Democrats devise health care plans for 2018

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Congressional Democrats are rolling out bills to patch holes in Obamacare and expand the federal footprint in health care, saying they want to have options ready to go if they win majorities in Congress next year.

Plans range from a total-government “Medicare for all” to the more limited “public option” that would pit individual government-run plans up against private insurance for people who weren’t able to find affordable coverage in Obamacare.

Sponsors are using President Trump’s own rhetoric in some cases, saying they, too, want “insurance for everybody” and to “bid” down drug prices, as they draw a contrast with GOP plans to rein in taxpayer-funded health care next spring.

“He wanted to give the government authority to negotiate lower drug prices. He said that — the president of the United States,” Rep. Elijah Cummings, Maryland Democrat, said in support of legislation that lets the government bargain for better prices under Medicare. “That’s exactly what this bill does.”

Democrats do not control either chamber of Congress or the White House, so none of their ideas will become law soon. But they’re emboldened by the GOP’s failure to repeal the 2010 health law and polling that suggests voters support governmental efforts to expand coverage and tamp down drug prices.

They also don’t want to fall into the trap that Republicans fell into earlier this year, promising “repeal-and-replace” for years and then lacking a surefire plan once they gained enough seats to enact their agenda.

“It’s for when we have the gavels,” said Sen. Brian Schatz, Hawaii Democrat, after he detailed a plan to let uninsured Americans buy into the Medicaid insurance program for the poor.

Already, party operatives plan to use the GOP’s stumbles as a cudgel during next year’s mid-term campaign.

“The one thing Republicans have to show for their last 10 months is that they’ve successfully undermined and destabilized the health insurance markets, driving up premiums and leaving Americans with fewer options — and voters will hold every GOP Senate candidate accountable,” said David Bergstein, spokesman for the Democratic Senatorial Campaign Committee.

Republicans say Democrats’ plans, such as the government-run Medicare-for-all plan pushed by Sen. Bernard Sanders, will scare voters.

“If Democrats want to turn 2018 into a referendum on socialized medicine, they’ll only ensure yet another disaster for their party at the polls,” said Bob Salera, spokesman for the National Senatorial Campaign Committee.

Mr. Sanders’ plan has become a dividing line for Democrats, with many of the party’s presidential hopefuls in Congress signing onto his bill — but party leaders wary of going that far.

Sen. Tim Kaine, Virginia Democrat, and Sen. Michael Bennet, Colorado Democrat, have pitched a slimmer “Medicare X,” a plan that would leverage the Medicare insurance program for seniors to provide a public option for people younger than 65.

It would rely on Medicare’s network of doctors and require similar reimbursement rates, though it would tweak its set of benefits to include things like maternity care — something seniors don’t generally need.

The plan would compete with private ones in Obamacare’s exchanges and initially be available in areas where there is a shortage of choices. By 2023, the “Medicare-extra” public option would be available in every ZIP code.

“What Americans don’t want is another shock to their system. And what they would like to see is better choices at a lower price, and that’s what my proposal I hope will do,” Mr. Bennet said.

Meanwhile Mr. Schatz and Rep. Ben Ray Lujan, New Mexico Democrat, authored a plan that would let uninsured Americans buy into Medicaid, saying the federal-state insurance program for the poor can provide decent coverage at a relatively low cost for the nearly 30 million people still without coverage despite Obamacare’s mandates.

Consumers could apply any Obamacare subsidies they qualify for toward the Medicaid buy-in. People who don’t qualify for tax credits would have health premiums capped at 9.5 percent of their income.

The bill would also increase Medicaid reimbursement rates, so the program is more attractive to primary doctors who would see patients.

Mr. Schatz said ways to pay for the plan are not in the bill yet, “but we’re not trying to pretend that it’s free.”

A report by the Health and Human Services Department said eight states will have only one insurer operating on their exchanges in 2018, and 29 percent of enrollees will be able to choose from only one insurer, up from 20 percent last year and 2 percent in 2016.

In order to halt those stumbles, Democrats are pushing for a quick vote on a bipartisan bill brokered by Sen. Lamar Alexander and Sen. Patty Murray to stabilize the market by authorizing “cost-sharing” payments to insurers and added flexibility for states.

Mr. Alexander, Tennessee Republican, has warned that failure to pass his bill would create chaos and open up a “four-lane highway” to a single-payer system championed by Mr. Sanders.

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