Health care proposals go to extremes
Medicare for all or complete control to states proffered.
WASHINGTON — Liberals and 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 roll- back 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 com
mon: 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 Demo- cratic senators supported it.
“Instead of wasting hundreds of billions of dollars trying to administer an enor- mously 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 cur- rent 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 subsi- dies 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 open
ended entitlement that now exists. States would receive a per-beneficiary allotment of federal money.
A goal of the Graham-Cas-
sidy bill is eventually to equalize the amount of federal money states receive for the health care of each per- son 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 pro- tections that allow passage in the Senate with a simple majority, rather than the 60 votes usually required to move major legislation.
Even with those protec- tions, 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 Congres- sional 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 sup
port 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 com
plete government takeover of health care is becoming the litmus test for the liberal left,” said Sen. John Bar- rasso, R-Wyo.
About 60 percent of House Democrats have endorsed a “Medicare for all” bill intro- duced 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 entitle
ment 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 ser
vices 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.