Democrats turn to big plans for health care, finally no longer having to play defense

“We’re talking about physical infrastructure, affordable housing. We’re talking about transforming our energy system to deal with climate change. We’re talking about human infrastructure,” Sanders said. “In the rescue plan, we were able to take a major step forward in lowering child poverty—very important. Now I want to deal with issues facing seniors as well.”

Biden goes part of the way in doing that with the $400 billion included in the first infrastructure package introduced this month for carrying for elderly and disabled people. Biden’s American Jobs Plan invests that money in caregivers, “expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities,” according to the White House. “These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need, while creating new jobs and offering caregiving workers a long-overdue raise, stronger benefits, and an opportunity to organize or join a union and collectively bargain.” It will also help people stay in their homes and out of long-term care facilities.

But that’s not enough for the growing population of not just seniors, but very elderly people, Sanders says. “We cannot continue to deal with millions and millions of seniors—primarily low-income seniors—who cannot afford to go to a dentist, so cannot ingest the food they eat, or the millions of seniors who live in isolation because they can’t hear,” he told The Washington Post.

Pelosi’s priority is expanding on what helped her gain—and barely keep—a Democratic House majority: protecting Obamacare. That’s not a bad bet considering how many more people have now signed up in the special enrollment period Biden opened up because of the pandemic. The ACA is only going to get more popular when more people get access to better and less expensive coverage. At this point, Pelosi apparently wants to limit immediate healthcare goals to making those gains permanent.

If that’s the case, she needs to add another agenda item to fixing Obamacare: dealing with the “family glitch” that’s keeping more than 5 million people from affordable coverage. Worried about the cost of the whole thing—as Democrats were in the 2010s—they created a problem for families in which one of the heads of household could get “affordable” coverage through work. The problem is that the definition of affordable applies only to that one person—if she doesn’t have to pay more than 9.83% of her household income to be covered herself, that insurance is affordable, even if coverage for the rest of her family would cost far more. One study estimates that these families in the glitch are spending an average of 15.8% of their income on their health insurance through work. President Biden issued an executive order calling for federal agencies to determine if it can be fixed through regulation, but dealing with it legislatively would be a sure way of correcting the problem.

Another way of dealing with Medicare expansion and ACA expansion—something Pelosi and Sanders can both get behind—is finally getting that public option on the Obamacare exchanges. During the campaign, the Biden-Sanders tax force on health care recommended a public option. “[W]e will give all Americans the choice to select a high-quality, affordable public option through the Affordable Care Act marketplace,” the task force asserted.

“The public option will provide at least one plan choice without deductibles, will be administered by the traditional Medicare program, not private companies, and will cover all primary care without any copayments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people.” That policy prescription proved to be very popular in polling conducted by Data for Progress after it was introduced, with 55% support to 18% opposition.

As always, though, the filibuster and what can be done through reconciliation is weighing on Democrats. That means making the Obamacare subsidy expansion permanent, and possibly expanding it to include the low-income people still shut out of Medicaid in the Republican states that refused to expand the program to cover poor adults. Either way, between the House progressives and Sanders, Medicare enhancements and expansion are going to have powerful support.

Extremist Trump courts aside, it’s a relief that congressional Democrats aren’t having to fight tooth and nail just to make sure that the ACA survives.

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