Pro­posed health care plans go to ex­tremes

Medi­care for all or com­plete con­trol to states prof­fered.

Dayton Daily News - - FRONT PAGE - Ron­ert Pear ©2017 The New York Times

Lib­er­als and con­ser­va­tives in Congress on Wed­nes­day set forth two rad­i­cally dif­fer­ent pro­pos­als for health care.

Lib­er­als and WASH­ING­TON — con­ser­va­tives in Congress on Wed­nes­day set forth two rad­i­cally dif­fer­ent pro­pos­als for health care: a huge ex­pan­sion of Medi­care, which would open the pro­gram to all Amer­i­cans, and a roll­back of the Af­ford­able Care Act that would in­stead give each state a lump sum of fed­eral money with sweep­ing new dis­cre­tion over how to use it.

The pro­pos­als sig­naled a re­sump­tion of the health care wars on Capi­tol Hill, as law­mak­ers tried — for op­po­site rea­sons — to move be­yond Pres­i­dent Barack Obama’s health care law. The one thing both ef­forts had in com­mon: Nei­ther is likely to be en­acted any time soon.

Sen. Bernie San­ders of Ver­mont, the one­time can­di­date for the Demo­cratic pres­i­den­tial nom­i­na­tion, pro­posed “a Medi­care-forall, sin­gle-payer health care sys­tem,” and said 15 Demo­cratic se­na­tors sup­ported it.

“In­stead of wast­ing hun­dreds of bil­lions of dol­lars try­ing to ad­min­is­ter an enor­mously com­pli­cated sys­tem of hun­dreds of sep­a­rate in­sur­ance plans, there would be one in­sur­ance plan for the Amer­i­can peo­ple with one sin­gle payer,” said a sum­mary of the bill pre­pared by San­ders’ of­fice.

At the same time, sev­eral Repub­li­can se­na­tors, led by Lind­sey Gra­ham of South Carolina and Bill Cas­sidy of Louisiana, un­veiled their bill, which would take money spent un­der the Af­ford­able Care Act and give it to states in the form of block grants.

Their pro­posal was the last gasp of Repub­li­can ef­forts to undo the Af­ford­able Care Act. Those ef­forts, which seemed sure of suc­cess in Jan­uary, ap­peared to meet a dead end on the Se­nate floor in late July, when Repub­li­cans could not muster even a sim­ple ma­jor­ity for a re­peal bill.

But Gra­ham and Cas­sidy have per­sisted, and they said they had en­cour­age­ment from the White House and some Repub­li­can gover­nors.

Un­der their pro­posal, money would be dis­trib­uted based on a com­plex for­mula that would include the re­gional cost of liv­ing. The spon­sors ac­knowl­edged that higher-spend­ing states like Mas­sachusetts would re­ceive less than un­der cur­rent law.

The block grant would re­place fed­eral money now be­ing spent un­der the Af­ford­able Care Act for the ex­pan­sion of Med­i­caid and for pre­mium tax cred­its and sub­si­dies that re­im­burse in­sur­ers for re­duc­ing out-of-pocket costs for low-in­come peo­ple.

The Gra­ham-Cas­sidy bill in­cludes many fea­tures of ear­lier Repub­li­can bills. It would re­peal the Af­ford­able Care Act’s re­quire­ments for most Amer­i­cans to have cov­er­age and for larger em­ploy­ers to of­fer it, and would also elim­i­nate a tax on med­i­cal de­vices.

In ad­di­tion, the Gra­ham-Cas­sidy bill would make deep cuts in Med­i­caid, putting the en­tire pro­gram on a bud­get and end­ing the ope­nended en­ti­tle­ment that now ex­ists. States would re­ceive a per-ben­e­fi­ciary al­lot­ment of fed­eral money.

A goal of the Gra­ham-Cas­sidy bill is even­tu­ally to equal­ize the amount of fed­eral money states re­ceive for the health care of each per­son with an­nual in­come from 50 per­cent to 138 per­cent of the poverty level (roughly $6,000 to $16,650 for an in­di­vid­ual).

But time is run­ning out on the bill. Af­ter Sept. 30, the Gra­ham-Cas­sidy leg­is­la­tion would lose pro­ce­dural pro­tec­tions that al­low pas­sage in the Se­nate with a sim­ple ma­jor­ity, rather than the 60 votes usu­ally re­quired to move ma­jor leg­is­la­tion.

Even with those pro­tec­tions, Sen. John Cornyn of Texas, the No. 2 Se­nate Repub­li­can, said he had seen no ev­i­dence that the bill had the 50 votes needed to win ap­proval in the Se­nate in the next two weeks. And he noted that it had not been an­a­lyzed by the Con­gres­sional Bud­get Of­fice, which likely would need a week or two to es­ti­mate how much the bill would cost and how many peo­ple would lose or gain cov­er­age.

Gra­ham, at a news con­fer­ence on Wed­nes­day, nee­dled Pres­i­dent Don­ald Trump and Se­nate Ma­jor­ity Leader Mitch McCon­nell, say­ing they should do more to build sup­port for his bill.

“The only thing stop­ping us from hav­ing this idea de­bated on the floor of the United States Se­nate is lack of lead­er­ship,” Gra­ham said. Repub­li­cans have promised for seven years to re­peal the Af­ford­able Care Act, and “we refuse to quit,” he added.

San­ders said his goal is to es­tab­lish health care as a right. His bill could serve as a po­lit­i­cal man­i­festo and a pos­si­ble cam­paign plat­form for pro­gres­sive can­di­dates. Among Democrats who have en­dorsed it are Sens. Cory Booker of New Jer­sey, Ka­mala Har­ris of Cal­i­for­nia and El­iz­a­beth War­ren of Mas­sachusetts.

Repub­li­cans seized on the San­ders bill as an op­por­tu­nity to por­tray Democrats as cham­pi­ons of costly, big gov­ern­ment pro­grams.

“It seems that this com­plete gov­ern­ment takeover of health care is be­com­ing the lit­mus test for the lib­eral left,” said Sen. John Bar­rasso, R-Wyo.

About 60 per­cent of House Democrats have en­dorsed a “Medi­care for all” bill in­tro­duced by Rep. John Cony­ers, D-Mich.

Demo­cratic lead­ers in the House and the Se­nate have not en­dorsed the San­ders bill and say their im­me­di­ate con­cern is to pro­tect cov­er­age un­der the Af­ford­able Care Act, which still faces at­tacks from Repub­li­cans.

San­ders’ bill would ex­pand Medi­care, one of the na­tion’s largest, most pop­u­lar en­ti­tle­ment pro­grams. Medi­care’s ben­e­fit pack­age would be ex­panded to include cov­er­age of den­tal care and hear­ing aids. The bill would also cover “com­pre­hen­sive re­pro­duc­tive, ma­ter­nity and new­born care, in­clud­ing abor­tion,” a sum­mary says.

The fed­eral gov­ern­ment would es­tab­lish a stan­dard list of cov­ered drugs — a pre­scrip­tion drug for­mu­lary for the “univer­sal Medi­care pro­gram” — and the sec­re­tary of health and hu­man ser­vices would ne­go­ti­ate prices with drug com­pa­nies. Such ne­go­ti­a­tions have the sup­port of con­sumer groups, but the adamant op­po­si­tion of drug­mak­ers.

San­ders did not say how he would pay for his bill. Aides said he would is­sue a list of fi­nanc­ing op­tions. The sum­mary says San­ders’ bill would elim­i­nate de­ductibles and most other out-of-pocket costs for con­sumers, but that the gov­ern­ment “may im­pose lim­ited co-pay­ments for pre­scrip­tion drugs in or­der to en­cour­age the use of lower-cost generic drugs.”

Un­der the San­ders bill, Medi­care — now avail­able to peo­ple 65 and older and to some younger peo­ple with dis­abil­i­ties — would be ex­panded over four years. In the first year, it would be opened to chil­dren through age 18 and to adults from 55 to 64. The el­i­gi­bil­ity age would drop to 45 in the sec­ond year and to 35 in the third year, with “ev­ery res­i­dent of the United States” en­ti­tled to ben­e­fits in the fourth year.

PHO­TOS BY TOM BRENNER / THE NEW YORK TIMES

At a news con­fer­ence re­gard­ing health care on Capi­tol Hill on Wed­nes­day, Sen. Bernie San­ders, I-Vt., pro­posed what he called “a Medi­care-for-all, sin­gle-payer health care sys­tem.” Sen. Lind­sey Gra­ham, R-S.C., at a news con­fer­ence on Capi­tol Hill on Wed­nes­day said he sup­ports a bill which would take money spent un­der the ACA and give it to states in the form of block grants.

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