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The Health 202: Biden wants a 'public option' health plan. Two Senate moderates say they have just the bill

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with Alexandra Ellerbeck

To get more Americans covered, President Biden wants to create a government-backed “public option” health plan and expand Obamacare subsidies.

Two moderate Democratic senators, Tim Kaine (Va.) and Michael Bennet (Colo.), insist they have just the bill to accomplish that. It’s called “Medicare-X.”

“We think the bill we’re introducing is the closest match to what came from the Biden campaign,” Kaine told reporters yesterday.

Kaine and Bennet have tweaked their bill to more closely reflect what Biden proposed during his campaign.

The legislation, which the duo first introduced back in October 2017, now includes an expansion of marketplace tax subsidies to ensure people don’t pay more than 8.5 percent of their income on monthly premiums. It would also eliminate a subsidy cap for people earning 400 percent of the federal poverty level or more.

This idea — aimed at addressing persistent affordability concerns among middle-income earners — was a mainstay of Biden’s health-care plan during the campaign. It’s also included in the coronavirus relief package Congress is working to pass.

The central tenet of Medicare-X also closely aligns with Biden’s vision.

That’s to create a public option plan to be sold on the marketplaces alongside private coverage. All three men — Kaine, Bennet and Biden — are in the camp of moderate Democrats who want to fill in coverage gaps with incremental reforms rather than a sweeping Medicare-for-all overhaul.

To that end, Medicare-X proposes adding a public option plan first in the parts of the country where consumers have the fewest private marketplace options, then moving to areas with higher plan costs and finally expanding into every Zip code in the country by 2025. The aim is to give consumers more options, while also putting competitive pressure on private plans to lower their costs.

“In our view, this bill helps finish the work of Obamacare. It gives the American people a choice,” Bennet said.

For the first time, it’s possible to envision a pathway for passing at least parts of Medicare-X.

Until this year the bill wasn’t destined to go anywhere, with President Donald Trump in office and Republicans controlling the Senate. It will still be hard for Democrats to pass partisan legislation this Congress, with only 50 Democratic senators and Vice President Harris serving as the tiebreaker.

So Democrats may rely on multiple budget reconciliation bills to get partisan priorities passed. This type of legislation — requiring just a simple Senate majority instead of the usual 60 votes — is the same way Republicans tried to repeal Obamacare back in 2017.

Kaine and Bennet want Medicare-X to hitch a ride on a reconciliation bill. Congress can only pass one of these bills a year and is using last year’s vehicle to do coronavirus relief. Two more budget reconciliation bills will be available during the current Congress — and Kaine and Bennet say they’ve revamped Medicare-X with an eye toward them.

There’s another potential hiccup. It’s not entirely clear whether all the elements of Medicare-X could go into a budget reconciliation bill, which can only include provisions directly related to federal spending. 

But Kaine and Bennet said they’re hopeful elements might make it into the next reconciliation package, which the Biden administration wants to use for economic recovery after the pandemic.

“It’s gotta be an equitable economy, and there is nothing that would make our economy more equitable than having broader availability of health coverage,” Kaine said.

Medicare-X leaves out one Biden proposal: lowering the Medicare eligibility age from 65 to 60.

The president backed that idea later on in his campaign, as yet another way of giving more Americans access to affordable coverage. Affordability of health insurance is an ongoing concern for many Americans — not only for those already covered but also for the nearly 30 million who remain uninsured, despite the sweeping 2010 health-care law.

Several other Democratic members of Congress have proposed legislation along these lines. Sen. Debbie Stabenow (D-Mich.) has proposed lowering the eligibility age to 50. The “Choose Medicare Act” from Sens. Dianne Feinstein (D-Calif.), Jeff Merkley (D-Ore.) and Chris Murphy (D-Conn.) would let any American buy into Medicare, including employers who could purchase Medicare plans for their employees.

But Kaine and Bennet did add in some new elements aimed at lowering coverage costs. Medicare-X would:

  • Allow Medicare to pay 50 percent more to rural hospitals and providers, up from a 25 percent allowance.
  • Require marketplace plans to fully cover primary care services with no cost-sharing for patients.
  • Fix the so-called “family glitch” in the Affordable Care Act, which bases a family's eligibility for marketplace subsidies on whether an employee's offer of workplace coverage was affordable for the individual but not necessarily affordable for the whole family.

Ahh, oof and ouch

AHH: Biden has picked Chiquita Brooks-LaSure to lead the Centers for Medicare and Medicaid Services.

The administration hasn't announced the selection, but four people confirmed to Dan Diamond and Amy Goldstein that Brooks-LaSure is the pick to lead the $1 trillion agency that oversees Medicare, Medicaid and large parts of the ACA.

“Brooks-LaSure served in the Obama administration as a senior CMS official who helped implement the Affordable Care Act’s coverage expansion and insurance-market reforms,” Dan and Amy report. “She also worked on Capitol Hill as a Democratic staff member for the House Ways and Means Committee, building ties with then-Rep. Xavier Becerra, Biden’s choice to lead the Health and Human Services department and who sat on the committee at the time.”

The role is considered the second-most-powerful position within the Department of Health and Human Services after the HHS secretary.

“During the presidential transition, Brooks-LaSure served as a lead for Biden’s HHS review team, helping assess the Trump administration’s operations,” Dan and Amy write. “She has most recently served as a managing director at Manatt Health, a consulting firm that works with the health-care industry — a role that raised some concerns inside the Biden administration given the president’s stringent ethics pledge and the potential for Brooks-LaSure to shape policies that might affect her former clients, said one person familiar with those concerns.”

But Brooks-LaSure was championed by allies on Capitol Hill, including the Congressional Black Caucus. As we wrote a few weeks ago, Mandy Cohen, the North Carolina health secretary and a fellow Obama veteran, was also considered for the role.

OOF: Biden and Fauci are butting heads over teacher vaccinations.

The tension is over whether teachers should be required to return to classrooms before getting the coronavirus vaccine. Some teachers unions – who were a major contributor to Biden's campaign – are insisting they shouldn't have to return to in-person learning until all teachers have been vaccinated. Yet upon becoming president, Biden made reopening schools a major goal – one that he has since appeared to back away from.

"Dr. Anthony S. Fauci said Wednesday that vaccinating all teachers against covid-19 before reopening schools is ‘non-workable,’ wading into an issue that has taken center stage for the Biden administration amid the ongoing pandemic,” Politico’s Ben Leonard reports.

“If you are going to say that every single teacher needs to be vaccinated before you get back to school, I believe quite frankly that’s a ‘non-workable situation,’” Fauci told “CBS This Morning.”

But top administration officials have "strained to avoid subscribing to the Centers for Disease Control and Prevention’s position that schools can reopen without teachers being vaccinated,” our colleague Aaron Blake reports

The White House has “repeatedly avoided endorsing the position of the health officials whose scientific guidance Biden assured the nation would be the North Star of his administration’s coronavirus response," he adds.

OUCH: A third of military service members are refusing the coronavirus vaccine, according to defense officials.

“Nearly 150,000 service members are fully vaccinated, a panel of defense officials told lawmakers in a House Armed Services Committee hearing on the Pentagon’s coronavirus response. About two-thirds of troops who were offered the vaccine accepted it,” The Post’s Alex Horton reports.

The acceptance rate “mirrors preliminary data that we see in other communities” of Americans, Air Force Brig. Gen. Paul Friedrichs, a Joint Chiefs of Staff health official, told lawmakers.

The military mandates that service members receive a variety of vaccinations at enlistment, but commanders are restricted in requiring the use of the Moderna and Pfizer-BioNTech coronavirus vaccines, which have received emergency use authorization from the Food and Drug Administration but have not received the standard FDA approval.

Service members are younger and healthier than the population on average, but infection outbreaks have interrupted operations on Navy ships. The Pentagon reports that 21 U.S. service members have died of coronavirus infections.

More in coronavirus

It's been a dark, covid-19 winter.

On three of the deadliest days in January, our reporters fanned out around the country to capture the stories of the people and places closest to the lives lost. They talked to a coroner in Pennsylvania, day care workers in Baltimore, hospice nurses in L.A. and a priest in El Paso, among others.

  • A group of prominent scientists is calling on the Biden administration to implement enforceable standards aimed at preventing airborne transmission of the coronavirus, Kaiser Health News’s Christina Jewett reports. In a letter sent to the CDC on Monday, the experts say that broader use of N95 masks, better ventilation and other public health measures are needed to protect workers in risky workplaces, including health care, food processing and prisons.
  • The Biden administration says it will invest more than $1.6 billion to increase coronavirus testing and sequencing, The Post reports.
  • The United Kingdom will infect healthy volunteers in the world’s first coronavirus “challenge trial,” The Post’s Karla Adam reports. The effort is aimed at accelerating scientific understanding of vaccines and treatments, but some have questioned whether the move is necessary given the rapid authorization and rollout of highly effective vaccines.
  • New York is suing Amazon over allege failure to provide adequate protection to its warehouse workers, The Post’s Jay Greene reports. New York Attorney General Letitia James has accused the company of cutting corners on health and safety requirements and retaliating against employees who complain. Amazon has disputed these accusations. (Amazon founder Jeff Bezos owns The Washington Post.)
The Biden administration announced on Feb. 17 that it will invest more than $1.6 billion to expand coronavirus testing and genetic sequencing. (Video: The Washington Post)

Fact-checking the administration

Vice President Kamala Harris gets two Pinocchios for her claim that the Biden vaccine plan was “starting from scratch.”

“There was no national strategy or plan for vaccinations. We were leaving it to the states and local leaders to try and figure it out. And so in many ways, we’re starting from scratch on something that’s been raging for almost an entire year!” Harris said in a recent Axios interview.

But the vice president’s statement directly contradicts with a comment by Fauci. “We certainly are not starting from scratch,” Fauci said during a White House press briefing last month.

Washington Post fact-checker Glenn Kessler waded into the dispute. He notes that vaccinations under the Trump administration reached a seven-day average of 980,000, virtually the goal of a million shots a day that Biden had set for himself. But Biden administration officials say that the plan set up by the Trump administration did not have a solid national strategy for vaccinating people once the first stage of inoculating health-care workers and long-term care residents was complete. 

Kessler’s verdict: Harris gets two Pinocchios for her comment — not an outright lie but misleading. “Biden administration officials may be proud of what they have accomplished, but they shouldn’t suggest that nothing was in place when they walked in the door,” he writes.

Vaccine dilemmas

Health officials worry that people may become picky about which vaccine they get.

“News coverage and social media posts about clinical trial results are creating a hierarchy of Covid vaccines in the minds of much of the public: ‘good vaccines’ and ‘bad vaccines.’ The former you might try to seek out; the latter might even prompt you to step out of line,” Stat News’s Helen Branswell reports.

Clinical trials showed that vaccines made by AstraZeneca and Johnson & Johnson are effective against the coronavirus, but less so than the ones made by Moderna or by Pfizer and BioNTech. Still, experts point out that the narrative is not that simple: AstraZeneca’s and Johnson & Johnson’s vaccines were being tested in clinical trials after new variants of the coronavirus started to circulate widely, which may have reduced their efficacy compared to the vaccines that completed their trials earlier.

The Post’s Akilah Johnson explains the challenges the Biden administration faces to distribute the vaccine to low-income, vulnerable communities equitably. (Video: Joy Yi/The Washington Post)

As more vaccines are authorized in the United States, experts worry that people may become choosy and turn down certain vaccines, potentially making it harder to reach herd immunity.

“To me, one of the trickiest things about this is that we are likely to end up with a vaccine — the J&J — that is showing somewhat less effectiveness than these amazing first two that came out of the gate and is also most appropriate for rural settings, low-resource settings, settings without really great freezers,” Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania, told Stat News.

Other news

Reports of carbon monoxide poisoning are pouring in as people turn to desperate measures to stay warm amid record cold.

A deadly winter storm left 3.2 million people without power and with no heat for more than 24 hours in Texas. Desperate to stay warm amid record-low temperatures, some people have turned their cars on in the garage or sought to hear their homes using charcoal grills. The result has been a spike in reports of carbon monoxide poisoning, The Post's Paulina Villegas reports. 

HUD's failure to enforce its environmental standards contributed to children living in lead-contaminated housing.

An inspector general report obtained by The Post found that the Department of Housing and Urban Development had failed to identify health risks to residents of public housing near toxic waste dumps in an East Chicago, Ind. apartment complex, The Post's Tracy Jan reports.

The West Calumet Housing Complex was built in 1972 atop a former lead smelting plant. Even after the Environmental Protection Agency discovered high levels of lead in 1985, HUD’s Indianapolis field office did not conduct the required environmental reviews, according to the report.

A 1998 investigation by the U.S. Department of Health and Human Services found that 30 percent of children under 6 years old in the community had elevated lead levels, which can damage the developing brain. But people continued to live in the apartment complex until it was deemed uninhabitable in 2016.

Sugar rush