COVID relief legislation makes health coverage more accessible and affordable

On March 11, 2021, President Biden signed the $1.9 trillion American Rescue Plan Act into law. This sweeping measure provides economic relief to individuals, families, businesses, schools, and state and local governments. The law offers new incentives for holdout states to expand their Medicaid programs to cover all low-income adults. The ARPA also temporarily subsidizes COBRA premiums for laid-off workers and, in a historic first, expands provisions of the Affordable Care Act to make health insurance more accessible and affordable.

The ARPA鈥檚 insurance changes don鈥檛 generally impact individuals who get insurance through their employer or via Medicare. But for many others, the ARPA provides new opportunities to get health insurance, upgrade coverage, and/or lower their costs for coverage. Whether you need a new insurance plan, or already have coverage, please keep reading for an overview of the ARPA, and be sure to check out this joint HFA-NHF insurance resource for more detailed advice on how you can make sure you are maximizing your health benefits under the new law.

Selected highlights of the ARPA:

  • Commercial health insurance
    • Individuals who were laid off and are eligible to continue their employer-sponsored health coverage under COBRA can have their premiums subsidized at 100% through the end of September聽2021.
    • ACA Marketplaces (open, in most states, for a special enrollment period that now runs until August 15, 2021) offer new opportunities to enroll in coverage and extra financial help to pay premiums.
      • You can get new coverage, stick with your current coverage or, in many states, switch plans to one that better suits your needs.
      • The new law will lower premiums for most purchasers who are eligible for ACA subsidies — including those who currently earn too much to qualify for subsidies.
      • In many cases, people who received unemployment insurance benefits at any point in 2021 will be eligible for $0 premium plans.
      • Visit to explore your options and/or make sure that your premium subsidies have been updated!
    • For more detailed information about these changes, and factors to consider as you weigh your insurance options, please read this HFA-NHF information sheet.
  • Stimulus and economic relief
    • Individuals (including children) will receive another round of economic impact payments ($1400/person for individuals earning under $75,000, phasing out at higher income levels).
    • Federal unemployment insurance benefits ($300/week) extend through September 2021 (and tax relief is provided for individuals who received enhanced unemployment benefits in 2020).
    • The law expands child tax credits for a period of one year.
    • The ARPA increases funding and expands access to the Paycheck Protection Program.
  • Direct Pandemic Response
    • The ARPA provides substantial federal funding to support vaccine development and distribution, COVID testing and treatment, and public health activities and capabilities.

Quick Hits

  • The Biden Administration issued a report finding that Medicaid work reporting requirements are linked with coverage losses and reduced access to care. Consistent with this finding, and with President Biden鈥檚 Executive Order on Medicaid coverage policies, the U.S. Centers for Medicare and Medicaid Services revoked permission for Arkansas and New Hampshire to cut off Medicaid benefits for noncompliance with work reporting requirements. Arkansas and Georgia have threatened to sue CMS over the agency鈥檚 announced and pending waiver revocations. Meanwhile, other ongoing litigation over the waivers has been paused (for now, at least) in the S. Supreme Court.
  • CMS announced that it would cancel a Trump Administration proposal to allow Medicare Part D plans to restrict coverage of drugs in the so-called six protected classes. Patient groups welcomed the news that Medicare plans will not gain the 鈥渇lexibility鈥 to limit their coverage of antiretrovirals, immunosuppressants, and other critical medications.
  • HHS announced that it would delay the effective date of the SUNSET rule, finalized on the last day of President Trump鈥檚 term. The SUNSET rule would have required HHS to review its regulations every ten years; if HHS missed any review deadline, the regulations at issue would automatically expire. House Democrats are pushing to reverse the SUNSET rule via use of the Congressional Review Act, a mechanism for undoing rules issued in the final days of a previous Administration.
  • The U.S. Department of Homeland Security formally removed the Trump Administration鈥檚 public charge rule from the U.S. Code of Federal Regulations. The public charge rule counted lawful immigrants鈥 use of Medicaid and other public benefits as a negative factor when those individuals applied for green cards or other changes in their immigration status. This rule, since its inception, has had a chilling effect on the use of benefits to which immigrants and their family members are legally entitled. The Administration also dropped its appeal of lower court rulings that had overturned the public charge rule.
  • The Senate confirmed Xavier Becerra to serve as Secretary, U.S. Department of Health and Human Services; Dr. Rachel Levine to serve as Assistant Secretary, HHS; and Dr. Vivek Murthy to serve as U.S. Surgeon General.
  • HFA staff were pleased to participate in NHF鈥檚 Washington Days meetings, advocating for support for bleeding disorders programs and federal action against accumulator adjusters.


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