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Even with one-party rule, Biden health care plan is no slam dunk

Opposition from industry and party's progressive wing looms

Joe Biden and Kamala Harris receive a briefing on COVID-19 from health experts during an event in Wilmington, Del., on Aug. 13.
Joe Biden and Kamala Harris receive a briefing on COVID-19 from health experts during an event in Wilmington, Del., on Aug. 13. (Mandel Ngan/AFP via Getty Images)

Democrats won control of the House in 2018 by pounding the issue of health care, and there is no sign they plan to change course this year as they try to build that majority and capture the Senate and White House. 

The party adopted a platform Tuesday at the Democratic National Convention that lays out presidential nominee Joe Biden’s plan to allow people to enroll in government-run Medicare coverage at 60 years old, down from 65, while younger people could buy that coverage through a “Medicare-like public option.”

But even if Democrats do get one-party control, Biden would face the hurdles of Senate rules that require supermajorities to pass legislation, an insurance industry already mobilizing to stop them, and the most liberal wing of the party that wants to go further.

Already, a coalition of the insurance and pharmaceutical industries, the Partnership for America’s Health Care Future, has released two ads opposing the policy to run during both parties’ conventions, part of a seven-figure ad campaign. The U.S. Chamber of Commerce also launched a campaign, Protecting Americans’ Coverage Together, last week against a Medicare buy-in or public option.

“A Medicare buy-in or public option is bad for business,” said Suzanne Clark, president of the U.S. Chamber. “It would inject uncertainty and pose direct threats to the nation’s health care system.”

Health care industry groups remain strong lobbyists and have been successful recently in blocking major legislation, such as an attempt to restrict surprise medical bills.

At the same time, progressive Democrats in the House, including California’s Ro Khanna and Michigan’s Rashida Tlaib, said they were voting against the platform because it did not push for a single-payer system, or one where the government is the only or the dominant health insurance provider.

Sanders: Biden would ‘greatly expand’ coverage

Vermont Independent Sen. Bernie Sanders, whose bids for the presidential nomination this year and in 2016 were built on eliminating private insurance, acknowledged he and Biden differ on how much the government should oversee health care. Speaking to the convention Monday night, however, he noted how Biden’s plan would expand coverage. 

“As you know, we are the only industrialized nation not to guarantee health care for all people,” he said. “While Joe and I disagree on the best path to get to universal coverage, he has a plan that will greatly expand health care and cut the cost of prescription drugs. Further, he will lower the eligibility age of Medicare from 65 down to 60.”

The convention on Tuesday included Biden talking with people who battled insurance companies when they or a family member was sick and advocates for universal coverage about the 2010 health care law and how to lower costs.

“The fear that you all live in, understandably, if somehow tomorrow they said ‘No insurance, you’re not covered,’ is just devastating,” Biden said, adding that he would implement a public option and expand eligibility for Medicaid under the 2010 health care law in states that have not done so.

Ady Barkan, a progressive activist with ALS who supports “Medicare for All,” said health insurance coverage shouldn’t hinge on someone’s employment status or income. Coverage often doesn’t go far enough to cover treatment like long-term care, Barkan said.

“Even during this terrible crisis, Donald Trump and Republican politicians are trying to take away millions of people’s health insurance,” he said, speaking through a computer because he is paralyzed by his illness.

Rep. Pramila Jayapal, D-Wash., a co-chair of the House Progressive Caucus and the lead sponsor of the House Medicare for All bill (HR 1384), said Monday during a Washington Post Live interview that the Biden campaign made concessions to progressives on a public option that would make the policy more palatable. For example, the platform says that a public option would be administered by the Centers for Medicare and Medicaid Services, not a private insurance company.

“What we did is we looked at the foundational pieces of Medicare for All that we could get into the platform,” she said. “That’s not necessarily saying the words Medicare for All, but untethering employment from health care. That is huge, and that’s what we did.”

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Agenda hinges on Democratic Congress

Still, it would be a significant lift for a Democratic Congress to adopt Biden’s plan. Congress, with Biden and President Barack Obama in the White House and Democrats in control of both chambers, last passed a major health insurance overhaul in 2010. But that fall, Democrats lost control of the House, and didn’t get it back until 2018 — after a public backlash against Republicans who tried to repeal parts of the law.

For Biden to sign major health care legislation into law, he would likely need voters to elect a Democratic majority in the Senate this fall. Since Democrats, should they be in the majority, are not expected to have a 60-vote supermajority, lawmakers would need to use the budget reconciliation process, allowing them to pass a measure with 51 votes.

Some Democrats, including most recently Obama, have also raised the possibility of eliminating the filibuster, which would lower the threshold for passing most bills in the Senate to 51 votes. Democrats need to win a net of four seats to take control of the Senate, or three seats and the White House, since the vice president breaks 50-50 tie votes.

It’s also unclear how the COVID-19 pandemic could influence Democrats’ health care agenda.

Julie Rodriguez, a senior adviser to the Biden campaign, said during a health care policy roundtable on Monday that addressing the public health crisis would be a top priority.

“The first thing that Joe would do is to focus on the immediate crisis at hand, and ensure that there was adequate access to [personal protective equipment], to testing, to treatment and to vaccinations once they become available, especially for workers who are called back to work or who are having to respond and address the front lines of this crisis,” she said.

Congressional leaders have been circumspect when speaking about Democrats’ next steps on health care. The House has voted on several health care bills in the last two years that would expand the health care law or reverse changes made by President Donald Trump’s administration. Committees have held hearings to debate both a public option and Medicare for All, but neither policy has been subject to a markup or gotten floor time.

At events this week associated with the convention, House Democrats pointed to legislation (HR 1425) that the House passed in June meant to make the 2010 health care law more generous, which are also aspects of Biden’s health plan.

That measure would expand the size of tax credits that help people afford their monthly premiums and ensure that no one paid more than 8.5 percent of their annual income on their health insurance. It would also offer financial incentives to states to expand Medicaid eligibility. To finance that funding, the measure would allow Medicare to negotiate drug prices, another major flank of the Democratic party’s health care agenda.

“This is what we promise as we go forward,” Speaker Nancy Pelosi said Monday during an event with the health care advocacy group Protect Our Care. “We’d love for the president to join us now, but in 78 more days we will have elected a new president and we’ll be continuing to write legislation that expands what we did in the Affordable Care Act that has some additional benefits but also opportunities for people.”

During Tuesday night’s keynote address, Rep. Colin Allred, D-Texas, outlined Biden’s plans to expand tax credits to make insurance more affordable and to allow Medicare to negotiate drug prices.

Several of the other officials speaking compared such changes to the 2010 health care law by paraphrasing a hot-mic comment Biden made to Obama when the bill was signed: “That’s a big f-ing deal.”

Lindsey McPherson contributed to this report.

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