Dems weigh narrower health ambitions for infrastructure package

“I think the situation is fluid,” said Senate CFO Ron Wyden (D-Ore.), Who helped authorize a non-partisan drug pricing bill in the last Congress. “But I know that in 2022 seniors will really be looking at the people who have campaigned [lowering drug prices] Year after year after year. I have brought this to the President repeatedly. “

Democrats’ choices were already limited with a 50:50 Senate and a weak majority in the House of Representatives, where spokeswoman Nancy Pelosi can only afford to lose two of her members to partisan legislation. The most pressing question for democratic leaders is how to please their moderate and progressive wings as they put together comprehensive laws that also affect roads, taxes, broadband and schools.

Biden will work out a plan in the coming weeks that will take shape What’s Coming on Capitol Hill? While they wait Progressives are calling for the package to include an expansion of Medicare benefits and a lowering of the eligibility age from 65 to 60 or even 55 in hopes of keeping Biden on a campaign pledge he made in part to support the left wing Party to win.

“We want to make sure we get there,” said Rep. Pramila Jayapal (D-Wash.), Chair of the 100-member Progressive Congressional Caucus.

But what is more likely, say sources, uses federal government to insure poor adults in states that have rejected Obamacare’s Medicaid expansion. Options include setting it up a narrow program for poor adults in states that have rejected Obamacare’s Medicaid extension or extended it in full The Affordable Care Act subsidizes these populations so they can get a free private plan in the law’s marketplaces. The leadership also advocates permanently expanding the temporary widening of Obamacare’s private coverage subsidies that Congress approved under Biden’s $ 1.9 trillion pandemic relief package – a move the Urban Institute said the Number of uninsured people in the US could reduce by 4.2 million.

Much Still depends on how big the Democrats are in the infrastructure package with drug price controls. The billions in savings planned for government health programs could offset new spending in other areas such as health insurance. Winning the votes, however, requires a delicate dance in the face of opposition from a politically powerful industry deeply involved in the pandemic response.

The House Democrats passed progressive law in Congress that would allow the government to negotiate directly on the prices of a wide range of drugs and save around $ 456 billion in a decade, according to Congressional Budget Scorekeepers. Biden is said to prefer a similar plan.

“Both his campaign plan and the democratic platform were much closer to the HR department. 3, ”said a source close to Biden who was working on the switch and who was not authorized to speak on the file. “The Senate bill was introduced last year when Republicans controlled the Senate, and it reflects that dynamic. It’s not what the moment demands. “

But some Democratic centrists are pushing for the Wyden co-authored Senate bipartisan drug pricing bill instead, which would sanction drug companies that raise prices faster than inflation and are expected to save about $ 100 billion in a decade.

Senator Bob Menendez (D-N.J.), Whose state is home to major pharmaceutical companies such as Merck and Johnson & Johnson, spoke out against any bill that would treat the pharmaceutical industry as such “Piggy bank” to finance other policies. He was the only Democrat to oppose an amendment to include a government negotiating provision in Wyden’s bipartisan law, and could be an obstacle to progressives’ hopes for broader industrial reform.

Menendez’s remarks echoed the largest drug lobby, the Pharmaceutical Research and Manufacturers Association of America, whose CEO Steve Ubl said this week they would turn down a package industry uses this to fund “competing health care proposals”.

Coupled with drug pricing, the Democrats have a lot to offer other health regulations that could translate into huge savings Compensate for coverage extensions. They could repeal a Trump administrative rule that prevents drug industry discounts from going to the middlemen involved in Medicare drug plans, which is expected to cost the government nearly $ 180 billion. You can also revise the billing practices of private Medicare Advantage plans.

Progressives want to prevail after giving in to calls by Democratic leaders in the earlier bailout to subsidize private Obamacare plans and commercial job insurance.

“The feeling I get in progressive circles is, ‘fool me once, be ashamed, fool me twice, be ashamed,” said Alex Lawson, executive director, Social Security Works, closely associated with Capitol Hill Progressives .

Progressive Caucus’ list of top infrastructure priorities focused on Medicare improvements and left out the permanent ACA subsidies prioritized by leadership, despite Jayapal saying it was a “wrong choice” to choose between the two.

“Both can be done and both must be done,” she said, adding that an aggressive drug-negotiating component could pay for both provisions. She stopped saying that the caucus would block the bill if it didn’t include her priorities.

In the meantime, Senator Bernie Sanders (I-Vt.) Is pushing for seniors to be provided with dental, visual and hearing aids through traditional Medicare care – something that has long been a priority for Pelosi as well. With the battle ahead, he won’t say whether the exclusion of this expansion is a deal breaker.

Some Democratic senators seem unwilling to delve into health policy and pick winners and losers before finalizing important details about roads and bridges.

“I’m just working on the infrastructure,” said West Virginia’s Joe Manchin, a highly-advertised swing vote. “Any other nuances I don’t know about.”

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