Today I wrote about pressure to cut funding for a key Dem initiative in half -- and, more broadly, about the internal dynamics as leaders choose from among popular, substantively important proposals.
To be clear, champions of different initiatives have not for generally attacked one another, publicly or even privately.
A big reason for that is that they are allies, and have a broadly shared enthusiasm for pretty much everything on the agenda. (2) huffpost.com/entry/caregivi…
Still, there’s only so much money to go around. And there will be even less if Manchin, Sinema and some other more conservative Democrats get their way.
That means some programs will get close to full funding. Others won’t.
That’s true of the spending proposal as a whole and it’s true for those that deal specifically with health care. (4) huffpost.com/entry/biden-ob…
Discussions fluid, multiple conversations taking place among WH/Congress/outside groups. Not everybody working off same numbers.
But what was true when I wrote this a few months ago seems to be true now, in terms of who cares most about what. (5) huffpost.com/entry/biden-ob…
And so, for example, plugging the Medicaid gap is a top issue for Pelosi and Clymer. So is making ACA improvements permanent.
Medicare dental is a must-have for progressives, especially w/Medicare age off the table.
Home/community care is huge for SEIU & disability groups. (6)
I've been hearing a lot about procedural issues, too.
E.g.: Home care in the House falls to Energy & Commerce -- which, in turn, doesn’t control revenue and can’t put its hands on big savings elsewhere. Makes it harder to change assumptions baked into budget resolution. (7)
In Senate, home care falls under jurisdiction of Senate Finance, which has both taxes and Rx pricing -- plus a less restrictive budget instruction. So more flexibility to change $$$ there.
Of course, in both houses, leadership can modify programs after committees are done. (8)
Separately, there's tension over Medicare dental.
Progressives cite the large numbers of seniors who don't get dental care now. And they say it's a political winner, something that will make a big impression on voters.
But like every other agenda item it comes with a big price tag.
Other Democrats less enthusiastic. One reason: Dollar for dollar, it probably does less to help the neediest than either plugging the Medicaid gap or funding home care. (10)
The $3.5T spending bill Democrats want to pass would arguably represent biggest expansion of government since LBJ/Great Society.
That's way too much, in the eyes of Republicans and conservative Democrats. wsj.com/articles/manch… (11)
But the nation also has a long list of unmet needs. Millions can't find affordable child care, pay for college, get basic medical attention. And that's to say nothing of the climate crisis.
Addressing these costs money. (12)
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A few weeks ago @jmartinwrites got in touch with me, because he wanted to share his story — about his efforts to take grad classes at Vanderbilt, part of pursuing his dream of becoming a high school English teacher (2) huffpost.com/entry/disabili…
I first wrote about @jmartinwrites during the ACA repeal debate.
He has cerebral palsy. Medicaid pays for supports and services that enabled him to attend college. And cuts in the GOP legislation would have jeopardized that funding. (3) huffpost.com/entry/medicaid…
As @zackcooperYale notes, the findings raise questions about how well insurers are negotiating prices -- which, after all, is a big part of the value they are supposed to bring to the health care system. nytimes.com/interactive/20…
One thing that stands out is the sheer magnitude of price variation, even for relatively standard/low-tech care.
Here is what three different insurers are paying for rabies vaccines (for people bitten by animals) at a Utah hospital. nytimes.com/interactive/20…
The importance of those Rx savings to other initiatives is one reason I continue to think — and continue to hear from some veteran operatives and staff — that ambitious reforms could actually pass despite all of the familiar obstacles huffpost.com/entry/prescrip…
Via multiple sources, Dem budget negotiators may scale back funding increase for home and community-based care. Like, by more than half -- from $400B, which was what Biden proposed, to below $200B.
Very much in flux, nothing decided. (1)
This is the initiative to boost funding of home care aides and other services that let the elderly, people w/disabilities live at home, stay in labor force, etc. (2)
Medicaid funds these services, but with limited allotments. That creates long waiting lists, plus the care workers are famously underpaid. huffpost.com/entry/joe-bide… (3)