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James Capretta of the American Enterprise Institute. (Image: Bipartisan Policy Center)

Life Health > Long-Term Care Planning

Congress Might Push a 2,500-Page Bill Out Soon

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What You Need to Know

  • James Capretta expects a 2,000-pages-plus package of legislation to show up around Christmas.
  • The candidates for the House Ways and Means chairmanship have all shown they can work with Democrats.
  • Sen. Bernie Sanders will lead the Senate HELP Committee, and Sen. Bill Cassidy will be the top Republican there.

Lawmakers may put all sorts of health insurance bills in a giant end-of-the-year package, but they are unlikely to make major changes to Medicare or to long-term care programs before the 2024 presidential elections.

Veteran federal health policy watchers gave that assessment Thursday during a post-election webinar organized by the Bipartisan Policy Center.

What It Means

For the next two years, your clients’ commercial health coverage, Medicare plans, long-term care planning arrangements and long-term care preparedness gaps could stay about the same.

The Bipartisan Policy Center

The center was founded by former Democratic senators Tom Daschle and George Mitchell and former Republican senators Howard Baker and Bob Dole.

The Voter Opinion Backdrop

Bill McInturff, a Republican pollster who founded Public Opinion Strategies, noted that typical members of Congress are much more likely to lose office due to a party primary defeat rather than in a general election.

Because of the pressure lawmakers face to win primaries, “I don’t see much room for compromise,” McInturff said.

But Robert Blendon, a public health professor at Harvard and a former survey program manager, presented data showing that, although Republicans and Democrats have different views on most health policy issues, they do have similar views about Medicare and long-term care.

In July 2019, 84% of Democrats, and 83% of Republicans, told the Kaiser Family Foundation that they have a favorable opinion about Medicare.

In response to a November survey, 16% of Republicans and 12% of Democrats ranked the “need for federal government programs to pay for home care services for seniors and people with disabilities” as a health care priority that affected how they voted in this year’s congressional elections.

The Next Month

James Capretta, a senior fellow at the American Enterprise Institute who worked in the White House Office of Management and Budget under former President George W. Bush, said that a 2,000-page or 2,500-page package of legislation — including health care and health insurance sections — could show up around Christmas.

That bill will likely include the provisions needed to keep Medicare running, such as sections that will keep existing funding streams and authorizing legislation in place, Capretta said.

The Next Two Years

In 2023 and 2024, lawmakers might try to restructure programs for people who are eligible for both Medicare and for Medicaid, and they might find ways to work together on mental health care and substance abuse, Capretta said.

“Normally, even in a very partisan House, there’s usually some pressure from the members to their leadership saying, ‘Hey, we can’t just do nothing forever,’” Capretta said.

Many Republican House members might like being able to take credit for expanding people’s access to mental health and substance abuse treatment, he added.

But, when it comes to major efforts to change Medicare or federal long-term care programs, “there’ll be a lot of talk, a lot of posturing,” Capretta said. “Analysts will come forward with some ideas, and some good conversations will take place. But very little action will take place on some big questions until after the next presidential election.”

Capretta and Democratic health policy specialist Chris Jennings agreed that one reason passing major long-term care legislation will be difficult is that easing immigration rules enough to bring in more workers will be critical to developing any new programs that actually expand access to care.

The Players

Capretta suggested that one key driver of federal health legislation over the next two years will be a group of about 15 to 25 senators who work in a bipartisan way and want to show the country that the Senate can still get things done.

Amy Jensen Cunniffe, the government relations leader at Numotion, a group that focuses on the rights of people with disabilities, said that House Republicans appear to be appointing leaders who have demonstrated their ability to work well with Democrats.

Cunniffe said she expects to see Rep. Cathy McMorris Rodgers, R-Wash., serve as the chair of the House Energy and Commerce Committee, which has jurisdiction over many health insurance bills; Sen. Mike Crapo, R-Idaho, as the highest-ranking Republican on the Senate Finance Committee; and Sen. Bill Cassidy, R-La., as the highest-ranking Republican on the Senate Health, Education, Labor and Pensions Committee.

Three Republicans are vying to be the next House Ways and Means chair.

“They all tend to be very conservative and also very aligned with bipartisan work,” she said.

Jennings noted that Sen. Bernie Sanders, a Vermont independent who caucuses with the Democrats, will be Senate HELP chair.

Sanders has been able to work well with Republicans in the past, and he and Cassidy could come to interesting agreements on issues such as support for community health centers and the mental health care workforce, he added.

Jennings pointed out that the new House Democratic leaders have focused mainly on areas other than health policy.

Because of that lack of health policy experience, House Democratic leaders may tend to defer to veterans such as Rep. Richard Neal, D-Mass., and Sen. Frank Pallone, D-N.J., in that area, he said.

Pictured: James Capretta of the American Enterprise Institute. (Image: Bipartisan Policy Center)


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