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June 9, 2021

The American Rescue Plan Act of 2021: A Historic if Transitory Expansion of the ACA

Author Affiliations
  • 1Brown University, Providence, Rhode Island
  • 2Harvard Law School, Harvard University, Cambridge, Massachusetts
  • 3Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts
JAMA. 2021;326(1):27-28. doi:10.1001/jama.2021.8389

The American Rescue Plan Act of 2021 (ARPA), a $1.9 trillion economic stimulus bill, was signed into law by President Biden on March 11, 2021.1 Although the bill largely focused on the devastation related to the COVID-19 pandemic, the ARPA is also poised to effectuate a momentous expansion of the Patient Protection and Affordable Care Act (ACA).2 With an eye toward increasing access to health care and bolstering affordability, the ARPA expands health insurance marketplace subsidies, defrays the health insurance costs of the unemployed, and incentivizes nonexpansion states to expand their Medicaid programs to all low-income adults.1 Projections of the Congressional Budget Office (CBO) suggest that in so doing, the ARPA will extend health care coverage to an estimated 2.5 million uninsured US residents by 2023.3 The CBO further projects that premiums will decline by as much as 100% for as many as 3.4 million low-income enrollees.3 This Viewpoint discusses the ARPA elements that bolster the ACA and describes their potential implications and uncertainties.

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