A closely divided Congress and a moderate Democrat in Joe Biden in the White House doesn’t bode well for a government-run single payer version of Medicare for All to emerge in 2021 despite the end of Donald Trump and Republicans opposed to expanding health coverage.
As Democrats talk about ways to strengthen the Affordable Care Act and possibly expand Medicare to age 60, it seems far less likely anything will emerge to resurrect Medicare for All or a related single-payer version of healthcare reform even with key supporters of such health policy serving in high-ranking roles in the Biden administration.
Both vice president-elect Kamala Harris and Biden’s pick for U.S. Secretary of Health and Human Services – Xavier Becerra – were supporters of Medicare for All while they served in Congress and would seem to be in a position to push it on the legislative front.
But Democrats have a slim majority in the U.S. House of Representatives and at best may control the Senate by a single vote even if the party wins two U.S. Senate runoff elections next week in Georgia. Such slim control of Congress doesn’t bode well for any effort to greatly expand Medicare or add a Medicare-like public option as a health plan choice alongside commercial offerings on the ACA’s public exchanges, analysts say
“It is hard to see how the more ambitious parts of the Biden health agenda, can move through Congress without a Democratic majority in the Senate,” says Tricia Neuman, senior vice president at the Kaiser Family Foundation and executive director of the group’s program on Medicare policy. “Even if the Georgia election results in Democratic control of the Senate, it would still be a challenge with such a narrow margin.”
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Further complicating any major Medicare expansion like the government-run single payer version of Medicare for All is that millions of seniors continue to flock to privatized Medicare Advantage. Biden is on record as supporting the private insurer’s role in administering Medicare benefits and offering coverage on the ACA’s exchanges.
And seniors like Medicare Advantage with enrollment doubling over the past decade to more than 24 million this year.
Practically every major health insurer selling Medicare Advantage expanded into new regions to offer more plans in 2021. CVS Health’s Aetna unit, Cigna, Humana and UnitedHealth Group were among the big health insurers offering more Medicare Advantage health benefit options in 2021 including richer benefit packages with lower co-payments.
Still, the New York Times reported a month ago Becerra would have powers to help expand coverage on a state by state basis via his waiver authority which “states can use to cover new groups or provide different types of health plans.”
“Without a Senate majority, it will be hard to advance some of the fundamental planks of the administration’s plans,” the Robert Wood Johnson Foundation’s Katherine Hempstead told the Times. “That’s where the waiver authority becomes important.”