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Shaheen, Senators Reintroduce Legislation to Limit 2021 Out-of-Pocket Health Care Costs

(Washington, DC) –U.S. Senator Jeanne Shaheen (D-NH) reintroduced her legislation to reverse a damaging rule change made by the Trump administration that increased out-of-pocket costs for millions of Americans and made fewer Americans eligible for the Affordable Care Act’s (ACA) premium tax credits, while also causing those who are eligible to receive less in tax credit support. The Trump administration changed the index by which eligibility for the ACA’s premium tax credits and maximum out-of-pocket limits are set each year, resulting in a 2.5 percent increase in the maximum out-of-pocket limit in 2020 compared to where out-of-pocket limits would have been under the old indexing factor. This change resulted in a $200 increase in the cap on out-of-pocket costs for individuals, and a $400 per year increase for families. Senators Chris Murphy (D-CT), Richard Blumenthal (D-CT) and Tammy Baldwin (D-WI) are original cosponsors of the legislation.

“Addressing health care affordability has never been so urgent as our nation grapples with millions of COVID cases – twenty-five million to date – and more growing by the day. Every effort to lower health care costs must be taken and we should start by reversing the dangerous Affordable Care Act sabotage efforts launched by the Trump administration that drove up costs for Americans, including thousands of Granite Staters,” said Shaheen. “That’s why I’ve introduced legislation to rescind Trump-era guidance that changed eligibility for health care tax credits and spiked out-of-pocket limits for patients. My bill would overturn regulations set by the previous administration and lower out-of-pocket costs.  I will continue to press for legislative action to make these changes, while also working with the Biden Administration on regulatory efforts to reverse the Trump-era regulations. Defending the ACA and finding common-sense solutions to improve our health care law will remain a top priority for me in the 117th Congress.”

“COVID-19 demonstrated the necessity of giving every American access to affordable health care,” said Murphy. “The Trump administration raised the maximum allowable out of pocket costs for families and that's potentially catastrophic in the middle of the pandemic. Our legislation will get rid of this change, saving many families hundreds of dollars in unnecessary health care expenses.”

“This bill will reverse the damaging and shortsighted Trump administration change that raised Americans’ out-of-pocket health care costs,” said Blumenthal. “By reverting to Obama-era rules to calculate premium tax credits and maximum out-of-pocket limits health plans can set, we can once again lower what patients pay for their health care. This common-sense adjustment should be enacted immediately, especially with millions of Americans reliant on the health care system due to the COVID-19 pandemic.”

“The Trump administration spent four years working to sabotage our health system, and more Americans are uninsured today than when Trump took office,” said Baldwin. “During this unprecedented pandemic, we need to protect and expand access to affordable health insurance. Our reform will help more Americans get the quality health care coverage they need, at a price they can afford.”

The Trump administration finalized a regulatory adjustment that, beginning in Health Care Plan Year 2020, changed the indexing factor that is used to determine eligibility for the Affordable Care Act’s premium tax credits and calculate the maximum out-of-pocket limit that health plans can set each year. This rule change replaced an indexing factor that is based on premium growth from employer-based plans with a new indexing factor that is based on premium growth across all private plans. Shaheen’s legislation would nullify this change and revert to the former indexing factor, lowering out-of-pocket costs.

Shaheen has led efforts in Congress to protect and improve the ACA, including leading all 47 Senate Democrats on a Senate resolution that would reverse the Department of Justice’s decision to side with U.S. District Court Judge Reed O’Connor’s ruling that would strike down the ACA. This health care sabotage could result in 133 million Americans losing protections for pre-existing conditions, millions more Americans without health insurance, soaring prescription drug costs for seniors, and nearly 90,000 Granite Staters losing health care coverage. Senator Shaheen also spearheaded Senate Democrats’ proposal to make health care affordable and accessible for Americans during the COVID-19 public health emergency. She introduced the Marketing and Outreach Restoration to Empower (MORE) Health Education Act of 2019 with Senators Tim Kaine (D-VA) and Gary Peters (D-MI) to counteract Trump administration sabotage efforts that have slashed funding for health care enrollment advertising and marketing by 90 percent since the President took office. She also introduced the Protecting Americans with Pre-existing Conditions Act with Senators Mark Warner (D-VA), Ben Cardin (D-MD) and Tammy Baldwin (D-WI) to prevent the Trump administration from using federal premium tax credits to  promote and incentivize enrollment in “junk plans” that do not provide coverage of pre-existing conditions or essential health benefits.  Shaheen, Baldwin and Warner previously called on the Trump administration to do more to prevent third-party web brokers from steering individuals toward these junk health insurance plans.  


Shaheen championed a health care affordability package that includes three pieces of legislation to reduce health care costs for patients and expand access to critical medical services. Together, the Marketplace Certainty ActImproving Health Insurance Affordability Act and Reducing Costs for Out-of-Network Services Act would make essential reforms to the health care law that would help stabilize the marketplace, lower premiums for middle-class families and combat escalating out-of-pocket health care costs.  



The full text of the legislation is available here.