Tagged U.S. Congress

Biden’s Big Health Agenda Won’t Be Easy to Achieve

If Joe Biden wins the presidency in November, health is likely to play a high-profile role in his agenda. Just probably not in the way he or anyone else might have predicted.

Barring something truly unforeseen, it’s fairly certain that on Jan. 20 the U.S. will still be in the grip of the coronavirus pandemic — and the economic dislocation it has caused. Coincidentally, that would put a new President Biden in much the same place as President Barack Obama at his inauguration in 2009: a Democratic administration replacing a Republican one in the midst of a national crisis.

Obama had only a financial crisis to deal with. Still, Biden would have a couple of advantages his Democratic predecessor lacked, including the fact that, as vice president, he helped guide the country through that financial meltdown. He’s also had time to plan how to address the crisis, which was not the case in 2009, when the economy was in freefall just as the new administration was taking office.

But like Obama before him, Biden will face a long must-do list on taking office. He will have to tackle the pandemic and economic crisis before he can turn to some of the big health changes he’s promised, such as expanding the reach of the Affordable Care Act, creating a “public option” that would allow every American to enroll in a government-sponsored plan and lowering the eligibility age for Medicare from 65 to 60.

And even if Democrats do retake the Senate majority and keep control of the House, it is unlikely the majority in either chamber will be as large as in 2009, when Obama had 60 Senate votes.

Still, no matter what the partisan makeup of Congress, “priority one is to get the COVID response going,” said Len Nichols, a professor of health policy at George Mason University.

Biden’s COVID plan includes taking major responsibility for the pandemic back from the states. His federal response would include more money for, and coordination of, testing and contact tracing; ensuring adequate protective equipment for health professionals; and assuring the public that new treatments and vaccines will be based on science, not politics.

In an updated version of his plan, Biden has also promised that one of his first calls if he is elected will be to Dr. Anthony Fauci, the government’s top infectious disease expert, who has been derided by President Donald Trump. “Dr. Fauci will have full access to the Oval Office and an uncensored platform to speak directly to the American people — whether delivering good news or bad,” says Biden’s website.

Biden’s COVID plan also addresses the economy — including calls for emergency paid leave for workers dislocated by the pandemic and more financial aid for workers, families and small businesses.

“If we’ve learned anything, it is that the health sector and the economy are not two separate spheres. They are connected,” said Nichols. “I think health care and the economy are complementary and will be for the foreseeable future.”

Assuming Biden gets beyond the pandemic and recession, he could move onto some of his bigger health promises, including expanding eligibility for Medicare, creating a “public option” health plan and boosting premium subsidies for the ACA.

Biden took heat throughout the primaries for his “moderate” approach to improving health insurance access and costs, compared with the “Medicare for All” plans for a government-run system supported by his top rivals, Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.). But that doesn’t mean his far less sweeping approach would be easy to get through Congress.

“There’s a really big difference when you’re running the government than when you’re running for office,” said Dan Mendelson, a former Clinton administration health official and founder of the health consulting firm Avalere Health.

Many of Biden’s proposals, including a public option and larger subsidies to help low- and middle-income people pay for insurance, are the very things that an overwhelmingly Democratic Congress could not pass as part of the original Affordable Care Act in 2010. Conservative Democratic senators objected to the plan.

“We pushed,” Obama said in a recent interview on the podcast “Pod Save America,” talking about the public option. “I needed 60 votes to get it through the Senate. Joe Lieberman, Ben Nelson and a couple others said, ‘I’m not voting for a public option.’”

Mendelson said another big obstacle is that for all the detail Biden has in his health plan, concepts like the public option “are not well-defined, and there are many different theories of what it should be and where it should be fielded. There’s no common vision about what it really means.”

The same thing is true, he added, for something that seems as simple as reducing the Medicare eligibility age. “More than half these people have commercial insurance,” he said. “What will happen to them?”

Grace-Marie Turner, of the conservative Galen Institute, suggested Biden — or Trump, if he’s reelected — might be better served by pursuing one of the more bipartisan health issues that already have broad support from the public, like prescription drug prices or “surprise” medical bills patients receive after getting care from a doctor outside their insurance network while being treated at an in-network facility. “It would be a big statement,” she said. “Whoever wins would then have the wind at their back.”

But even those issues have a way of getting complicated. Both Democrats and Republicans say they want to bring down drug prices, but Republicans are vehemently against one of the Democrats’ preferred ways of doing that: by allowing Medicare to negotiate with drugmakers. And surprise medical billing has so far defied efforts to fix it, as Congress seems unable to choose between health insurers and health providers, who each want the other to bear the additional costs.

As always, even when health is at the top of the agenda, it proves difficult to address.

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Outnumbered on High Court Nomination, Democrats Campaign for a Different Vote

Democrats on the Senate Judiciary Committee know that, barring something unexpected, they lack the votes to block President Donald Trump from installing his third justice in four years on the Supreme Court and creating a 6-3 conservative majority.

They also know that, in a normal year, by mid-October Congress would be out of session and members home campaigning. But 2020 is obviously no normal year. So, while the rest of Congress is home, Democratic Judiciary members are trying something very different in the hearings for nominee Amy Coney Barrett. Rather than prosecuting their case against Barrett, currently a federal appeals court judge, they are refighting the war that helped them pick up seats in 2018 — banging on Republicans for trying to eliminate the Affordable Care Act.

Conveniently, the ACA is relevant to the Supreme Court debate because the justices are scheduled to hear a case that could invalidate the law on Nov. 10 — exactly a week after Election Day.

As California Sen. Kamala Harris, a member of the Judiciary Committee and the Democratic vice presidential candidate, put it to Barrett on Tuesday, “Republicans are scrambling to confirm this nominee as fast as possible because they need one more Trump judge on the bench before Nov. 10th to win and strike down the entire Affordable Care Act. This is not hyperbole. This is not hypothetical. This is happening.”

Said Sen. Richard Durbin (D-Ill.), also on Tuesday: “We really believe the Supreme Court’s consideration of that case is going — could literally change America for millions of people.”

To be sure, Republicans too were playing to their electorate during the questioning of Barrett, as they expounded on her conservative credentials on issues such as gun rights.

Nonetheless, Democrats were uniformly disciplined in their assault on her potential vote in the ACA case. They chided both Barrett and the Republicans who are rushing her nomination to the floor literally days before a presidential election. In addition, Democrats criticized Republicans for spending time on a nonemergency nomination while continuing to ignore the need for financial and other relief for the COVID-19 pandemic.

And they raised what in more normal times would be the featured talking point for Democrats: the threat to abortion and other reproductive rights from Barrett, who before her elevation to the federal bench publicly opposed abortion and taught law at Notre Dame, one of the nation’s preeminent Catholic universities.

“For many people, and particularly for women, this is a fundamental question,” said Sen. Dianne Feinstein (D-Calif.), the committee’s top Democrat.

Barrett, like every other Supreme Court nominee for the past three decades, declined to offer positions that could suggest which way she might rule on hot-button issues, including abortion and the ACA.

She repeatedly cited what has come to be called the “Ginsburg rule” — after the justice she would replace, Ruth Bader Ginsburg — saying “no hints, no previews, no forecasts.”

Still, Democrats suggested that she may have tipped her hand on the Affordable Care Act case. In pointing out that the issues in the case, now known as California v. Texas, are different from the previous cases upholding the health law in 2012 and 2015, she said the current case will turn on “severability.”

She was referring to the question of whether, if one portion of a law is found to be unconstitutional, the rest of the law can stand without it. In the current ACA case, a group of Republican attorneys general — and the Trump administration — are arguing that when Congress reduced the ACA’s penalty for not having insurance to zero, the requirement to be covered no longer had a tax attached, and therefore the law is now unconstitutional. They based their argument on Chief Justice John Roberts’ 2012 conclusion that the ACA was valid because that penalty was a constitutionally appropriate tax.

The law’s opponents say the rest of the law cannot be “severed” and must therefore fall, too. A federal district judge in Texas agreed with them.

But merely saying the case turns on severability suggests that Barrett has already prejudged major parts of the case, Democrats said. Sen. Chris Coons (D-Del.) noted, “You don’t get to the question of severability if you haven’t already determined the question of constitutionality.”

Barrett insisted repeatedly that despite an article she wrote in 2017 suggesting that the 2012 case upholding the law was wrongly decided, “I have no animus to nor agenda for the ACA,” as she told Sen. Amy Klobuchar (D-Minn.) on Wednesday.

In their rare show of unity of message, Democrats made clear that their primary audience in these hearings was not their Senate colleagues, but the voting public. While this battle looks lost, they hope to win the War of Nov. 3.

HealthBent, a regular feature of KHN, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

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With Senate Control at Stake, Trump and COVID Haunt Ernst’s Fight to Keep Her Seat

The week that Iowa reported its 90,000th confirmed case of COVID-19, Sen. Joni Ernst sat behind a plexiglass partition and told a debate audience watching from home what she thinks about masks.

“Even though they’re homemade, they work,” said Ernst, an Iowa Republican, showing off a mask emblazoned with the logo of Iowa State University, the largest university in the state.

But what about requiring people to wear masks when they cannot safely distance themselves? On that, she sided with the state’s Republican governor and President Donald Trump, contradicting evidence that states with mask mandates have seen bigger drops in coronavirus cases than those without: “We know that it doesn’t work,” she asserted about mandates.

Trump and COVID-19 loom large in this race and they are putting Ernst in a precarious position. In less than six years, she has gone from being a rising star — who was reportedly under consideration to become Trump’s vice presidential running mate in 2016 — to running neck and neck against a political newcomer, businesswoman Theresa Greenfield. The race is critical to the Republicans’ hopes of keeping control of the Senate.

Part of her problem is Trump. A Des Moines Register/Mediacom Iowa poll last month showed more than 1 in 3 Iowa voters think Ernst’s relationship to Trump is “too close.”

Art Cullen, a Pulitzer Prize-winning journalist who runs The Storm Lake Times in northwestern Iowa, recently wrote: Ernst “is in lockstep with Trump and McConnell on nearly every issue,” referring to the Senate’s Republican majority leader, Mitch McConnell. “Iowans don’t like that. They like mavericks.”

But another part of her problem is how the Trump administration has mishandled the response to the pandemic. Iowa suffered from some of the nation’s bigger COVID-19 outbreaks, with the state reporting in recent days record numbers of hospitalizations. It has been bad enough that last week the White House coronavirus task force called on Iowa to institute a statewide mask mandate.

Candidate Theresa Greenfield, center, speaks with attendees during a campaign event in Waverly, Iowa, on Oct. 5.(Rachel Mummey/Bloomberg via Getty Images)

Greenfield is capitalizing on Ernst having toed the party line on downplaying the COVID-19 threat. The Register poll found that Greenfield, who is campaigning on the ideas that Ernst has done too little to protect Iowans during the pandemic and been too friendly to corporate donors, had a slight edge over the incumbent senator, 45% to 42%. That result is well within the poll’s margin of error. A Quinnipiac poll released Wednesday also found Greenfield has a slight lead over Ernst, 50% to 45%, just outside the poll’s 2.8-point margin of error. Political analysts say the race is a toss-up.

It doesn’t help Ernst that Trump has lost strength in Iowa. Polls show the president, who won the Iowa vote by more than 9 percentage points in 2016, is in a dead heat with the Democratic nominee, former Vice President Joe Biden.

And that decline could very well be because of COVID-19. A New York Times analysis released this summer showed voter support for Biden grew by about 2.5 percentage points locally when a county experienced “extremely high levels” of COVID-19 fatalities — similar to the way support for elected officials drops during wartime in areas that have lost troops.

Those deaths were costing Republicans running for the Senate “as much as they are costing the president,” the analysis found.

In August, Ernst fanned the flames of a conspiracy theory amplified by Trump and at least one other vulnerable Republican that only 10,000 Americans had died of COVID-19. (More than 185,000 had died at that point.) She said at a campaign event in Waterloo, Iowa, that she was “so skeptical” of the official death toll and raised the possibility that doctors were inflating the numbers for financial gain.

Her comments sparked a sharp backlash and, a few days later, she released a statement concurring with the official death toll from public health experts. The Ernst campaign did not respond to an interview request for this story.

In a statement last week, Greenfield said elected officials must listen to public health experts and set clear examples to help Iowans take the crisis seriously. “By pointing fingers and playing politics, not passing the relief Iowans urgently need, and refusing to apologize for her dangerous comments about the Covid-19 death toll, Senator Ernst has failed to put Iowa first during this pandemic,” she said.

Last spring the virus spread through the state’s meatpacking plants, potentially exposing thousands after Trump ordered the plants to stay open. In early October the state’s fourth-largest city, Sioux City, ranked in the top 10 of affected metropolitan areas nationwide, with about 64.3 cases per 100,000 residents.

Students returning to Iowa State University and the University of Iowa in August sparked two of the largest outbreaks nationwide at that time, prompting an editorial in the University of Iowa’s student newspaper: “The University of Iowa is not safe.”

Gov. Kim Reynolds, a Republican who has refused calls to impose a mask mandate, closed bars in six counties for less than three weeks before working to loosen quarantine restrictions — against the recommendations of the Centers for Disease Control and Prevention.

About 15% of likely voters in Iowa said COVID-19 is the most important issue, although just 1% of Republican voters said the pandemic is their top concern, according to a recent Des Moines Register/Mediacom Iowa poll. The most important issue is the economy, 31% of likely voters say.

Iowa has borne the blow of Trump’s trade disputes, with farmers forced to accept millions in federal bailout money after a tit-for-tat tariff war with China and other nations cut off crop exports.

Leonard Foster of Mason City, Iowa, 82, spoke of a neighbor who was struggling to sell his grain and cattle because of the disputes. The future of Social Security and Medicare are his biggest concerns, though he said he also worries about his children and grandchildren contracting COVID-19. A lifelong Democrat who had voted for Chuck Grassley, Iowa’s other Republican senator, he is not planning to back Ernst.

“She’s agreeing with Trump too much, as far as I’m concerned,” he said.

Ernst faces pressing questions about her party’s failure to agree on a replacement for the Affordable Care Act. The Supreme Court will hear a case next month that could overturn the law, an outcome that looks more likely if Trump’s latest nominee, Amy Coney Barrett, is seated in time to participate. Ernst has insisted she supports the ACA’s popular protections for preexisting conditions as critics point out that her past votes to repeal the law would have eliminated those protections.

Congress’ failure to renew aid for struggling businesses and families has left some Iowans feeling, at best, that the government is not doing enough and, at worst, that politicians like Trump are hampering economic recovery.

Melissa Warren of Wellman, Iowa, said her husband has been sick with COVID symptoms and unable to work since March. Though he was hospitalized for pneumonia and remains ill, she said he has not tested positive for the virus. That disqualifies him from the few federal protections against COVID-19 bills.

Their high-deductible insurance plan is expensive, and he does not qualify for other benefits. After visits to specialists like cardiologists and pulmonologists, the medical bills are piling up, Warren said.

A Methodist pastor who works with low-income communities, Warren described presiding over one of the first funerals in Iowa for a COVID victim and the fear and pain of a family that could not even gather to grieve due to public health restrictions.

“Watching, for example, the president choosing to not wear masks, to give information that’s incorrect, has been very devastating for communities trying to build themselves up and care for one another,” she said in an interview before the announcement of Trump’s own diagnosis.

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