states still refusing, Biden and congressional Democrats would provide a federal fallback for uninsured low-income people. That includes about 2 million people currently ineligible for government-sponsored health insurance and at least as many who are legally entitled to purchase an ACA plan but probably cannot afford it, even with subsidies.

Adding a racial justice dimension to the push, many who would be helped are Black Americans.

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Sen. Raphael Warnock, D-Ga. J. Scott Applewhite/Associated Press

“This is an equity issue,” said Democratic Sen. Raphael Warnock. Georgia’s first Black senator, Warnock has made Medicaid his signature issue as he prepares for a reelection campaign next year.

“We have the opportunity to uphold the promise we made 11 years ago when we passed the Affordable Care Act,” Warnock said. “Every day that we delay is another day that the least among us continue to suffer.”

On a side note, the estimates from the Urban Institute and the Commonwealth Fund, as well as the one from the American Action Forum, project the Democratic bill would reduce the number of uninsured by about 7 million people. It’s the budget office that produced the smaller estimate of 4 million.

That doesn’t reflect a disagreement about the bill’s impact but more of a technicality. The CBO said it’s due to different assumptions that the researchers made in calculating their estimates. For example, CBO assumed that some of the Medicaid holdout states would expand their programs if federal law stays the same. The other two groups of experts did not.

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