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He and other leading Democrats talk about what's ahead for health care after Biden's plan.

COURTESY PHOTO - U.S. Sen. Ron Wyden, D-Ore., says controlling drug prices and restoring the federal authority to negotiate Medicare drug prices are next steps in health care after expanded premium subsidies included in President Joe Biden's $1.9 trillion pandemic recovery plan.U.S. Sen. Ron Wyden says among the next steps Congress must take on health care are to lower the soaring cost of some medications — specifically insulin — and restore the ability of the federal government to negotiate drug prices for Medicare.

The Oregon Democrat joined the chairs of two other congressional committees Tuesday, March 16, on a conference call sponsored by Protect Our Care, a coalition of progressive groups formed in late 2016 to defend the Affordable Care Act against Republican attempts to repeal it.

Wyden, Washington Sen. Patty Murray and New Jersey Rep. Frank Pallone discussed in detail what President Joe Biden's $1.9 trillion pandemic recovery plan does for health care. The plan broadens federal subsidies for health insurance premiums under the 2010 law, often known as "Obamacare" after the president who signed it. It also extends federal incentives to the 12 states that still do not take part in the expansion of Medicaid coverage for low-income people.

But Wyden said a constituent question during a March 14 virtual town hall from Astoria focused attention on one of the next steps — dealing with the high cost of medications.

"People are getting mugged at the pharmacy counters. That was the message coming out at meetings with constituents all over this country," he said. "I am committed to lowering pharmaceutical drug costs."

A week before Democrats became the Senate's majority party in January — and Wyden took over as chairman of the Finance Committee, which has authority over three big federal health insurance programs — he and Iowa Sen. Charles Grassley, his Republican predecessor as chairman, released an investigative report about why the price of insulin has increased dramatically during the past decade.

Insulin, developed a century ago, helps people with diabetes control their blood sugar. But its price has tripled in the past decade. The Wyden-Grassley report noted the links between its three primary manufacturers and three pharmacy benefit managers that are the go-betweens with health plans.

Their bill gave insulin makers a choice between reducing its cost, paying a penalty if they maintain current prices, or paying even more in penalties if they increase prices. Although the Finance Committee approved the bill on a split vote, it never reached a vote of the full Senate last year because the majority Republicans were divided.

"If Big Pharma hike their prices over inflation, they are going to lose some of their subsidies," Wyden said. "We really send a message that there are pocketbook consequences."

Wyden said his bipartisan efforts in 2019 and 2020 came to naught even though then-President Donald Trump said he favored lowering drug prices.

"He did nothing except deliver blustery statements," Wyden said.

Wyden also endorsed a bill, which passed the Democratic-controlled House in late 2019 but died in the Senate without a vote, to restore the authority of the health and human services secretary to negotiate drug prices for Medicare, the federal program of health insurance for people 65 and older and for some people with disabilities.

"What the House is doing to lift the restriction, so that Medicare can negotiate and bargain on behalf of millions of seniors, is also urgent business," he said.

Medicare enrolled more than 61 million people and accounted for 21% of overall health spending in the United States in 2019. But under legislation that created prescription-drug coverage under Medicare in 2003, Republican congressional majorities barred the government from negotiating drug prices.

Pallone is the chairman of the House Energy and Commerce Committee, which has authority over health care legislation in that chamber.

He restated his support for federal authority to negotiate drug prices for Medicare.

Other steps

Pallone also said he has scheduled a hearing for other steps, such as finding permanent funding for the Children's Health Insurance Program and curtailing low-premium, low-benefit insurance plans that Trump promoted as an alternative to the Affordable Care Act, which sets "essential benefit" levels for coverage. Pallone said such plans are "junk."

The Children's Health Insurance Program, which Congress created in 1997 and has renewed periodically, provides coverage for children in households earning too much to qualify for the joint federal-state program known as Medicaid.

Obamacare rated coverage plans as bronze, silver or gold, based on the amount of monthly premiums and out-of-pocket costs, but all are tied to specific minimum benefits. The lower the premiums, the higher the expenses.

"We were emphatic that we wanted people to have essential-benefit packages that were similar to average (private) plans, Pallone said. "I think President Trump violated the law by allowing these 'junk' plans the way he did on a long-term basis."

Pallone is the lone member of six in Congress as an original drafter of the law, which survived repeated attempts by Republican congressional majorities to repeal it in 2017.

"When we were drafting it, we never envisioned that because of Republican obstruction, it would be 11 years before Congress would revisit and update the law," Pallone said. "The good news is that the law was more resilient than we had hoped and would emerge from Republican and Trump's assault and emerge more popular than ever."

Biden health care plan

Murray is chairwoman of the Senate Health, Education, Labor and Pensions Committee. She outlined the health care elements in Biden's pandemic recovery plan:

• Continued coverage under their employers' plan for two years for people who lost their jobs in the pandemic. A 1985 law offers that continuation for people in between jobs, but the premiums are often too expensive.

• Increased subsidies for premiums under the 2010 law for households earning less than 400% of the federal poverty level. For a single person earning $18,000, there is no premium for two years; for someone earning $30,000, $85 monthly instead of $195; for a family of four with income of $50,000, $67 monthly instead of $252.

• A premium cap of 8.5% of household income for people in households earning more than 400% of the federal poverty level, who otherwise would not qualify for subsidies.

• Incentives for the 12 states that did not expand Medicaid coverage under the 2010 law to do so with greater federal payments. (The most populous states in this category are Texas, Florida and Georgia. Oregon was among the first to take advantage of the expansion, and the Oregon Health Plan enrolled 1.27 million people as of March 8.)

"The plan we just passed will make a real difference in millions of lives," Murray said. "After four years of fighting off health care attacks, we are glad to say we are finally building on the progress of the past… and we are not done yet."

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Gov. Brown speaks for her Cover All People plan

COURTESY PHOTO - Gov. Kate Brown calls on lawmakers to extend health insurance coverage to the 6% of Oregon adults who still lack it. She testified Tuesday, March 16, on behalf of House Bill 2164 pending in the House Health Care Committee.Gov. Kate Brown has called on lawmakers to extend health insurance coverage to the estimated 6% of Oregon adults who still do not have it.

The Democratic chief executive testified Tuesday, March 16, for House Bill 2164 in the House Health Care Committee. Her proposed budget contains $10 million to cover 2,000 adults.

Oregon estimates that 94% of adults and all children have coverage under federal, state or private insurance.

"The pandemic has taught us this is not good enough," Brown said in her testimony. "And unfortunately, our communities of color have paid the price. Gaps in coverage persist, and these gaps are disproportionately borne by communities of color.

"Everyone deserves access to health care. It's the right thing to do, the just thing to do. And it's smart economic policy."

The bill would authorize the Oregon Health Authority to create a Cover All People program, modeled on the Oregon Health Plan, which as of March 8 covered 1.27 million people. It emerged from the health equity committee of the Governor's Racial Justice Council.

The new program would cover legal permanent residents, young adults who age out of Oregon's Cover All Kids program, DACA recipients (young people brought illegally to the United States as children) who have deferrals from deportation, and undocumented adults.

Brown said the new program is not just socially responsible but makes economic sense.

"Across agriculture, manufacturing, the service sector and our health care system, front-line workers from our immigrant and refugee communities have gone to work every day during the pandemic to very literally keep our society going. Many of them worked through wildfires and breathed harmful smoke," she said.

"The very least we can do in a just society is to make sure they have access to this basic human right."

— Peter Wong


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