After the new Congress is sworn in next January it may address several issues that directly affect the well-being of older adults as well as younger people with disabilities. The House, which will be controlled by Democrats, and the Senate, still run by Republicans, will have very different perspectives on these issues but both chambers are likely to confront the future of Medicare and funding for aging services. The House may well raise the profile of long-term care financing reform. And lawmakers of both parties will have to manage of often-inconsistent demands of President Trump. Here is a look at several aging related issues Congress likely will address next year.
Medicare drug prices: Look for House Democrats to pass legislation aimed at curbing drug prices, a favorite topic during the recent campaign. The only two questions are: How ambitious will the bill be and will Republicans sign on.
For years Democrats have pushed the idea of direct negotiations between Medicare and the pharmaceutical companies. The likely incoming chairman of the House Energy & Commerce Committee, Frank Pallone (D-NJ) already has promised to move such a bill, as well as legislation called the Creates Act that makes it more difficult for brand-name drug makers to block generics from the market.
Pallone told reporters on Nov. 14, “I think you need negotiated prices under Medicare, and I think you need the Creates Act and other initiatives that will aggressively bring generics to market,” Pallone said. “There’s an area where the president agrees with me and the Democrats, so why not?”
Does Trump agree? During his presidential campaign Donald Trump did indeed endorse direct price negotiations by Medicare. But The Trump Administration’s recent regulatory initiatives aimed to holding down drug prices have been far more modest. While in office, Trump tried to jawbone drugmakers into holding down price hikes but that seemed only to work until election day. How will Trump react to an aggressive House bill? Like most things Trump, it is simply impossible to know. But there is an opportunity for a bipartisan deal.
One wildcard in the drug pricing debate is Sen. Chuck Grassley (R-IA), who will replace the retiring Orrin Hatch as chair of the Senate Finance Committee, the panel that has jurisdiction over Medicare. Unlike Hatch, a strong supporter of the pharmaceutical industry, Grassley has been a long-time critic of high drug prices. Will he follow his old instincts or give in to pressure from the Senate GOP leadership to keep drug pricing legislation modest? The answer likely will depend on what Trump wants.
Other Medicare issues: Outgoing House Speaker Paul Ryan was a strong advocate of limiting Medicare (and Social Security) benefits and increasing health care costs for older adults. While those ideas were included in many House bills, they never got traction in the Senate. And Trump blew hot and cold on the idea of Medicare cuts—promising to protect the program from cuts in his campaign, then proposing $553 billion in savings in his budget.
For now, Ryan’s ideas are a dead letter. But will House Democrats move in the opposite direction and try to expand Medicare eligibility, as many have suggested? Democrats are mulling at least three different ideas under the rubric of “Medicare for all” Two would make Medicare available to the under 65 population. The third isn’t really a Medicare plan but rather would create a universal single-payer government health plan for all.
Long before they confront that issue Congress also will have to respond to administration efforts to reduce Medicare payments to providers and restructure the payment system to one based on quality of outcomes rather than number of services that docs and hospitals provide. This could be an area where House Democrats and the administration could find some agreement—if they want to.
House Democrats also are likely to take a close look at Medicare Advantage plans. While they may not try to make legislative changes in 2019, they will use oversight hearings to review the effects of managed care on Medicare beneficiaries.
Funding for the Older Americans Act and other federal programs. Trump repeatedly proposed slashing funding for these programs but in the end Congress maintained—and in some cases—increased funding for services for older adults, such as nutrition, information assistance, falls prevention, respite care, and many others. But don’t expect much change with a Democratic House. Funding was roughly frozen throughout the Obama Administration and Congress still will have to work within overall spending caps. The best bet: Few cuts, but few increases, in these budgets.
Medicaid. Democrats have been supportive of the move away from nursing homes to home and community based care for Medicaid recipients receiving long-term care benefits. The administration has suggested giving Medicaid additional flexibility to provide supports such as housing benefits. However, this idea will raise red flags among some Democrats who fear it will be a step towards a broader block grant program for senior services. Their fear: Blocks grants will inevitably lead to funding cuts.
Long-term care financing reform. Earlier this year, Pallone developed draft legislation to create a public catastrophic long-term care insurance program. The idea, roughly similar to a proposal developed by the Long-Term Care Financing Collaborative and a more detailed version by policy experts Marc Cohen and Judy Feder, would provide a universal benefit of roughly $100 after a two-year waiting period.
But Pallone’s bill left out a critical detail: How it would be funded. And until he deals with that issue, it is hard to see much movement in Congress. With Republicans and even many Democrats reluctant to raise taxes on middle-income households, it is hard to see where the money for such a program would come from. Still, with Pallone in a high-profile chairmanship look for the issue of long-term care to get some attention in the next Congress.
With Democrats in control of the House, Republicans in charge of the Senate, and Trump in the White House, and both parties gearing up for the 2020 elections, expect a lot of 2019 talk about Medicare and related health and long-term care issues. But don’t count on many changes in the law.