HEALTH CARE BRIEFING: Senate Budget Bill Carries $1T for Health

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Senate Democrats laid out an ambitious plan to expand public health insurance programs yesterday, with a price tag that could hit more than $1 trillion.

Democratic leaders released text of their budget resolution, setting up President Joe Biden’s $3.5 trillion economic plan. Roughly a third of that plan will consist of expanding Medicare’s benefits and lowering the program’s eligibility age, extending the Obamacare expansion achieved earlier in the year, expanding home and community-based care programs, and preparing for the next pandemic, according to a memo released yesterday.

The lofty costs for all these items will likely mean some will be temporary, and some could be dropped completely. “This is all a jigsaw puzzle more complicated than you can ever imagine to design health care expansion policies, and then create revenues and budget savings to pay for them,” said Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation. “The less revenues and savings you create, the less you can spend.”

Here’s how the costs break down, all over 10 years:

  • Expanding Medicare’s benefits to include dental ($238 billion), vision ($30 billion), and hearing ($89 billion), for a total of $358 billion;
  • Home and community-based care expansion of up to $400 billion;
  • Closing the Medicaid gap, for $100 billion;
  • Preparing for the next pandemic, for $30 billion;
  • Addressing the provider shortage, for $50 billion; and
  • Lowering the Medicare eligibility age to 60, for a cost of $200 billion.

Democrats have vowed to offset about half of the $3.5 trillion economic package with other provisions, and have eyed offsetting much of the health-care spending by authorizing the federal government to negotiate with drugmakers. “We will save taxpayers hundreds of billions by requiring that Medicare negotiate prescription drug prices with the pharmaceutical industry, and we will use those savings to expand Medicare,” Senate Budget Chairman Bernie Sanders (I-Vt.) said yesterday.

This also means that some of these health care priorities might squeeze out others. Sen. Bob Casey (D-Pa.), who has introduced sweeping legislation to expand Medicaid’s home-care offerings, said he’s negotiating with his colleagues over how much of the budget reconciliation package will be dedicated to home and community-based care. Read more from Alex Ruoff.

Biden’s Expansive Economic Agenda Teed Up for Vote: Biden’s big plans for the U.S. economy are on the verge of passing their first major legislative tests in the Senate, leaving their future to intra-party struggles between Democratic progressives and moderates. A broad group of Democratic and Republican senators is prepared to place a bipartisan stamp of approval on a cornerstone of the Biden agenda — a $550 billion infrastructure program — in a vote scheduled to begin late this morning. The remainder of Biden’s economic agenda is encompassed in a $3.5 trillion budget resolution the Senate is scheduled to consider next. Read more from Mike Dorning, Steven T. Dennis and Billy House.

The Coronavirus Pandemic

Delta Strains Hospitals Across U.S.: Hospitals across the U.S. were parceling out beds for Covid patients yesterday, hunting for doctors and nurses as the delta variant sweeps coast to coast. The disease is outstripping any mitigation measures. In a few states, the unvaccinated are entering intensive care at rates matching the winter wave. The vaccinated are coming to realize that a sweet summer of release may have been a fantasy, as they again calculate the risks of working, seeing relatives and circulating in society.

Delta’s march began in the U.S. in the Ozarks and South, in states and regions with low vaccination rates. But the surge has shown that even the best vaccinated areas still don’t have enough immunity against the easy-spreading variant. Many experts believe the delta wave will crest without last year’s mortality: The vaccinated can get infected but are vastly less likely to die. Hospitalizations in highly vaccinated areas are increasing relatively slowly. Still, those waves are just beginning, and infections can take weeks to send people to the ICU. Read more from Angelica LaVito, Jonathan Levin and Francesca Maglione.

Map of coronavirus delta variant transmission in the United States

Pentagon to Mandate Vaccination for Troops: The Defense Department will make vaccinations against Covid-19 mandatory for members of the military by Sept. 15, Defense Secretary Lloyd Austin announced yesterday. “I want you to know that I will seek the president’s approval to make the vaccines mandatory no later than mid-September, or immediately upon” approval by the Food and Drug Administration, “whichever comes first,” Austin said in a memo to all department employees. Travis J. Tritten has more.

U.S. Prepares to Send Mexico Moderna, Astra Shots: The U.S. is preparing to send Mexico vaccines from Moderna and AstraZeneca in coming days to bolster its southern neighbor’s fight against Covid-19, according to people familiar with the discussions. In a phone call yesterday, Mexican President Andres Manuel Lopez Obrador thanked Vice President Kamala Harris for assistance combating Covid-19, including delivery of more than 4 million vaccines, Harris’s office said. Harris told Lopez Obrador that the U.S. is committed to sending more shots to Mexico but the White House didn’t provide specifics. Read more from Eric Martin and Jennifer Jacobs.

Pfizer Booster May Have Fewer Side Effects: Most people who got a booster shot of the Pfizer-BioNTech Covid-19 vaccine had similar or fewer side effects than they did after the second shot, according to an early study by Israel’s largest health maintenance organization. Of the 4,500 respondents to the survey, 88% reported “a similar or better feeling” than their reaction to the previous shot, with 31% saying they had localized effects such as pain or swelling in the site of injection, it said. Yaacov Benmeleh has more.

  • BioNTech raised its forecast for this year’s Covid-19 vaccine sales to $18.7 billion and said it’s pushing forward plans to test its mRNA technology in cancer. BioNTech and Pfizer signed contracts to deliver some 2.2 billion doses of the two-shot vaccine in 2021 and over 1 billion doses in 2022 and beyond, the German company said yesterday. Their vaccine is on track to be one of the best-selling drugs of all time. Read more from Naomi Kresge.

Judge Says Eviction Ban Is ‘Gamemanship’: A federal judge in Washington said the administration engaged in “gamesmanship” last week by extending an eviction moratorium in areas hit hard by Covid-19 after the Supreme Court indicated that only Congress could do so. At a hearing yesterday, U.S. District Judge Dabney Friedrich signaled skepticism over a new ban, and landlord groups have fought the policy, saying Biden bowed to political pressure even though he knew it was illegal. David Yaffe-Bellany has more.

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What Else to Know

Texas Judge Blocks Obamacare LGBTQ Anti-Bias Rule: A federal district court judge in Texas permanently blocked the Department of Health and Human Services from forcing certain Christian medical providers and seven states to provide or pay for gender transition-related care and abortions. Judge Reed O’Connor, of the U.S. District Court for the Northern District of Texas, issued a permanent injunction yesterday.

The order prohibits HHS Secretary Xavier Becerra, the agency, and anyone acting in concert with it from interpreting the anti-discrimination protections under Obamacare or enacting regulations that would force the states and providers involved in the dispute to perform or provide insurance coverage for gender-transition procedures or abortions. Read more from Lydia Wheeler.

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To contact the reporter on this story: Brandon Lee in Washington at

To contact the editors responsible for this story: Zachary Sherwood at; Giuseppe Macri at; Michaela Ross at

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