Biden rebuffs Democrats on big health changes in infrastructure plan

Politico Pro

May 3, 2021 4:37 am

Democratic lawmakers waited for weeks to see how hard President Joe Biden would push for big health care changes in the next portion of the sweeping infrastructure package. The answer is leaving many frustrated.

The American Families Plan that Biden is set to roll out in a joint address to Congress Wednesday night contains just one big priority for Democrats and the health care industry: a permanent boost to subsidized health coverage in Obamacare markets. It’s devoid of other agenda items like drug price controls or expansions of Medicare and Medicaid that many of the party faithful saw as must-haves while Democrats maintain full control of Washington.

The White House will tout the ACA subsidies as a way to help 4 million uninsured people into private coverage and reduce the premiums of another 9 million by an average of $50 a month.

A senior administration official on a call Tuesday night called the extended subsidies “one of the most impactful investments we can make both in terms of reducing the cost of health insurance for those buyers, as well as making it more accessible and expanding coverage to those who have not previously had health insurance.”

Left unsaid was the administration’s desire to avoid a prolonged fight with entrenched health care interests as it tries to deliver what’s likely to be the last big tranche of pandemic relief. While the officials said Biden remains committed to lowering drug prices through direct government negotiations, they gave no details on how he’d accomplish that — or explain why proposals like a House drug price control plan, H.R. 3 (117), were left out of the infrastructure plan.

That’s leaving Democrats with few realistic options. They have little chance of advancing other ambitious health priorities as standalone legislation with their slim House and Senate majorities and a rapidly shrinking congressional calendar. And some lawmakers suggested they are already having trouble uniting around what policies to prioritize.

“We’ve got more work to do to get consensus around a broad health care package,” said Sen. Debbie Stabenow (D-Mich.). “I think we care so passionately about health care and we have a lot of different ideas. We just need to bring everybody together.”

While their priorities may differ, both moderate and progressive lawmakers are left facing a difficult midterm cycle where they had hoped to wield drug pricing reforms as a signature accomplishment.

“This is what elderly voters are going to be looking at in the fall of 2022,” Senate Finance Chair Ron Wyden (D-Ore.) told POLITICO. “There’s a real urgency about this and I conveyed that to the President and the Cabinet and key staff. And I said, ‘if you regard this as an emergency, you can’t wait a single minute.’”

A fact sheet the White House circulated Tuesday night claimed Biden “has a plan” to allow Medicare to negotiate prices, create a public insurance option, lower the Medicare eligibility age to 60 and enact a federal expansion of Medicaid in states that haven’t opted to enlarge their programs under Obamacare. But the administration intends to keep all of that separate from the infrastructure package.

Democrats in the House and Senate and outside advocacy groups have spent the last few weeks petitioning the White House to address precisely those issues this year.

In a wave of calls, letters and meetings with the White House, the lawmakers and activists warned the infrastructure package might be the last major bill Congress is able to pass this year, and a failure to keep the Medicare and drug pricing pledges Biden campaigned on would hurt Democrats’ efforts to defend their majorities in Congress.

Key lawmakers are insisting they still can go it alone. House Democrats led by Speaker Nancy Pelosi have reintroduced the sweeping drug price negotiation bill, with a hearing set for next week. Senate Budget Chair Bernie Sanders (I-Vt.) says he’ll soon follow suit.

“Congress determines legislation,” he responded when asked about Biden leaving the measures out of his plan. “And I’m going to do everything I can to make sure that we lower prescription drug costs in America for everybody and that we negotiate prescription drug prices for Medicare and that we use those savings to expand Medicare to include dental, hearing aids and eyeglasses.”

But even the most ardent advocates of these policies say the odds of accomplishing anything are daunting.

“Pharma is ferocious and they won’t go quietly into the night,” Rep. Peter Welch (D-Vt.) told reporters on a call on Monday, adding that many Democrats are loath to take on the industry. “The political situation now, with a razor-thin majority in the House and a 50-50 Senate, means that the effort to get the votes will be very, very tough. We’ve got to take seriously how hard this is.”