KHN’s ‘What the Health?’: How to Expand Health Coverage

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Democrats in Congress and several states are making it a priority to try to boost health insurance coverage, but they have very different ideas. Some are working to expand the Medicaid program, some seek to build on the Affordable Care Act, and others want to expand Medicare. And as support for a federal “public option” government-run plan wanes in Washington, several states are attempting their own proposals.

Meanwhile, efforts to rein in prescription drug prices continue, and lawmakers may have to reach an agreement if they want to be able to finance their coverage expansions with the savings from those proposals.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Shefali Luthra of The 19th.

Among the takeaways from this week’s episode:

• Sen. Ron Wyden’s (D-Ore.) outline for reducing Medicare drug prices leaves many questions unanswered. Among them is what sort of mechanism he would use to set drug prices, which drugs would be subject to drug price cuts, how the government would determine prices and whether price controls would affect health plans for younger people not on Medicare.
• Finding a way to cut Medicare drug prices could provide a major windfall for the federal government, and Democrats hope it would help finance other programs, such as making permanent the enhanced premium subsidies for insurance plans purchased on the Affordable Care Act’s insurance marketplaces. But proponents of efforts to cut drug prices don’t yet have buy-in from all Democratic lawmakers, many of whom maintain close ties to drugmakers.
• It’s also unclear whether drug prices are a top priority for the administration. President Joe Biden has said he supports efforts to bring down pharmaceutical costs, but he has not emphasized it in his budget or policy initiatives.
• Lawmakers from the progressive wing of the Democratic Party are signaling they hope to lower the eligibility age for Medicare and expand its benefits as part of a budget deal this summer. Biden ran on a platform of establishing a health plan run by the government — called a “public option” — that consumers could choose on the ACA marketplace, but that is not being discussed much right now.
• For progressives, that public option has never been as enticing as a single-payer plan run by the government that would cover the entire nation. And since the health care industry might fight a public option as vehemently as it would a single-payer plan, expanding Medicare seems a better choice to those liberals.
• Democratic lawmakers are also looking for ways to provide health coverage to uninsured, low-income people living in states that refused to accept the ACA’s Medicaid expansion. Some propose bills that would allow cities or counties to opt into the expansion program when state officials don’t or while others back proposals that would let those consumers purchase subsidized plans on the ACA marketplaces, a provision that was not provided in the landmark health law because it was assumed that states would expand their Medicaid programs.
• Missouri legislators have begun negotiations to renew funding proposals for long-term care in the state’s traditional Medicaid program. As part of that effort, they are considering new limits on what contraceptives Medicaid will cover. Lawmakers are considering banning reimbursement for IUDs and emergency contraception, on the incorrect belief that those methods are abortifacients.
• Colorado and Nevada, following an initiative by Washington state, are setting up public options for their residents. But the programs will not necessarily reduce premiums, and if the federal government opts to make permanent the increased premium subsidies that took effect this year for marketplace customers around the country, such state efforts may look less appealing.
• Even as the U.S. begins to return to more normal routines and open up businesses and events as the pandemic eases, concern is growing about the covid virus’s delta variant, which is spreading quickly across the country and the world. Public health experts are working to persuade residents who haven’t been vaccinated to step up for a shot because that can prevent serious illness. Officials have been keen to use incentives to bring people in for vaccination — cash and merchandise prizes, for example — but have been hesitant to penalize anyone for not getting inoculated. That strategy may not be working.

Also this week, Rovner interviews Michelle Andrews, who reported and wrote last month’s KHN-NPR “Bill of the Month” episode about a very expensive sleep study. If you have an outrageous medical bill you’d like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Washington Post’s “Workplace Wellness Programs Are Big Business. They Might Not Work,” by Katherine Baicker and Zirui Song

Tami Luhby: The Associated Press’ “Watchdog: Nursing Home Deaths Up 32% in 2020 Amid Pandemic,” by Ricardo Alonso-Zaldivar

Alice Miranda Ollstein: The New York Times’ “Desperate for Covid Care, Undocumented Immigrants Resort to Unproven Drugs,” by Amy Maxmen

Shefali Luthra: KHN’s “Hemmed In at Home, Nonprofit Hospitals Look for Profits Abroad,” by Jordan Rau

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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