Congress represents a fascinating portion of American life. Elected officials in both chambers find themselves on every major issue needing to decide whether their vote will advance the interests of their supporters in congressional districts and states back home, who made it possible for them to be elected, or have it enhance the welfare of the nation as a whole. Conflicts of this nature arise all the time. For example, improving the environment would seem to be a goal with widespread appeal, but if it means seriously damaging the fossil fuel industry in a state that is heavily dependent on jobs and revenues from oil, coal, and gas economic activities, it becomes less easy for officials from there to cast votes that favor the nation over the locale. Doing so usually will result in a rapid, undesired exit from political office following the next election.

Despite several decades of efforts on Capitol Hill to ensure that all inhabitants of the U.S. have adequate health insurance coverage, many individuals continue to lack that form of protection. Congress is balanced evenly in the number of Democrats and Republicans in the Senate while the House tilts slightly in favor of the Democrats numerically. As reported on March 5, 2021 in the New England Journal of Medicine, on the issue of universal health insurance coverage, the two parties’ constituents appear to be sharply divided. Nearly nine in 10 Democrats (87%) reported that they believe it is the responsibility of the government to ensure all individuals in the U.S. have health insurance coverage, a view shared by fewer than one in four Republicans (23%). Among Democrats, 75% reported that they prefer a health insurance system mostly run by the government, whereas 79% of Republicans reported that they prefer a system based mostly on private health insurance.

Regarding specific coverage proposals, Democrats expressed support for the following: building on the Affordable Care Act (ACA) [93%], Medicare-for-All (85%), and a Medicare buy-in to the ACA referred to as “the public option” (82%). In contrast, only 30% of Republicans expressed support for building on the ACA and 28% supported Medicare-for-All. While 62% of Republicans reported that they support a Medicare buy-in to the ACA, that support does not represent an endorsement of the notion that government should ensure universal coverage. Also, 64% of Republicans reported that they support replacing the ACA with a state-based private health insurance alternative compared with 36% of Democrats. These substantial differences do not bode well for implementing major changes any time soon in how health insurance is provided in this nation.

Medicare Payment Advisory Commission (MedPAC)

Apart from highly trained staff members in Congress, elected officials often profit from advice provided by other sources, one of which is MedPAC. The Commission is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105–33) to advise the Congress on issues affecting the Medicare program. Besides advising that body on payments to health plans participating in the Medicare Advantage program and providers in Medicare’s traditional fee-for-service program, MedPAC has additional responsibilities that involve analyzing access to care, quality of care, and other issues affecting the Medicare program. Its 17 members can seek to influence the work of Congress in several ways, one of which is the issuance of reports in March and June each year that contain various Commission recommendations.

The report sent on March 15, 2021 consists of 14 chapters that deal with such matters as: the near-term consequences of the coronavirus pandemic and the longer-term effects of Medicare spending on the federal budget and the program’s financial sustainability, and an option for Medicare’s coverage of telehealth services after the coronavirus public health emergency. Both the short- and long-term contexts for the Medicare program are sobering. Because of the pandemic, in the short term, beneficiaries are at particular risk. Patients over 65 are more likely to suffer severe COVID-19 cases and complications and die than those who are younger and have fewer comorbidities. Long-term, the financial future of the Medicare program was already problematic, but as a result of job losses, in 2020 the Congressional Budget Office projected that Medicare’s Hospital Insurance Trust Fund will become insolvent by 2024, two years earlier than previously expected.

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Medicare Payment Advisory Commission (MedPAC)

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