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Health care makes some surprising appearances in President Joe Biden’s $2 trillion infrastructure plan, even though more health proposals are expected in a second proposal later this month. The bill that would help rebuild roads, bridges and broadband capabilities also includes $400 billion to help pay for home and community-based care and boost the wages of those who do that very taxing work. An additional $50 billion is earmarked for replacing water service lines that still contain lead, an ongoing health hazard.

Meanwhile, more than half a million people have signed up for health insurance under the new open enrollment for the Affordable Care Act — and that was before the expanded subsidies passed by Congress in March were incorporated into the federal ACA website, healthcare.gov.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s podcast:

  • When announcing the new ACA marketplace insurance numbers, federal officials said the enrollment opportunity has been particularly popular with Black residents and lower-income customers.
  • As part of its effort to spur more enrollment, the administration dramatically increased funding for marketing and outreach, including commercials during the NCAA basketball tournament. The Trump administration had cut advertising by 90%.
  • The enrollment bump came even before the new, more generous subsidies were reflected on healthcare.gov, the federal website offering health plans. Biden’s covid relief plan boosted the federal tax credits for people eligible to buy marketplace insurance, especially to middle-income families and those closer to the federal poverty level.
  • In describing Biden’s plan to enhance home and community-based health care, administration officials describe it as a jobs measure because it will help raise wages for people doing the work and help others not have to leave their jobs to care for a loved one.
  • The need for more help caring for older people has often been overlooked because policymakers do not have an easy way to pay for such programs. But as Americans live longer, officials are grappling with the difficult transition from a health system based on acute disease to one that must handle chronic health issues, too.
  • Vaccine credentials are increasingly being required before people can be admitted to public gatherings, but the U.S. does not have a standardized record-keeping system for consumers. When vaccinated, most people get a white card with handwritten details about the date and type of vaccine. Although some health systems and states are keeping records of that, not every facility has an easy way for consumers to get a new record if they lose their card. So, experts are urging them to at least take photos of the card and store that photo electronically.
  • The White House has said it is not in favor of setting up a federal vaccine passport system, and the World Health Organization also said it does not want that now. In the U.S., much of the opposition is being raised by conservatives, who object to federal mandates on issues such as health. But the WHO’s concerns stem from fears raised by groups on the left over vaccine distribution: Because so many doses have gone to First World countries, residents of poorer nations would be disadvantaged by a passport system.