Biden plan omits major health care measures pushed by Democrats

President Biden’s American Families Plan unveiled Wednesday leaves out two major health priorities pushed by congressional Democrats: reducing the cost of prescription drugs and lowering the eligibility age for Medicare.

The major legislative package, which Biden will discuss in an address to Congress on Wednesday night, includes measures in areas like child care and paid leave, but largely steers clear of health care.

It does include a measure to make permanent the increased subsidies under the Affordable Care Act to help people afford their premiums after the American Rescue Plan earlier this year had increased those subsidies for two years.

But the plan leaves out other major health care measures: allowing the secretary of Health and Human Services to negotiate lower prices for Medicare recipients and people with private insurance, and lowering the eligibility age for Medicare to 55 or 60.

Congressional Democrats from across the ideological spectrum had pressed Biden to include those measures in recent days.

More than 80 House lawmakers, including moderates like Reps. Jared Golden (D-Maine) and Conor Lamb (D-Pa.), as well as progressives like Rep. Pramila Jayapal (D-Wash.), wrote to Biden on Monday calling for measures to be included to lower the Medicare eligibility age and address drug pricing.

Sen. Bernie Sanders (I-Vt.) and 16 Democratic senators sent a similar letter, also calling for Medicare benefits to be expanded to include dental, vision and hearing coverage.

“We have an historic opportunity to make the most significant expansion of Medicare since it was signed into law,” they wrote.

Asked why the plan does not include these health care measures, a senior administration official did not directly answer during a call with reporters. But the official said Biden remains committed to lowering drug prices and indicated he will discuss the idea in his speech.

“The president has been very, very clear that he remains fully committed to negotiations to reduce prescription drug prices, that you will hear him reiterate as a very top priority and something he deems urgent,” the official said.

The official added that the savings from drug price legislation could be used to both expand Medicare benefits and fill in coverage gaps in certain areas of the country — likely a reference to covering people in states rejecting Medicaid expansion.

Without inclusion in the American Families Plan, though, the path forward for those health care measures remains unclear. It is possible multiple different packages will be combined down the line into one larger bill passed under fast-track rules known as reconciliation. 

It is also possible congressional Democrats will add health care measures back into the families plan even though Biden did not include them. 

Importantly, Speaker Nancy Pelosi (D-Calif.) is a major proponent of the drug pricing legislation, particularly House Democrats’ signature measure on that front, known as H.R. 3. 

She released a statement last week, amid uncertainty from the White House, calling the measure’s inclusion in the families plan “a top priority for House Democrats.”

There is a debate among Democrats, though, over how to spend the roughly $500 billion over 10 years in drug pricing savings. Some Democrats wanted the extension of enhanced ObamaCare subsidies, while others pushed for lowering the Medicare eligibility age and expanding its benefits. 

Leaving major health care measures out also sidesteps fierce opposition from the pharmaceutical industry, which argues the drug pricing measure would harm innovation leading to new drug development. An even broader swath of the industry would oppose lowering the Medicare age.