Democrats are running into the reality that they may not be able to expand government health care programs as much as they want in President Biden’s $3.5 trillion package of social welfare spending.
It is dividing Democrats and splitting the House and Senate over what health care priority to cut back: expanding Medicare to cover dental, vision and hearing for older adults or growing Obamacare to cover more lower-income people.
The reality check set in as the Senate Budget Committee scrambles to complete the entire package by the Sept. 15 deadline set by Senate Majority Leader Charles E. Schumer, New York Democrat.
Senate Budget Committee Chairman Bernard Sanders referenced the contentious drafting process in a recent speech to voters in his home state Vermont.
“People are writing it, and I’m arguing with chairmen every day,” said Mr. Sanders, a democratic socialist who caucuses with Democrats.
Expanding what Medicare covers is a top priority for Mr. Sanders, but covering more of the uninsured, who are disproportionately people of color, is tops in the House, especially for the Black and Hispanic caucuses.
At the same time, moderate Democrats are splashing cold water on the idea of doing both and some oppose a plan to give Medicare stronger drug-pricing power, which is key to paying for the left’s health care wish list.
A priority for House Speaker Nancy Pelosi, California Democrat, is to empower Medicare to strong-arm drug companies into lowering the prices for older adults. The Congressional Budget Office estimates it would save $456 billion for Medicare — money Democrats plan to spend on expanding government healthcare programs.
The nation’s drug industry is intensely lobbying against the plan, saying the cut to their bottom line would result in their research labs developing fewer new cures.
The lobbying, including a TV ad blitz, is paying dividends. Ten moderate House Democrats recently wrote to Mrs. Pelosi echoing the pharmaceutical industry position.
The spending package can only pass the Senate with the support of all 50 of the chamber’s Democrats since no Republicans are expected to support the massive spending bill. One Democratic senator, Robert Menendez of New Jersey, has expressed concerns about the drug-pricing proposal but a spokesman said he is studying the proposal.
Another two, Sens. Joe Manchin III of West Virginia and Kyrsten Sinema of Arizona, have said the $3.5 trillion price tag is too high for the package, which includes a grab bag of liberal priorities from climate change measures to creating a path to citizenship for illegal immigrants.
A bipartisan approach proposed by Republican Sen. Chuck Grassley of Iowa and Democratic Sen. Ron Wyden of Oregon would require drug companies to give Medicare beneficiaries a 7% discount and cap how much out-of-pocket costs insurers can charge in any month. The plan would only save the government about $95 billion.
“Medicare benefit improvements will largely be paid for through prescription drug reform. The more robust the drug reform is, the more benefits can be expanded,” said Dan Adcock, government relations and policy director for the National Committee to Preserve Social Security and Medicare, which is pushing the proposal to force drug companies to negotiate down drug prices.
Advocates of expanding Medicare argue that lack of dental, vision and hearing care leaves older adults vulnerable to serious health problems. In a letter to congressional leaders on Saturday, Mr. Adcock’s group pointed to National Institutes of Health research that found untreated hearing loss accelerates dementia and Alzheimer’s disease.
By 2050, the amount Medicare and Medicaid spend on treating Alzheimer’s is expected to balloon from $305 billion to $777 billion, according to the NIH study.
“If a higher percentage of seniors with age-related hearing loss had hearing aids, the skyrocketing cost of treating people with Alzheimer’s disease and dementia could drop significantly,” said the letter from Max Richtman, the National Committee to Preserve Social Security and Medicare’s president and CEO.
Still, expanding coverage of Obamacare to more low-income people remains the overriding concern in the House. It’s being pushed by Rep. Joyce Beatty, chairwoman of the Congressional Black Caucus, and Rep. Raul Ruiz, chairman of the Congressional Hispanic Caucus.
Congress and the Biden administration temporarily expanded the Affordable Care Act in a $1.9 trillion coronavirus relief package earlier this year. The American Rescue Plan temporarily gave Obamacare subsidies to low-income people who, under the original rules, made slightly too much money to qualify for government assistance. It also increased the amount of the federal subsidy. Mrs. Pelosi has said she wants to make permanent the measures that otherwise are due to run out on Jan. 1.
Democrats hope to create a new federal program to cover those without insurance in 12 Republican-run states that did not expand Medicaid under the Affordable Care Act. The new program would cover those who make too much to qualify for Medicaid in those states but still live below the poverty line.
An estimated 60% of the 2.2 million who would get insurance under the new program are people of color.
“Closing this is one of the single most important steps we can take to reduce racial health inequities across the United States,” Mrs. Beatty of Ohio and Mr. Ruiz of California wrote in a recent letter to fellow Democrats.