Competing Health Care Plans Rip Current Through Capitol Hill

WASHINGTON (CN) – After months out of the legislative spotlight, health care returned to Capitol Hill on Wednesday with Republicans and Democrats unveiling competing proposals that would fundamentally alter health care in the country.

Sen. Bernie Sanders, I-Vt., released his long-promised Medicare for All bill, a single-payer health care plan that was a feature of his campaign for the Democratic nomination last year. The bill drew the support of 16 Democratic co-sponsors, including Sens. Kamala Harris of California, Elizabeth Warren of Massachusetts and Cory Booker of New Jersey — each of whom is said to be launching White House bids in 2020.

Sanders said at a Wednesday afternoon press conference that his goal with the proposal is to shape health care as a right.

“The American people want to know what we’re going to do to fix a dysfunctional health care system which costs us twice as much per person as any other country and yet leaves 28 million people uninsured and even more underinsured,” Sanders said. “That’s what the American people want to know in terms of what we’re doing.”

The Medicare for All Act would implement an overarching federal health care program over four years, enrolling people under 18 in the new program and lowering the eligibility age for Medicare to 55 in the first year.

The eligibility age would drop by 10 years in each of the next three years, with everyone being able to enroll in the program four years after the plan passes. The new plans would cover a wide variety of services, including hospital and emergency care, primary and preventative care services, prescription drugs, mental health services, and reproductive care, including abortions.

Sanders focused on the larger meaning of moving to a government-run program, with health care practitioners and patients joining him at the press conference Wednesday to voice their support for a single-payer system.

A woman named Rebecca Wood spoke about feeling torn sometimes between paying the “exorbitant” cost of her asthma medicine or treatment for her daughter, Charlie, who was born prematurely but can live a more normal life through therapy.

She always chooses Charlie, Wood said.

One time when she did so, however, it was at the expense of a crucial dental procedure. Wood said putting the procedure off sent her to the emergency room: she developed an infection that spread in her mouth and jaw, causing swelling that obstructed her airway.

“The next day I had all of my teeth pulled, the infection drained, and parts of my jaw scraped away in a six-hour procedure under local anesthesia,” Wood said. “I could not afford to have it done under general anesthesia. I cried the entire ride home afterwards.”

Calling the American health care system broken, Wood said a single-payer system would prevent American families from having to make such impossible choices.

The Sanders plan has essentially no chance of clearing the Republican-controlled Congress, and Democratic leadership has not explicitly come out in favor of the proposal. The unveiling on Wednesday did not delve into specifics on how the plan will be financed, a common point of attack for opponents of single-payer health care.

During his campaign for president, Sanders proposed to fund the program with a series of new income taxes on individuals and businesses. The Urban Institute estimated in a May 2016 report that the taxes would raise $15.3 trillion over the next decade but that Sanders’ plan would still increase federal spending by $32 trillion over the same time period, leaving it underfunded.

That cost was a major topic Wednesday for a quartet of Republicans who unveiled a separate health care plan: one that would take the federal dollars that go toward the system in place now under the Patient Protection and Affordable Care Act, and give them to  individual states as block grants.

The proposal originally grew in July from the ashes of another Republican plan to repeal and replace the Affordable Care Act.

Sponsored by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wis., the bill would do away with the requirements that most people buy health insurance and that most employers provide it, as well as a tax on medical devices. It would also repeal “the structure and architecture” of the Affordable Care Act, instead sending money directly to the states to put together their own health care programs.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen,” Graham said while unveiling the new plan at a press conference on Wednesday.

Initially, each state would receive a block grant equal to the amount of money it gets under the Affordable Care Act’s Medicaid expansion, plus the current law’s tax credits, federal cost-sharing payments and other federal programs.

Starting in 2021, the amount of money each state would receive would be tied to the number of people living in the state who earn between 50 percent and 138 percent of the federal poverty line. By 2024, the law would give additional money to states that have high enrollment — something the bill’s supporters said would incentivize governors to put in place health care programs that increase coverage.

The proposal would change the way Medicaid payments are calculated in the same way as the failed Republican plan to repeal and replace Obamacare, which the Congressional Budget Office found would have resulted in deep cuts to the program.

The bill’s sponsors say the proposal would mean a more equitable distribution of federal health care money and put health care decisions in the hands of state governments that can experiment and more easily answer to the concerns of their citizens. 

“What Graham-Cassidy-Heller-Johnson does is it returns that power to the states,” Johnson said on Wednesday. “It make states more responsible, more responsive, so hopefully those premiums will come down because states will be granted more flexibility. And of course it’s going to be a whole lot fairer.”

Graham cast the Republican plan as a stark alternative to Sanders’ single-payer proposal, and warned his colleagues that his bill is the best way to stop the “inevitable” passage of government-run health care.

“There are three choices: prop up Obamacare, Berniecare or our bill — that’s where you’re at,” Graham said on Wednesday. “Count me out for propping up Obamacare. Hell no to Berniecare. Count me in for an idea that gives a patient the voice that they would never have under single-payer healthcare. Count me in for people in my state making decisions about health care versus some bureaucrat in Washington.”

But Graham hit Republican leadership for not completely supporting his plan. Graham said he thinks Senate Majority Leader Mitch McConnell, R-Ky., would vote for the bill, but has largely left the responsibility of rounding up votes to the bill’s sponsors and supporters.

“The idea that the Republican Party has done its best to repeal and replace Obamacare is a joke,” Graham said Wednesday. “The idea that we can do this by ourselves is unreasonable. We have given a pathway forward that is fair, that fundamentally transforms medicine in the country, gives patients a stronger voice, repeals and replaces Obamacare forever, and everyone is telling us ‘give us 50 votes and we’ll help you.'” 

President Donald Trump tepidly supported the new Republican plan Wednesday, but stopped short of fully endorsing it.

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