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Democratic plans to expand healthcare programs hang in the balance as spending bill stalls

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Democrats' hopes to expand federal healthcare programs, including Medicare, Medicaid, and Obamacare, hang in the balance as President Joe Biden's $3.5 trillion spending program faces the prospect of being scaled back.

“I think that they can still get it done, but it may have to be done on a scale that's smaller than we would have hoped,” said Dan Adcock, the government relations and policy director at the liberal National Committee to Preserve Social Security and Medicare. “I think this is something that, at least in the advocacy community, people had anticipated this and know that this was going to be a likely outcome. I think there's still going to be a bill, but it may not be as ambitious as we would have liked.”

Democrats want to pass the bill using the budget reconciliation process, which requires only 51 votes in the Senate. But with the Senate divided 50-50 between Democrats and Republicans, there are no votes to spare.

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Sen. Bernie Sanders, an independent from Vermont, has been pushing a provision in the bill to add dental, vision, and hearing benefits to Medicare. Other Democrats, many from Southern states, are pushing for the federal government to cover the roughly 4.4 million poor people from the 12 states that have not expanded Medicaid under Obamacare.

The American Rescue Plan passed by Congress in March included $36 billion to expand for two years of subsidies for insurance premiums on Obamacare exchanges. Democrats are hoping to extend those subsidies for another 10 years in the spending package.

The total cost of these expansions over 10 years is about $600 billion.

But centrist Democratic Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona have balked at the spending bill. Manchin has suggested that Congress take a “strategic pause” on the legislation until possibly 2022, and Sinema has said she could not support spending $3.5 trillion.

Reducing the amount spent on the overall bill would also mean reducing spending on the healthcare provisions.

The resistance of Manchin and Sinema are not the only threats to these healthcare proposals.

Much of the funding to pay for it was supposed to come from H.R. 3, “The Elijah E. Cummings Lower Drug Costs Now Act,” which would allow the Department of Health and Human Services to negotiate on prescription drugs for the first time. According to the Congressional Budget Office, this was supposed to save the federal government over $450 billion over 10 years.

Whether that bill will pass the House seems increasingly unlikely. The House Ways and Means Committee passed the bill last week, but it failed to clear the Energy and Commerce Committee, where four centrist Democrats opposed it. Back in May, 10 Democrats signed a letter to Speaker Nancy Pelosi expressing reservations about the bill.

Democrats have 220 members in the House to the GOP’s 212, which means that they can afford only three defections if they are to pass H.R. 3.

“The Democratic leadership has a couple of options,” said Doug Badger, a senior fellow at the conservative Heritage Foundation. “First, they could pressure moderates who opposed the price control provision in committee to back passage on the floor. More likely, they will try to cobble together a price control package that gives them less savings and scale back the other expansions.”

Badger suggested that Democrats would most likely scale back the Obamacare subsidies, extending for them for only three or four years.

“Democrats will be betting that a future Congress won't let the program expire,” Badger said.

Adcock thought it would be possible for Democrats to come up with most of the money for the healthcare proposals by finding it in other parts of the spending bill. Yet, that would require eliminating other spending proposals in the bill.

He conceded that it would be “a monumental task in terms of negotiation.”

Another possibility is that Democrats remove these provisions from the spending bill and vote on them later as stand-alone bills. But the chances of that seem remote.

“It's possible, but [Senate Majority Leader Chuck Schumer] is generally reluctant to bring a bill to the floor that would be open to amendment and debate. He would need an ironclad commitment from 10 GOP senators to prevent amendment and debate,” said Badger.

Adcock also thought it was unlikely.

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“I think it still would have to be done under budget reconciliation because I think it's unlikely that Democrats would get Republicans to vote for those kind of benefit improvements,” said Adcock.

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Tags: Healthcare, Medicare, Medicaid, Medicaid Expansion, Medicare and Medicaid, Obamacare, Health Care Exchanges, Joe Manchin, Kyrsten Sinema, House Ways and Means Committee, House Energy and Commerce Committee, Drug Policy

Original Author: David Hogberg

Original Location: Democratic plans to expand healthcare programs hang in the balance as spending bill stalls

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