Social spending fight may claim progressives’ Medicare expansion

“We have no intention of giving in,” Jayapal said on Tuesday evening when he called lawyers. Addressing the possibility of fewer health programs in the bill, she said, “A lot of people have asked, ‘Isn’t something better than nothing?’ And the answer is simply no. Because when it comes to something and not nothing, it is always the same people who are forced not to be satisfied with anything. “

Progressives are joining Medicare’s expansion because it represents the best chance of translating part of their Medicare for All vision into law. But in doing so, they have drawn criticism from other Democrats that the benefits of Medicaid would go to the rich at the expense of poor people and color communities, along with threats from health industry groups that it could increase premiums for seniors. The cost of the program of more than $ 350 billion

In a new letter to committee chairmen received by POLITICO, a major centrist MP Jared Golden (D-Maine) said he supported the Medicare benefit proposal in principle but believed that the current version of the House was “underdeveloped “and on” budget “are dependent on gimmicks” like delayed implementation.

The progressives argue that Congress can still control costs by only approving the new Medicare benefits for a few years, believing they would prove so popular that future Congresses would have to renew them. Meanwhile, centrists like Golden and Senator Joe Manchin (DW.Va.) insist that all benefits be means tested so that they are limited to the poorest Americans – a non-starter for many leftists who say this is a rationale of the Social insurance. and Depending on how low Manchin and others cut the total bill, the Medicare extension could be dropped altogether.

“We have to move from snacks to chops,” said a senior Democratic adviser.

Pelosi’s Democratic leadership wants the party to invest more money in fewer social spending programs – specifically, expanding subsidies under the Affordable Care Act and extending Medicaid coverage to more low-income people in a dozen conservative-led states who own theirs Programs.

“The consensus in the group is that we have to do everything we have in the package very well, instead of spreading things out so thinly that you don’t have the desired effect across the country,” said Rep. Anna Eshoo (D -Cal.), Chair of the House Energy and Commerce Health Subcommittee.

Democratic lawmakers and aides said that the proposed Medicare expansion is most likely to fail completely due to the high cost and difficulty of introducing it quickly – a key factor as Democrats plan to campaign their scarce next year in the fight for the new programs To hold congressional majorities.

Even the House of Representatives’ $ 3.5 trillion plan proposed postponing the start of dental care until 2028, and Rep. Mark Pocan, D-Wis., Who formerly co-ran the Progressive Caucus with Jayapal, admitted that it was difficult to make it available much earlier.

“Some of these are getting harder to move up significantly,” he said.

The slow rollout is also a sore point for those members who rely on the bill’s programs to keep their seats in the swing districts.

“I don’t want this to be an amorphous thing where we say to someone who is 68 years old, ‘You may never see the benefit, but guess what, we’ve passed it on to the next generation'”, said Rep. Susan Wild (D-Pa.). “It doesn’t do it politically and it doesn’t do it for the people we are fighting for here.”

Some outside advocates and lobbyists say that if forced to vote, Democrats are more likely to prioritize Medicaid in must-win swing states – like Florida, Georgia, and North Carolina – and Affordable Care Act subsidies for millions across the country, while keeping their eyes on their prospects of choice.

The expansion plan also threatens the Democrats’ ongoing inability to agree on a drug cost reduction plan that they rely on, at least in part, to fund the costly expansion of benefits.

To make the math work, some lawmakers have suggested poking around the Medicare benefit proposal until next year. You could also just include the dental benefits as many argue the most urgent health need of the three, or seeing and hearing, which are much cheaper.

“We could see them split up,” House budget chairman John Yarmuth (D-Ky.) Told reporters. “Although I don’t think [Medicare expansion advocate] Bernie [Sanders] want to do that. “

The progressives, encouraged by their ability to tie the fate of Infrastructure Act HR 3684 (117) to the social spending package, say they are ready to withhold assistance again if Medicare benefits are cut in the upcoming negotiations.

Sanders, the Senate chairman for the budget, this week described the inclusion of dental, vision and hearing systems as “non-negotiable.” And Pocan told POLITICO that it was evident in the Zoom call with the White House that they were being taken seriously.

“They realize that if someone is willing to invest real capital and withhold our votes, it is us,” he said.

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