WASHINGTON – New Medicare Benefits for Older Americans, such as dental care.
An extension of Medicaid eligibility for low-income people in Republican-controlled states who have refused to take this step.
And potentially a historic effort to curb prescription drug prices – if Congressional Democrats can overcome objections from moderates in their party.
The massive $ 3.5 trillion budget reconciliation package that House Democrats finished sketching out this week would make significant changes to the way Americans get health care.
The proposals were drafted on the basis of President Joe Biden’s “Build Back Better” policy plan. The broad lines of House Democrats could be changed in the Senate, where some senators want to change those policies (including giving seniors these enhanced Medicare benefits earlier).
Any bill will also have to go through procedural review with the Senate parliamentarian, who may decide that certain sections of the bill cannot be passed through the reconciliation process. This procedure allows bills to pass with a single majority vote in the equally divided Senate, meaning reconciliation could reach the president’s office without any support from Republicans.
Here is more information on the health care provisions incorporated into this legislation and how they work:
Dental, hearing and vision coverage for the elderly
One of the ambitions of the proposal put forward in the House is to fill gaps in Medicare coverage. The federal health insurance program for the elderly and the disabled currently does not cover most dental, hearing or vision care – services that beneficiaries now have to pay for out of pocket or through additional coverage. .
Pending legislation would add these benefits so that dentures, hearing aids, eye exams and glasses would become part of the traditional medicare program.
However, dental benefits would not take effect until 2028, years after hearing and vision coverage. Some Senate Democrats have objected to the long delay in bringing dentists into the Medicare program and launched a voucher program to shorten the transition.
Not in the House bill? Lower the age of eligibility for Medicare
One change to medicare unsuccessfully sought by some Democrats was to lower the age of enrollment for medicare, from 65 to 60 now.
This effort – backed by Sen. Bernie Sanders, a Vermont independent who caucuses with Democrats, as well as some centrist House Democrats – has not been incorporated into House legislation. He could be added to the Senate, but he’s likely to face tougher odds in this chamber.
More access to Medicaid
Another major change would be the extension of health insurance coverage to more low-income Americans. This would happen in part by expanding eligibility in 12 states that have refused to accept federal funding to expand their programs.
The 12 states that refused to align with Medicaid eligibility requirements in the Affordable Care Act of 2010 – which extended coverage to adults with incomes up to 138% of the poverty level – include the Wisconsin, Kansas, Tennessee, North Carolina, Georgia and Florida, according to the Kaiser Family Foundation.
Beginning in 2025, residents of states that have not extended Medicaid could join a federally administered Medicaid program.
Until this new all-federal option comes into effect, the proposal would extend the ACA premium tax credits to those with incomes below the poverty line, to make it easier for them to obtain health coverage via insurance exchanges.
The proposal would also require states to start Medicaid coverage for people incarcerated 30 days before their release, so that people who leave prison have medical coverage when they re-enter society.
And states would also be required to extend coverage for the postpartum Medicaid program and children’s health insurance program for one year after pregnancy ends, instead of just 60 days. The US bailout passed earlier this year gave states the opportunity to make that change, when the reconciliation proposal would require it.
Conflict over drug price controls
A key challenge in expanding these safety net programs is how to pay for the new costs, and part of the answer is believed to lie in the savings resulting from overhaul in prescription drug prices.
This proposal would allow the federal government to negotiate the prices of hundreds of drugs, including insulin, and penalize drugmakers who are raising prices faster than inflation. These changes, which are part of a separate bill, HR 3, are expected to save $ 456 billion over a decade.
But the overhaul met with opposition from a small group of moderate House Democrats who were seeking a narrower approach.
With three Democrats: Rep. Kurt Schrader of Oregon; Scott Peters, of California; and Kathleen Rice, from New York – joining Republicans in voting against the drug price proposal on the Energy and Trade Committee, the panel found itself at a deadlock.
The pricing plan was abandoned by the Ways and Means Committee, which was developing another part of the reconciliation bill. But he also lost another Democratic vote there, with opposition from Rep. Stephanie Murphy, D-Fla.
“I strongly support many provisions in the House Ways and Means section of the Rebuild Better Act, in particular the historic arrangements to tackle the existential threat of climate change, ”she said in a statement. “But there are also spending and tax provisions that make me think about it, so I cannot vote for the bill at this early stage.
“As this process moves forward, I remain optimistic that the full reconciliation agenda will be properly targeted and financially responsible, funded through tax provisions that promote fairness but do not harm working families.”
The fight to control the prices of prescription drugs is far from over. Trade groups representing pharmaceutical companies have been lobbying and advertising against the proposal for weeks. Some Senate Democrats have also been skeptical of the drug pricing plan.