The Washington PostDemocracy Dies in Darkness

The Health 202: Democrats are using their coronavirus relief package to try expanding health coverage

with Alexandra Ellerbeck

Democrats are taking a swing at health insurance costs in their coronavirus relief package.

But it’s limited — and steers clear of the hardest-to-achieve coverage expansions President Biden campaigned on.

House committees have rolled out legislation to expand health coverage options for people without employer-sponsored insurance.

Over the past 48 hours, the two committees with major health-care jurisdiction unveiled their own pieces of Biden's $1.9 trillion relief package Congress is seeking to pass. Democrat-led House committees are starting to hold hearings on various portions of the package, leading up to final House action later this month, Jeff Stein and Erica Werner report.

Legislation from the House Energy and Commerce Committee offers the dozen states that haven't expanded their Medicaid programs under Obamacare a fresh new incentive to do so. Under the proposal released late last night, the federal government would cover an extra 5 percent of costs for all of their Medicaid enrollees – not just the expansion population – if states agreed to expand the program. The extra contributions would last two years.

And the House Ways and Means Committee proposes expanding Obamacare subsidies and making COBRA coverage more affordable for people who have recently been laid off. Its legislation would:

  • Extend full-premium subsidies to those receiving unemployment benefits who buy a plan on or the state marketplaces.
  • Extend subsidies to marketplace consumers earning 400 percent or more of the poverty level, to ensure they don’t spend more than 8.5 percent of their income on premiums. People at this income level currently aren’t eligible for subsidies.
  • Expand marketplace subsidies for people in lower income brackets. Those making up to 150 percent of the federal poverty level could get fully subsidized premiums.
  • Subsidize premiums for COBRA coverage at 85 percent.
These proposals have broad support within the Democratic Party.

They aren’t likely to create any major holdups as the relief measure moves through the House and the Senate over the next few weeks. Democrats are using the budget reconciliation process to avoid the need to get any GOP votes, since reconciliation bills require just a simple majority in the Senate.

These proposals would make insurance options more affordable, both for Americans who recently lost their jobs — and subsequently their health plans — and people who didn’t have employer-sponsored coverage to begin with. 

Right now, when someone loses their job and stays on their plan through COBRA, they must start paying the full cost of premiums. That’s typically a huge added expense because employers often cover much of these premiums. But under the relief package, the federal government would kick in 85 percent of the costs.

And enhancing Obamacare subsidies — a key part of how the Affordable Care Act made marketplace coverage more affordable for low-income Americans — could persuade more people to buy plans on, just as it opens for a special pandemic-related enrollment period starting Monday.

Democrats have long advocated increasing these subsidies as a way of improving on the ACA, but they’ve been unable to garner GOP support.

Yet the changes aren’t permanent — and fall far short of what Democrats say they’d like to accomplish on expanding health coverage.

In the legislation Democrats are proposing, the enhanced ACA subsidies would last just this year and next, before returning to the original levels laid out in the 2010 health-care law. The COBRA subsidies would last just through this fiscal year.

And expanding government subsidies for private insurance is the low-hanging fruit when it comes to Democratic health overhaul goals. Bolder moves, such as adding a government-backed “public option” plan to the marketplaces or lowering Medicare’s eligibility age to 60 or even 55, will be much trickier given the party’s slim majorities in Congress.

“It gets harder from here,” said Larry Levitt, a senior vice president with the Kaiser Family Foundation. “Increasing subsidies is popular. The public option and lowering the Medicare eligibility age is going to run into buzzsaw opposition from the health-care industry.”

Democrats aren’t likely to garner any GOP support for these ideas, so they’d have to try using a budget reconciliation bill requiring 50 Senate votes (with Vice President Harris breaking the tie). And Congress can pass only one budget reconciliation bill a year. Democrats are already using up this year’s bill by focusing on coronavirus relief. It’s unclear exactly how they plan to use next year’s budget reconciliation bill.

Ahh, oof and ouch

AHH: New variants mean the coronavirus is here to stay, but maybe as a lesser threat.

“In early December, the end of the pandemic glimmered on the horizon. Blockbuster vaccine results suggested a clear path forward,” Carolyn Y. Johnson reports. “Then the euphoria dissipated. The illusion — or, as one scientist puts it, the delusion — that science had bested the virus crumbled as mutation-ridden variants with concerning new characteristics were detected,” she continues.

New coronavirus variants are able to slip passed some of the immunity generated by existing vaccines and prior infections. To keep up with the variants, scientists will need to update vaccines and perhaps prepare for the possibility the coronavirus is here to stay.  

In December, “the measles situation was on the table, and the polio situation was on the table. If you’ve got a vaccine so good it prevents almost all cases, and it prevents transmission, you vaccinate your population, and you’re fine even though it still exists elsewhere in the world,” Shane Crotty, a virologist at the La Jolla Institute for Immunology, told The Washington Post. “That was the perspective, which was legit. Now … that’s looking like a stretch.”

The path forward is still hopeful. Vaccines are already protecting many of the most vulnerable, which could soon have an impact on hospitalization rates and deaths. And as more of the population is vaccinated, experts expect the crisis phase of the pandemic will end. As immunity builds up, the coronavirus may end up as a mild endemic disease, more comparable to the common cold or the flu. 

Still, experts say that vaccinations need to ramp up quickly. As long as the virus is still circulating, immune pressure can spark the emergence of new variants.

OOF: The WHO team in Wuhan dismissed the lab leak theory but appears no closer to discovering the origins of the coronavirus.

After a 12-day visit, a World Health Organization mission to Wuhan is unlikely to satisfy U.S. officials who are demanding transparency from China or critics who have raised questions about whether the WHO is equipped to investigate the pandemic’s origins, Gerry Shih and Emily Rauhala report.

“At a news conference, the team of Chinese and international researchers said they found that the virus was spreading in Wuhan during December 2019 both inside and outside the Huanan Seafood Market. That suggested the market was not necessarily the original source of the outbreak,” Gerry and Emily write.

But the team dismissed as “unlikely” a theory that the virus had escaped from laboratories at the local Wuhan Institute of Virology (WIV) and said that they will not recommend further investigation into a lab-based origin. The team cited lab safety protocols at the WIV.

In the absence of crucial evidence of how the new coronavirus began comes many theories — one is that the virus accidentally escaped from a lab in Wuhan, China. (Video: Sarah Cahlan, Meg Kelly/The Washington Post)

Most researchers believe the virus jumped from bats to an intermediary host before evolving into a form transmissible among people. A smaller number of scientists say the possibility it escaped from a lab cannot be ruled out. Some scientists have raised doubts the mission could dismiss this possibility based on interviews with scientists at the WIV.

The team also gave some support to the possibility the virus may have been transmitted through cold chain food packaging, a theory that the Chinese government and its state media have pushed as part of an argument  the virus may not have originated in China. On Tuesday, Chinese officials declared the China leg of the WHO probe complete and called for its scope to be expanded globally.

OUCH: Hospital lobbyists are chalking up big wins in Washington.

“The hospital business is booming on Capitol Hill like never before. Lawmakers showered the industry with more than $275 billion last year, and handed hospitals wins even on seemingly unrelated issues. And Democrats’ agenda will almost certainly be better for their bottom lines,” Stat News’s Rachel Cohrs reports.

“The Covid-19 pandemic has transformed the industry’s image in Washington, where large health care systems have long been vilified as corporate profit mongers instead of community caregivers. Now, more than two dozen lobbyists and consultants told STAT that they are keenly aware of just how much power the industry has accrued — and are prepared to seize the moment,” Rachel continues.

But Biden could pose a possible obstacle to hospitals. While he supports policies, such as expanding Medicaid,  popular with hospitals, he also left them completely out of his coronavirus relief proposal. And Xavier Becerra, Biden’s nominee for health secretary, built a reputation as an enemy of hospital consolidation, after winning a half-billion-dollar antitrust settlement from a health system in California.

More in coronavirus

Public health officials are weighing whether to require domestic travelers to show proof of a negative coronavirus test before boarding their flights.

The proposal is drawing fierce opposition from airlines, labor unions and lawmakers, Lori Aratani, Michael Laris and Ian Duncan report.

In an interview broadcast Sunday, Transportation Secretary Pete Buttigieg told Axios on HBO there is an “active conversation” with the CDC about whether to require coronavirus testing for domestic flights. Pressed Monday in a CNN interview on the likelihood of that happening, Buttigieg said “the CDC is looking at all its options.”

“The federal government already requires international travelers to be tested before they board flights to the United States — a mandate that drew praise from many in the aviation industry," our colleagues write. “But requiring tests for domestic travelers raises a different set of challenges for the administration.”

  • The Biden administration will ship vaccine doses directly to community health centers, which often serve some of the nation’s most vulnerable populations, Akilah Johnson reports.
  • Dementia patients are twice as likely to develop covid-19, and the risk is particularly high for Black people with dementia, William Wan reports. 
  • The Food and Drug Administration granted an emergency-use authorization for Eli Lilly’s combination monoclonal antibody treatment, citing a clinical trial that showed that an infusion of the antibodies significantly reduced covid-19-related hospitalizations and deaths, Laurie McGinley reports.
  • A sluggish vaccine program could delay a return to normal and allow for the emergence of new coronavirus variants, Harry Stevens, Aaron Steckelberg and Naema Ahmed report.

The other epidemic

A bipartisan group is urging Biden to ease regulations on prescribing an opioid treatment.

It has to do with a two-decade-old requirement, first mandated by Congress, that physicians undergo a day’s training before being allowed to prescribe buprenorphine for opioid-use disorder. 

"Biden had criticized the prescribing rules as unnecessary last year and vowed to lift them if elected. But his administration instead preserved the rules last month by halting a last-minute Trump administration plan intended as a workaround, frustrating doctors and public health groups that say the rules are slowing the response to the nation’s worsening opioid crisis. The administration said the Trump plan was premature,” Dan Diamond reports.

Now Sens. Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska) are leading an effort to reintroduce legislation that would eliminate the rules. The lawmakers urge Biden to support the bill, citing his previous statements in support of medication-assisted treatment.

Three administration officials told The Post that the Biden administration is reviewing options to eliminate the waiver.

“Medical groups have hailed buprenorphine as a lifesaving treatment, particularly as the opioid crisis has accelerated during the coronavirus pandemic. The Centers for Disease Control and Prevention reported that more than 81,000 drug overdose deaths occurred in the United States during the 12-month period ending in May 2020, the highest 12-month death count on record,” Dan writes.

Marijuana legalization stumbles

A South Dakota judge ruled against a voter-approved constitutional amendment to legalize marijuana.

More than 54 percent of South Dakota voters supported a ballot measure that would have legalized recreational marijuana in November, but on Monday a circuit court judge ruled the change was unconstitutional, Teo Armus reports. 

Judge Christina Klinger ruled that the amendment violated a state requirement that restricts such measures to a single topic. The judge argued that the marijuana amendment was too far-reaching and would affect taxes, business licensing and hemp cultivation. Proponents of marijuana legalization in the state have said that they will appeal to the state Supreme Court.

Sugar rush