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The Health 202: Democrats are also aiming for Medicaid expansion in their go-it-alone bill


with Alexandra Ellerbeck

Beyond expanding Medicare benefits, Democrats say they’ll fit another health priority into their $3.5 trillion reconciliation bill: getting Medicaid expansion to adults in states that have refused it.

Finding a workaround in GOP-led states scorning Medicaid expansion would be deeply gratifying to Democratic lawmakers, both policy-wise and politically. But it’s sure to be a more complex task.

“This push for Medicaid expansion is now on the road to being included in the next economic package,” Sen. Raphael G. Warnock (D-Ga.) told reporters on a call yesterday. “I’m glad to be part of a caucus asking the right questions during this moment.”

Medicaid expansion is Democrats’ next big frontier to further expand the Affordable Care Act.

They want to go around about a dozen GOP-led states to get Medicaid to more than 4 million low-income adults.

These adults live in states — mostly southern ones — that refused the Affordable Care Act’s offer of Medicaid expansion for people earning up to 138 percent of the federal poverty level. About half in this group do have individual marketplace coverage but could be eligible for lower-cost Medicaid under expansion. The rest don’t have access to federally subsidized health insurance at all.

Democrats have long wrung their hands over the situation but have been powerless to force the GOP-led states to expand the program. But now, energy is building among liberal activists, lawmakers and administration officials to try to tackle the issue in the Democrats-only reconciliation bill aimed for later this year.

“We’ve been really very much focused on getting it done and having it look as close as possible to Medicaid,” said Judy Solomon, a senior fellow at the Center on Budget and Policy Priorities. “For today, we’re kind of celebrating.”

More details about what will be in the budget reconciliation bill emerged yesterday.

“Senate Democrats on Wednesday offered fresh details about their sweeping $3.5 trillion budget proposal, promising that it would augment Medicare coverage, lower prescription drug costs, invest heavily in new programs to combat climate change and tackle long-standing policy priorities on immigration,” our colleagues Jeff Stein and Tony Romm report.

“The plan lays the groundwork for a massive expansion in the size and power of the government, which supportive lawmakers likened in significance to the post-Depression era of the New Deal, stressing that they plan to fund much of the proposal with new taxes on wealthy Americans and corporations,” they add.

Warnock has a Medicaid expansion bill, but it won’t necessarily be the one Congress uses.

Warnock teamed up with Sen. Jon Ossoff, also a Democrat from Georgia, and Sen. Tammy Baldwin (D-Wis.) on legislation that would create a program that closely resembles Medicaid — but is administered by the federal government, not the states themselves.

The bill orders the Centers for Medicare and Medicaid Services to offer a Medicaid-like plan to those eligible in holdout states. People could enroll in the coverage through the year and could only be charged small co-payments and no premiums, the way Medicaid works in most states.

But other Democrats have worked on Medicaid expansion approaches, too. Rep. Lloyd Doggett (D-Tex.) has a bill that would let cities and counties undertake Medicaid expansion on their own. House Energy and Commerce Committee staff are also working on a pathway.

One key is to make sure the measure still incentivizes states to expand on their own.

Under the Warnock measure, states could be rewarded for expanding Medicaid with a 10 percent increase in their federal reimbursements for non-expansion enrollees. The extra payments would last for a decade. That incentive is far stronger than what was included in a spring coronavirus relief bill, which provided a 5 percent payment increase for just two years.

“Those sweeteners, if you will, are still there, but in the meantime we’re saying the people shouldn’t have to suffer because the politicians are playing politics,” Warnock said.

ACA data analyst Charles Gaba:

There are additional targets to hit.

Democrats want to ensure whatever Medicaid plan is created closely resembles typical Medicaid coverage, with a range of benefits and little-to-no costs for enrollees.

And they can’t forget this — it must get a nod from the Senate parliamentarian. Democrats are fitting Medicaid expansion into a budget reconciliation bill, requiring just a simple Senate majority to pass, and there are certain rules about what can and cannot be included. There are limits around creating new government programs, and any element must have a direct impact on government spending.

“I think over the coming weeks, an appropriate measure will be developed that will pass muster and still close the coverage gap,” Solomon said. “There will be a way to do it.”

HuffPost reporter Jonathan Cohn:

Loren Adler, a health policy expert at Brookings:

Medicaid expansion is far from the only health-care measure Democrats want to pack into budget reconciliation.

As we wrote yesterday, Senate leaders have committed to expanding Medicare to include vision, hearing and dental coverage. They're also planning to make extra ACA subsidies permanent, direct more funding to long-term, in-home care and try to reduce the cost of prescription drugs, in potentially the largest effort to reshape the United States health-care system since the 2010 health care law was passed.

Ahh, oof and ouch

AHH: Schumer introduced legislation to decriminalize marijuana at the federal level.

Senate Majority Leader Charles E. Schumer (D-N.Y.), Sen. Cory Booker (D-N.J.) and Sen. Ron Wyden (D-Ore.) introduced a draft bill that would remove federal penalties associated with cannabis, expunge nonviolent federal cannabis-related criminal records and begin regulating and taxing the drug, The Post’s Eugene Scott reports. Businesses and individuals would be allowed to use the drug without fear of federal punishment in states that had legalized it.

“This is monumental, because, at long last, we are taking steps in the Senate to right the wrongs of the failed war on drugs,” Schumer said at a Capitol Hill news conference, in which he vowed to use his clout as majority leader to support its passage. “I was the first Democratic leader to come out for the legalization of marijuana.”

Eighteen states, two territories and the District of Columbia have made recreational use of small amounts of marijuana, reflecting growing public support for loosening drug laws. A recent Pew Research Center poll found that 91 percent of Americans say marijuana should be legal in at least some form.

But that public support has not yet translated into majority support in Congress. A similar bill to decriminalize marijuana passed with bipartisan support in the House last year, but failed to get any Republican backers in the Senate. For the bill to pass, Schumer would need 60 votes, meaning the support of all Democrats and at least 10 Republicans.

“What’s he been smoking?” Sen. John Cornyn (R-Tex.), a senior member of the Senate Judiciary Committee, quipped in April when told of Schumer’s wishes.

OOF: Drug overdoses soared to a record 93,000 last year.

The death toll jumped by more than 21,000, or nearly 30 percent, from 2019, according to provisional data released by the National Center for Health Statistics, The Post’s Lenny Bernstein and Joel Achenbach report.

Opioids, especially illegal fentanyl, continued to drive deaths, as they have for years, although cocaine and methamphetamine deaths also rose. Nora Volkow, head of the National Institute on Drug Abuse, said that fentanyl has so infiltrated the drug supply that 70 percent of cocaine overdose deaths and 50 percent of methamphetamine overdose deaths also involve the powerful painkiller.

The worldwide pandemic stretched heath-care resources thin and made it hard for people to obtain anti-addiction treatment. It also meant that many users were more isolated and more at risk of overdosing without other people nearby to summon help.

“It’s terrifying. It’s the biggest increase in overdose deaths in the history of the United States, it’s the worst overdose crisis in the history of the United States, and we’re not making progress. It’s really overwhelming,” said Keith Humphreys, a psychiatry professor at Stanford University and an expert on addiction and drug policy. 

OUCH: Brazilian President Jair Bolsonaro was hospitalized after 10 days of hiccups.

“Bolsonaro has had a run of health scares. He nearly died on the 2018 campaign trail after being stabbed in the abdomen. He lost a lot of blood and suffered a serious wound to his intestine. He contracted covid-19 last July after playing down the coronavirus for months. While in quarantine, he was bitten by an emu-like giant bird. He’s had a stubborn cough, too,” The Post’s Sammy Westfall reports.

Now, he can’t seem to shake a case of the hiccups.

“In the many recent presidential live streams, Bolsonaro’s hiccuping is evident, and he has prefaced some appearances by acknowledging his hiccupping and disrupted speech. In one July 8 clip, Bolsonaro hiccuped approximately 14 times within the first minute,” Sammy writes.

While transient hiccups are very common, persistent hiccuping that lasts for days is very rare. Experts have suggested that the hiccups could be linked to a recent dental surgery. In a tweet on Wednesday, however, Bolsonaro blamed health complications following an assassination attempt.

Hill happenings

Senate Democrats are looking to drug pricing reform to offset the costs of a $3.5 trillion budget deal.

A framework of the draft package obtained by medical news site Stat suggests that Democrats will use drug pricing provisions to offset other measures in a sweeping package that includes initiatives on clean energy, early-childhood tax credits, and expanding safety net programs.

“Most of the details on drug pricing are vague, though the draft includes a specific repeal of a pricey initiative advanced by the Trump administration to eliminate the drug rebates that pharmacy middlemen and insurers use to negotiate down the price of certain drugs,” Stat’s Rachel Cohrs reports.

Details of the draft are likely to change as lawmakers negotiate to try to bring all Democrats on board. Moderate Democrats, such as Sen. Joe Manchin III (D-W.Va.) have pressured committee heads to offset new federal spending. But it’s not clear whether major drug pricing reform will gain the unanimous Democratic approval needed to pass. Several Democrats, including Sens. Robert Menendez (D-N.J.) and Thomas R. Carper (D-Del.), have expressed reservations about the party’s policies to lower drug prices.

More in coronavirus news

Actress and musician Olivia Rodrigo talked about the importance of vaccinations for young people at the White House briefing on July 14. (Video: The Washington Post, Photo: Demetrius Freeman/The Washington Post)
  • Families are struggling to find data on coronavirus vaccine rates at nursing homes, information that could help them pick a facility for their loved ones, the Associated Press’s Ricardo Alonso-Zaldivar reports.
  • A vocal group of anti-vaccine chiropractors has been spreading misinformation about coronavirus vaccines. More than 35 million Americans visit a chiropractor each year, and many look to them for medical advice. While the cadre of anti-vaccine chiropractors do not represent all chiropractors, their doubts have exposed a long-standing split in the profession, the New York Times’s Maggie Astor reports.

Elsewhere in health care

A man is now able to communicate using electrical impulses in his brain.

An extensively paralyzed man, whose voice was silenced by a brain stem stroke 15 years ago, is able to communicate using a technology that deciphers electrical impulses generated by his brain when he attempts to speak.

“The advance, announced by the University of California at San Francisco, is believed to mark the first time anyone has restored the power to communicate in words and short sentences to someone who had lost it because of neurological damage,” The Post’s Lenny Bernstein reports.

University of California San Francisco researchers have developed a method of translating signals from the brain to the vocal tract into words on a screen. (Video: University of California San Francisco)
The VA has halted its rollout of a digital health system for veterans.

“Veterans Affairs Secretary Denis McDonough on Wednesday acknowledged fundamental flaws in the agency’s troubled $16 billion effort to modernize veterans’ medical records, a project championed by former president Donald Trump and his son-in-law that is beset by cost overruns, delays, misrepresentations to Congress and a disastrous rollout at its first hospital,” The Post’s Lisa Rein reports.

McDonough told Senate lawmakers that an internal review found so many problems that he can no longer continue to roll out the electronic health records system. He did not say when the rollout will resume.

Sugar rush