How health care could change under “President Biden”

The stars seem to be aligning for the kind of expanded government health care program many Democrats have been waiting for.

Millions of workers are losing employer-provided insurance along with their jobs, as the coronavirus pandemic forces business closures nationwide. Democratic presidential contender Joe Biden favors a new government program for people who can’t find affordable coverage in the private market, and he recently proposed lowering the eligibility age for Medicare from 65 to 60. Biden leads President Trump in the polls, and there’s a growing chance Democrats could take control of the Senate in November.

So the party that favors a bigger government role in health care could end up running the legislative and executive branches in 2021. Big changes could be coming, right?

Probably not. “I don’t think expanding Medicare in in the cards,” Douglas Holtz-Eakin, president of the American Action Forum, says in the latest episode of the Yahoo Finance Electionomics podcast. “It’s a health crisis and these individuals, these uninsured, that’s unacceptable. But people are afraid of these bigger reforms.”

Holtz-Eakin was director of the Congressional Budget Office from 2003 – 2005, and chief economic adviser to Sen. John McCain when he ran for president in 2008. McCain’s health care plan relied on tax incentives and other reforms to make insurance in the private market more affordable. McCain lost to Barack Obama, who ended up signing into the law the Affordable Care Act in 2010, providing different types of subsidies to help people buy insurance more cheaply.

Republicans unanimously opposed the ACA, but Congress was able to pass it because they controlled both houses and most party members voted for it. That’s why some people think Congress could once again pass an expanded health care bill if Democrats control both houses.

A man wearing a face mask walks past signs for Joe Biden’s 2020 presidential campaign amid the coronavirus outbreak on May 11, 2020 in Alexandria, Virginia. (Photo by Olivier DOULIERY / AFP) (Photo by OLIVIER DOULIERY/AFP via Getty Images)

But Democrats learned a sour lesson about passing party-line legislation, losing control of House in the 2010 midterm elections, and losing seats in the Senate as well. Part of the groundswell was opposition to the ACA. Republicans went through the same thing after passing the 2017 tax-cut law with complete Democratic opposition, as they lost control of the House in the 2018 midterms.

“The American people are wary of that sort of single-party-jam-something-big-through,” says Holtz-Eakin. “They want to see what they saw on the CARES Act, which is, you guys got together and did something on behalf of the country.” The CARES Act is the $2 trillion coronavirus stimulus legislation Congress passed in March with bipartisan support.

Biden surged ahead in the Democratic primaries by campaigning as a pragmatic moderate opposed to radical change. But he has drifted leftward in an effort to consolidate the vote of Bernie Sanders and Elizabeth Warren backers. If he wins, that wing of the party will mount serious pressure to move legislation similar to the Sanders “Medicare for all” plan that would eliminate private insurance and enroll everybody in a huge government program.

The battleground will be the Senate, where any Democratic majority will be narrow and vulnerable to reversal in the 2022 midterms. Most Senate legislation requires 60 votes, to avert a filibuster, and there’s no chance Democrats will have a 10-seat majority in 2021. So any health care legislation would have to have some bipartisan support and probably be targeted only at the newly unemployed. “There’s a chance that in order to cover these individuals, they will invent something,” Holtz-Eakin says. “It’ll be targeted and it’ll be temporary.” To get anything more, Democrats may have to spend a few years convincing voters they’re not going to screw anything up.

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