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Neal’s Hard Choices on Healthcare to Lead Top Issue

April 25, 2019

By Robert Weiner and Ben Lasky

National Report from Washington–A monthly Series exclusive to LaborPress

The number one issue in the congressional elections of 2018 was health care and could be again in 2020.  

Workers and unions have always understood that they will be the ones paying for healthcare for families if the government does not. Right now it’s a mess where the USA pays twice the cost of other civilized countries. Health costs are the #1 reason for private bankruptcies.

Two approaches for improvement are that Congress can fix Obamacare by paying for the exchanges, or, as some have advocated, they can embrace Medicare for All.

The Trump administration announced a court challenge that would get rid of the Affordable Care Act (Obamacare), trying a legal route after failing in Congress more than 60 times. This action  lays out a clear campaign battle line on the issue while offering no alternative for immediate replacement. The unions or workers’ own pockets will have to pick up the mess for their members if health care coverage is drastically reduced.

Richard Neal (D-Springfield), the chairman of the powerful House Ways and Means Committee, is in the news for requesting that the IRS provide his committee with Trump’s tax returns. But he also has a tough decision to make on healthcare. Half of the Democratic Caucus are pushing for Medicare for All, while those who oppose it as well as Republicans are asking where the government is going to get the money from.  Some from both parties seek to repair Obamacare by funding the exchanges. Almost all are seeking cheaper drug prices.

Rep. Pramila Jayapal (D-Seattle), replaced Rep John Conyers (D-Detroit) as prime sponsor of the Medicare for All bill, providing free healthcare, matching most other countries. Conyers’ bill was co-sponsored by a majority of House Democrats in the last Congress, and Jayapal this Congress has a near-majority of 107. Health care goes through Neal’s committee. 

“Medicare is not as good a health benefit as the Affordable Care Act. So, if you are to do Medicare-for-all you have to improve the package — and when you improve the package, you have to have more money,” said House Speaker Nancy Pelosi on April 4.

“Is this a bold and ambitious plan? It has to be,” Jayapal, co-chair of Congressional Progressive Caucus, said when introducing the bill. 

Critics of the bill all have the same question: “How will we pay for it?” There is a concrete answer.  Jayapal suggested reversing the Trump tax breaks for the rich and continuing the Medicare formula of contributions from employers as ways to fund the bill.

However, rarely does anyone ask how we pay for government programs that are ingrained in American society. Do we ask how we’re going to pay for police and the fire department? Or trash pickup? Public education? Libraries? Does anyone ask how to pay for the military? Those have no “pay for”.  That’s what taxes are for.

As The Washington Post’s Paul Waldman wrote, “The questions about the cost of Medicare-for-All seem to come from a bizarre alternate universe where we aren’t spending anything now on health care, and we’re going to have to come up with a shocking amount of new money to fund this crazy idea of giving everyone coverage.”

The chair of the Ways and Means Social Security Subcommittee, John Larson (D-Hartford, CT), told us that he’s “proud” to be a sponsor of Jayapal’s bill and that in fact “it’s revenue neutral:” Estimates have universal healthcare costing $14 trillion to $32 trillion per decade – meaning 1-3 trillion a year. Under the current system, Americans are expected to spend $50 trillion on healthcare over the next decade. Even the lesser step of Obamacare – the existing Affordable Care Act — has already reduced the rates of increase, a fact not mentioned by critics

There are many other ways to pay for everyone in the U.S. to have healthcare. Since Trump wants to pull the U.S. military out of Afghanistan, the government can use the trillion for that war to pay for it

Neal supports “Medicare for All” but says the approach musty be “incremental”.  That could still satisfy the objective of coverage for all. Here’s how: 

Medicare for All” has to be an option, where if you like your insurance, you can keep your insurance. Larson agreed. Under the “option” plan, the country’s “pay for” total drops drastically.  

This isn’t fantasy– quite the opposite. A “public option” was in the House-passed version of the Affordable Care Act in 2010 before the Senate’s private insurance-based compromise superseded it. 

It would be political suicide to get rid of people’s ability to still receive private insurance. Sen. Kamala Harris (D-Ca.) recently found that out after telling CNN’s Jake Tapper, “Let’s eliminate all of that.” It took less than a day for her campaign to reverse course. A Hill-Harris poll released on Feb. 7 found only 13 percent in favor of a healthcare system that does away with private insurance.

One of the other arguments against Medicare for All is that taxes would go up. However, a recent Kaiser Family poll found that 77 percent of Americans understand that taxes will increase, and 56 percent still either strongly or somewhat support Medicare for All. People know how much health care costs them now. Federal volume can create cost-effectiveness. 

Republican Senator Lamar Alexander (TN) and Democrat Patty Murray (WA) led a bipartisan fix-Obamacare bill in the Senate supporting the exchanges that the Administration unfortunately blocked after first indicating support.  It’s time for that bipartisanship on the issue. 

President Trump calls anything the Democrats come up with “socialism.” Actually, people programs are called “America”. When Social Security was passed in 1935, opponents decried “socialism’.  When Medicare was passed in 1966, opponents on the Hill then, and surprisingly Ronald Reagan and Newt Gingrich later, called it “socialism.” When the Affordable Care Act was enacted in 2010, Republicans cried “socialism” even though the compromise empowered private insurers as Republicans had asked. 

To wade through the complicated health care legislative maze and make a bill happen, Neal’s leadership will be critical. 

Robert Weiner was drug policy spokesman in the Clinton and Bush White House and Chief of Staff of the House Aging Committee and Health Subcommittee. Ben Lasky is senior policy analyst at Solutions for Change.

April 25, 2019

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