Dental care for the elderly with health insurance. The end of the rock bottom prices on prescription drugs. New options for long-term home care. Coverage for low-income people excluded from Medicaid by ideological battles.

These are just a few of the healthcare changes Democrats want to make with President Joe Biden’s massive “Build Back Better” plan. The $ 3.5 trillion national agenda bill touches almost every aspect of American life, from taxes to climate change, but the components of health care are a cornerstone for Democrats, magnified during the COVID-19 crisis.

For the nearly 145 million Americans covered by government health programs, as well as their families and communities, investing in the nation’s services could make a difference in quality of life for decades.

“It’s a holistic look at how health care can be not only expanded, but better geared to the real needs of people,” said Kathleen Sebelius, Federal Secretary of Health to President Barack Obama of the project. of Biden Law. “You have a plan that really targets the serious gaps in health care that keep people uninsured or running out of money for their treatments.”

But Democrats can only be successful if they bridge the divides between them. Don’t look for Republicans to help you.

With Medicare’s long-term finances under a cloud, Republicans say now is not the time to add new benefits. They plan to oppose not only the healthcare provisions but the entire Biden package, voting against it as being too big, expensive and a slide towards “socialism.”

Conscious of the politics to come, Democrats are pulling the package together with their weak grip on Congress. Instead of launching new experiments that many progressives prefer, they have chosen to invest more resources in existing programs, from Medicare and Medicaid enacted during the Great Society to the Affordable Care Act of the Obama era.

It’s sort of a compromise, led by Biden’s approach, paid for by taxes on corporations and the wealthy, those who earn more than $ 400,000, as well as savings on prescription drug prices paid. by the government to pharmaceutical companies.

“I have said many times before: I believe we are at an inflection point in this country – one of those times when the decisions we are about to make can change – literally change – the trajectory of our nation. for years. and maybe decades to come, ”Biden said in remarks last week at the White House.

Polls have shown that key healthcare provisions appeal to voters of all political lines. Many Republican voters, for example, generally approve of Medicare negotiating the prices of prescription drugs, even if GOP lawmakers do not. While Obama’s health law was primarily aimed at helping uninsured working-age people and their families, Biden’s coda emphasizes the elderly, who are also reliable voters in mid-election. mandate.

The main healthcare provisions in the mix include:

—Allow Medicare to negotiate the prices of the most expensive drugs, including insulin. Private insurers and employer plans could then access these lower prices. Annual increases in the prices of established drugs would be limited. Elderly reimbursable expenses would be capped.

A RAND Corporation study finds that such an approach could cut U.S. spending on major drugs in half.

Strong opposition from large pharmaceutical companies and major industrial groups has left Democrats divided over the structure of the program.

Four House Democrats opposed the measure in committee votes last week, enough to derail the entire bill. In the past, they had argued to give Medicare the power to negotiate, but they are voicing a series of concerns about the scope of House Speaker Nancy Pelosi’s plan. The Senate could take a somewhat different approach.

Medicare’s bargaining power is the keystone of all healthcare as expected savings would be used to deliver new benefits.

—Expand medicare to cover dental care, vision and hearing aids for the elderly. This provision, championed by Senator Bernie Sanders, I-Vt., Has been a long time coming. Vision care would start at the end of next year and hearing aids in 2023, but in an apparent cost cut, dental coverage would not begin until 2028.

—Based on Obama’s health care law. The idea is to provide health insurance to more than 2 million low-income people in GOP-led states that have rejected “Obamacare” Medicaid expansion. The workaround is a major demand for health equity for black lawmakers, as many of those caught in the coverage gap are minorities in the southern states.

Biden’s plan also calls for making health insurance more affordable for people who buy their own policies by increasing subsidies for Obama’s health law. The richest subsidies are temporarily provided in Biden’s COVID-19 relief bill to people who do not have employer coverage, and the White House wants to make the subsidies permanent. Lawmakers may only be able to meet the president halfway.

—Promote a shift to long-term care in the patient’s home as opposed to care facilities, which have turned into incubators for the coronavirus as the pandemic spreads. Biden had wanted $ 400 billion for this initiative as part of Medicaid, but it appears Congress will give him about half of it.

—Permanently fund the politically popular children’s health insurance program so that it does not face recurring votes in Congress that could disrupt services.

—Improved maternal health by providing postpartum coverage for 12 months through Medicaid.

With key centrist Democrats, including the senses. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona, saying the overall price of $ 3.5 trillion is too high, Democrats are looking for ways to cut costs, either by cutting some programs or, more likely, by shaving. some cost or duration of what has been proposed.

Other Democrats, however, have warned that a thinner package could disappoint voters who sent them to Washington on their promises to make big changes.

“My constituents expect and pledge to deliver,” said Rep. Lauren Underwood, D-Ill., Whose professional background is in health care policy.

Biden’s approval rating plunged following the chaotic and violent consequences of the United States’ exit from Afghanistan and the resurgence of the coronavirus at home after proclaiming the pandemic was on the wane, and as Democrats in Congress are gearing up for next year’s midterm elections.

Democratic pollster Celinda Lake said the healthcare provisions in the budget bill appeal to lawmakers’ own instincts for self-preservation. The proposals resonate with older voters and women, two key groups in the 2022 contests, with Democrats battling to retain the House.

“If you want to protect yourself in your district, you have to double the health care provisions,” she said.


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