“We have no intention of backing down,” Jayapal said on a call with lawyers Tuesday evening. Addressing the possibility of reducing the number of health programs in the bill, she said: “A lot of people have asked, ‘Isn’t there something better than nothing? And the answer, quite simply, is no. Because when it comes to something rather than nothing, these are the same people who are forced to settle for nothing over and over again.
Progressives are closing ranks behind the expansion of Medicare because it represents the best chance of getting part of their vision of “Medicare for All” into law. But in the process, they drew criticism from fellow Democrats that the benefits would benefit the rich at the expense of the poor and communities of color on Medicaid, as well as threats from health industry groups that it could. increase premiums for the elderly. The program’s cost of more than $ 350 billion over a decade, by some estimates, has also made it a major target for cuts as leaders attempt to rally voices to pass the package in the face of what should be opposition. unanimous republican.
In a new letter to committee heads obtained by POLITICO, Representative Jared Golden (D-Maine), a key centrist, said he supported the Medicare benefits proposal in principle, but believed the current version House was “underdeveloped” and depended on “budget gimmicks” as a delayed implementation.
Progressives argue that Congress can still control costs by allowing new Medicare benefits for just a few years, believing they would be so popular that future Congresses would have to renew them. Meanwhile, centrists like Golden and Sen. Joe Manchin (DW.Va.) insist that all benefits be means-tested so that they are limited to the poorest Americans – a non-runner for many. on the left who say it would undermine a basic principle of social insurance. And depending on the drop in the cost of the bill by Manchin and others, the expansion of Medicare may be abandoned entirely.
“We have to go from the shears to the chops,” said a senior Democratic official.
Pelosi’s Democratic leadership wants the party to invest more money in fewer programs in the social spending program – especially expanding Affordable Care Act subsidies and extending Medicaid coverage to more low-income people in a dozen Conservative-led states that have yet to expand their programs.
“The consensus within the caucus is that whatever we have in the package, we have to do it really well, instead of spreading things so thinly that you don’t get the impact you want across the country,” said the representative. Anna Eshoo (D-Cal.), Who chairs the Health Subcommittee of House Energy and Commerce.
Democratic lawmakers and their aides have said the planned Medicare expansion is most likely to be abandoned in its entirety due to its high cost and the difficulty of deploying it quickly – a key factor as Democrats anticipate to campaign on the new programs next year as they fight. to maintain their small majorities in Congress.
Even the House’s $ 3.5 trillion plan proposed to delay the start of dental coverage until 2028, and Rep.Mark Pocan (D-Wis.), Who previously led the Progressive Caucus with Jayapal, acknowledged the difficulty in making it available much earlier.
“Some of them are going to be harder to increase significantly,” he said.
Slow deployment is also a sore point for members who depend on Bill’s programs to help them maintain their seats in swing neighborhoods.
“I don’t want it to be an amorphous thing where we say to someone who is 68, ‘You might never see the benefit of this, but guess what, we’ve passed it on to the next generation. said Rep. Susan. Sauvage (D-Pa.). “It doesn’t do it politically and it doesn’t do it for the people we are fighting for here.”
Some outside advocates and lobbyists say that, if forced to choose, Democrats are more likely to prioritize Medicaid in must-see swing states – like Florida, Georgia and North Carolina – and Affordable Care Act grants to millions of people nationwide as they keep their eyes on their electoral prospects.
The expansion plan is also threatened by Democrats’ continued inability to agree on a plan to cut drug costs, which they rely on to at least partially fund the costly expansion of benefits.
To make the calculations work, some lawmakers have suggested rejecting the Medicare benefits proposal until next year. They could also only include dental benefits, which many say is the most urgent health need of the three, or vision and hearing, which are much cheaper.
“We could see them go their separate ways,” House Budget Speaker John Yarmuth (D-Ky.) Told reporters. “Although I don’t think [Medicare expansion advocate] Bernie [Sanders] wants to do that.
Progressives, emboldened by their ability to tie the fate of infrastructure bill HR 3684 (117) to the social spending package, say they are prepared to again suspend support if Medicare benefits are cut in upcoming negotiations.
Sanders, the Senate budget chairman, this week called the inclusion of dental care, vision and hearing “non-negotiable.” And Pocan told POLITICO it was evident in the Zoom call with the White House that they were taken seriously.
“They realize that if there was someone ready to invest real capital and withhold our votes, it is us,” he said.