Last night President Biden made his first speech to Congress and presented his vision for how we can “grow the economy from the bottom up and middle-out.” A transcript of his remarks is here.


In the speech, the President outlined his "American Families Plan” - see the White House fact sheet here.  This plan is just one signal from the administration regarding what it views as part of its “human infrastructure” priorities.  His speech also went beyond the provisions in the American Families Plan and included a broader set of policies to help low- and middle-class families.  Below are highlights of two key pieces of President Biden’s agenda and challenges to Congress to act. 

More Help with the Cost of Health Insurance

Very good news is the American Families Plan permanently extends the temporary improvements in the Affordable Care Act health insurance premium tax credits included in the American Rescue Plan Act (ARPA).  

The ARPA is the COVID-19 relief bill signed into law on March 11. That new law dramatically increases premium tax credits for people who are currently eligible and expands eligibility to people with incomes that were previously too high for financial help.  The ARP capped premiums at 8.5 percent of income for everyone and many people pay much less.  There will be no ACA premiums for folks with family incomes under 150 percent FPL.  

Making these improvements to the premium tax credit is critically important for West Virginia.  In our state, these improvements made 16,900 more West Virginians newly eligible for help with the cost of health insurance through the premium tax credit. Almost 4,000 uninsured West Virginians became eligible for free health insurance coverage. We do not want to say next year “sorry that help is going bye-bye” to these West Virginians who struggle with access to health care.

The American Rescue Plan’s premium tax credit enhancements and expansions make coverage more accessible and affordable for hard-working West Virginia families without affordable health insurance through their employer.  No West Virginian should have to continue to “play by the rules” and work hard only to find that they and their family could be financially devastated by one serious illness. Or worse face avoidable health risks that can lead to death.

Lower Prescription Drug Costs 

President Biden touched on other health action beyond what is in the American Families Plan that he wants to advance including addressing the unaffordable cost of prescription drugs:

Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower prices for prescription drugs.  

That won’t just help people on Medicare – it will lower prescription drug costs for everyone.  

The money we save can go to strengthen the Affordable Care Act – expand Medicare coverage and benefits – without costing taxpayers one additional penny. 

We’ve talked about it long enough – Democrats and Republicans.  

Let’s get it done this year. 

This is all about a simple premise: Health care should be a right, not a privilege in America. 

What Happens Next?

President Biden has laid out his vision and aspirations for federal legislative action.  Now the U.S. House of Representatives, under the leadership of House Speaker Nancy Pelosi, will put together a package of bills and proposals.  Once passed by the House, the package goes to the U.S. Senate.  If the package moves in the Senate as part of the budget reconciliation process, it will take 51 votes to pass.  Outside of this process, legislation must pass by 60 votes.  Right now it is unclear what the House will pull together in its package; perhaps most important, it is unclear how much of that package will move under the Senate budget reconciliation process.  In many ways, it all boils down to what is moving under that Senate budget reconciliation process.  Remember that Democrats have 50 seats in the Senate (and Vice-President Harris can cast the 51st vote.).  This means that every Senate Democrat must support the package and moving the package through the budget reconciliation process. 

West Virginia’s Senator Manchin will be key to these decisions.  

The “Pay-Fors” Debate

A big part of the debate in Congress will be how to pay for these policies and others in any package of legislation. President Biden is proposing to raise taxes for the wealthiest Americans and corporations.  He explained:

Recent studies show that 55 of the nation’s biggest corporations paid zero federal tax last year. Those 55 corporations made in excess of $40 billion in profit. A lot of companies also evade taxes through tax havens in Switzerland and Bermuda and the Cayman Islands. And they benefit from tax loopholes and deductions for offshoring jobs and shifting profits overseas. It’s not right.

We’re going to reform corporate taxes so they pay their fair share and help pay for the public investments their businesses will benefit from as well….

We’re going to get rid of the loopholes that allow Americans to make more than $1 million a year and pay a lower tax rate on their capital gains than Americans who receive a paycheck. We’re only going to affect three-tenths of 1 percent of all Americans by that action. Three-tenths of 1 percent. The I.R.S. is going to crack down on millionaires and billionaires who cheat on their taxes. It’s estimated to be billions of dollars by think tanks left, right and center.

Again, West Virginia’s Senator Manchin’s support of tax code changes that enhance tax fairness and do not raise taxes for anyone making over $400,000 a year will be critically important.

Holding on to the Vision

As the President and Congress work together over the summer, we must recognize that the work started by the American Rescue Plan is not done.  We are at a unique moment in the history of our nation.  We have the opportunity to continue good policies that are pulling families out of the economic and health crises created by the COVID-19 pandemic.  The pandemic opened our eyes as a nation to the health inequities of our healthcare system.  Temporary policies begin to address some of the longstanding barriers that contributed to the disproportionate toll COVID-19 took on low-income people and Black and brown communities.  Now is the time to fight for permanent change and to further address longstanding unfair and discriminatory barriers to economic security. 

Good health and access to quality health care is an essential element to this effort. A healthy workforce is an essential element to restarting our economy and infrastructure. Our job is to remind the Biden administration and federal policymakers that health care is central to healthy equity and economic growth.  Health care is fundamental to any definition of “infrastructure” – policies that are a prerequisite for productive workers and economy growth.

West Virginians for Affordable Health Care applaud President Biden and look forward to working to educate West Virginians about the American Families Plan provision that can make coverage and care more affordable, accessible, and equitable for West Virginia families.  And West Virginians for Affordable Health Care will support action to lower prescription drug costs by empowering Medicare to negotiate drug prices. 

The time to be bold is now.  Stay tuned.  It will be an exciting summer. 


Kat Stoll


- Principal of Kat Consulting - Morgan County, WV - Policy Director,West Virginians for Affordable Health Care - Former Deputy Executive Director, Families USA