Exactly what American health care will look like if Democrats can pass their $3.5 trillion spending plan is unclear, but the senator negotiating its health-related provisions hopes what emerges will be dramatic: the first complete health care system for older Americans and significantly reduced costs for everyone else.
“We are setting very, very ambitious goals,” Sen. Ron Wyden (D-Ore.) told KHN. “And that’s appropriate because the fact is a lot of challenges have gotten short shrift — and I’m not just talking about the last four years, I’m talking about 10 years.”
But the budget plan is highly controversial within the Democratic caucus and on a tight time frame. Senate Majority Leader Chuck Schumer set a Wednesday deadline for Democrats to agree on the broad outlines. Wyden insists that lawmakers from different wings of his party can come together to support a framework to move forward.
“He told us to be ready on Wednesday, and we will be,” said Wyden, who chairs the powerful Finance Committee and is also a member of the Budget Committee.
While health policy questions have generally taken a back seat in the recent debate over possible infrastructure and climate provisions in the package, health care will account for a large proportion of the cost.
Provisions would include steps to reduce prescription drug costs, to extend the generous federal subsidies for people buying insurance on the Affordable Care Act’s marketplaces, to provide coverage for low-income residents in states that did not expand their Medicaid programs and to massively increase health care options for older Americans.
Medicare could wind up with new programs to provide people with dental, vision and hearing care for the first time. The plan could realize President Joe Biden’s proposal to spend $400 billion so seniors would get home-based and community health care to live at home longer instead of moving to nursing homes.
Drug spending would be lowered partly by allowing Medicare to negotiate prices with pharmaceutical companies, thus saving the federal government and consumers money.
In raw dollars, the health care components of the plan Democrats announced last week could easily exceed the initial $940 billion cost estimates of the Affordable Care Act.
“I think it’s huge,” said Paul Ginsburg, a professor of health policy at the University of Southern California and senior fellow at the Brookings Institution.