March 30, 2022 – For Democrats in Washington, this week is about changes in health care, as they seek to draw attention to proposals to expand access to medical care, the White House unveiling its new budget request and lawmakers revisiting the “Medicare-for-all” approach.
President Joe Biden’s budget request for fiscal year 2023, which begins Oct. 1, asks Congress to increase funding for mental health services and programs to treat people with opioid use disorders . Members of Congress have been able to find bipartisan agreement on both issues in recent years, which makes Biden’s proposals seem workable.
In the coming weeks, congressional committees will dig into the details of Biden’s request, which was unveiled on March 28.
The House Appropriations Committee will hold a March 31 hearing on the Department of Health and Human Services spending plan. The panel will likely dive deep into White House plans for funding federal agencies, including the National Institutes of Health and the CDC. On April 5, the House Ways and Means Committee, which oversees Medicare and Medicaid, will hold its own hearing, where members are likely to raise questions about rules on doctor payments and private insurance plans. .
Debating Medicare for All
However, regardless of Biden’s budget request, some Democrats are continuing their efforts to push for a major overhaul of how the government pays for health care.
The House Committee on Oversight and Reform held a hearing Tuesday on the barriers that prevent many people from receiving medical care. The “Medicare for All” bill proposed by Rep. Pramila Jayapal (D-WA) was highlighted during the hearing.
Jayapal’s bill would establish a government-run national health insurance program and limit the use of private insurance to items not covered by the new federal plan. Under his bill, the creation of a new federal insurance program would not affect coverage provided by the Department of Veterans Affairs or the Indian Health Service.
Other Democrats have offered a less sweeping plan, known informally as “Medicare for everyone who wants it.” Officially titled the Medicare-X Choice Act, this bill by Rep. Antonio Delgado (D-NY) would create a federal health care plan to compete on the insurance exchanges with offerings from private insurers such as UnitedHealth and Blue Cross.
Opposing Jayapal’s bill during the hearing, a witness was called by the Republican members of the committee. Grace-Marie Turner, president of the nonprofit Galen Institute, noted that implementing Jayapal’s bill would cause major upheaval.
“While the promises of Medicare for All seem utopian, what about the vast majority of at least 173 million people who don’t want to give up their occupational insurance? What if 64 million seniors like their plans current Medicare and Medicare Advantage and you don’t want the program abolished and replaced?” Turner asked in his testimony. “And what about union members who have made significant wage sacrifices to earn their wealthy social advantages?”
The Democrats’ chances of succeeding in creating a large, single national medical insurance program seem decidedly slim, at least in the short term. Jayapal’s bill drew support from only about half of his fellow House Democrats and no Republicans
Carry costs into account
Democrats used Tuesday’s House oversight hearing to point out how private health plans take the money consumers give them for medical care and spend it on items like promotions.
A government-run system would be more efficient because it would eliminate that waste, Democrats said.
Rep. Katie Porter (D-CA) asked a panel witness, Sarah R. Collins, PhD, vice president for health care coverage and access at the nonprofit Commonwealth Fund, to consider the difference in administrative costs between Medicare and private plans. Medicare administrative costs eat up about 3% to 5% of the giant federal program’s budget, compared to 17% to 18% for private insurers, Collins said.
Noted for her whiteboards and other tools she uses to try to explain complex issues during House hearings, Porter had a stack of $1 bills at the ready in this instance. She counted $17, then dropped off about 14 bills and held up $3 to show the potential savings of a government-run plan.
Porter then went over with Collins some of the ways private plans spend their clients’ money, in addition to applying the bulk of the premiums to medical expenses. These include share buybacks for shareholders, Porter noted. She also noted that private insurers are spending more on executive compensation.
“Does Medicare spend money on marketing? Private insurance likes to put its name on stadiums and PGA tournaments. Is there a Medicare arena?” Porter asked rhetorically.
the Expedition of the post of Saint-Louis last month reported that Centene Corp had reached a 15-year deal for naming rights to a stadium in that city.
“Centene will have its name emblazoned outside the 22,500-seat facility, on the dashboard and on other signs,” the paper said, adding that terms of the deal were not disclosed. . Centene’s business model is largely based on profit while managing the care of people covered by government-funded Medicaid and Medicare programs.
Another example is the Kaiser Permanente Arena in Santa Cruz, GA, named after a giant nonprofit insurer.
Opting for the sleeker administrative style of government-run Medicare would leave money free to expand benefits, Porter said.
“We could spend that money to allow patients to see dentists. We could spend that money to allow patients to pay for hearing aids, to help seniors afford glasses, to reduce the cost of prescription drugs , to finally pay mental health professionals for the work they do,” Porter said. “Instead, all that money is wasted.”
Drop the term “abuse”
Biden’s budget requests for fiscal year 2023 seek $42.5 billion for various substance abuse efforts, an increase of $3.2 billion from current annual spending.
In addition, the budget request proposes to change the name of the National Institute on Drug Abuse to the National Institute on Drugs and Addiction and to change the name of the National Institute on Alcohol Abuse and Alcoholism in National Institute on the Effects of Alcohol and Effects Associated with Alcohol. Troubles.
“Individuals do not choose to ‘abuse’ drugs and alcohol; they suffer from a disease known as addiction,” HHS said in a budget document, calling for an end to “obsolete language and stigmatizing that harms the individuals and families who suffer from it”. addiction.”
The Biden budget also calls for what it describes as full parity between physical health care and behavioral health care, which includes mental health and addictions care.
Other proposals in Biden’s budget request include:
- $7.5 billion for mental health, to be spent over 10 years to expand access to services.
- $4.1 billion for permanent funding for community mental health centres.
- $1.2 billion to strengthen consumer protection and increase access to behavioral health services in the private insurance market, including a proposal to require coverage for three behavioral health visits without cost sharing with the patient.
- $3.5 billion to improve Medicare mental health coverage, including plans to cover three behavioral health visits a year without cost sharing and to eliminate the 190-day lifetime limit on psychiatric hospital services.
- $35.4 billion to improve access to mental health in Medicaid.