WASHINGTON — The health care proposals packed into Democrats’ $3.5 trillion social services and climate change package could help millions of Georgians gain coverage or reduce out-of-pocket spending.
But only if Democrats can overcome fierce disagreements over the size of the bill and what it should include. Some of the provisions, such as a plan to expand Medicaid in Georgia and 11 other states, could be scaled back or eliminated.
Georgia lawmakers say closing the Medicaid gap in these remaining states should be prioritized.
“We push for the expansion of Medicaid because that’s what Georgians voted for when they sent me and Jon Ossoff to the Senate, and that’s what the American people voted for when they gave us the majority,” U.S. Sen. Raphael Warnock said at a Thursday press conference attended by Ossoff and U.S. Rep. Carolyn Bourdeaux.
“Now, we owe it to them to deliver this legislation that will literally help save lives,” Warnock said.
State leaders in Georgia have said that expanding Medicaid would be too expensive, even with the federal government paying 90% of the cost. Under the bill, the federal government would cover all expenses. About 646,000 Georgians would gain coverage.
That approach, however, has angered Democratic lawmakers representing states that already expanded Medicaid and are shouldering some of the costs.
The bill would also extend tax credits and subsidies that make health insurance more affordable for 262,000 Georgians. Another element would provide about 1 million Medicare recipients in Georgia with hearing, vision and dental coverage.
And millions of adults could see savings if the bill includes language that allows the federal government to negotiate prescription drug prices with pharmaceutical companies.
The question is whether Democrats can do it all.
That isn’t just a question about the health care items, but also portions of the bill that deal with reducing greenhouse gas emissions, increasing access to early childhood and higher education, tax credits for low-income families and tax increases on the rich to help pay for it all.
Democrats say the ongoing effects of the coronavirus pandemic make the case for why they should support President Joe Biden’s agenda, which created the framework for the bill and, specifically, the health-related proposals.
Ossoff said he doesn’t want Democrats to miss their opportunity to “deliver transformative investments in health care for Georgians.”
“This chance to expand Medicaid to help hundreds of thousands of Georgians who lack access to get the health care they need, to improve the quality of Medicare for Georgia seniors, to bolster Georgia’s hospitals and clinics — we can’t squander this chance,” the Atlanta Democrat said.
The bill is being drafted using a process called reconciliation that will allow Democrats to pass the measure without a single Republican vote — if they stick together.
Democrats have just a five-vote majority in the House. In the Senate, just one Democrat voting with Republicans can kill the bill.
Republicans are united in opposition to the package, which they say is too costly and would increase the national debt with programs that should not be within the purview of the federal government. U.S. Rep. Buddy Carter, a Pooler Republican, is a pharmacist by trade and has supported numerous health care initiatives during his tenure in office.
He said he likes some of the goals Democrats have outlined in the $3.5 trillion package but disagrees with how much they want to spend and how they are going about it. For example, he dislikes the proposal to expand Medicare benefits and does not want the federal government negotiating prescription drug prices. Instead, he advocates for capping out-of-pocket costs for consumers and transparency regulations for drugmakers.
“They want socialist, government-run health care,” Carter said of Democrats. “And I think when you get socialist, government-run health care that you’re going to have wait times increase, you’re going to have rationed care and you’re not going to have provider choice.”
Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a conservative think tank, said Democrats have not found the right balance in their bill.
“I think that a lot of the provisions in the reconciliation proposal on the health care side are overly broad and expansive,” he said. “It’s a bunch of spending without necessarily addressing a lot of the underlying problems in these existing programs.”
Denson said he also worries about the overall price tag and whether it could lead to more inflation.
Even among Democrats there is disagreement about whether the current proposal would add too much to the national debt or create unintended consequences for families or businesses. U.S. Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona have said they want to see the overall amount reduced, and their votes are essential to the bill’s passage.
Some House moderates have also raised concerns, including a few who sided with Republicans in removing the prescription drug negotiations provision. It was restored later, but the discussion worried lawmakers who were banking on the savings from that initiative to fund other pieces of the legislation.
Bourdeaux, who lives in Suwanee, said she supports the health care policies in the bill, especially Medicaid expansion, a cause she campaigned for and included in a stand-alone bill she introduced with Warnock.
But she wants to ensure Democrats are fiscally responsible in how they implement their health agenda.
She wants to see access to some programs based on income. “For instance, when we think about the Medicare issues — because those are very, very expensive — a first step might be in this bill to focus on the need and where people might not have the income or the resources to get a hearing aid or get their teeth fixed.”
Brad Woodhouse was a senior official in the Democratic Party who helped sell the 2010 Affordable Care Act. Now serving as executive director of Protect Our Care, an organization created to defend the law, Woodhouse says Democrats should go big, especially when it comes to addressing the cost of prescription drugs.
“The virtuous thing about the health care piece is that it’s a win-win-win-win if you do it right,” he said. “Because the savings you get from letting Medicare negotiate for lower prices, that is a saving to the taxpayers to a large extent in the Medicare program.” That money can be used to address the other priorities, such as new Medicare benefits and Medicaid expansion, he said.
Because the party of the president in office often loses seats in a midterm election, House Democrats could see their majority disappear in 2022. That explains one reason why Democrats are trying to pack so many priorities into the package, because their window to pass sweeping measures could close soon.
Woodhouse said Protect Our Care’s polling shows that many of the health care proposals are popular, even among conservatives. Voters gave Democrats the majority in both chambers of Congress and the White House in part because voters supported their health care platforms, and now it’s time to follow through, he said.
“It’s not just a sense of urgency to get it done because you may not have a chance to get done after the next election,” he said. “It is to get it done because you have no hope of winning the next election if you don’t deliver.”
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