Health care reforms on the backburner

Will Democrats get anything done on renewing Obamacare subsidies or curbing drug prices?

It is sad but true that policymakers in the nation’s capital and the thousands of reporters who ply their trade there can only focus on one issue at a time.

In the wake of the horrific murders of innocent children and teachers in Uvalde, coverage of Capitol Hill has focused on bipartisan negotiations that might enact some minor changes to the nation’s gun laws. Even before that gets done (if it gets done), the Supreme Court will hand down its decision repealing Roe v. Wade, which will send the media stampeding to cover reaction to five rightwing judges’ cancellation of a woman’s right to choose. That will be followed by wall-to-wall coverage of actions by Red states to ban abortion and Blue states to become reproductive health care destination sites.

The background noise is daily reporting of inflationary price increases (sans explanation for any of it) that have reached levels not seen since the 1970s. That has drowned out the news that the job market is better than at any time since the late 1990s; there are two job openings for every job seeker; and, if your town is like mine, there isn’t a major road or bridge that isn’t under repair, the first fruits of the $1 trillion infrastructure investment that will play out over the next several years ensuring the boom in corporate profits will continue.

Sadly, no one in the mainstream media is focused on the twin social disasters that will take place in health care later this year if the Democratic Party-controlled Congress fails to act. Millions of people will lose their health insurance and the pharmaceutical industry will once again have dodged the bullet on drug price controls, even the minor reforms that are being pushed by the party’s leadership on Capitol Hill.

Here’s what is at stake:

Obamacare coverage

• Last year’s American Rescue Plan expires at the end of this year and with it, the enhanced premium tax credits that allowed close to two million more people to sign up for health insurance plans on the Affordable Care Act exchanges. If Congress does not act this summer, a large majority of the 14.5 million people with Obamacare plans will have to pay substantially higher premiums in 2023.

The Urban Institute estimated over 3 million people will drop coverage if the additional premium assistance isn’t renewed. The uninsured rate among those who earn under 400% of the poverty level will rise by 17%. The uninsured rate for everyone between 55 and 64 will rise by 12%.

Memo to Sen. Joe Manchin: The impact would hit hardest in poor states like West Virginia, where the Center for Budget and Policy Priorities estimates the average Obamacare purchaser saved over $1,500 per year because of the higher subsidies.

Medicaid

• Millions of people on Medicaid face a deadline of their own. The administration hasn’t signaled it will end the public health emergency declared in 2020 because of the Covid-19 pandemic. But even if it is extended for another three months before it expires in July, officials at Health and Human Services will likely let it expire at the end of October.

That will trigger the requirement that states regularly review the eligibility of low-income people for free health insurance, which was suspended during the public health emergency. “Eligible enrollees could lose coverage if they don’t receive a notice to renew or don’t return the required documents in the requested timeframe, or if Medicaid agencies fall behind in processing paperwork,” the CBPP warned in this policy brief.

Millions will also be deemed ineligible, especially in states that didn’t expand Medicaid to cover people up to 138% of the federal poverty level. Whether by inattention or design, an estimated 15 million people or nearly one in every five people in the program could lose coverage.

Congress can act to avoid this disaster by helping states ease poor peoples’ entry into Medicaid during the transition. They could give grants to states to send notices to enrollees that their coverage needs to be renewed; hire new personnel to streamline the paperwork process; and help people transition to subsidized coverage on the exchanges if they are no longer eligible for Medicaid.

Drugs

• Finally, there is the stalled drug pricing reform legislation, which Democrats promised they would address once they won control of Congress and the White House. The House has passed a bill, but there’s radio silence in the Senate.

Senate Majority Leader Chuck Schumer (D-N.Y.) and the administration have been negotiating with Senators Joe Manchin and Kyrsten Sinema (D-Ariz.) to bring back a slimmed down Build Back Barely bill that includes something on drug prices. If Democrats want to hold onto their slim majorities in both houses, they had better pay attention to this core promise from their 2018 and 2020 campaigns.

The potpourri of possible reforms includes capping out-of-pocket costs; giving Medicare the right to negotiate prices; capping prices on the most expensive drugs Medicare buys; limiting annual price increases on already approved drugs; pegging new drug prices to their actual medical value; stop paying for drugs given accelerated approval if they don’t complete trials proving clinical benefit; scrapping the 6% markup on drugs either infused or injected in physicians’ and hospitals’ clinics in favor of a flat fee for administration; and collecting evidence on the real world benefits of drugs so CMS can have hard evidence for determining their actual value.

The Medicare Payment Advisory Commission included several of these proposed reforms in its latest report to Congress. Normally, politicians on both sides of the aisle play scant attention to the advisory body’s recommendations. The drug industry’s campaign contributions and army of lobbyists invariably determines the outcome. If Democrats are interested in self-preservation, they will pay attention this time.