Build Back Better Act would fill gaps in health insurance

WASHINGTON – Of all the "bitter disappointments" he had as President, Harry Truman once wrote, "the one that has troubled me most personally" was the failure to adopt a national program that gave all Americans "a full" some degree of opportunity to achieve and enjoy good health. "

More than 75 years after Truman first proposed universal coverage, the Democrats are still pursuing his dream. When President Biden's Social Policy Act becomes law, they will make great strides in enforcing it.

An estimated 3.4 million Americans would get health insurance under the bill that was passed in the House of Representatives last month but faces a tough road ahead in the 50:50 Senate. New York Senator Chuck Schumer, the majority leader, said Tuesday that his goal was to see him off before Christmas.

The bill would expand access to health care for children, make insurance more affordable for adults of working age, and improve Medicare benefits for disabled and elderly Americans. Regardless, health regulations are "piecemeal, incremental change," said Caroline Pearson, senior vice president of health care at NORC at the University of Chicago, a non-partisan research organization.

Taken together, however, these policies represent the biggest step towards universal coverage since the Affordable Care Act was passed in 2010.

"This is an exceptional opportunity to improve health policies and improve people's health insurance," said Stan Dorn, director of the National Center for Coverage Innovation at Families USA advocacy group.

Faced with almost unanimous opposition from Republicans and opposition from more centrist members of their own party, Democrats in the House of Representatives neglected to include some of the zippy health proposals discussed at the start of negotiations on the package.

Medicare adds hearing protection, but no visual or dental benefit. The government will not be able to cut prices on hundreds of prescription drugs, although it can cut prices for 20 each year under the Medicare program.

If the measure goes through, the United States will maintain its patchwork system of people getting different health insurances based on where they live, income, place of work and age.

Even so, Ms. Pearson said, legislation is "one of the biggest steps in filling the holes" in the system.

According to an analysis of data from the Committee on Responsible Budget Congressional Budget Office, health care will cost $ 330 billion over the next decade, with offsetting savings of $ 325 billion. But this balance sheet is a little misleading: The savings parts are designed to be permanent, while several new coverage provisions would expire after 2025.

Even with the changes, the Congressional Budget Office estimates that more than 27 million people would remain uninsured, including many undocumented immigrants who the bill won't help. Many of the remaining uninsured would be eligible for extended Obamacare grants or Medicaid, but are not expected to enroll.

Here are some of the programs – and people – the legislation would affect.

Christina Ruiz had a lot to fear when she was born two months early in August 2020.

Their young daughter spent five weeks in the neonatal intensive care unit while Ms. Ruiz, 34, dealt with her postpartum complications herself. She developed high blood pressure and the stitches on her caesarean section began to peel off three weeks after giving birth.

There was one thing Ms. Ruiz didn't have to worry about: medical bills. She had signed up for Medicaid at the beginning of her pregnancy and it fully covered both her and her daughter's expenses.

But while Medicaid has become a major source of health insurance during pregnancy – roughly 40 percent of the country's babies are born to mothers who receive the insurance – it ends 60 days after delivery. Researchers say this is an especially troubled time for women to lose health insurance if they are still at high risk for postpartum complications.

The United States has the highest maternal mortality rate in the developed world, and about 12 percent of these deaths occur more than six weeks after delivery. A lack of insurance can play a role.

The social policy bill would give new mothers Medicaid for a full year after childbirth instead of just two months, leaving more time to deal with postpartum medical problems that may arise later.

The Century Foundation estimates that the scheme would extend protection to approximately one million women over the next decade.

The legislation would also expand coverage for children by permanently funding the children's health insurance program, which covers 10 million low and middle income children, and making it more difficult for children to lose Medicaid coverage due to typographical errors or fluctuating family income.

The coverage after the birth could help Ms. Ruiz, who is now pregnant with her second child.

Tim Floyd of Guntown, Miss., Was working in construction in 2012 when he noticed numbness in his foot. It was neuropathy, a sign of diabetes. But he was not insured and could not afford a doctor's visit.

"When you have to pay $ 60 out of pocket, you say, 'Well, it's not quite right, but it doesn't stop me from doing anything, so I'll just keep going,'" Mr. Floyd, 45, explains.

Neuropathy prevented Mr. Floyd from feeling a stone that had slipped into his boot while he was working. The stone left a wound on his right foot. A doctor treated the wound, but it festered for five years. By the time Mr Floyd found out he had diabetic ulcers, the infection had spread to his bones and left him no choice but to have his leg amputated from the knee down.

He lives in one of 12 states where Republicans have refused to expand Medicaid under the Affordable Care Act, citing the cost, of which the states would eventually pay 10 percent. The social policy bill would close the so-called Medicaid coverage gap by offering free private insurance to an estimated 2.2 million low-income adults like Mr Floyd – but only for four years.

Unable to work after losing his leg, Mr. Floyd turned to singing and playing the drums, performing with his cover band Proximity Rule. But just as he was learning to walk with a prosthesis, he noticed a lump on the back of his neck. He waited a year, then went to a doctor who told him he had Hodgkin lymphoma, a type of blood cancer.

Mr Floyd said a North Mississippi Medical Center social worker helped arrange free treatments – surgery, chemotherapy, and radiation. "The precaution," he said, "is what I couldn't get."

Jill Swenson and her husband raised buffalo in New York State in 2009 when he got skin cancer again. The couple did not have health insurance, a factor that Ms. Swenson said contributed to her husband's suicide. The Affordable Care Act regained her access to coverage in 2014, and she has had it every year since, but it's still been a long way.

She now lives in Appleton, Wisconsin, where she works as a freelance editor and literary agent. She made around $ 45,000 last year and was paying more than $ 300 a month for her insurance. During the pandemic, Congress temporarily increased the premium subsidies provided under the Health Act – a $ 200 per month discount that, according to Ms. Swenson, 63, has allowed her to shop for birthday gifts for her niece and nephew, and with the growing grocery store Keeping up with costs and paying utility bills and their mortgage.

"There's nothing to cut," she said. "It's not like I'm living on pigs."

The temporary spike in subsidies expands the income spectrum up and down and lowers insurance costs for almost anyone who buys them through Obamacare marketplaces. The social policy bill would keep it in force until the end of 2025.

Biden's draft law on social policy at a glance

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At the heart of Biden's domestic agenda. The massive $ 2.2 trillion spending bill is designed to combat climate change, expand health care, and strengthen the social safety net. Here are some important regulations and how they could affect you:

Health care. The bill's health provisions, which represent the largest step toward universal coverage since the Affordable Care Act, would expand access for children, make insurance more affordable for working-age adults, and improve Medicare benefits for disabled and elderly Americans.

The change was in response to widespread concern that the Affordable Care Act had actually not made insurance affordable enough for many Americans. According to an analysis by the Kaiser Family Foundation, more than half of those who were uninsured in the past year qualified for premium subsidies or Medicaid. Since the introduction of the new subsidies, along with a major boost in advertising, another 2.8 million people have signed up for coverage.

After recovering from cancer, Shara Clark decided to become a domestic helper in June to give back. "When you go through a medical horror like me, you develop empathy for others," she said.

She works for an agency in Charlotte, N.C. 25 to 40 hours per week helping clients get dressed, prepare a meal, or get around.

But Ms. Clark, 41, also has two part-time jobs. "Because I only get $ 10 an hour, that's not the cost of living," she said.

The $ 150 billion spending on home and community services has two goals. It would allow more elderly and disabled people receiving Medicaid to qualify for subsidized care in their homes or community programs, which will help them avoid moving to nursing homes. There are currently an estimated 800,000 people on waiting lists for these services.

The money is also to be used to raise wages for home care workers like Ms. Clark.

Home care workers make an average of less than $ 14 an hour or less than $ 30,000 a year, according to a new study by the Economic Policy Institute, a liberal group. Most of the workers are women and many are colored.

"Wages have to go up if services are to go up," said Ai-jen Poo, executive director of the National Domestic Workers Alliance, an advocacy group. "These two goals are absolutely interdependent."

Mariah Forster Olson's treatment for childhood cancer left her with a number of health problems and a long list of prescriptions. Ms. Forster Olson, 42, takes 30 prescription drugs and about 50 pills a day each month, which requires weekly visits to the pharmacy. Your Medicare coverage makes a huge difference, but it still leaves you with thousands of dollars in bills.

There is currently no limit to how much Medicare beneficiaries can pay out of pocket for their medication, a situation where some who take expensive medication can face annual bills of $ 15,000 or more. But for the 2.5 million beneficiaries who spend more than $ 2,000 a year on their medication, Medicare would pay all of their costs over that amount off the bill.

Legislation would also limit insulin expenses to $ 35 a month. That change alone could affect the more than three million Medicare beneficiaries who take the drug to treat their diabetes.

Ms. Forster Olson of La Crosse, Wisconsin, who qualifies for Medicare because she is disabled, said her drug bills could go up to $ 7,000 next year without change. "A cap of $ 2,000 would be fantastic," she said.

Anne Madison, a retired computer systems engineer in Baltimore, started losing her hearing in her 50s. Now 71 she can't afford hearing aids, which can cost up to $ 5,000. Medicare won't pay them.

"I can't get the Mastercard out," she said. "If I put that much money on it, I'll be in trouble for the rest of my life."

Almost two-thirds of Americans over 70 have hearing loss, but fewer than 20 percent of them use hearing aids, said Dr. Frank Lin, ear, nose and throat surgeon at the Johns Hopkins School of Medicine.

When Congress founded Medicare in 1965, hearing aids were still in their infancy, said Dr. Lin, and hearing loss was "not considered remotely important". Today medical professionals know better; Not only is hearing loss "arguably the leading risk factor for dementia," it can also lead to social isolation and depression, said Dr. Lin.

But while Medicare pays for an audiologist's diagnosis, this is where most of the coverage ends.

The bill passed by the House would add hearing services to Medicare from 2023. Audiological services, including advice on hearing aids, would be reimbursed and the devices themselves would be covered for people with "moderate, severe or profound hearing loss". ”

Ms. Madison from Baltimore is tackling her hearing problem in a different way for now: She enrolled in a study at Johns Hopkins that looked at over-the-counter hearing amplifiers, which cost around $ 150. She can now attend meetings and church services, and has liked her neighbors by turning down the volume on her television.

And she said, "I was amazed to be able to hear my little grandchildren."

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