Congressional Democrats are not waiting around for President Joe Biden to propose big changes they want to see in the nation’s health care system, including reducing drug prices and expanding Medicare.
Committee chairs in both chambers are working on aggressive steps to broaden benefits and government involvement in health care. The push has won the support of party leaders, though still faces many challenges to making it into the bills, much less becoming law.
Biden has moved swiftly on less controversial measures, including bolstering the Affordable Care Act and reversing several of former President Donald Trump’s efforts to weaken the landmark health reform law and Medicaid.
But he has yet to take action on his more significant campaign promises, such as reducing Medicare’s eligibility age and allowing the federal government to negotiate drug prices. Instead, his $1.8 trillion American Families Plan, which he introduced last week, only calls for making permanent more generous Obamacare subsidies, which his relief package provides for just two years.
With the building pressure from Capitol Hill, the President referenced support for these larger measures in his first congressional address last week.
“Let’s do what we’ve always talked about for all the years I was down here in this — in this body — in Congress,” Biden said. “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices.”
“And the money we save, which is billions of dollars, can go to strengthen the Affordable Care Act and expand Medicare coverage benefits without costing taxpayers an additional penny,” he continued. “We’ve talked about it long enough. Democrats and Republicans, let’s get it done this year.”
Reducing drug costs
Several senior congressional Democratic leaders have already started the ball rolling, though it won’t be easy to get such major health care measures even included in the recovery package or muster enough support to pass them.
Although Americans consistently rank high drug prices as one of their top concerns, lawmakers have repeatedly failed to unite to pass meaningful legislation, in part because of stiff opposition from the powerful pharmaceutical industry.
Last week, Energy and Commerce Committee Chairman Frank Pallone, Jr., Democrat of New Jersey, reintroduced legislation that would empower the Health and Human Services Secretary to negotiate prescription drug prices in Medicare and make those negotiated prices available to commercial health insurance plans. Ways and Means Committee Chairman Richard Neal of Massachusetts and Education and Labor Committee Chairman Bobby Scott of Virginia are co-sponsors.
The earlier bill, which was backed by House Speaker Nancy Pelosi, passed in December 2019. The measure would allow annual negotiations on at least 50 costly brand-name drugs and up to 250 medications, including insulin. Prices would be capped at 1.2 times their cost in certain other developed countries.
Unlike the original legislation, however, the new bill does not direct the savings to expand Medicare benefits. Instead, lawmakers want to keep their options open, said a spokesperson for the committee, which is holding a hearing on the proposal on Tuesday.
Pelosi said last week that the bill would be “transformative” for families and that “lowering health costs and prescription drug prices will be a top priority for House Democrats to be included in the American Families Plan.”
However, when asked on Thursday about the legislative path forward on prescription drugs, the Speaker did not commit to putting it in the American Families Plan.
“What is in one bill or another is not really what is important,” she said.
Meanwhile, Senate Finance Committee Chairman Ron Wyden, whose previous bipartisan bill with then-Finance Committee Chairman Chuck Grassley did not get far, plans to work his colleagues in both chambers to pass legislation.
“Chairman Wyden is committed to making good on Democrats’ promise to lower drug costs for Americans and allow Medicare to negotiate prices,” said a spokesperson for Wyden, a Democrat from Oregon.
A Schumer spokesperson told CNN on Sunday that the majority leader supports legislation to both reduce drug prices and expand Medicare benefits. He will push for these provisions to be included in the recovery bill.
Expanding Medicare
Just how the American Families Plan and its companion infrastructure-focused American Jobs Plan work their way through Congress is not yet clear, which complicates the efforts to insert the health care measures. West Virginia Sen. Joe Manchin, a Democrats whose support is critical to advance any bills, has already expressed concerns over their combined $4 trillion price tag and the associated tax increases.
One reason some Democratic lawmakers are so interested in prescription drug legislation is that they want to use the savings to fund an expansion of Medicare benefits, though others may opt to offset different recovery provisions. The negotiation provision of the 2019 House bill would lower spending by about $456 billion, according to the non-partisan Congressional Budget Office.
More than 100 House and Senate Democrats — including both progressives and moderates — recently wrote to Biden to urge him to include Medicare expansion in his latest recovery proposal. They asked him to reduce the Medicare eligibility age to as low as 50, from the current 65, to expand coverage to include dental, vision and hearing benefits and to place a limit on out-of-pocket spending.
“We have an historic opportunity to make the most significant expansion of Medicare since it was signed into law,” wrote the lawmakers, led by Vermont Sen. Bernie Sanders and Washington Rep. Pramila Jayapal, both champions of Medicare for All.
While a Sanders aide acknowledges the path forward is filled with hurdles, “the goal is to get Medicare negotiation and the expansion of Medicare benefits into the next reconciliation package,” he said.
The fact that Biden mentioned it in his address “was no small thing,” even though the President did not include the provisions in his package. And the measures have garnered support from an array of Democrats.
“It’s an uphill battle, but at the same time you are starting from a relative place of strength. It isn’t just a progressives-only proposal,” he said.
