The most pressing concern is the fate of the tax credits that help low- and middle-income Americans buy health insurance each year. Unless Congress extends those subsidies, about 13 million people will see their monthly premiums increase in January, according to an estimate by the Kaiser Family Foundation — in some cases by hundreds of dollars per person.
Some Democrats also hope to offer new help to the roughly 2.2 million people, mostly women and people of color, who find themselves in even direr financial straits: They are too poor to qualify for federal aid but unable to enroll in Medicaid because they live in 12 states where Republican leaders have refused to expand eligibility for the program.
Democrats initially sought to address both issues as part of the roughly $2 trillion Build Back Better Act that President Biden approved and House lawmakers passed late last year. . In the Senate, however, Manchin opposed this broader package largely for budgetary reasons. Some of his apprehension extended to some health spending proposed by Democrats, raising questions about the extent to which they might have to lower their ambitions to end the gridlock.
Many Senate Democrats would not discuss the confidential negotiations on Tuesday. But lawmakers left a private lunch insisting they are making progress despite being months behind schedule.
“I expect to vote on a reconciliation bill before we leave here in August,” said Sen. Tim Kaine (D-Va.), adding that “continue the grants” that help millions to ensure are “very essential”. to that.
A spokesman for Senate Majority Leader Charles E. Schumer (DN.Y.) declined to comment on the talks. Sam Runyon, a spokeswoman for Manchin, highlighted his past comments, noting that the senator remains concerned about “rising inflation, a looming recession and the state of American energy security.”
“He continues to work in good faith to see if there is a way forward to boost home energy production and reduce emissions, reduce health care costs for the elderly and working families, and s ensuring that everyone pays their fair share of taxes,” she said. in a report.
For Democrats, the case strikes at the heart of the legacy of the more than decade-old Affordable Care Act (ACA). Lawmakers maintain their work is unfinished to cut coverage costs, reduce drug prices and expand access to care in a country where illness can spell financial ruin – and an estimated 30 million people still do not have insurance.
On the road to winning the White House and capturing both houses of Congress, party leaders had offered a sweeping vision for further reforms. Some lawmakers, including Sen. Bernie Sanders (I-Vt.), have called for plans like Medicare-for-all that could have guaranteed universal coverage. But their attempts to turn their political vision into law quickly ran into serious obstacles. Republicans immediately rallied to block the efforts — and even some Democrats, including Manchin, grew skeptical of their colleagues’ more ambitious and expensive health care proposals.
For now, Democrats believe they have reached an agreement on lowering prescription drug costs for seniors, a plan that would give the government the power to negotiate the price of certain drugs offered under Medicare. Schumer finalized the legislative text with Manchin last week, allowing Democrats to take the next step to prepare it for the process known as budget reconciliation. Parliamentary procedure allows them to push forward any final spending deal by a simple majority, avoiding unanimous Republican objections, provided Democrats satisfy Manchin and stay united.
“I believe we have 50 votes for these prescription drug pricing provisions,” Sen. Ron Wyden (D-Ore.), the head of the tax-focused Senate Finance Committee, predicted on Tuesday.
However, the fate of insurance subsidies is still unresolved. In a coronavirus relief package passed last year, lawmakers provided additional financial assistance to low-income Americans who purchase insurance through national or state exchanges — and they extended those benefits to Americans at average income for the first time.
But the expanded grants are due to expire at the end of this year. While many Democrats hoped to make existing aid permanent, Manchin sought to cut that spending. The West Virginia moderate focused on eligibility, aiming to further limit grants by income level, according to two people familiar with the matter who spoke on condition of anonymity to describe the deliberations. Manchin’s objection stems from a broader belief that federal benefits should be means-tested to focus only on the poorest, a more conservative approach than that supported by other members of his party, who want to ensure that families in higher cost areas also receive help. .
Any attempt to cut existing subsidies to address Manchin’s concerns would end up increasing insurance costs for some of the 13 million people currently benefiting from the program. Talks to modify the proposal are underway, the two people familiar with the matter said, expressing optimism that a solution could be found soon.
Other, the financial difficulties could prove to be immense. About 3 million people who currently have access to insurance through insurance exchanges could be prices out of the market, leaving them uninsured, according to a March report from the Department of Health and Human Services. Nearly 9 million people could lose hundreds of dollars in financial aid each year, and about 1.5 million could lose their grants entirely.
The serious potential consequences have prompted eight major health groups – such as the American Cancer Society Cancer Action Network and the American Medical Association – to warn of “premium shock” if Congress fails to grant a enhanced financial assistance to ACA consumers. State insurance market officials, meanwhile, have been pleading with Congress in recent weeks to act quickly because July is when they typically try to set their rates for next year.
Democratic lawmakers joined in expressing their panic, fearful of the political backlash they could face in what is already a tough election year. In May, more than two dozen swing-district Democrats called on Schumer and House Speaker Nancy Pelosi (D-California) to extend subsidies and “fulfill the promises we made to our constituents to lower their costs of health and protect their care. .” More than a dozen Democratic senators delivered their own pleas a month later.
Closing the Medicaid coverage gap in the 12 Republican states that have long refused to expand benefits poses an even greater challenge.
Democrats made their first attempt last year to provide premium-free health coverage to more than 2 million affected adults through insurance exchanges through 2025. But Manchin said at the time that the federal government should not be held responsible for subsidizing some states’ benefits while others cover their own costs.
Since then, the proposal has largely disappeared from renewed negotiations, according to two people familiar with the matter, as Schumer and Manchin focus on other health policy issues and seek ways to reduce the overall costs of the legislation. Some congressional aides say it’s unlikely to be included in a final spending deal, though they warn nothing has been decided.
Yet Democrats have continued to push their cause anyway: On Tuesday, for example, Sen. Raphael G. Warnock (D-Ga.) pointed to the fact that hundreds of thousands of residents in his state alone are affected by the deficit of Medicaid. The senator, who is leading a close re-election race that could determine control of the Senate next year, said he has therefore made expanding Medicaid a top priority.
“Imagine having Social Security or Medicare in 38 states,” Warnock said. “It’s unimaginable because it’s the law of the land.”
Some strong supporters of closing the Medicaid gap have stepped up their advocacy efforts, particularly in response to Dobbs v. Jackson Women’s Health Organizationthe Supreme Court decision that overturned Roe vs. Wade. Protect Our Care, a Democratic-aligned advocacy group, circulated memos on Capitol Hill this week saying abortion bans coupled with lack of Medicaid expansion “are impacting women of color. and their families, leaving them without coverage and at risk for serious childbirth outcomes.
Rep. Robin L. Kelly (D-Ill.), the head of the Congressional Black Caucus Health Braintrust, added in an interview that many of those impacted by the Medicaid gap are women — meaning inaction could worsen maternal mortality at a time of great uncertainty. She said Tuesday that she raised the issue directly with Schumer, emphasizing “the importance of postpartum Medicaid coverage and closing the gap.”
“There are still too many people in the wealthiest country in the history of the world without health care or without adequate health care,” Kelly said.
