Sun Sentinel Palm Beach Edition
Medicaid gets fixes in Biden budget, but not Medicare
WASHINGTON — Medicaid issues are turning up as winners in President Joe Biden’s social agenda framework even as divisions force Democrats to hit pause on far-reaching improvements to Medicare.
The budget blueprint Biden released Thursday would fulfill a campaign promise to help poor people locked out of Medicaid expansion across the South due to partisan battles, and it would provide lowincome seniors and disabled people with more options to stay out of nursing homes by getting support in their own homes. It also calls for 12 months of Medicaid coverage after childbirth for low-income mothers, seen as a major step to address national shortcomings in maternal health that fall disproportionately on Black women.
But with Medicare, Democrats were unable to reach consensus on prescription drug price negotiations. Polls show broad bipartisan support for authorizing Medicare to negotiate lower prices, yet a handful of Democratic lawmakers — enough to block the bill — echo pharmaceutical industry arguments that it would dampen investment that drives innovation. Advocacy groups are voicing outrage over the omission, with AARP calling it “a monumental mistake.”
Not getting a deal on prescription drugs has consequences. Without expected savings from lower drug prices, Medicare dental coverage for seniors is on hold, as is vision coverage. The Biden framework does call for covering hearing aids, far less costly. Also on hold is a long-sought limit on out-ofpocket drug costs for Medicare recipients. Discussions are continuing around a more limited approach to drug price negotiations, according to a senior Democratic aide in the House, who spoke on condition of anonymity to describe a fluid situation.
While traditionally Medicare has been politically favored, Medicaid was long regarded as the stepchild of health care programs because of its past ties to welfare. Just a few years ago, a Republican-led Congress unsuccessfully tried to slap a funding limit on the federal-state program.
In that battle, “many people realized the importance of Medicaid for their families and their communities,” said Judy Solomon of the Center for Budget and Policy Priorities, a nonprofit that advocates for low-income people. “I think there was a new appreciation of Medicaid, and we are seeing that.”
As Medicaid grew to cover more than 80 million people, nearly 1 in 4 Americans, it became politically central for Democrats. Biden’s Medicaid-related provisions have a strong racial justice dimension, since many of the people who would benefit from access to health insurance in the South or expanded coverage for new mothers across the land are Black or Hispanic.
Expanding Medicaid has been the top policy priority for Democrats in Deep South states for years, citing the poverty and poor health that plagues much of the region. The decision by some Republican-led states to reject expansion of Medicaid under the Obama health law meant that 2 million poor people were essentially locked out of coverage in a dozen states, and another 2 million unable to afford even subsidized plans. Texas, Florida and Georgia are among the Medicaid hold-outs.
Under the Biden blueprint eligible uninsured people in states that have not expanded Medicaid could get subsidized private coverage through HealthCare.gov at no cost to them. The fix is only funded for four years, a budgetary gimmick intended to make cost estimates appear lower.
In a coda of sorts, the Biden framework also provides permanent funding for Medicaid in U.S. territories, including Puerto Rico. It would permanently reauthorize the popular Children’s Health Insurance Program, or CHIP, avoiding periodic nailbiting over coverage for nearly 10 million kids.