As sweeping as the Democrats' budget measure is, its goal in health care is to fill in gaps, not overhaul the system.
Cover poor people in 12 states not expanding Medicaid.
Expand community-based care.
Address ACA affordability.
Add dental, hearing, and vision to Medicare.
Filling in these health care gaps would be paid for primarily by negotiating drug prices in Medicare and limiting price increases to inflation.
While that would be a big deal, Medicare has for years controlled prices for hospital and physician care.
The more unprecedented part of the Democrats' health agenda is giving privately-insured patients access to government-negotiated drug prices. That's quite common in other countries, but does not happen here for drug prices or any other type of health care.
The drug industry, which has significant clout, is having some success right now politically.
Seniors -- who would benefit from lower drug prices, and additional Medicare benefits -- also have clout.
Poor people in Republican states that haven't expanded Medicaid? Not so much.
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Key details about the House plan to cover poor people in states not expanding Medicaid:
ACA marketplace coverage 2022-2024 with nominal cost-sharing.
Coverage in a new federal Medicaid plan starting in 2025.
States that drop the expansion have to continue paying their share.
Here are links to the proposed legislative language from the House Energy and Commerce Committee to cover poor people in states that have not expanded Medicaid under the ACA.
COVID vaccines are widely available and free to people whether they have insurance or not.
Now, under President Biden's plan, workers at businesses with 100+ employees will also get paid time off to get vaccinated and recover from any side effects.
It's sort of remarkable that your ability to work, attend many entertainment events, and go to certain restaurants and bars is still going to depend on proving vaccination using a flimsy, oddly-sized CDC card with no electronic verification.
A vaccine mandate means unvaccinated workers lose their jobs. A health insurance surcharge for unvaccinated workers is less coercive and likely less effective. It also opens up a hornet's nest of issues around whether people's behavior should affect what they pay for health care.
If Democrats are able to accomplish all these goals in the budget resolution released today, it would be the biggest reform of the health care system since the Affordable Care Act passed more than a decade ago.
The policy guidelines that accompany the budget resolution are not binding. It's up to Congressional committees to match expansions with new revenues and savings to solve a complex jigsaw puzzle that matches budget targets.
The cost of these health care expansions can be dialed up or down to fit within available revenues.
One key way to lower the budgetary cost of a health care expansion: Give it an expiration date.
Every time I help a family member or friend enroll in Medicaid, I come away amazed at how many people actually manage to succeed in navigating the application process.
We focus a lot on eligibility for public benefits and not nearly enough on the complexity of accessing them.
7.3 million people are uninsured but eligible for Medicaid.
More outreach and help navigating the application process could no doubt reduce that number.
In some cases, burdensome application processes for public benefits like Medicaid may simply reflect lack of thoughtful attention to the needs of applicants.
In other cases, it's a purposeful effort to reduce enrollment and costs.
Possibly the biggest gap in the ACA is that there are 2.2 million poor, uninsured people who have no affordable health care options in the dozen states that have not expanded Medicaid.