This article by Politico Pro will be helpful in informing our members’ advocacy now that the 117th Congress has begun, particularly when paired with this infographic explaining the reconciliation process discussed below. However, some of the strategy laid out below may be affected by the fact that the House now has enough votes to proceed with a new impeachment proceeding against President Trump for inciting violence at the Capitol last week. House Speaker Nancy Pelosi (D-CA) has stated she will proceed with impeachment if the President does not resign, which pundits acknowledge is highly improbable. The article below predates that development.
“Democratic lawmakers after the party’s sweep in Georgia’s two Senate elections are eyeing a new opportunity for advancing health legislation through an arcane budget maneuver — the same one they used to pass the Affordable Care Act on a party-line vote a decade ago.
Along with a narrow House majority, Democrats will own a razor-thin Senate majority that will enable President-elect Joe Biden to enact major planks of his agenda if Democratic lawmakers torn over their health care ambitions can find common ground.
Democrats are studying how they could push through changes over Republicans’ objections by using reconciliation, a byzantine budgetary process requiring just a simple majority in both chambers. Democratic Hill staffers in the aftermath of Georgia’s election acknowledged they’re in the early phases of determining what’s now possible, with a senior aide framing the discussions as ‘preliminary.’
There’s initial thinking that Biden may be able to use the budget procedure to follow through on campaign promises to expand Affordable Care Act insurance subsidies to people in low- and middle-income brackets, roll back Trump administration rules expanding short-term health plans that skirt ACA coverage requirements and possibly lower the Medicare eligibility age from 65 to 60.
Two other major items on Biden’s agenda, the creation of a government-run health insurance option and Medicare drug negotiations, could still be challenging to achieve through the fast-track procedure, given some moderate lawmakers’ concerns with both proposals. With 50 Democratic senators and Vice President-elect Kamala Harris poised to play tiebreaker, the party can’t afford a single defection on partisan legislation.
After Democrats campaigned heavily on health care the past two election cycles, Biden may face pressure to go big on health care now that Democrats will have unified control of Washington. Yet he will also have to bridge competing factions of progressives favoring a “Medicare for All”-style overhaul and establishment lawmakers urging incremental changes seen as more achievable. While powerful health care groups support more Obamacare subsidies, many are set to oppose further government expansions like lowering the Medicare age and creating a public option.
Senior Democratic aides said they’re likely to focus initially on simple policies that could be enacted quickly and provide immediate, tangible benefits to voters, such as an expansion of Obamacare subsidies. That could avoid a confrontation with health care interests and prevent the party from getting drawn into a complicated and more divisive policy debate. Structural changes, like a public option or lowering the Medicare eligibility age, would take longer to legislate and likely would take time to roll out.
Democrats will have two opportunities to use the reconciliation process this year since lawmakers didn’t pass a budget for the current fiscal year. Aides said the first crack at reconciliation will likely focus on battling the pandemic and shoring up the teetering economy. Aides said a second package this summer could include health care, along with other priorities like a tax overhaul.
Budget experts cautioned that while reconciliation could be attractive legislative maneuver for approving partisan legislation, it comes with complex rules that must be navigated carefully. Each provision must directly raise or lower spending or revenue levels, all spending must be offset, and any changes can’t affect Social Security.”