Congress Democrats hope to pass a slew of health priorities later this year aimed at expanding access to coverage and making it more accessible to patients.
There seems to be broad agreement on the types of health policies that should be in the package, such as closing the Medicaid coverage gap and adding dental and vision benefits to Medicare, but the details have also been resolved by the committee staff and Congressional offices and nothing is certain.
The stakes are high for Democrats who see this as their last chance to carry out major health care reform before the midterms, in which their majorities in the House and Senate are in line.
“I think there’s a common denominator around what people want and a growing alignment around expectations,” said Eliot Fishman, senior director of health policies at Families USA, which advises Democrats on issues such as ACA and Medicaid.
House and Senate Democrats hope the package will close the coverage gap in non-Medicaid expansion states, add dental and visual benefits to Medicare, permanent expansion of ACA subsidies to median incomes, lower deductibles in the market, lower drug prices, expanding access to home- and community-based services and addressing maternal mortality.
They’re likely to use reconciliation – a budget maneuver that only needs 50 votes to pass and can’t be filibustered – but for that to work, all Democrats must be on the same page – a heavy lift for the close-ups of the House and Senate.
The current thinking is that Congress will pass a bipartisan bill focused on “hard” infrastructure, such as roads and bridges, followed by a democratic-only reconciliation bill that addresses key parts of the bill. so-called “employment” and “family” plans of President Biden.
“There’s no unity or consensus yet, but there’s a facsimile – there’s an agreement on the contours of what’s going to be similar,” said Alex Lawson, executive director of Social Security Works, which works with progressive Democratic offices. on issues such as drug prices and Medicare expansion. Here are some of the provisions that could end up in a reconciliation bill, which Democratic leaders hope to pass this fall.
Closing the Medicaid expansion gap
A major priority for Democrats in the House and Senate is closing the coverage gap in the 12 states that have rejected the Medicaid expansion of the Affordable Care Act.
The ACA has allowed states to extend Medicaid to low-income adults by making about 138% of the federal poverty level – or about $ 17,000 a year for an individual. It has helped secure more than 14 million people, except in states that have rejected expansion in protest of the politically controversial ACA.
“I am convinced that if you give Texas a penny and a half, the ideological objections are such that they will not accept it,” said Rep. Lloyd Doggett (D-Texas).
Congress aid, including the office of Senate President Ron Wyden, is looking at several possibilities to close that coverage gap, including extending ACA aid to those people so they can buy insurance on to exchanges. Doggett presented a project that will allow localities to revolve around states to extend Medicaid within their jurisdictions.
“I’m just here to try to find a practical way that we can include in the reconciliation that gets this job done,” Doggett said.
About 2.2 million people are in the coverage gap, doing too little to qualify for ACA grants to buy individual market insurance but also not qualifying for their state’s Medicaid programs, which traditionally cover only people. at very low incomes, pregnant women and people with disabilities.
Often they are not insured, which seals the hospitals with uncompensated care.
The latest COVID-19 relief project has offered increased Medicaid funding to states that are not expanding to encourage them to expand their programs, but no one has taken the bait.
Progressive Democrats also want to lower the Medicare eligibility age from 65 to 60 and add dental, visual and auditory benefits.
“It will be there,” Senate Committee Chairman Bernie Sanders (I-Vt.) Told reporters this week, referring to the conciliation bill that his committee must write a resolution by July.
“For me, it’s incomprehensible that in the richest country in the history of the world, that if you’re 80, you don’t have teeth in your mouth to digest your food, maybe you can’t hear your grandson talking. to deal with that problem and we will deal with it. ”
Hospitals and insurers are opposed to lowering the age of eligibility for Medicare, because it would result in fewer people having business insurance, which tends to pay providers more than public coverage. Decreasing the eligibility age is more likely to fall off the radar, according to people working on reconciliation, but the addition of dental, visual and auditory benefits is a better shot to pass.
Lower drug prices
Democrats hope to pay for those added Medicare benefits through a reconciliation benefit that will lower drug prices.
Senate Finance Chair Wyden is working with senators on a project that will allow HHS to set Medicare-covered drug prices. Currently, the federal government is not allowed under the law to interfere in private negotiations between drug producers and sponsors of the plan, which Democrats result in Medicare paying too much for drugs.
“I’m talking to senators, asking them to put some ideas on paper. That’s what you’re going to do when there’s a 50-50 Senate,” Wyden said this week.
The nonpartisan Congressional Budget Office (CBO) estimated a similar bill passed by the House last year that included that provision could save the government $ 500 billion over 10 years.
Expansion of home and community based services
Senator Bob Casey (D-Penn.) Told Modern Health “it’s the plan” to get the $ 400 billion for home-based and community-based expansion into reconciliation, noting that Democrats are quite united on the problem.
The details are expected to be published in a couple of weeks, but it’s likely to give states more funding to move people off waiting lists for these services. Because HCBS Medicaid coverage is not mandatory, many states have waiting lists for these services, with nearly 1 million people.
Expanding HCBS also has the support of President Joe Biden.
Congress would likely link that funding to requirements for better benefits and increased salaries for caregivers, who earn on average about $ 12 an hour and are disproportionately black women.
More ACA subsidies and deductible reduction
While the most recent COVID-19 relief project has expanded ACA subsidies to average revenues, that benefit expires in 2023.
The reconciliation bill is expected to permanently expand these subsidies while potentially lowering franchises for people in the market. This benefit could involve expanding assistance to share costs or attaching premium tax credits to a more comprehensive Gold plan.
“These policies enjoy support from across the ideological spectrum in the democratic caucus and should be part of the discussion when the Senate considers legislation to lower health care costs,” a Democratic aide said.
More than 160 members of Congress urge House and Senate leaders to include in the conciliation bill several provisions aimed at improving maternal health and access to coverage for new mothers.
Led by Rep.Lauren Underwood (D-Ill.), Members have asked the bill to extend Medicaid coverage for 1 year postpartum to new mothers,
Under the law, coverage ends 60 days after delivery.
The most recent COVID-19 relief project gives states the option to extend Medicaid for an entire postpartum year, but it expires in 2027 and is optional for states.
“We can’t afford to take coverage out of new mothers at a time when they need it most,” lawmakers wrote in the letter.