Capitol Correspondence - 04.20.21

Congressional Democrats Begin Scaling Back Health Proposals Ahead of Negotiations on Jobs and Infrastructure Package

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As congressional Democrats begin to think through proposals to bring to life President Biden’s American Jobs Plan – a wish list that includes a request for a $400 billion investment in the Home and Community-Based Services program – they are considering scaling down health components ahead of negotiations within the party and across the aisle. Influential Senator Tom Carper, a longtime ally of President Biden, has even expressed willingness to consider a separate package focused only on physical infrastructure if the GOP produces a “solid proposal.” We share this Politico Pro reporting to help capture the shifting nature of these proposals.

“Democratic leaders are signaling they’ll scale back the party’s pent-up ambitions for Medicare expansion and drug pricing reform as negotiators eye the next phase of President Joe Biden’s sweeping infrastructure package.

The ‘social infrastructure’ piece of the $2 trillion-plus bill would be progressive lawmakers’ best chance to broaden the social safety net and curb pharmaceutical costs before the mid-term election, with Democrats’ full control of Washington on the line. It’s also the only sure vehicle to make good on some of Biden’s signature campaign pledges, like lowering Medicare’s eligibility age.

The leaders aren’t publicly ruling anything out until the White House makes its wishes known. But congressional sources close to the negotiations tell POLITICO that Democratic leaders are only sold on a narrow expansion of health coverage for poor adults and for making permanent the Obamacare subsidies they temporarily expanded earlier this year. These would be paid for by drug-pricing reforms that could be more modest than progressives want, though even that carries the risk of setting off rifts within the caucus.

‘I think the situation is fluid,’ said Senate Finance Chair Ron Wyden (D-Ore.), who co-authored a bipartisan drug pricing bill in the last Congress. ‘But I know that in 2022, seniors are going to really be looking at the people who campaigned on [lowering drug prices] year after year after year. I brought that up to the president repeatedly.’

Democrats’ choices were already limited with a 50-50 Senate and a tenuous majority in the House, where Speaker Nancy Pelosi can only afford to lose two of her members on partisan legislation. The most pressing question for Democratic leaders is how to keep their moderate and progressive wings satisfied as they piece together sweeping legislation also affecting roads, taxes, broadband and schools.

Biden is due to lay out a plan in the coming weeks that will shape what’s to come on Capitol Hill. As they wait, progressives are demanding the package include an expansion of Medicare’s benefits and lowering its eligibility age from 65 to 60 or even 55, hoping to hold Biden to a campaign pledge he made in part to win support from the party’s left wing. […]

But what’s likelier, sources say, is using the federal government to cover poor adults in states that have refused Obamacare’s Medicaid expansion. Options include establishing a narrow coverage program for poor adults in states that have refused Obamacare’s Medicaid expansion or extending full Affordable Care Act subsidies to this population so they can get a free private plan on the law’s marketplaces. Leadership also favors making permanent the temporary expansion of Obamacare subsidies for private coverage that Congress approved as part of Biden’s $1.9 trillion pandemic relief package — a move that could reduce the number of uninsured in the U.S. by 4.2 million, according to the Urban Institute.

Much still hinges on how big Democrats go on drug price controls in the infrastructure package. The billions of dollars in projected savings to government health programs could offset new spending in other areas like health coverage. But winning the votes will require a delicate dance in the face of opposition from a politically powerful industry that’s deeply enmeshed in the pandemic response.