President Joe Biden’s budget will explicitly call for major health care legislation this year, even though it won’t put actual numbers or policy specifics on several key proposals, White House officials told HuffPost on Friday.
“The Budget document will reiterate the President’s strong call to Congress during his joint address for prompt action to reduce prescription drug costs, and expand and improve health coverage,” White House press secretary Jen Psaki told HuffPost in an email.
“The construct for this budget is that it’s the things we’re trying to get done this year ― and we’re definitely saying that health care is one of those things,” said another senior official.
The statements came in response to ongoing worries that Biden will postpone or abandon a push for several policies that he endorsed during the 2020 campaign ― among them, legislation that would give the federal government new power to set prescription drug prices.
Anxiety over Biden’s commitment to these policies flared up even more on Friday, following new reporting in The Washington Post. An article by reporters Jeff Stein and Tyler Pager quoted several officials saying that Biden’s budget would not include specifics on prescription drugs or other past Biden promises on health care, like a vow to create a public option in which any American could enroll.
The White House has said the budget will be out May 28.
What’s In The Budget And Why It Matters
The president’s budget is not a binding document. It is simply a statement of how the president would like to see Congress allocate revenue and spending in the course of passing bills in the coming year.
But when the president’s party controls Congress, as Democrats do now, and especially when it’s the first year of a new term, as it is this year, the presidential budget tends to set the legislative agenda because lawmakers will usually follow the president’s lead.
The budget itself consists of both narrative sections, which describe in plain English what the president wants to do and why, as well as detailed statistical tables breaking out the fiscal impact of each proposal on a year-by-year basis.
The narrative section on health care in this year’s budget will mention all of the major ideas that Biden has endorsed in the past, senior officials told HuffPost. That list includes not just prescription drug legislation and the creation of a public option, but also adding new benefits (visual, dental, hearing) to Medicare and allowing people 60 and above to buy into a version of Medicare.
The budget will also mention financing insurance for people who fall into the “Medicaid gap” — those who live in one of 12 Republican-controlled states that have not expanded eligibility to include everybody with incomes below or just above the poverty line.
But while the narrative section will mention these policies, the statistical sections will not say anything about how much they would cost or save.
The big question is what, if anything, that means.
On Friday, administration officials told HuffPost that it would be a mistake to interpret the lack of numbers on the health care proposals as an indication that Biden is less serious about pushing for them.
They noted that the budget is leaving out some other, non-health care ideas altogether. By including health care in the narrative sections, officials said, Biden is conveying that he still considers health care a priority.
“By being very explicit about [health care legislation] in the budget, the intent is to signal that this really is something we are committed to trying to get done,” one of the senior officials said.
One reason to avoid too many specifics on health care right now, the officials said, is that it would give Congress more room to work through some still-contentious debates over policy.
What Biden Has Said About Health Care Already
The omission of specifics on those health care ideas is consistent with the way Biden has treated health care policy so far.
In March and April, Biden sketched out two major sets of policies, the American Jobs Plan and the American Families Plan, both of which included health-care-related proposals. Administration officials have said those two packages should be the basis for legislation that Congress passes this year.
The American Jobs Plan included a major initiative to finance home health aides and other supports that make it possible for the disabled and elderly to avoid institutional care. The American Families Plan called for making permanent some significant, but currently temporary, increases in financial assistance available to people buying health insurance through HealthCare.gov and state-based insurance exchanges.
The May 28 budget will include specific figures for the cost impact of these two proposals.
But neither the American Jobs Plan nor the American Families Plan had anything specific on prescription drugs, adding a public option or addressing the Medicaid gap. That decision alarmed progressives and their allies, who interpreted the decision as indicative that Biden was less determined to push for these policies.
At the time, White House officials insisted that was not the case. And Biden, during his address to a joint session of Congress in April, mentioned prescription drug legislation specifically.
“Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices,” Biden said.
Roughly the same sequence seems to be playing out now.
Why Everybody Is Watching Biden’s Signals So Closely
The political backdrop for the latest machinations is an ambitious agenda that, on the one hand, recognizes the huge crises America still faces but, on the other hand, almost certainly is more than what Congress can pass. That’s especially true given a razor-thin Democratic majorities in the House and Senate.
As a result, Biden and Democratic leaders will have to make some tough choices ― about what to pursue now and what to pursue later, as well as about where and how to make compromises. And each piece of Biden’s health care agenda, like every major idea he has endorsed, comes with a set of tradeoffs touching both policy and politics.
That’s clearly true for action on prescription drugs, which would provide struggling consumers with relief while yielding budget savings for the federal government. Those savings could then offset the cost of other initiatives, like adding dental benefits to Medicare or filling in the Medicaid gap.
But any meaningful action on prescription drugs would run into opposition from the drug industry, which will argue that reducing its revenue will limit innovation and development of new drugs. However valid that argument may or may not be, the drug industry is historically among the most powerful and influential in Washington.
Overcoming that resistance would almost certainly require a strong push from the White House, which is why everybody is watching its signals so closely.