Illustration: Brendan Lynch/Axios
President Biden's fiscal 2024 health budget contains few bombshells. But it's a useful guide to what he sees as accomplishments to build on — and likely previews key parts of a prospective 2024 campaign platform.
The big picture: With a divided Congress and little chance of major legislation, Biden's best bet may be drawing contrasts with Republicans on pocketbook issues like drug costs and to portray the GOP as intent on cutting voters' health care and retirement benefits.
- And with the nation gripped by high inflation and public debt, Biden's pitching big parts of his agenda as an exercise in deficit reduction, by hiking taxes on the wealthy and proposing steps like expanding Medicare’s ability to negotiate drug prices on a faster timeline.
- "With the ACA as the status quo, President Biden's budget does not call for transformational health reform. Rather, he is focused on sustaining Medicare, filling in gaps and addressing affordability, especially with respect to prescription drug costs," Larry Levitt, KFF executive vice president for health policy, wrote on Twitter.
Reality check: Most of the changes would require legislation, which isn't likely to happen in a divided Congress.
The details: Some of the most prominent health proposals are add-ons to Democratic policy wins from the last Congress.
- Biden would expand Medicare drug negotiations in the Inflation Reduction Act to more medicines on a faster timeline.
- He'd make Affordable Care Act enhanced subsidies that are set to expire at the end of 2025 permanent and extend "Medicaid-like coverage" for eligible people in states that have yet to expand their Medicaid programs.
- The blueprint also calls for lower insulin costs for commercially-insured people and making drugmakers pay rebates in the commercial market if they enact price increases greater than inflation — a major step in extending the IRA's reach beyond Medicare to private plans that was rejected by the Senate parliamentarian during the IRA debate.
- The plan would additionally expand coverage of mental health benefits and strengthen the network of behavioral health providers for privately insured.
The intrigue: One potential bipartisan rallying point is a proposed "subscription model" that would pay manufacturers fixed prices for unlimited access to Hepatitis C drugs. Senate health committee Ranking Member Bill Cassidy (R-La.) was instrumental in passing a similar program in his home state.
- But, as we've previously reported, many other budget requests will be caught up in multiple battles over raising the debt ceiling, as well as abortion policies, "gain of function" research and other contentious issues. Of special note is a $48.6 billion request for the National Institutes of Health that represents only a modest bump over existing levels.
- Raymond James analyst Chris Meekins said if all sides can't agree on policies to include in a final agreement and concessions to make, the likely outcome could be flat funding heading into the election year.
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