Compromises outweigh campaign pledges in health care reform debates

Published: Jul. 22, 2021 at 1:56 PM EDT
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WASHINGTON (Gray DC) - From Texas Republicans to Northeast Democrats, just about every lawmaker argues health care in this country is in urgent need of reform. But, when it comes to writing a policy prescription, cross-party consensus remains hard to find though not necessarily impossible.

The Affordable Care Act is as stable as it’s ever been. It survived yet another Supreme Court challenge, pandemic relief funds lowered exchange plan costs, and enrollment is up and open through mid-August.

Christen Young, deputy director of the administration’s Domestic Policy Council for Health Care, highlights boosted subsidies and more than a million newly-covered Americans as substantial achievements for the President Joe Biden’s White House.

But, she noted more policy changes could deliver additional affordability and access. “There’s a lot of work to do across our priorities, we very much look forward to working with Congress,” she said.

For the moment, the Biden policy team is prioritizing compromise over big campaign promises. The president’s 2020 pledge to allow anyone to buy an exchange plan is sidelined. The current focus is on making new exchange subsidies permanent and giving Medicare the right to negotiate the prices it pays to prescription drugmakers.

Biden’s former 2020 Primary rival, Sen. Bernie Sanders (I-Vt.) is on-board with both policies and is temporarily shelving his signature campaign issue. He will not give up on getting every American covered under government-run insurance but concedes Medicare-for-All is not politically feasible in the current climate.

Sanders is still lobbying for bigger reforms than his more moderate peers, most notably, adding dental, hearing, and vision services coverage under Medicare.

Meanwhile, many Republicans who voted to scrap the Affordable Care Act in 2017, and falling just one vote short, now prefer to reform it following the Supreme Court’s most recent decision.

Bill Hoagland spent decades in the weeds of health policy as a Republican Senate staffer and in the private sector. Now a senior vice president with the Bipartisan Policy Center, he sees progress in many of the recent policy discussions.

“Hopefully, we can start to find some common ground,” he said.

Last year, just before the pandemic derailed most policy debate, the B.P.C. compiled a package of proposed reforms its experts believe could deliver meaningful change and support from both sides of the political aisle. Hoagland said he’s been heartened to see the Biden administration pursuing some of the ideas they highlighted, like increased subsidies.

Now, Hoagland sees renewed chances Congress could pass some of the others, like policies promoting telemedicine, requiring more price transparency from care providers, and moving nursing home care out of giant facilities and into smaller settings.

He expects said allowing Medicare to negotiate down the drug prices it pays to manufacturers should be an easy change to get behind for both parties. Lower costs would benefit patients wallets and the government’s bottom line.

Health reform proposals currently on the table are wrapped up in the on-going, multi-trillion dollar debate over infrastructure, the budget, and everything else.

Bipartisan negotiators say they’re making progress. Hoagland argued bipartisan support is critical to any new law’s long-term stability and success. “Yeah, it’s tough,” he said, “but it’s possible.”

Democratic leaders are prepared to push ahead on their own though if talks break down, that is, if they can keep their own party together. With a 50-50 Senate, they cannot afford to lose a single vote.

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