Democrats in Congress are trying to push through the biggest health care expansion since President Obama’s presidency, spending more than $ 800 billion on everything from additional Medicare benefits to home care.
The measures are all built into the 2,468-page tax and spending package that Speaker Nancy Pelosi (D-Calif.) Is trying to get through the House. The overall cost of the bill is estimated at $ 3.5 trillion, including hundreds of billions for green energy, child care and scholarships, including universal kindergarten.
The bill still faces significant hurdles. Even if he clears the House, he would need the support of the 50 Senate Democrats to avoid Republican obstruction and move to a simple majority through a process called budget reconciliation with Vice President Kamala Harris knocking out ties. The Democratic leadership has yet to convince two moderates: Senator Kyrsten Sinema (D-Arizona) and Senator Joe Manchin (DW.Va.). That hardened on Thursday as Manchin indicated his spending limit would be $ 1.5 trillion, a potential break for progressives in both the House and Senate.
The jockey can continue for a while. How to pay the high price of the bill is pending. Democrats are proposing various tax hikes for businesses and individuals, and they hope to save at least $ 500 billion through drug price reforms.
Congressional tally on total costs and revenue metrics has not been released, making the numbers fluid and almost sure to change.
Nonetheless, here is an overview of the main health care provisions of the bill and the issues for consumers and businesses.
Medicare and Medicaid extension
Democrats aim to include vision, dental and hearing benefits in Medicare, and they want to fill the “Medicaid void,” expanding grants and programs for low-income Americans to get insurance through plans Medicaid “Marketplace” managed by the private sector.
Medicare benefits alone would cost $ 358 billion over 10 years, according to preliminary estimates from the Congressional Budget Office.
Dental coverage would begin in 2028, including preventative care like x-rays and cleanings, dentures, and major treatments like root canals. His fate is uncertain. The American Dental Association, the industry’s leading lobby group, is against it.
Vision and hearing care coverage would start earlier: in 2022 for vision and 2023 for hearing. Vision coverage would include routine eye exams and subsidies for eyeglasses and contact lenses, up to $ 85 for two years of contact lenses and $ 170 for frames and lenses. Hearing aids would be covered once every five years.
Medicaid coverage would get a big boost as part of a move to expand eligibility in many states. Democrats want to lower income thresholds for coverage and provide grants to more people to get Medicaid under Marketplace plans. An estimated 5.8 million uninsured adults in 12 states that have not extended Medicaid would be able to get coverage, according to the Commonwealth Fund, a health care advocacy group.
Other measures would expand Medicaid to include more postpartum services, coverage for children, and money for long-term home care. In total, expanding Medicaid programs would cost around $ 300 billion, according to Brownstein law firm Hyatt Farber Schreck.
Medicare subsidies and drug prices
The bill would extend subsidies or tax credits to people who buy so-called Obamacare insurance in state markets. Those grants were temporarily increased in the $ 1.9 trillion America Rescue Plan Act, a stimulus package passed by Congress and the Biden administration earlier this year.
The Stimulus Act extends eligibility for insurance subsidies to people with incomes above 400% of the federal poverty line, or $ 106,000 for a family of four, according to the Commonwealth Fund.
Democrats also hope to reduce drug prices through various mechanisms. In addition to asking the government to negotiate prices, the bill would require manufacturers to offer discounts to Medicare beneficiaries if the price of a drug rises faster than inflation.
For beneficiaries of the Medicare drug plan, annual disbursements would be capped at $ 2,000, starting in 2024. Currently, Medicare Part D coverage caps certain drug expenses up to $ 6,550, when one. catastrophic coverage may come into effect.
Home and community services
Democrats aim to spend $ 190 billion on home and community health services over 10 years. Most of that money would go to states for home and community services, increasing their grants by 7% from current levels.
People providing long-term care to an elderly parent or child would also benefit from tax relief. The bill introduces a new tax credit for expenses related to the care of the elderly and children. Credits cap at $ 4,000 and decrease by 1 percentage point for every $ 2,500 a taxpayer’s adjusted gross income exceeds $ 75,000, according to Brownstein.
Write to Daren Fonda at [email protected]