Victories by Democrats Raphael Warnock and John Ossoff in Georgia’s Senate runoffs Tuesday have changed the dynamics for health-care legislation. However, experts believe that small changes are more likely than major structural overhauls, according to the New York Times.
A series of tweaks bolstering the Affordable Care Act stand the best chance of passage. Legislators could make insurance subsidies more generous, get coverage to low-income Americans in states that haven’t expanded Medicaid and render moot a pending Supreme Court lawsuit that aims to overturn the entire law.
But structural overhauls such as Medicare for All, which would move all Americans to a government-run health plan, face a much tougher road. So would elements of Joe Biden’s health agenda, such as a public option, which would give Americans a choice between a new public plan and private insurance.
There are several areas of health policy where congressional aides and health policy experts could see Democrats focusing their efforts this year. Smaller policy reforms are expected to be easier, both legally and politically, while more ambitious policies may not easily slot into strict parliamentary rules — or the political preferences of enough Democratic lawmakers.
ACA expansion
Congress is most likely to act on a set of changes meant to expand the ACA and make health coverage less expensive for those who buy their own plans. One priority is raising the income ceiling for those who receives subsidies, which would expand the number of people who qualify for help. Another is rewriting formulas to peg the size of the subsidy to a more generous health insurance plan, a way to increase the amount of assistance.
Closing the Medicaid gap
In the 12 states that do not participate in the health law’s Medicaid expansion, millions of low-income Americans are left without affordable coverage options. Many Democrats are eager to change this but have so far been stymied by states’ decisions to decline the program. One option that has been floated is to extend the ACA’s tax credits to this population. They wouldn’t get to enroll in Medicaid, but they would have access to a highly subsidized private plan on the health law’s marketplace.
Reducing drug prices
Lowering drug prices has been a Democratic policy priority for many years, and one that Biden endorses, at least in general. Experts believed that certain drug pricing controls might be possible with reconciliation, since they have clear budgetary effects. But the politics of passage could be difficult with narrow majorities in both the House and Senate and such strong opposition from the drug industry.
Public option
Biden included a public health insurance option, available to all Americans, in his 2020 campaign platform. The slim majority in the Senate, however, may make it hard to move this type of plan forward.
Medicare for All
The obstacle to such a plan is more likely political than procedural. Currently, a majority of House Democrats back Medicare for all, but that would not be nearly enough votes to pass such a bill. An even smaller share of senators back the plan.