Why Biden isn’t (yet) following through on his core health-care promise. Paul Waldman

Why Biden isn’t (yet) following through on his core health-care promise. Paul Waldman

Washington Post 

Opinion by 

Paul Waldman

Columnist

April 13, 2021 at 5:11 a.m. GMT+9

Then-candidate Joe Biden speaks about health care on Oct. 28, 2020, in Wilmington, Del. (Andrew Harnik/AP)

No policy issue animated the 2020 Democratic presidential primaries like health-care reform did. Yet President Biden has talked about it less than other issues since taking office, and as The Post reports, different officials within the Democratic Party are beginning to exert pressure to get their preferred health reforms put high on Biden’s agenda.

This puts Biden in a tough spot, in which he’ll have trouble satisfying everyone. And it shows how hard it will be to keep the promises he made on this subject during the campaign.

According to The Post’s reporting, many Democrats are looking to the American Families Plan, the second part of the infrastructure package that they hope will pass the Senate by simple majority through reconciliation, as the vehicle for health reforms they want.

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For instance, House Speaker Nancy Pelosi (D-Calif.) is pushing to have made permanent a temporary — but very generous — increase in subsidies for people who get private insurance on the Affordable Care Act marketplaces that was included in the recent covid relief bill. It not only made millions of people newly eligible for subsidies but also reduced many people’s premiums dramatically.

But Sen. Bernie Sanders (I-Vt.) is most interested in two other ideas: lowering the Medicare eligibility age from 65 to 55 or 60 and providing dental, vision and hearing care to those already on Medicare.

One reasonable question would be, why not do it all? It is possible — especially since the administration is already hoping to force pharmaceutical companies to charge lower prices for prescription drugs — but what happens will depend on how many fights the White House wants to pick.

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One thing’s for sure: The centerpiece of the health-care plan Biden presented when he was running for president is not on the table, at least for now.

You may remember that, while other candidates advocated a single-payer Medicare-for-all program, Biden instead wanted to create a public option, a Medicare-like plan people could buy into if they chose.

Even though it was the “moderate” alternative at the time, it represented a significant move to the left from where the Obama administration had been. And Biden’s public option proposal was comprehensive, building on plans that had circulated in Democratic circles for some time.

It would allow people to join the new public plan if they now have private insurance they bought on the individual market or if they now get coverage through their employer. It would offer public option coverage to low-income people unfortunate enough to live in states where Republican governments have refused to expand Medicaid under the ACA. It would automatically enroll people in either the public option or Medicaid whenever they interacted with the government.

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In other words, Biden’s public option would create a huge new program potentially enrolling millions or even tens of millions of Americans in government insurance. I happen to think that would be a great thing, and so do many other people — in this Kaiser Family Foundation poll, two-thirds of Americans said they favored a public option. But if and when it gets turned into legislation, it will be an absolutely gigantic political battle to get it passed.

It’s unclear when the Biden administration and congressional Democrats will feel ready to take on that fight, but with zero votes to spare in the Senate and only a few in the House, they clearly think now is not the time. So they’d prefer to take other, smaller ideas and tack them on to an enormous piece of legislation that may have sufficient momentum to pass even if all kinds of measures get attached to it.

To be clear, that’s not to say that making the ACA subsidies permanent, lowering the Medicare eligibility age or adding dental coverage to Medicare wouldn’t be a big deal and benefit lots of people. Any of them would.

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But they’re not as big a deal as a public option, which would essentially create a three-program insurance foundation, with Medicare and Medicaid, that could eventually move us toward the day when nearly everyone has government insurance of one kind or another.

Biden hasn’t exactly broken his campaign promise yet. But this is a reminder that campaigns exist in a strange world of the imagination, where anything a president wants to happen will happen, no matter the political impediments.

In that world, every candidate insists that their plan will not only cruise through Congress, but also do so intact. They all present their future Oval Office selves as legislative wizards whose agenda will inevitably be turned into law. But that’s not the reality.

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It’s still worth hoping that conditions will eventually allow Biden to follow through on his campaign promise and try to pass a public option. If Democrats get a midterm miracle in 2022, it might be possible. But it’s never going to be easy, and for now it’s going to have to wait.

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