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WASHINGTON -- By a vote of 220-211, the House on Wednesday passed the -- also known as the American Rescue Plan Act -- paving the way for President Biden's signature.

"The American Rescue Plan is aggressive, no doubt about it, but researchers and health professionals have told us this is what's needed to scale up testing and tracing, to address PPE [personal protective equipment] shortages, and to speed up equitable vaccine distribution," said Rep. John Yarmuth (D-Ky.), chairman of the House Budget Committee. "They have told us these investments are needed if we want to save lives and defeat this pandemic once and for all ... It helps feed hungry Americans and provides financial support so families can afford health coverage during the greatest health crisis of our lifetimes. The American Rescue Plan will provide resources needed to reopen schools safely and make up for lost time in the classroom."

But Rep. Jason Smith (R-Mo.) disagreed. Democrats "could have focused on timely and targeted relief to support those that are most in need, to reopen schools in our communities... and to crush the virus and put shots in Americans' arms," said Smith, who led the Republican side of the floor debate on the bill. "Instead, less than 9% of this bailout goes to crushing the virus and dispensing vaccines. Only 5% of K-12 education funding will be spent this year even as Americans are told this money is needed to reopen our children's schools."

At a press conference Wednesday afternoon announcing a COVID-19 vaccine manufacturing partnership between Johnson & Johnson and Merck, President Biden appeared to refute the idea that the bill was not targeted to COVID relief. "Everything in the American Rescue Plan addresses a real need -- including investments to fund our entire vaccination effort, more vaccines, more vaccinators, and more vaccination sites," he said. "Millions more Americans will get tested, including home testing. Schools will soon have the funding and resources to reopen safely -- a national imperative." Biden said he was looking forward to signing the bill, which is expected to happen on Friday.

The 627-page bill, which the Senate passed on Saturday, contains provisions on a wide variety of COVID-related issues, including employment, housing, education, and healthcare. Some of the major healthcare provisions include:

Help with COBRA premiums. COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, the law that created the program) allows people who have been laid off from their jobs to purchase health insurance from their former employer -- however, they have to pay the entire premium themselves, plus a little extra. Under the House bill, the government would pay 85% of the COBRA premium, and in the Senate version, the federal government would pay the entire amount. In either case, the subsidy would last only through September.

Help with ACA exchange premiums and subsidies. The bill contains a number of provisions in this area, most of which expire at the end of 2022. One provision would increase the amount of advance premium tax credits -- which are refundable -- that people could get to help them pay for insurance plans bought through the ACA's insurance exchanges. For example, under current law, an individual making up to 150% of the federal poverty level -- or $19,320 -- has to pay a premium amounting to slightly more than 2% of their income for a benchmark "silver" plan from the exchange. The bill would reduce that premium to zero; it also would allow people with incomes beyond 400% of the poverty level to receive subsidies, although the amount would gradually decrease as their income level rose.

Changes to the Medicaid program. Under current law, pregnant women eligible for Medicaid as a result of their pregnancy lose their eligibility 60 days postpartum. The bill would extend that 60-day period to 1 year. "That may impact the lives of more people" than the bill's other Medicaid provisions, said Myra Simon, principal at Avalere, a healthcare consulting firm, in a phone interview.

The measure also provides incentives for states that haven't expanded Medicaid to do so. When the ACA was first passed, the federal government paid states who agreed to expand their Medicaid programs 100% of the cost of expansion for the first 3 years; that amount then tailed off to 90%. Under the bill, the federal government's contribution toward expansion would still be capped at 90%, but the state would get an increase in the "matching fund" percentage for the rest of its Medicaid enrollees.

The bill "includes many provisions to help hospitals and health systems provide care to their patients and communities," Rick Pollack, American Hospital Association (AHA) president and CEO, said in a statement issued Saturday after the passage of the Senate version. "These include measures to increase access to health coverage for those who lose insurance or are uninsured. It also makes critical investments to bolster the nation's COVID-19 response, with resources for vaccines, treatment, testing, contact tracing, personal protective equipment, and workforce development. Additionally, the bill expands eligibility and provides more resources for the Paycheck Protection Program, which has helped save jobs in the hospital field."

Although the bill also provides financial relief for rural hospitals, "the AHA is disappointed that the bill does not deliver more overall funding for the Provider Relief Fund, which has been crucial in supplying hospitals, health systems, and other providers with resources during the pandemic," Pollack said. "We are also concerned that this bill does not include an extension of relief from Medicare sequester cuts, which will go back into effect at the beginning of next month, and also fails to provide loan forgiveness for Medicare accelerated payments for hospitals."

The American Cancer Society's Cancer Action Network praised the bill's passage. "We welcome the final passage of the coronavirus relief bill and its numerous provisions to expand access to affordable comprehensive health coverage," said network president Lisa Lacasse, in a statement. "These changes will make a significant difference to thousands of people, including those with a history of cancer, who may have found themselves out of work and without insurance due to the pandemic."

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