WASHINGTON – Democrats face difficult moral and political decisions about how to achieve their centuries-old dream of universal health care as their ambitious $ 3.5 trillion social safety net almost certainly needs to be cut.
While trying to cut the bill’s cost, members of the party disagree on whether to prioritize expanding coverage to more poor adults in states whose leaders have denied it, or to introduce new Medicare to the elderly across all income levels – provide services.
The Southern Democrats in particular are calling on their leaders to prioritize insurance coverage for 4.4 million working poor in the 12 states, mostly in the South, with Republican or split leaders who have refused to expand Medicaid under the Affordable Care Act. But the progressives, led by Senator Bernie Sanders, the independent and former Vermont presidential candidate, are determined to provide dental, hearing and visual aids to older Americans.
Many provisions of the intricately crafted bill are interlinked, and the split over how to cut prescription drug costs and raise taxes is likely to prevent the party from acting boldly on both fronts.
“I believe health care is a human right, and if you believe it is a human right, you don’t believe it is a human right for 38 states,” said Senator Raphael Warnock, Democrat of Georgia, of his urge for extension of Medicaid in his state was central to his special election victory last year, and who will strive to bring such a feat to voters when he runs for re-election next year. “People literally die because they have no access to medical care at all.”
Health care has long been a winning issue for the Democrats. It provided them with the House of Representatives in 2018 and helped get them to run the Senate in 2020, thanks largely to the Georgia runoff elections of Mr Warnock and Senator Jon Ossoff.
But in broad political terms, most of the states that have refused to expand Medicaid – like Alabama, Mississippi, South Carolina, South Dakota, Tennessee, and Wyoming – are out of reach of Democrats. Older Americans, on the other hand, are consistent voters who are increasingly winning. These voters want Medicare to start paying for dental, visual, and hearing care.
Some Democrats also say Congress should not reward states that refuse to expand Medicaid for their working poor by creating a separate insurance program, fully funded by the federal government. Under the Affordable Care Act, Medicaid pays 10 percent of the cost. The issue was raised recently during a political lunch for the Senate Democrats.
“Some members have raised the question if we give a Medicaid benefit to states that haven’t expanded, those that expand will feel, ‘wait a minute,'” said Senator Tim Kaine, Democrat of Virginia. although he said that was not his view.
Democratic leaders envisioned four major components of health care: it would fill what is known as the coverage gap for Medicaid and reach poor adults who earn too much to qualify for traditional Medicaid but too little to qualify for private, subsidized insurance to qualify under the 2010 health law. It would provide dental, visual, and hearing care to Medicare beneficiaries for the first time. It would extend recently passed subsidies to help middle-income people get insurance under the Affordable Care Act.
All of this would be paid for by a provision that would allow Medicare to negotiate prices with drug manufacturers and tie drug prices to those of other developed countries.
Republicans are largely absent from the conversation; they reject the budget measure altogether and therefore do not consider whether to expand Medicare or Medicaid. However, they have long been opposed to Medicare negotiating drug prices, which they believe would stifle innovation in the pharmaceutical industry.
That part of the bill is now in jeopardy. Last week, three Democrats on the House of Representatives Energy and Trade Committee sided with Republicans to get it out of the law. The House Ways and Means Committee approved it with one vote against, but if the prescription drug measure fails to survive a full House vote, it will mean a loss of about $ 500 billion in savings that the Democrats will make to the Enlargement of Medicare and Medicaid wanted to spend. The total cost is approximately $ 600 billion over 10 years.
Between these competing imperatives stand lawmakers like MP Lloyd Doggett, a senior Democrat on the Ways and Means Committee whose home state Texas did not expand Medicaid. In the struggle for scarce resources, he said, seniors who already have good insurance coverage for most of their health needs under Medicare must take a back seat to the working poor who have no insurance at all.
“I prioritize the ones that have been left out completely,” he said. “You are desperate.”
While committees in both the House and Senate work to write their versions of the bill, Democrats across the philosophical spectrum struggle to decide what their own priorities are.
Representative Charlie Crist, a Florida Democrat who was once the state’s Republican governor, found that 800,000 of its residents are without health insurance because the government refuses to expand Medicaid. But Florida also has a significant elderly population who want expanded Medicare coverage.
“I think you are in favor of both; This is 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 all of our people with health care, and we have to. “
Senator Elizabeth Warren, a Democrat of Massachusetts, said that “drug companies have the best lobbyists in town,” but that the party shouldn’t give up cracking down on rising prescription costs to free up money for both priorities.
“I say the choice is between the billionaires and people who have no health care,” she said.
Pragmatists recognize that some concessions need to be made. Mr Kaine said it was possible that the Democrats would expand both Medicare and Medicaid in more modest ways, perhaps through phasing in benefits.
The four House Democrats who spoke out against drug measures – Kurt Schrader from Oregon, Scott Peters from California, Kathleen Rice from New York, and Stephanie Murphy from Florida – are enough to overturn all of the law in the tightly divided House . And more churns are likely from representatives with pharmaceutical interests in their districts who have had no opportunity to interfere.
Democrats advocating Medicare’s expansion have largely remained silent given the sensitivity of the issue. But they see a political blessing in the enlargement, which was approved by the House Committees last week. Seniors would see immediate visual aid coverage. A hearing would be added in 2023. Dental care, which would have to be created from scratch, would not start until 2028.
Medicare advocates say Congress has given sufficient time and incentives to states that haven’t expanded Medicaid, and it is time to focus on other priorities. The $ 1.9 trillion pandemic bailout bill this year included huge new subsidies for these states if they agreed to expand Medicaid. Not one.
States pay up to half the traditional Medicaid cost, but under the Affordable Care Act, the federal government pays 90 percent of the cost of the growing population.
The two Senators from Georgia and Senator Tammy Baldwin from Wisconsin, who also did not expand Medicaid, originally envisioned a Medicaid-like program from Washington that would give stubborn states even more federal funding when they finally joined Medicaid, and them of practically all fiscal responsibility.
Two House Committees – Ways and Means and Energy and Commerce – passed a measure last week that would extend existing Affordable Care Act premium subsidies for the time being to those who are now too poor to qualify and 94 percent of theirs cover all healthcare costs. increase to 99 percent by 2023. By 2024, the Department of Health and Welfare will have a Medicaid-like program modeled on the Senate proposal for these 4.4 million people.
To some liberal Democrats, the plan appears unfair to the 38 states that expanded Medicaid under the original terms of the Health Act – at a higher cost for those states.
Warnock has an answer to this: “I want to remind my colleagues that Georgia gave us the majority.”
“We would not have the privilege of debating these priorities and a package we are putting forward if the people of Georgia had not stood up and sent me and Jon Ossoff to the United States Senate,” he added. “That’s why we owe it to them to give them the coverage they deserve.”