KHN’s ‘What the Health?’: Compromise is coming — maybe

Reviewed by Emily Henderson, B.Sc.Nov 4 2021

Democrats on Capitol Hill hope they are nearing the finish line in their months-long quest to enact President Joe Biden's social spending agenda. After briefly dropping from the massive bill provisions aimed at lowering prescription drug costs, lawmakers in the House and Senate reached a compromise on that issue over the weekend. Also back in the bill — at least in the House — are provisions for paid family leave. But the bill cannot get to Biden without the signoff of every Democrat in the Senate, which has not happened yet.

Meanwhile, the Supreme Court heard hours of complex arguments over Texas' novel abortion ban. But the debate was less over abortion or the court's landmark Roe v. Wade decision and more about whether Texas succeeded in its effort to write the law in a way that cannot be challenged in federal court.

This week's panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Mary Ellen McIntire of CQ Roll Call.

Among the takeaways from this week's episode:

• You could call it the “Great Uncoupling": It appears that House Democrats are ready to move forward on a vote on the bipartisan infrastructure bill that has already passed the Senate, without getting assurance of a vote in the Senate on the social spending bill. Progressives in the House had for weeks used the vote on the infrastructure bill as leverage to try to get moderate senators, such as Joe Manchin of West Virginia, to agree to support their programs in the social spending plan. Democrats' gubernatorial election defeat in Virginia on Tuesday added to the momentum.
• The Medicare drug pricing plan announced by lawmakers is considerably different from what the House passed last year. It is not nearly as aggressive, but it does provide key protections for consumers, including a redesign of the Part D prescription drug program to limit out-of-pocket expenses to $2,000 a year.
• Despite strong protests from progressives, it appears highly unlikely the spending bill will provide dental or vision care for Medicare beneficiaries. Negotiators say it will contain hearing benefits. It could be years again before Democrats get an opportunity to press for dental benefits, which were the most expensive of the three targeted benefits and the provision that created the biggest backlash from industry groups.
• It’s now open enrollment for both the Affordable Care Act’s marketplace insurance plans and for private Medicare Advantage and drug plans. Despite the availability of elaborate websites to browse policies and compare options, few people bother to consider switching, even though they could save hundreds or even thousands of dollars. The exercise is just too daunting.
• The Supreme Court heard expedited arguments Monday on the Texas law banning most abortions in the state. The expectation is the court may rule quickly on the case, but the decision could easily deal with aspects of how the law is being enforced rather than abortion's legality. The justices' questions suggested they might allow abortion providers to sue Texas over the law.
• Many observers expect the justices to have something to say about abortion this term, but any ruling will likely come in a different case based on a Mississippi law banning abortion after 15 weeks of pregnancy. Those arguments will be heard in December.
• Although abortion appeared to play a key role in California Gov. Gavin Newsom’s successful fight to avoid a recall, the issue did not seem to have a strong influence on Virginia Democratic gubernatorial candidate Terry McAuliffe, who lost a tight election Tuesday in a state Biden won easily just a year earlier. That may suggest that if the court limits abortion rights, it will not have the impact with voters that Democrats are hoping for.

Also this week, Rovner interviews KHN's Rae Ellen Bichell, who reported and wrote the latest KHN-NPR "Bill of the Month" episode, about an emergency bill for nonemergency service. If you have an outrageous medical bill you'd like to send us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KHN's "Labs With No One to Run Them: Why Public Health Workers Are Fleeing the Field," by Anna Maria Barry-Jester.

Margot Sanger-Katz: The New York Times' "If Only Laws Were Like Sausages," by Robert Pear.

Alice Miranda Ollstein: ProPublica's "Babies Are Dying of Syphilis. It's 100% Preventable," by Caroline Chen.

Mary Ellen McIntire: STAT's "'There Was No Plan': Throwing Spaghetti at the Wall to Overcome Covid-19 Vaccine Hesitancy," by Theresa Gaffney.

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