Jul 15, 2019
Joe Biden
rolled out a health care plan Monday whose policies and political priorities
are both rooted firmly in the Affordable Care Act.
Details: The cornerstone
of Biden's proposal is a new public insurance option, which would compete
alongside private insurance. The public plan would be available to everyone,
even people who get their coverage from an employer. That's an important
difference from the one that was debated in 2010.
- Biden
also would make the ACA's premium subsides more generous and more widely
available.
On cost
control, the plan would give Medicare the power to directly negotiate
drug prices and establish a new board to determine a fair price for new,
first-in-class drugs.
- Drugmakers
would also have to pay a tax if they raise their prices above inflation.
- There's
a proposal to end surprise hospital billing, but otherwise not a lot in
there on hospital costs.
One potential
controversy: Biden's new public option would automatically take the place of
the Medicaid expansion in states that haven't expanded.
- States
that have expanded would have to keep paying their share of the bill for
the expansion.
- In
other words, non-expansion states would get a better deal than those that
participated in the expansion — arguably, rewarding their resistance to
the ACA.
The bottom
line: Health care may be the most defining substantive policy
disagreement among the 2020 field.
- Biden's
proposal is more ambitious than anything that was seriously on the table
during the ACA debate, but looks decidedly moderate compared to Bernie
Sanders' plan — which is significantly more ambitious than almost any
other health care system in the world.
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