Politics

Senate Democrats push for public option as Biden weighs health-care reform plans

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Key Points
  • Two Senate Democrats, Michael Bennet and Tim Kaine, are pushing for a public health-care option plan as Democrats decide how best to expand insurance coverage.
  • Biden also called for a public option, but it is unclear when he plans to address health-care reform as he focuses on coronavirus relief and economic recovery.
  • Democrats would likely have to pass any health-care plan expanding government insurance options without Republican votes, and have to placate members of the party who have supported universal coverage through "Medicare for All."
Senator Michael Bennet, D-Colo., speaks during a Senate Finance Committee hearing for Janet Yellen, of California, President-elect Joe Biden's nominee for Treasury Secretary in Washington, January 19, 2021.
Anna Moneymaker | Pool | Reuters

Two Senate Democrats have put forward a bill they hope will kick-start the process of expanding health-care coverage while the party holds unified control of Congress and the White House.

Sens. Michael Bennet, D-Colo., and Tim Kaine, D-Va., this week reintroduced their Medicare-X Choice Act — this time with a president in Joe Biden more sympathetic to their cause. The plan would set up a Medicare public option for individuals and small businesses, first in areas with limited access to coverage and then nationwide by 2025.

The legislation, first proposed in 2017 when Donald Trump sat in the White House and Republicans in control of Capitol Hill aimed to repeal the Affordable Care Act, includes provisions designed to cut health-care costs. It would allow the secretary of Health and Human Services to negotiate drug prices for Medicare Exchange and Medicare Part D and expand subsidies and tax credits to enable low- and middle-income Americans to afford coverage, among other policies.

"As we continue to face a devastating pandemic where millions of Americans are uninsured or underinsured, we are committed to working with the Biden Administration to strengthen the ACA," Bennet said in a statement Wednesday introducing the bill.

Among the top priorities for Democrats when they gained broad power last month, health-care reform nonetheless faces a murky path ahead. Biden and most Democrats called to expand public health-care choices even before the coronavirus caused millions to lose their jobs and employer-provided coverage in the last year.

The president and congressional Democratic leaders made a $1.9 trillion pandemic relief package their top priority. They hope to pass that bill by mid-March. Democrats have also introduced an immigration proposal and Biden hopes to approve an economic recovery plan this year.

Where expanding health-care coverage fits into the agenda is unclear. Republicans, who have resisted efforts to increase government involvement in insurance, will likely block a Democratic insurance proposal in the Senate.

Democrats have to decide how to use their limited attempts at budget reconciliation, which enables the Senate to pass bills with a simple majority. The party is using the fiscal 2021 budget process for the coronavirus relief package. It will get two more shots at reconciliation during the current Congress.

Bennet and Kaine aim to include their proposal in Biden's coming economic recovery plan, a spokesperson for Kaine confirmed. Democrats will likely have to pass the package through reconciliation, as well.

Biden ran for president on creating a "Medicare-like public option" to expand coverage. A White House spokesperson did not immediately respond to a request to comment on the president's current plans for health-care reform and whether he has reviewed the senators' proposal.

Democrats gained House control in 2019 in part because of the GOP's efforts to repeal the Affordable Care Act. Since then, the party has not coalesced around a way to build upon Obamacare.

The 2020 Democratic primary highlighted the divide. A handful of candidates led by Sen. Bernie Sanders, I-Vt., called for a single-payer "Medicare for All" system, and others including Biden pushed for a public option. Progressives in Congress have called for universal coverage throughout the pandemic as many Americans who got fired due to factors outside of their control also lost health insurance.

Both Biden and House Speaker Nancy Pelosi, D-Calif., have opposed Medicare for All.

Senate Democrats will need to find a plan that wins over all 50 members of their caucus. They could encounter problems in satisfying the full range of senators in the party, as the GOP did when it tried and failed to repeal Obamacare through reconciliation in 2017.

Biden has taken initial steps to alleviate the health-care crisis worsened by the pandemic. He signed an executive order that opened a special ACA enrollment period starting this month.

In December, the Kaiser Family Foundation estimated 2 million to 3 million people lost employer-based coverage between March and September of last year.

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