WASHINGTON (AP) – With the Affordable Care Act now secured as part of the nation’s health care programs, Democrats are eager to move beyond it.
They want to expand insurance coverage for working-age people and their families, add new Medicare benefits for seniors, and lower prescription drug costs for patients and taxpayers.
But healthcare is expensive, deficits are cause for concern, and Democrats holding a mere majority in Congress, lower expectations look likely later this year.
For now, Democrats are relishing Thursday’s Supreme Court ruling upholding “Obamacare” for the third time in a decade. The latest challenge to the law had been seen as a stretch by many legal experts, but a 7-2 vote from the Conservative court was unexpected.
“I think Democrats know once again that they have a moment and that they want to make the most of it,” said Kathleen Sebelius, President Barack Obama’s health secretary during the passage and implementation of the health law. “I think people are motivated and ready to go. “
There is no shortage of proposals. Some, like allowing Medicare to negotiate prescription drug prices, could potentially save hundreds of billions of dollars, depending on how they’re structured. But extending coverage and benefits could cost the same amount or even much more.
The complex budget procedures Democrats plan to use to pass President Joe Biden’s national platform through a simple majority vote in the Senate may also limit the types of proposals that can be considered.
“There is a sorting going on,” said John McDonough, who was a senior Democratic official in the Senate during the debate on the health bill. “Not all of these ideas are viable, but you don’t always know which ones to start with. McDonough is now a professor at the Harvard TH Chan School of Public Health.
The Democrats’ ideas fall into two broad headings: expanding coverage and benefits through public programs such as Medicare and the Obama Act, and using the power of government to bring down the price of prescription drugs. In theory, savings on prescription drugs can fund program expansion without increasing the deficit or raising taxes.
“These are not single-digit billion-dollar proposals,” said Marc Goldwein, senior policy director at the Committee for a Responsible Federal Budget. “We’re talking about $ 100 billion, $ 200 billion or more, but in different directions. The more they save, the more they can spend. His group is arguing for cutting federal deficits, and Goldwein adds “I hope they stick to the basic rule that you pay for what you are willing to spend.”
Very early on, a hierarchy of proposals began to emerge.
At the top of the list, and most likely to be included, is Biden’s plan to permanently expand the more generous HealthCare.gov insurance subsidies. They are now being provided until the end of next year as part of its COVID-19 relief bill. The price to pay is estimated at 163 billion dollars over 10 years.
Another health law issue is figuring out how to cover over 2 million low-income people in mostly southern states that have not expanded their Medicaid programs. A federal solution is not just about injecting more money because of obscure legal issues involving Medicaid.
The prospects of allowing Medicare to negotiate the prices of prescription drugs are also uncertain.
House Speaker Nancy Pelosi, D-Calif., Passed a robust bill in the House almost two years ago, and the issue remains a priority for Congressional Democrats as well as Biden. The 2019 legislation would have saved the government more than $ 450 billion over 10 years through Medicare price negotiations, but Pelosi’s strict approach to the politically powerful pharmaceutical industry is seen as a problem for some Senate Democrats.
The catch is that without significant savings on prescription drugs, it becomes more difficult to implement other parts of the health care program. For example, adding dental, vision and hearing benefits to Medicare could cost around $ 360 billion over 10 years.
Some ideas that energize progressive Democrats may find it most difficult to get through the winnowing process.
This could be the case with the proposed new “public option” health insurance scheme that would be offered alongside subsidized private coverage through HealthCare.gov. It is not clear whether such a proposal can be accepted under fiscal rules that would allow Biden’s agenda to wipe out the Senate without Republican votes.
On the other hand, a proposal to lower the Medicare age of eligibility from 65 to 60 could prove tricky. Republicans are already pointing out that the giant Medicare trust fund is expected to be in the red by 2026. They say leaving more people in the program would only weaken it further. Democrats may not want to be drawn into a Medicare solvency debate.