ICYMI: New York Times: Democrats’ Bill Would Go Far Toward ‘Patching the Holes’ in Health Coverage
December 1, 2021
|Key Point: “More than 75 years after Truman first proposed universal coverage, Democrats are still chasing his dream. If President Biden’s social policy bill becomes law, they will make major strides toward fulfilling it. … The bill would expand health care access for children, make insurance more affordable for working-age adults and improve Medicare benefits for the disabled and older Americans.”|
New York Times: Democrats’ Bill Would Go Far Toward ‘Patching the Holes’ in Health Coverage
By Reed Abelson, Sarah Kliff, Margot Sanger-Katz and Sheryl Gay Stolberg
December 1, 2021
More than 75 years after Truman first proposed universal coverage, Democrats are still chasing his dream. If President Biden’s social policy bill becomes law, they will make major strides toward fulfilling it.
An estimated 3.4 million Americans would gain health insurance as a result of the legislation, which passed the House last month but faces a tough road in the 50-50 Senate. Senator Chuck Schumer of New York, the majority leader, said Tuesday that his goal is to have it pass before Christmas.
The bill would expand health care access for children, make insurance more affordable for working-age adults and improve Medicare benefits for the disabled and older Americans. Separately, its health provisions are a “piecemeal of incremental changes,” said Caroline Pearson, a senior vice president for health care at NORC at the University of Chicago, a nonpartisan research organization.
But taken together, these policies represent the biggest step toward universal coverage since the passage of the Affordable Care Act in 2010.
“This is a moment of extraordinary opportunity for improving health policy and improving the health coverage that people get,” said Stan Dorn, director of the National Center for Coverage Innovation at the advocacy group Families USA.
Here are some of the programs — and people — the legislation would affect.
Providing Medicaid to New Mothers for a Year
Christina Ruiz had plenty to worry about when she gave birth two months early, in August 2020.
Her infant daughter had to spend five weeks in the neonatal intensive care unit while Ms. Ruiz, 34, dealt with her own postpartum complications. She developed high blood pressure, and the stitches on her C-section incision began to unravel three weeks after delivery.
One thing Ms. Ruiz did not have to worry about: medical bills. She had enrolled in Medicaid early in her pregnancy, and it fully covered both her and her daughter’s costs.
The social policy bill would provide Medicaid to new mothers for a full year after delivery instead of just two months, allowing more time to address postpartum medical issues that can surface later.
The Century Foundation estimates the provision would extend coverage to about one million women over the next decade.
The postpartum coverage could help Ms. Ruiz, who is now pregnant with her second child.“It makes all the difference,” she said, “not having to worry about health care bills.”
Erasing the ‘Coverage Gap’ for Poor Adults
Tim Floyd of Guntown, Miss., was working construction jobs in 2012 when he noticed numbness in his foot. It was neuropathy, a sign of diabetes. But he was uninsured and could not afford a doctor visit.
By the time Mr. Floyd learned he had diabetic ulcers, the infection had spread to his bones, leaving him no choice but to have his leg amputated from the knee down.
He lives in one of 12 states where Republicans have refused to expand Medicaid under the Affordable Care Act, citing the cost, of which states would eventually pay 10 percent. The social policy bill would close the so-called Medicaid coverage gap by offering an estimated 2.2 million low-income adults like Mr. Floyd free private insurance — but only for four years.
He waited a year, then saw a doctor, who told him he had Hodgkin’s lymphoma, a type of blood cancer.
Mr. Floyd said a social worker at North Mississippi Medical Center helped arrange for free treatments — surgery, chemotherapy and radiation. “The preventive care,” he said, “is what I couldn’t get.”
Providing Premium Subsidies to Middle-Class Americans
Jill Swenson and her husband were raising buffalo in upstate New York in 2009, when he had a recurrence of skin cancer. The couple had no health insurance, a factor that Ms. Swenson says contributed to her husband’s suicide. The Affordable Care Act made coverage accessible to her again in 2014, and she has had it every year since, but it was still a stretch.
During the pandemic, Congress has temporarily increased the premium subsidies provided under the health law — a $200-a-month discount that Ms. Swenson, 63, said has allowed her to buy birthday gifts for her niece and nephew, keep up with rising grocery costs, and pay utility bills and her mortgage.
“There’s nothing to cut,” she said. “It’s not like I’m living high on the hog.”
The temporary boost in subsidies extends up and down the income spectrum, lowering the cost of insurance for almost everyone who buys it through the Obamacare marketplaces. The social policy bill would keep it in place until the end of 2025.
Expanding Home Care, and Raising Wages for Those Who Provide It
After she recovered from cancer, Shara Clark decided to become a home health aide in June as a way to give back. “When you go through a medical scare such as I did, you develop empathy for others,” she said.
But Ms. Clark, 41, also has two part-time jobs. “Because I’m only getting paid $10 an hour, that does not match the cost of living,” she said.
The $150 billion in the spending bill for home and community-based services has two goals. It would allow more elderly and disabled people on Medicaid to qualify for subsidized care in their homes or at community programs, helping them avoid moving to a nursing home. There are currently an estimated 800,000 people on waiting lists for these services.
But the money is also supposed to go toward raising wages for home care workers like Ms. Clark.
Home care workers make an average of under $14 an hour, or less than $30,000 a year, according to a new study from the Economic Policy Institute, a liberal group. Most of the workers are women, and many are of color.
“Wages have to go up if services are going to go up,” said Ai-jen Poo, the executive director of the National Domestic Workers Alliance, an advocacy group. “Those two goals are absolutely interdependent.”
Capping How Much Medicare Recipients Spend on Drugs
There is currently no limit on how much Medicare recipients can be expected to pay out of pocket for their drugs, a situation that leaves some who take expensive medicines with annual bills of $15,000 or more. But for the 2.5 million beneficiaries who spend more than $2,000 a year on their drugs, Medicare would pay all their costs above that amount under the bill.
The legislation would also cap out-of-pocket costs for insulin at $35 a month. That change alone could affect the more than three million Medicare beneficiaries who take the drug to manage their diabetes.
Ms. Forster Olson, of La Crosse, Wis., who qualifies for Medicare because she is disabled, said her drug costs could be as high as $7,000 next year without a change. “A cap of $2,000 would be amazing,” she said.
Hearing Aids for Older Americans
Anne Madison, a retired computer systems engineer in Baltimore, started losing her hearing in her 50s. Now 71, she cannot afford hearing aids, which can cost as much as $5,000. Medicare will not pay for them.
“I can’t whip out the Mastercard,” she said. “If I put that much money on it, I’ll be in trouble for the rest of my life.”
Nearly two-thirds of Americans older than 70 have hearing loss, but fewer than 20 percent of them use hearing aids, said Dr. Frank Lin, an ear, nose and throat surgeon at Johns Hopkins School of Medicine.
The House-passed bill would add coverage of hearing services to Medicare beginning in 2023. Audiology services, including counseling for hearing aids, would be reimbursed, and the devices themselves would be covered for people with “profound or severe hearing loss.”