Dems Push to Retool Health Care Program09/19 09:32

   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.

   WASHINGTON (AP) -- 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' out-of-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 long-term 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.

   With key centrist Democrats, including Sens. Joe Manchin of West Virginia 
and Kyrsten Sinema of Arizona, saying the overall $3.5 trillion price tag is 
too high, Democrats are looking for ways to cut costs, either by eliminating 
some programs or, more likely, shaving some costs or duration off what has been 
proposed.

   Other Democrats, though, warned that a slimmer package might disappoint 
voters who sent them to Washington on their promises to make big changes.

   "My constituents are expecting me to deliver, and I'm committed to doing 
it," said Rep. Lauren Underwood, D-Ill., whose professional background is in 
health care policy.

   Biden's approval rating has taken a dive following the chaotic and violent 
consequences of the U.S. exit from Afghanistan and the resurgence of 
coronavirus at home after he proclaimed the pandemic was waning, and as 
Democrats in Congress look ahead to next year's midterm elections.

   Democratic pollster Celinda Lake said the health care provisions in the 
budget bill appeal to lawmakers' own instincts for self-preservation. The 
proposals resonate with older voters and women, two key groups in the 2022 
contests, with Democrats battling to hold on to the House.

   "If you want to protect yourself in your district, you ought to double down 
on the health care provisions," she said.