Dems Eye Major Medicare Expansion

Plus, Americans’ medical debts much larger than previously thought

Tuesday, July 20, 2021

Senate GOP Threatens to Block Infrastructure Vote as Talks Continue

Senate Majority Leader Chuck Schumer’s scheduled vote Wednesday on the bipartisan infrastructure framework appears doomed to fail — but that doesn’t mean that the infrastructure plan is dead.

Schumer on Monday set in motion the steps to hold a procedural vote on the on the as-yet unfinished infrastructure legislation Wednesday, but Senate Republicans are reportedly united in their intention to vote against moving forward without a final agreement, meaning that the package won’t be able to get the 60 votes needed to advance.

"We have a pretty good sense of where our members are. They won’t get 60," Senate Minority Whip John Thune (R-SD) said. "Our members are committed to actually having a bill and [Congressional Budget Office] scores and all that kind of stuff before they vote to get on a bill."

Centrist Republicans on Tuesday pressed Schumer to postpone the planned vote until Monday to give negotiators more time to resolve their differences and finalize a deal. "My hope is that Sen. Schumer will agree to postpone the vote. We’re making significant progress," said Sen. Susan Collins (R-ME), one of the negotiators.

Sen. Mitt Romney, another member of the negotiating group, also called for more time. "I think it should be Monday, not Wednesday. Give us time to resolve the remaining issues," he said. Romney reportedly said that negotiators had resolved three-quarters of the outstanding issues over the last two days and that he expects the rest would be addressed by the end of the week. "We’ll be ready Monday. We won’t have the full text, of course, but we’ll have a detailed outline," he said.

Sen. Bill Cassidy (R-LA), another member of the group, reportedly said he "hopes" a deal can be reached by the end of the week but the negotiators still needed to get feedback from the White House, Congressional Budget Office scorekeepers and other lawmakers.

A note on the pay-fors: CNN Congressional Correspondent Lauren Fox reported Tuesday that multiple aides had pointed out that it was "wild" that Republican negotiators had pushed to eliminate a key financing mechanism — an increase in IRS funding meant to boost tax collections, representing about $100 billion in revenue in the deal they agreed to weeks ago. One Democrat said of the proposed pay-fors in the deal: "[W]e knew damn well some of it was hokey, and we knew we weren't gonna get a CBO score. Now, all of a sudden, they have to have a CBO score and all this stuff. It's fine, but it just takes a lot longer."

Schumer presses ahead: Schumer urged Republicans to agree to advance the bill, arguing that the Senate often votes to begin debate on legislation that is still being negotiated. Schumer said that if that bipartisan bill is not ready, he would fill the shell brought up for the vote with bipartisan transportation, water and energy bills, allowing negotiators more time to finish their work.

"It is not a final deadline for legislative text. It is not a cynical ploy. It is not a fish-or-cut-bait moment. It is not an attempt to jam anyone," Schumer said on the Senate floor Tuesday. "It is only a signal that the Senate is ready to get the process started – something the Senate has routinely done on other bipartisan bills this year."

He added: "The bottom line is very simple: if senators agree to start debate, there will be many, many opportunities for the bipartisan group to make their agreement the base of the bill."

If the vote fails: The bipartisan talks could still continue. "We’ve resurrected everything but Lazarus around here so we can resurrect this one," Sen. Joe Manchin (D-WV) said after a Democratic lunch on Tuesday. Senate Minority Leader Mitch McConnell (R-KY) told reporters Tuesday that a failed vote would still leave Schumer an opportunity to bring up the bill again once the text is ready. "All that does is give him the opportunity to move to reconsider and if at some other point the bipartisan deal comes together, we can reconsider the vote," the GOP leader said. "No time is lost by the very simple principle that we’re not going to the bill until we know what the bill is."

The bottom line: Schumer’s effort to impose a deadline on negotiators after a month of bipartisan talks appears set to fail, and with a crowded legislative calendar, that means the infrastructure bill may not get done before the August recess, as Democrats had hoped.

Dems Debate Lowering the Age for Medicare Eligibility

Democrats are reportedly debating the possibility of lowering the eligibility age for Medicare as part of their $3.5 trillion spending package currently under construction in Congress.

Lowering the Medicare eligibility age to 60 was not included in the budget blueprint Democrats released last week, although the idea was endorsed by then-presidential candidate Joe Biden in the spring of 2020. Progressive lawmakers, including Senate Budget Committee Chair Bernie Sanders (I-VT), have long supported the proposal.

Adding the age change would increase the cost of the overall spending package by about $200 billion, Axios’s Hans Nichols reports, which could force lawmakers to find new sources of revenue or cuts in other programs.

Determining the final cost will be difficult, though, until lawmakers provide additional details, including how long they plan to fund the program.

Americans’ Medical Debts Are Far Larger Than We Thought

Collection agencies in the U.S. hold about $140 billion in unpaid medical bills, according to a study published Tuesday by JAMA: The Journal of the American Medical Association.

The new analysis raises the estimate of the nation’s medical debt held by collection agencies significantly, well above the $81 billion figure researchers produced in 2016.

The new study found that about 18% of Americans have medical debt that is owned by collection agencies. Between 2009 and 2020, medical debt became the largest type of debt that is owed to such agencies, even as overall debt levels fell during the period.

"If you think about Americans getting phone calls, letters and knocks on the door from debt collectors, more often than not it’s because of the U.S. health care system," Neale Mahoney, a health economist at Stanford University and the paper’s lead author, told The New York Times.

More where that came from: The study looked only at medical debt held by collection agencies, which means the true total is much larger. Hospitals sometimes hang on to unpaid bills and try to recover debts on their own, while some medical expenses end up on credit cards.

A major Medicaid effect: The study also found that medical debt is becoming more concentrated in states that have not expanded their Medicaid systems under the Affordable Care Act. Even before the ACA came along, people living in the states that did not expand Medicaid owed more in medical debt. But after the majority of states expanded Medicaid to cover millions of additional low-income families, the debts of those living in non-expansion states became a larger share of the total. By 2020, the average medical debt in non-expansion states was about $375 higher than in the average debt in expansion states.

Economist Amy Finkelstein told the Times that health coverage isn’t limited to matters of physical and mental health. "It’s a misnomer — it’s not just to insure your health," she said, referring to health insurance. "It’s actually to protect you economically in the event of poor health."

Democrats eye expansion: Democrats included the possibility of expanding Medicaid in the 12 states that have declined to do so in the $3.5 trillion budget blueprint released last week. Although the idea is still being debated, one proposal would allow the federal government to offer Medicaid in non-expansion states, bypassing the state health care systems. Lawmakers still need to hammer out the details, though, including how to pay for the cost of such a program.

Column of the Day: What Democratic Tax Reform Should Look Like

Washington Post columnist Paul Waldman says that the congressional back and forth about Democrats’ push to give the Internal Revenue Service more money to crack down on tax cheats "raises an important question Democrats should consider as they make their policy plans for the next few years: What should real tax reform look like?"

Waldman, a liberal, suggests that Democrats have an opportunity to "seize the ‘tax reform’ mantle" and "unite around a number of straightforward, easily understood ideas that are both good policy and good politics."

Those policies, he says, include:

Boosting the IRS budge to enforce the law, even against the rich: This effort to close the "tax gap" and collect more of the hundreds of billions of dollars in taxes that go unpaid every year "will increase fairness, improve the government’s bottom line and leave Republicans arguing that rich people should be allowed to cheat on their taxes."

End the stress and cost of tax filing: "Most Americans don’t actually need to spend time and money filling out tax forms; they have one source of income where taxes are deducted from their paychecks, and they take the standard deduction. The government already knows what they earned and what they paid," Waldman writes. So the United States should do what many other countries already do and have the government do your taxes for you, allowing you to make changes if necessary.

"Why don’t we have such a system in the United States?" Waldman asks. "One key reason is the lobbying power of Intuit, the corporation that owns TurboTax, and the other tax software companies. Democrats should relish a fight with them to create a return-free system that tens of millions of families would benefit from."

Tax all income the same: "It would be simpler and fairer, and once again it would leave Republicans arguing for tax advantages for the wealthy," Waldman argues.

Focus on fairness: "This should be the guiding light for every Democratic proposal: Does it make the system more fair?" Waldman says. Such a focus would mean tax higher rates for corporations, more tax brackets for top earners, eliminating loopholes for the rich — and raising more revenue

"We have one of the lowest tax-to-GDP ratios in the developed world," Waldman argues, "but it doesn’t have to be that way. With more tax revenue we could do more to improve life for all Americans."

Read the full piece at The Washington Post.

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Dems Eye Major Medicare Expansion