Medicare Expansion Budgetally Conflicts Healthcare for the Poor


WASHINGTON — Despite their ambitious $3.5 trillion budget, Democrats face tough moral and political decisions about how to pursue their age-old dreams of universal healthcare. social safety net bill almost certainly will should be clipped back.

While party members seek to reduce the cost of the bill, they disagree on whether to prioritize expanding coverage to more poor adults in states whose leaders have rejected it, or to give new Medicare benefits to older people at income levels.

Southern Democrats, in particular, are urging their leaders to prioritize insurance coverage for the 4.4 million working poor in the United States. 12 statesMostly in the South, with Republican or divided leadership refusing to expand Medicaid under the Affordable Care Act. But Vermont independents and progressives, led by former presidential candidate Senator Bernie Sanders, are adamant. giving older Americans teeth, hearing and vision coverage.

Many provisions of the delicately crafted bill are interlinked, and the division over how to lower prescription drug costs and raise taxes will likely prevent the party from acting boldly on both fronts.

“I believe healthcare is a human right, and if you believe it’s a human right, you don’t believe it’s a human right for 38 states,” said Georgia Democratic Senator Raphael Warnock. was the state center last year’s special election victoryand he is eager to bring such success to the electorate when he runs for reelection next year. “People are literally dying without access to any kind of care.”

Healthcare has long been a winning issue for Democrats. He handed them the House in 2018, and largely thanks to it, helping them get the Senate in 2020. Mr Warnock and Senator Jon Ossoff’s second-round victories in Georgia.

But in crude political terms, most states that refuse to expand Medicaid—such as Alabama, Mississippi, South Carolina, South Dakota, Tennessee, and Wyoming—are out of reach for Democrats. Older Americans, on the other hand, are consistent voters who are more and more up for grabs. These voters want Medicare to start paying for dental, vision and hearing care.

Moreover, some Democrats say Congress should not reward states that refuse to expand Medicaid by creating a separate insurance program for the working poor, fully funded by the federal government. Under the Affordable Care Act, states that expand Medicaid pay 10 percent of the cost. The topic came up at a recent policy luncheon for Senate Democrats.

“Some members have raised the question that if we made a Medicaid benefit for states that didn’t expand, what would expand would feel like ‘Wait a second,'” said Virginia Democratic Senator Tim Kaine. though he said it wasn’t his opinion.

Democratic leaders envisioned four main healthcare components into the bill: It would close the so-called coverage gap for Medicaid, reaching poor adults who earned too much to qualify for traditional Medicaid but too little to qualify for private, subsidized insurance under 2010. health law. It will provide dental, vision and hearing care to first-time Medicare recipients. It will extend the recently enacted subsidies that help middle-income people buy insurance under the Affordable Care Act.

All of this would be paid for, with a provision that allowed Medicare to negotiate prices with drug manufacturers and tie drug prices to those paid by other developed countries.

Republicans largely do not participate in the conversation; they oppose the budget measure altogether and therefore do not weigh in on whether to expand Medicare or Medicaid. But they have long opposed allowing Medicare to negotiate drug prices, arguing that this would stifle innovation in the pharmaceutical industry.

This piece of the bill is now in jeopardy. three Democrats last week sided with the Republicans To remove it from the law in the House Energy and Commerce Committee. The House Ways and Means Committee approved it with a dissent, but if the prescription drug measure doesn’t survive a full House vote, it will mean about $500 billion in lost savings that Democrats hope to spend on expanding both Medicare and Medicaid. The total cost will be approximately 600 billion dollars in 10 years.

Among those competing mandates are lawmakers such as Representative Lloyd Doggett, a senior Democrat on the Ways and Means Committee, whose home state has not expanded Medicaid in Texas. In a fight for scarce resources, he said the elderly, who already have good coverage for most of their health needs under Medicare, should take a back seat to the working poor with no insurance.

“I prioritize the completely excluded,” he said. “They’re helpless.”

While committees in both the House and Senate are trying to write their own versions of the bill, Democrats across the philosophical spectrum are struggling to decide where their priorities lie.

Florida Democrat Representative Charlie Crist, who was once the Republican governor of his state, noted that 800,000 residents did not have health insurance because the state leadership refused to expand Medicaid. But Florida also has a significant elderly population seeking expanded coverage under Medicare.

“I think you’re defending both; That’s my position,” he said. “It’s extremely important. We are the richest country in the world and one of the few industrialized countries that does not provide healthcare to all of our people, and we have to.”

Massachusetts Democratic Senator Elizabeth Warren said that “pharma companies have the best lobbyists in town” but that the party should not stop curbing rising prescription costs to free up money for both priorities.

“I say the choice is between billionaires and people who don’t get healthcare,” he said.

Pragmatists realize that some compromises have to be made. Mr Kaine said it’s possible for Democrats to expand both Medicare and Medicaid in more modest ways, perhaps incrementally.

Four House Democrats — Kurt Schrader of Oregon, Scott Peters of California, Kathleen Rice of New York and Stephanie Murphy of Florida — who have expressed their opposition to the drug measures are enough to bring down the entire bill in the narrowly divided House. And there are probably more asylum seekers in their area than representatives with pharmaceutical interests who don’t have a chance to weigh in.

Democrats who support Medicare expansion have largely remained silent given the sensitivity of the issue. But they see a political boon in the enlargement approved by House committees last week. Seniors would see immediate coverage of vision care. A trial will be added in 2023. Dental coverage, which had to be built from scratch, would not start until 2028.

Medicare advocates say Congress has given states that haven’t expanded Medicaid enough time and incentives to do so, and it’s time to focus on other priorities. This year’s $1.9 trillion pandemic bailout bill included massive new subsidies for those states if they agreed to expand Medicaid. Nobody did.

States pay half the costs of traditional Medicaid, but under the Affordable Care Act, the federal government pays 90 percent of the costs for the expanding population.

NS two Georgia senators and Senator Tammy Baldwin The Wisconsin capital, which also did not expand Medicaid, envisioned a Medicaid-like program initially run from Washington that would offer recalcitrant states even more federal funds if they eventually joined Medicaid, freeing them from nearly any financial liability.

Two House committees — Roads and Vehicles and Energy and Commerce — passed a measure last week that would expand existing premium subsidies under the Affordable Care Act to those currently too poor to qualify for them, and would cover 94 percent of total healthcare costs. It rises to 99 percent in 2023. By 2024, the Department of Health and Human Services will have launched a Medicaid-like program for those 4.4 million people, following Senate recommendation.

For some liberal Democrats, the plan seems unfair to the 38 states that expanded Medicaid under the original terms of the health care law — at a higher cost to those states.

Mr. Warnock has a ready answer: “I remind my colleagues that Georgia gave us a majority.”

“If the people of Georgia hadn’t stood up and sent me and Jon Ossoff to the United States Senate, we wouldn’t have had the privilege of discussing these priorities and a package we’ve put forward,” he added. “So we owe it to them to give them the coverage they deserve.”



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