President Biden and congressional Democrats have embarked on a major political experiment, testing the public’s willingness to delay gratification on seeing big benefits of a landmark measure with important elements to improve their health and wellbeing.
Is it more persuasive to regular folks that one political party is trying to tackle huge problems, or will relentless naysayers reap rewards for doing little or nothing?
As a little more than four score days remain before important midterm elections, Democrats will be seeking to convince voters of the significance of the giant Inflation Reduction Act — aka the much-reduced Build Back Better legislative package originally proposed by President Biden.
The act, approved by the narrowest of margins in the U.S. House and Senate, will:
- Make the largest and most significant long-term federal investment in battling extreme weather and the proven scientific peril of climate change;
- Immediately prevent millions of poor, working poor, and middle-class Americans from losing increased federal support for them to receive health insurance via public exchanges, aka Obamacare;
- In three years (2025), cap at $2,000 the amount that seniors on Medicare can be charged in a year for prescription drugs;
- Next year (2023), impose a $35-a-month cap on the cost of insulin but only for Medicare recipients;
- In four years (2026), allow Medicare to negotiate with Big Pharma the prices for a handful of prescription drugs.
Republicans and Democrats have bickered for months over these measures. The act includes taxes on big corporations and deficit-reduction moves. The president and his party in recent months have emphasized their inflation-fighting potential — an argument supported by leading economists.
The package inarguably provides a path-breaking federal role in combating climate change, attacking energy costs, buttressing cleaner energy sources, and affecting transportation and the environment in ways that Americans will come to appreciate in the decades ahead. Other information sources will delve deeper into the act’s effects on climate change and the environment. But will the public grasp the health policy effects of this act, especially as they roll out, as mentioned above, over several years?
Expanded health insurance help extended
Will millions of workers and families who have gotten health coverage — despite the calamitous economic and employment conditions caused by the coronavirus pandemic — value the greater accessibility and affordability of their insurance under the even-more Affordable Care Act? The president and Congress shored up and even expanded Obamacare as part of the pandemic response. But the more generous subsidies would have expired at year’s end, unless they were renewed, as they were, in the inflation act.
Just before the Senate took up the law, federal officials pounded home what Obamacare — with Democratic support, as opposed to years of virulent GOP assault — has meant to the country: “The number of people living in America without health insurance coverage hit an all-time low of 8% [in 2022],” the government has found, the AP reported, adding:
“The uninsured rate fell to just under 9% last year with the improved subsidies. The Biden administration also began to step up advertising and increased the number of counselors who helped sign up people for plans during the open enrollment season last year. Prior to last year, the uninsured rate had consistently remained in the double digits for decades … Roughly 26 million people remain without health insurance in the U.S. Just under 2% of children are now uninsured.”
Health insurance, just to remind, still comes at too high a cost for too many Americans. Most folks get coverage through employers, who have shifted rising health care costs onto employees and their loved ones. To keep down ever-rising monthly premiums, companies have exploded policy deductibles — sums that people must pay of out of pocket and before their insurance kicks in. This has caused too many people to defer or forego medical services because they cannot afford them.
Still, insurance — via employers or the ACA — is an economic game-changer, spreading risk and helping patients avoid bankruptcy. Because insurers negotiate with medical providers over an array of services and goods, those with coverage often are not hit with the most crushing costs for medical care. Doctors, hospitals, labs, and others slap the uninsured, on the other hand, with maximal charges, often the highest allowed. These too often kick the already poor and struggling with an economic gut punch, increasing the too common shame of the U.S. health care system: medical debt.
A breakthrough on negotiating drug costs
The soaring cost of prescription drugs, of course, has caused untold nightmares for patients. Democrats have argued for decades that the federal government should be allowed to use its huge clout, notably through programs like Medicare and Medicaid that pay staggering sums for drugs, to negotiate with Big Pharma over medication costs as occurs in many other advanced nations.
Republicans, in theological fashion, have resisted this idea, as well as most any federal involvement in health care. To be clear, they also have not proposed viable alternatives, instead showing themselves more than willing to ignore or tolerate extreme suffering, instead.
In the inflation-fighting act, Democrats broke through ferocious campaigning by the GOP and Big Pharma and won the right for Medicare officials to start haggling over a select few drugs each year. Taxpayers, via Medicare, spend more than $180 billion on prescription meds, with a disproportionate amount going for a relatively few drugs, the Kaiser Family Foundation has found. If regulators can drive down costs for even a few of these, the savings could be big and provide leverage to lower costs for other drugs, too, advocates say.
The inflation act’s drug-negotiation element was not a giant but a vital step forward, as key indicators showed. Big Pharma dropped a wad of cash in lobbying against even this barest price oversight. Republicans, with little explanation or defense, also showed their fury over Democrats’ advancing health measures, ripping diabetics who are not seniors.
Caps on drug costs — and GOP cruelty
The GOP did so by mustering enough opposition to strip the $35-a-month cap on insulin costs from most insurers, though seniors receiving Medicare will enjoy this relief. Insulin, which costs companies a few dollars to make, costs patients hundreds a month.
For seniors with chronic, costly conditions besides diabetes, the inflation act also soon will cap at $2,000 the annual sum they spend on their prescription meds. This benefit does not kick in immediately but will be game-changing for millions of older Americans, some of whom take long lists of drugs whose costs add up. Other seniors also will find huge relief because they take only a few but highly priced drugs.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous and bankrupting drugs.
Critics and advocates alike agree that the inflation-fighting act offers far less in changes in the world’s most expensive health care system than are needed. The approved law contains only a few of the bigger shifts that advocates hoped for, as the web site Politico reported:
“Some of Democrats’ most vulnerable members in the House and Senate have argued for months that a federal expansion of Medicaid in the dozen states that have declined to take advantage of the Obamacare provision would give them a significant boost in their reelection bids. Now, lawmakers from Georgia, Wisconsin, Florida, and North Carolina — states Democrats will need to hold the House and Senate — will face voters without bringing home that benefit.
“Democrats also abandoned their effort to pour hundreds of billions of dollars into the home health care system for the elderly and people with disabilities, meaning the current long wait lists and worker shortages are likely to continue. And while many of the new legislation’s drug pricing benefits are targeted at seniors, the party’s promised expansion of Medicare to cover dental, vision, and hearing benefits did not materialize.”
Sen. Bernie Sanders, the independent from Vermont who caucuses with the Democrats, made a last-minute attempt to amend the inflation act to include many more health care elements. He failed. His proponents said the outspoken senator was pushing for potential next steps — all reliant on Democrats at least retaining and possibly expanding their vote margins in the House and Senate. That, of course, will depend on whether voters see progress, or if they prefer the GOP approach. But now, who ever saw the health care plan promised by the former president, um, for at least half a decade, much less the party proposals also never delivered?
We have much work to do to keep making our health care a right, not a privilege, and ensuring it is accessible, affordable, safe, innovative, efficient, and excellent.
