In his book, Reflections On The Revolution In France, Edmund Burke stated in 1790: “When I see the spirit of liberty in action, I see a strong principle at work; and this, for a while, is all I can possibly know of it. The wild gas, the fixed air is plainly broke loose: but we ought to suspend our judgment until the first effervescence is a little subsided, till the liquor is cleared, and until we see something deeper than the agitation of a troubled and frothy surface.” Some ambitious plans by President Biden and congressional Democrats are at a juncture where various restraints in policy-making progress are beginning to manifest themselves as both intra- and inter-party disagreements become more prominent, revealing that some early froth has begun to subside.
June 17, 2021 marked another important day in the history of the Affordable Care Act. The U.S. Supreme Court on a 7-2 vote ruled that a lawsuit led by several Republican states and the former Trump administration challenging the constitutionality of this legislation did not have legal standing because the provision did not injure the plaintiffs. The decision preserves the law, thus guaranteeing continued access to health plans by its beneficiaries. The case centered upon the constitutionality of maintaining the ACA in place after the penalty for the individual mandate, a requirement that individuals enroll in a health insurance plan, had been zeroed out. In a decision in 2012, the court ruled on a 5-4 vote that the penalty was a tax. When a 2017 reform law eliminated the tax, plaintiffs argued that the entire law no longer was constitutional.
Medicare’s Role In Meeting The Costs Of Vaccinations For COVID-19
As a major force in the provision and financing of health care services, the Medicare program is making it possible to furnish assistance for home-bound beneficiaries who have difficulty meeting the costs of being vaccinated during the current pandemic. The agency has agreed to pay an additional $35 per dose for COVID-19 vaccine administration in that setting. The purpose is to facilitate access to immunization for individuals who find it difficult either to leave their homes or seek vaccinations in a community setting. The Centers for Medicaid & Medicaid Services (CMS) estimates that the policy will aid 1.6 million adults age 65 and older. An additional payment increases the cost per vaccine dose from $40 to $75, depending on geographic location to account for costs associated with providing the vaccine at home and monitoring patients after the drug is administered.
In a related action, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra notified insurers and providers in a letter sent on June 9, 2021 to remind them that they have signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients encountering any cost.
Limits Imposed On Use Of The Reconciliation Mechanism For Budgetary Matters
The December 2020-January 2021 issue of the newsletter in this column explained how Congress is able to use budget reconciliation procedures to pass some tax and spending measures in areas, such as Affordable Care Act enhancement, pandemic relief, and climate change. The process begins with a budget resolution. Next, reconciliation legislation is then considered using a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. This approach has attractive features since the Senate is split 50-50. Democrats expressed considerable enthusiasm over the prospect of using multiple reconciliation initiatives to advance President Biden’s Build Back Better, which is a comprehensive undertaking aimed at enacting the American Jobs Plan, the American Families Plan, and various health care reform proposals designed to expand the Medicare program and lower the price of prescription drugs.
Their hopes were dashed, however, when Senate Parliamentarian Elizabeth MacDonough ruled that Democrats can only use the budget reconciliation process one more time during 2021 to pass one legislative package with a simple-majority vote. Her position is that a revision to the 2021 budget resolution cannot be discharged automatically from the Senate Budget Committee, requiring Democrats to secure at least one Republican vote on a panel where members are split 11-11 along party lines.