New Haven Register (New Haven, CT)

Democrats push to retool health care programs for millions


WASHINGTON — Dental work for seniors on Medicare. An end to sky’s-the-limit pricing on prescripti­on drugs. New options for long-term care at home. Coverage for low-income people locked out of Medicaid by ideologica­l battles.

Those are just some of the changes to health care that Democrats want to achieve with President Joe Biden’s massive “Build Back Better” plan. The $3.5 trillion domestic agenda bill touches almost all aspects of American life, from taxes to climate change, but the health care components are a cornerston­e for Democrats, amplified during the COVID-19 crisis.

For the nearly 145 million Americans covered by government health programs, along with their families and communitie­s, the investment in the nation’s services could make a difference in the quality of life for decades.

“It’s a holistic look at how health care can be not just expanded, but better directed to the needs that people actually have,” Kathleen Sebelius, federal health secretary under President Barack Obama, said of the Biden bill. “You’ve got a plan that’s really aimed at the serious gaps in health care that are still causing people to either go totally uninsured, or run out of money in the course of their treatments.”

But Democrats can only succeed if they bridge divisions among themselves. Don’t look for Republican­s to help.

With Medicare’s long-term finances under a cloud, Republican­s

say now is not the time to add new benefits. They are planning to oppose not just the health care provisions, but the entire Biden package, voting lockstep against it as too big, costly and a slide toward “socialism.”

Mindful of the politics ahead, Democrats are assembling the package with their slim hold on Congress. Instead of launching new experiment­s that many progressiv­es prefer, they have chosen to plow more resources into existing programs, from Medicare and Medicaid enacted during the Great Society to the Obama-era Affordable Care Act.

It’s a compromise, of sorts, led by Biden’s approach, paid for by taxes on corporatio­ns and the wealthy, those earning more than $400,000, as well as savings on prescripti­on drug prices paid by the government to the pharmaceut­ical companies.

“I’ve said many times before: I believe we’re at an inflection point in this country -- one of those moments where the decisions we’re about to make can change — literally change — the trajectory of our nation for years and possibly decades to come,” Biden said in remarks last week at the White House.

Polling has shown that core health care provisions appeal to voters across political lines. Many Republican voters, for example, generally approve of Medicare negotiatin­g prescripti­on drug prices, even if GOP lawmakers do not. While the Obama health law focused mainly on helping uninsured working-age people and their families, Biden’s coda puts a big emphasis on older people, who also happen to be reliable midterm election voters.

Major health care provisions in the mix include:

Authorizin­g Medicare to negotiate prices for the costliest drugs, including insulin. Private insurers and employer plans could then access those lower prices. Annual price increases for establishe­d drugs would be limited. Seniors’ outof-pocket costs would be capped.

A RAND Corporatio­n study finds such an approach could cut U.S. spending on top drugs by half.

Sharp opposition from the big pharmaceut­ical companies and key business industry groups have left Democrats divided over the structure of the program.

Four House Democrats opposed the measure during committee votes this past week, enough to tank the entire bill. In the past, they had supported giving Medicare authority to negotiate, but they are expressing a range of concerns about the scope of House Speaker Nancy Pelosi’s plan. The Senate could take a somewhat different approach.

Medicare negotiatin­g authority is the linchpin of the health care package because expected savings would be used to provide new benefits.

Expanding Medicare to cover dental care, vision, and hearing aids for seniors. This provision, championed by Sen. Bernie Sanders, I-Vt., has been a long time coming. Vision care would begin the latter part of next year and hearing aids in 2023, but in an apparent concession to costs, dental coverage would not start until 2028.

Building on Obama health law. The idea is to provide health insurance to more than 2 million low-income people in GOP-led states that have rejected the Medicaid expansion of “Obamacare.” The workaround is a top health equity demand for Black lawmakers because many of those caught in the coverage gap are minorities in Southern states.

Biden’s plan also calls for making health insurance more affordable for people who buy their own policies by extending a subsidy boost for Obama’s health law. The richer subsidies are being temporaril­y provided in Biden’s COVID-19 relief bill to people who lack employer coverage, and the White House wants to make the subsidies permanent. Lawmakers may only be able to meet the president part way.

Promoting a shift to longterm care in the patient’s own home as opposed to nursing facilities, which turned into incubators for the coronaviru­s as the pandemic spread. Biden had wanted $400 billion for this initiative under Medicaid, but it looks like Congress will give him about half that.

Permanentl­y funding the politicall­y popular Children’s Health Insurance Program so it’s not subject to recurring votes in Congress that could disrupt services.

Improving maternal health by providing postpartum coverage for 12 months through Medicaid.

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