Georgia is now the only state in the US to implement work requirements in its Medicaid program – a feat many Republican lawmakers nationwide will be closely monitoring.
But unlike GOP-led states’ prior attempts to impose work mandates in Medicaid, Georgia’s effort is expected to increase the number of people with health insurance, rather than strip coverage away from an untold number of low-income residents. That allowed it to pass muster in court, though critics still deride the program as complicated, ineffective and expensive.
Pathways to Coverage, which began July 1, comes as House Republicans in Congress are pushing to expand work requirements in the nation’s safety net programs, particularly Medicaid and food stamps.
There is no federal work mandate in Medicaid, but 13 states received permission during the Trump administration to require existing enrollees to work, volunteer or meet other criteria to retain their health insurance. In Arkansas, the only state that implemented work requirements and terminated coverage, more than 18,000 people were disenrolled in 2018 before its waiver was voided by a federal court.
States paused their initiatives because of litigation or the Covid-19 pandemic, and then the Biden administration withdrew the waiver approvals. But Georgia challenged the withdrawal, and a federal judge ruled in the state’s favor in August 2022, allowing it to implement Pathways to Coverage.
Georgia has among the nation’s strictest eligibility requirements for Medicaid. It is one of 10 states that has not expanded the program to all low-income adults under the Affordable Care Act. Parents only qualify if they make less than 31% of the federal poverty level for a family of three – or about $7,700 this year, according to KFF, a health policy research organization.
Under Pathways to Coverage, adults making up to 100% of the federal poverty level – about $14,600 for an individual – can enroll if they work, participate in job training or community service, take higher education classes or meet other criteria for at least 80 hours a month.
“In our state, we want more people to be covered at a lower cost with more options for patients,” Gov. Brian Kemp said in his State of the State address in January.
Just how many people are expected to gain coverage varies. In his speech, Kemp said up to 345,000 Georgians are potentially eligible for the program, while the state Department of Community Health said the state has budgeted for an estimated enrollment of 100,000 residents in the first year.
Interest in the program is continuing to grow, said the department, which is working with insurers, community groups and others to get the word out.
Others, however, estimate far fewer people will gain coverage. The state funds allotted for the program in the current fiscal year will allow about 47,500 to enroll, according to the Georgia Budget and Policy Institute, a left-leaning advocacy group.
Fully expanding Medicaid would cover far more people and at a lower cost to the state, said Leah Chan, the institute’s director of health justice. Some 482,000 Georgians earning up to 138% of the federal poverty level – or about $20,100 for an individual – could gain coverage.
Also, the federal government covers a larger share of the costs of the full expansion enrollees and would temporarily provide a boost in federal funding for existing traditional Medicaid participants under a provision of the American Rescue Plan Act aimed at enticing holdout states to expand.
If Georgia fully expanded Medicaid, each newly eligible enrollee would cost the state about $496, Chan said. But under Pathways to Coverage, each will cost $2,490 because the program does not qualify for the enhanced federal match.
“It doesn’t make sense for us to implement a program that’s going to cover fewer people at a higher cost when we have an option that could close the coverage gap and draw down millions and millions – some estimates say billions – in federal dollars,” Chan said.
Plus, it could be tough for low-income residents, particularly those in rural areas of the state where many of the uninsured live, to work enough hours consistently to qualify, she said. And those who do may get tripped up in submitting the necessary monthly documentation.
Another issue: There are no exemptions for parents of dependent children or other caregivers, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. Other states that sought to implement work requirements during the Trump administration had such exemptions.
“A small number of people may get coverage, but the likelihood of them retaining that coverage for a while is not very high,” Alker said. “And this is an especially problematic structure for parents.”
Georgia officials, however, say Pathways to Coverage is the right program for the state.
“This approach is Georgia-centric and ensures we can expand Medicaid coverage to those who were previously ineligible without forcing others off their preferred private insurance,” the state Department of Community Health said in a statement to CNN. “Unlike the top-down approach of traditional Medicaid expansion, Georgia Pathways was developed by Georgians and is run by Georgians to address our state’s specific needs.”
This story has been updated with additional information.
Two consumer advocacy groups filed a lawsuit in a Florida federal court Tuesday seeking to halt the state’s termination of residents’ Medicaid benefits.
The suit is the first in the nation to challenge states’ resumption of reviewing Medicaid enrollees’ eligibility and dropping those deemed no longer qualified. The process, which Congress had suspended for three years during the Covid-19 pandemic, restarted as early as April, depending on the state.
The Florida Health Justice Project and the National Health Law Program filed the lawsuit on behalf of three Floridians in US District Court in Jacksonville against the state’s Agency for Health Care Administration and the Department of Children and Families. The residents are a 25-year-old woman and her 2-year-old daughter, who has cystic fibrosis, as well as a 1-year-old girl.
The plaintiffs argue that the notices the agencies are sending to inform enrollees that they are no longer eligible are confusing and don’t provide sufficient explanation as to why they are losing coverage.
“As a result, Plaintiffs and class members are losing Medicaid coverage without meaningful and adequate notice, leaving them unable to understand the agency’s decision, properly decide whether and how to contest their loss of Medicaid coverage, or plan for a smooth transition of coverage that minimizes disruptions in necessary care,” the complaint reads. “Without Medicaid coverage, Plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations, and post-partum care.”
The advocates are asking the court to require the state to stop terminating enrollees until the agencies provide adequate notice and an opportunity for a pre-termination fair hearing.
Mallory McManus, deputy chief of staff for the Department of Children and Families, called the lawsuit “baseless.” While she said the state cannot comment on pending litigation, she said the letters to recipients are “legally sufficient.”
The federal Centers for Medicare and Medicaid Services “approved the Department’s redetermination plan based on their regulations. There are multiple steps in the eligibility determination process and the final letter is just one of multiple communications from the Department,” said McManus, adding that the agency “continues to lead on Medicaid determinations and being fiscally responsible.”
The Agency for Health Care Administration did not immediately return a request for comment.
Nearly 183,000 Floridians have been issued notices saying they no longer qualify for Medicaid, according to the lawsuit. Hundreds of thousands more will have their coverage reviewed in the coming year.
In addition to those determined ineligible, nearly 226,000 were dropped for so-called procedural reasons, typically because enrollees did not complete the renewal application, according to KFF, formerly the Kaiser Family Foundation. This often happens because it may have been sent to an old address, it was difficult to understand or it wasn’t returned by the deadline.
Nearly 898,000 Florida residents have had their coverage renewed, according to KFF.
Nationwide, more than 5.2 million people have been disenrolled since the so-called Medicaid unwinding began in the spring, according to KFF. Nearly three-quarters of those who have lost coverage were dropped for procedural reasons.
Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.
Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.
The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.
But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.
“There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.
The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.
By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.
“This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”
The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.
“In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.
Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.
Only 37% of hospitals in the US nowoffer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.
While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.
The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.
In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.
“Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.
In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.
“Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.
Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.
The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.
The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.
Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.
Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.
“Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”
Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.
More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.
At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.
“Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.
And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.
“There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”
“When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.
“Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a]lower, more difficult payment environment in general, are going to find it especially hard.”
Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.
A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.
Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.
“These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”
Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.
“It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.
In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.
“That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”
When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.
“I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”
Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.
“My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”
Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are stayingin emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.
It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.
Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.
“There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.
When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.
“For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.
“If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”
Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.
“People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”
Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.
Increased access to children’s mental health services
With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.
“How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.
There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.
“If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”
Most experts CNN spoke to agreed: Seek care for your child early.
“Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”
Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.
“Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.
Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.
“A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.
After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.
It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.
“We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”
Joe Biden and Donald Trump are bizarrely on the same page on the top issue so far in the 2024 White House race, as they aim huge, possibly campaign-defining swings at Republicans who they claim will shred retirement benefits.
The current and former presidents – bitter rivals who agree on little else – are both forcing their foes into political retreats and attempts to whitewash past support for changes that could cut Medicare and Social Security payouts.
Their strategy is reinforcing a truism of presidential election campaigns that candidates who even entertain the notion of “reforming” these cherished entitlement programs for seniors are playing with fire.
With typical bluntness, Trump has blasted his potential top rival, Florida Gov. Ron DeSantis, as a “wheelchair over the cliff kind of guy” after he voted, as a member of the US House, for non-binding resolutions that would have raised the age at which most seniors can collect their benefits to 70. As a 2012 congressional candidate, he supported privatizing Social Security, CNN’s KFile has reported. But trying to ease his vulnerability on the issue, DeSantis insisted in a Fox News interview last week: “We’re not going to mess with Social Security.”
Despite his own proposed cuts to these programs as president, Trump has kept up the attacks. “We’re not going back to people that want to destroy our great Social Security system – even some in our own party; I wonder who that might be – who want to raise the minimum age of Social Security to 70, 75 or even 80 in some cases, and who are out to cut Medicare to a level that will be unrecognizable,” he said at the Conservative Political Action Conference last Saturday.
A few days later, another Republican hopeful gave both Biden and Trump a new opening to exploit.
Former South Carolina Gov. Nikki Haley was forced to make clear Thursday that her striking and unspecific call the day before for raising the retirement age was only supposed to refer to Americans currently in their 20s, who are in effect a half century away from drawing their pensions. But her clarification won’t protect the former ambassador to the United Nations from Trump, who is splitting his party down the middle, yet again, by pouncing on competitors who have voiced traditional conservative orthodoxy on cutting or changing the programs. Biden is sure to also highlight Haley’s remarks as he claims only he can thwart a secret GOP agenda to kill off the vital programs.
“I guarantee you, I will protect Social Security and Medicare without any change. Guaranteed,” the president vowed in Philadelphia on Thursday. “I won’t allow it to be gutted or eliminated as MAGA Republicans have threatened to do.”
Biden browbeat Republicans during his “State of the Union” address last month to confirm on camera that they support shoring up Social Security and Medicare. And he’s anchoring his likely reelection bid on the most forceful campaign by a Democratic candidate in years on the issue. Some of his attacks are fair; others take statements by GOP leaders out of context. But they’re still potent – since both he and Trump know that when conservatives are explaining that they don’t plan to cut Medicare or retirement benefits, they are usually trying to dig out of a losing position.
And Biden has public opinion on his side. A Fox News poll last month, for instance, showed that Democrats are preferred over Republicans to better handle Medicare (by 23 points) and Social Security (by 16 points). No wonder Biden seems to relish this particular political battlefield.
The odd confluence of approaches – from a former president who sought to overturn an election and a successor who sees his administration as vital to saving democracy – says so much about each man’s political instincts, backgrounds and campaign strategy. It is also reflects the shifting character of the Republican Party, which Trump has torn from its corporate, ideologically pure conservative roots to build a new coalition that includes working class voters, often in the Midwest, that Biden is battling hard to win back.
In one sense, possibly the most thorny domestic issue of the years to come should, of course, have a place in a presidential campaign. But when candidates use it to inflame their political bases, it only makes it harder to address in government. This is especially the case with entitlements since they cut into the DNA of each party and have defined the dividing lines between them for decades – at least until Trump came along and took over the GOP.
Ever since the New Deal reforms of Franklin Roosevelt, who was president from 1933 to 1945, Democrats – through presidents Lyndon Johnson, Barack Obama and Biden, especially – have sought to use government power to secure the living standards and health care of less well-off and elderly Americans. Republicans, from 1980s President Ronald Reagan onwards, have increasingly sought to find ways to shift the burden of some of this care to the private sector and to reduce or eliminate government’s role in an attempt to whittle away the New Deal reforms of FDR and the Great Society program of LBJ, who was president in the 1960s. They have often paid a heavy price. Republican President George W. Bush’s failed attempt to partially privatize Social Security contributed to a disastrous second term. And Trump still rails against former House Speaker Paul Ryan, who promoted a similar plan.
While raising the alarm about threats to social programs for seniors might be a shrewd political tactic – especially in mobilizing older voters more likely to show up at the polls – it usually does nothing to address the program’s increasingly dire solvency challenges.
The latest Congressional Budget Office projection found that Social Security’s retirement trust fund could be exhausted by 2032. At that point, with fewer workers paying into the program and with a rapidly aging population, benefits could be cut by at least 20%, CNN’s Tami Luhby reported. Medicare is even more precarious since its hospital insurance trust fund, known as Part A, will only be able to fully pay scheduled benefits until 2028, its trustees said in their most recent forecast.
Biden, who released a new budget on Thursday that will help shape the message of his likely reelection bid, has proposed a plan to raise taxes on people earning more than $400,000 a year to shore up the program and would expand the range of drugs for which its managers can negotiate prices. He says the move would keep Medicare solvent until 2050 and would involve no cuts in benefits. The president also wants to target those who earn more than $400,000 with increasing payroll taxes to secure Social Security for the future. There is an infinitesimal chance, however, that the Republican-led House will agree to tax increases, so Biden’s plan represents more a device to deliver a political message than a viable plan.
Despite warning his fellow Republicans to avoid cutting these programs, it’s unclear how Trump would save them if he wins back the White House – and doing nothing isn’t an option. And while other Republicans insist they don’t want to cut benefits or raise taxes, it’s unclear how they can square the circle.
Florida Sen. Rick Scott has now excluded Social Security and Medicare from his proposal for all spending programs to be reviewed every five years. His original plan, released when he was leading the Senate GOP’s campaign arm, sparked the ire of his Republican Senate colleagues, including Minority Leader Mitch McConnell, who quickly identified it as a political liability. That hasn’t stopped Biden from repeatedly claiming that it represents Republican policy.
House Speaker Kevin McCarthy has, meanwhile, said that cuts to Social Security and Medicare are “completely off the table” in what he insists must be negotiations with Biden over raising the government’s borrowing limit later this year. But that position has put him in a bind because it means that in order for the GOP to honor their pledge to slash spending, they will probably have to take aim at other social programs that could also prove unpopular with voters.
America is not the only country staring down a crisis.
French President Emmanuel Macron sparked nationwide strikes and protests with his plan to raise the retirement age to 64 from 62. Even China’s Communist Party is struggling as a falling birthrate threatens to inflict severe costs on the world’s most dynamic emerging economy.
Back in the US, whoever wins the 2024 elections for the White House and Congress, there seems no easily identifiable solution to safeguard these vital programs on which millions of Americans depend. And time is running out.
In pressing Republicans on Social Security and Medicare, President Joe Biden is reprising one of the most dramatic moments of his long career.
During the 2012 vice-presidential debate, Biden engaged in a nearly 11-minute exchange with GOP nominee Paul Ryan over Republican plans to reconfigure the two massive programs for the elderly, several of which Ryan had authored himself.
Biden and many Democrats felt he had won the argument on stage. Yet on Election Day, Ryan and GOP presidential nominee Mitt Romney routed Biden and President Barack Obama among White seniors, and beat them soundly among seniors overall, exit polls found.
That outcome underscores the obstacles facing Biden now as he tries to recapture older voters by portraying Republicans as threats to the two towers of America’s safety net for the elderly. While polls consistently show that voters trust Democrats more than Republicans to safeguard the programs, GOP presidential nominees have carried all seniors in every presidential election back to 2004 and have reached at least 58% support among White seniors in each of the past four contests, exit polls have found. Democrats have likewise consistently struggled among those nearing retirement, older working adults aged 45-64.
Those results suggest that for most older voters, affinity for the GOP messages on other issues – particularly its resistance, in the Donald Trump era, to cultural and racial change – has outweighed their views about Social Security and Medicare. Those grooves are now cut so deeply, over so many elections, that Biden may struggle to change them much no matter how hard he rails against a range of GOP proposals that could retrench or restructure the programs.
Biden’s charge that Republicans are threatening the two giant entitlement programs for the elderly – which triggered his striking back and forth exchanges with GOP legislators during the State of the Union – fits squarely in his broader political positioning as he turns toward his expected reelection campaign.
As I’ve written, the 80-year-old Biden, at his core, “remains something like a pre-1970s Democrat, who is most comfortable with a party focused less on cultural crusades than on delivering kitchen-table benefits to people who work with their hands.” As president he’s expressed that inclination primarily through what he calls his “blue-collar blueprint to rebuild America” – the planks in his economic plans, such as generous incentives to revive domestic manufacturing, aimed at creating more opportunity for workers without a college degree. Politically, Biden’s staunch defense of Social Security and Medicare, programs critical to the economic security of financially vulnerable retirees, represents a logical bookend to that emphasis.
“We all know that whose side you are on is a critical debate point for every election and this debate over Social Security and Medicare really helps crystallize whose side Biden is on versus whose side Republicans are on in a very effective way for him,” said Democratic pollster Matt Hogan, who helped conduct an extensive series of bipartisan polls during the 2022 campaign measuring attitudes among seniors for the AARP, the giant lobby for the elderly.
From Franklin Roosevelt through Hubert Humphrey and Tip O’Neill, generations of Democrats have framed themselves as the defenders of the social safety net for seniors against Republicans who they say would unravel it. Biden showed how comfortable he was stepping into those shoes during his 2012 vice-presidential debate with Ryan, then a young representative from Wisconsin who Romney had selected as his running mate.
Nearly 30 years Biden’s junior, Ryan was an unflinching advocate of restructuring Social Security and Medicare to reduce costs over time. In particular, Ryan was the principal supporter of a conservative plan to convert Medicare, the giant federal health insurance program for the elderly, into a system called “premium support.” Under that proposal, Medicare would be transformed from its current structure, in which the government directly pays doctors and hospitals who provide care for beneficiaries, into a voucher (or “premium support”) system, in which the government would provide recipients a fixed sum to purchase private insurance. Ryan had also drafted proposals to partially privatize Social Security by allowing workers to divert part of their payroll taxes into private investment accounts, a change that would have reduced the tax dollars flowing into the system and eventually required substantial cuts in guaranteed benefits.
For nearly 11 minutes during the debate in October 2012, moderator Martha Raddatz of ABC skillfully guided Biden and Ryan through a heated, but civil and substantive, discussion of Social Security and Medicare’s future. Ryan insisted that changes were needed to preserve the programs’ long-term viability and that current seniors and those near retirement would not see their benefits reduced.
Biden appealed openly to the Democrats’ historic image as the programs’ protectors and condemned Ryan and the GOP for wanting to partially privatize them. At one point in the debate, Biden declared: “we will be no part of a [Medicare] voucher program or the privatization of Social Security.” A few moments later, he insisted: “These guys haven’t been big on Medicare from the beginning. And they’ve always been about Social Security as little as you can do. Look, folks, use your common sense. Who do you trust on this?”
At the time, Democrats felt Biden had at least held his own, restoring the party’s momentum after Obama’s surprisingly listless performance eight days earlier in his first debate against Romney. And Democrats through the rest of the campaign railed against the Republican ticket as a threat to Social Security and Medicare.
But on election day, those arguments did not translate into gains for Obama and Biden among seniors or the older working adults (aged 45-64) nearing retirement. As Hogan noted, the newly passed Affordable Care Act, which generated some of its funding through savings in Medicare, was extremely unpopular at the time among older voters. Obama and Biden not only lost seniors and the older working age adults, but actually ran slightly more poorly among both groups in 2012 than they did in 2008.
In fact, no Democratic presidential nominee since Al Gore in 2000 has carried most seniors in a presidential campaign; Obama in 2008 was the only one since Gore to carry most of the older working age adults. Among older Whites, the Democratic deficit is even more pronounced: the Republican presidential nominee has carried around three-fifths of both White seniors and those nearing retirement in each of the past four elections. Biden in 2020 slightly improved on Hillary Clinton’s anemic 2016 performance with both groups, but still lost to Trump by 15 percentage points among White seniors and by 23 points among the Whites nearing retirement, according to the exit polls conducted by Edison Research for a consortium of media organizations including CNN. Biden performed especially poorly among older Whites without a college degree – an economically stressed group heavily reliant on the federal retirement programs.
Estimates by Catalist, a Democratic targeting firm, and the Pew Research Center likewise found that Trump in both 2016 and 2020 beat his Democratic opponents among both seniors and the older working adults. Like the exit polls, the Catalist data show the Republican nominees carrying about three-fifths of White seniors and older working adults in each of the past three presidential elections.
The story is similar in congressional contests. In House elections, the exit polls found Republicans winning all seniors and older working adults comfortably in the 2014 and 2022 midterm campaigns and narrowly carrying them even in 2018 when Democrats romped overall. In all three of those midterm congressional elections, Republicans carried about three-fifths of the near retirement White adults, while they also reached that elevated threshold among White seniors in both the 2014 and 2022 campaigns.
Republicans have maintained these advantages with older voters despite polls showing that most Americans trust Democrats more than the GOP to protect Social Security and Medicare, and that most Americans, especially seniors, oppose the intermittently surfacing GOP proposals to partially privatize both programs.
Politically, “Democrats have used Social Security and Medicare really a lot over the past two or three decades, maybe four decades,” said Jim Kessler, executive vice president for policy at Third Way, a centrist Democratic group. “The payoff has been a lot less than Democrats have generally thought it would be.”
Could this time be different for Biden and the Democrats? Congressional Republicans have certainly provided plenty of evidence for his claim that they still hope to restructure the programs. The proposed 2023 budget by the Republican Study Committee, the members of which include about three-fourths of House Republicans, reprises the ideas of converting Medicare into a premium support system and establishing private investment accounts under Social Security, while also raising the retirement age for both programs and reducing Social Security benefits over time. And although Florida Sen. Rick Scott renounced the idea late last week, his “Rescue America” agenda did include a proposal to require Congress to reauthorize all federal programs, including Social Security and Medicare, every five years.
These ideas have precipitated an unusual degree of open Republican dissension. Senate GOP Leader Mitch McConnell repeatedly, and unreservedly, denounced the Scott plan until the Florida senator backed off. Trump recently released a video in which he declared the GOP should not cut “a single penny” of Social Security or Medicare benefits – which put him directly at odds with the three-fourths of House Republicans in the Republican Study Committee. House Speaker Kevin McCarthy, bending more toward Trump’s position, seems unlikely to incorporate into the GOP budget plans the RSC’s most sweeping changes in Social Security and Medicare.
Kessler believes Biden may succeed where other Democrats have failed at hurting the GOP with the issue, and he argued that the conspicuous Republican infighting demonstrates they share that concern. “We are watching a high-profile battle that I’ve never really seen before on these issues in the Republican Party,” Kessler said. “And part of it is clearly they think it’s a problem when they didn’t years ago. If they think it’s a problem, maybe it’s a problem.”
Stuart Stevens, who served as Romney’s chief strategist in the 2012 campaign but has since become a fierce critic of the Trump-era GOP, also believes the party could face more risk over its entitlement agenda than it did back then. The reason is that he thinks the idea of sunsetting Social Security and Medicare every five years, even if Scott is trying to jettison it, may prove more immediately tangible and understandable to voters than Ryan’s complex ideas of partially privatizing both programs.
“The question I always ask myself in campaigns is ‘are you talking about something the other side doesn’t want to talk about?’” Stevens said. “That’s probably a good sign that they are losing on the issue.”
Whether Biden proves more effective than other recent Democrats at attracting older voters around Social Security and Medicare will likely pivot on whether seniors believe the GOP genuinely would cut the programs if given the power to do so, argued Robert Blendon, a professor emeritus at the Harvard School of Public Health, who specializes in public attitudes about the social safety net. “If the senior community actually believes that it’s being threatened it really would affect their votes,” he predicted. But, he added, “as long as they are not threatened, the other values of seniors on top issues more and more correspond with Republicans.”
There’s no doubt about the second half of that equation. Polling has consistently found that older Whites, in particular, are more receptive than their younger counterparts to hardline Trump-era GOP messages around crime, immigration and the broader currents of racial and cultural change: for instance, about half of Whites older than 50 agree that discrimination against Whites is now as big a problem as bias against minorities, a far higher percentage than among younger Whites, according to a new national survey by the Public Religion Research Institute. Older Whites are also more likely than younger generations to lack a college degree or to identify as Christians, attributes that generally predict sympathy for GOP cultural and racial arguments.
Through the 21st century, those cultural and racial attitudes among older White voters have consistently trumped any concerns they may hold about the Republican commitment to Social Security and Medicare. Despite Biden’s impassioned articulation of the case against the GOP, that didn’t change even in 2012 when Republicans placed on their national ticket a vice presidential nominee who directly embodied the GOP aspirations to reconfigure and retrench those programs.
Even small changes in seniors’ preferences could have a big impact in closely balanced states with a large retiree population like Arizona and Pennsylvania. But the entrenched GOP advantage among older voters over the past two decades suggests Biden’s hopes in 2024 may pivot less on improving with the “gray” than maximizing his vote among the “brown”: the diverse, younger generations that recoil from the same Republican messages on culture and race that electrify so many older Whites.
The majority of American children now receive their health insurance through Medicaid and the Children’s Health Insurance Program, according to a new report published Wednesday by the Georgetown Center for Children and Families.
But that could change starting this spring. As many as 6.7 million children are at risk of losing that coverage once states restart their reviews of recipients’ eligibility, according to Georgetown.
Medicaid enrollment ballooned during the pandemic thanks to an early Covid-19 pandemic relief provision passed by Congress that barred states from involuntarily disenrolling beneficiaries in exchange for higher federal matching funds. But lawmakers voted late last year to end that continuous enrollment provision on April 1, freeing states to start winnowing ineligible recipients.
More than 42 million children were covered by Medicaid and CHIP as of August, up 17.5% from February 2020, just before the pandemic started.
Ten states plus the District of Columbia have more than 60% of their children insured through the public programs, according to Georgetown. New Mexico leads the nation with more than three-quarters of its kids covered by Medicaid and CHIP.
By contrast, fewer than a quarter of children in Utah are enrolled in the programs.
The number of children who gained Medicaid and CHIP coverage during the pandemic varied by state. Indiana had the largest surge, with a nearly 45% increase. Wyoming, North Dakota, Missouri and Georgia saw their child enrollment grow by roughly a third.
On the flip side, Vermont experienced less than an 8% growth in child enrollment in Medicaid and CHIP.
More than 83 million people, including more than 34 million children, were covered by Medicaid as of August. And another 4 million children were enrolled in Medicaid financed by CHIP. All will have their eligibility reviewed, and in some cases, the children will continue to qualify even if their parents do not.
“If they’re getting the message that they’re losing their own coverage, a lot of times a parent understandably thinks that their child is also losing coverage,” said Joan Alker, executive director of the Georgetown Center for Children and Families.
A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.
When states reevaluate families’ eligibility, they need to look separately at adults and children, Alker said. Officials should work with pediatricians, schools, child care centers and others to explain the situation to parents and make sure the children retain coverage if they continue to qualify.
Nearly three-quarters of the children projected to be dropped will remain eligible for Medicaid but will likely lose coverage because of administrative issues, such as their parents not submitting the necessary paperwork or procedural errors, according to Georgetown.
Although states have 14 months to complete the unwinding process, some will look to do so more quickly.
“My concern is that a large number of children could become uninsured in states that do not take their time and pay particular attention to the unique needs of children,” Alker said.
“In the next 11 years, we have to have a better plan in place than what we do today. Or we’re going to see – under existing circumstances – some reductions of as much as 24% in some sort of a benefit. So, let’s start talking now because it’s easier to fix it now that it would be five years or six years from now,” Rounds told CNN’s Jake Tapper on “State of the Union.”
In recent days, President Joe Biden has made a forceful argument against Republicans by highlighting his support for Social Security and Medicare. The president has specifically seized on a proposal from GOP Sen. Rick Scott of Florida to sunset federal legislation – including Social Security and Medicare – every five years and require Congress to pass them again.
Referencing his “spirited debate” with Republicans at the State of the Union, Biden called Scott’s proposal “outrageous” and vowed he would veto such a plan during a speech in Florida last week.
“The very idea the senator from Florida wants to put Social Security and Medicare on the chopping block every five years I find to be somewhat outrageous. So outrageous that you might not even believe it,” he said, pulling out a pamphlet detailing Scott’s plan.
Scott told CNN’s Kaitlan Collins last week that his proposal is intended to eliminate wasteful spending and help ensure the government can “figure out how to start living within our means.”
“I want to make sure we balance our budget and preserve Medicare and Social Security, and I’ve been clear all along,” he said.
Rounds also stressed Sunday that Republicans want to better manage Medicare and Social Security in order to improve the programs – not strip them from the American people.
“We think that there are possibilities out there of long-term success without scaring people and without tearing apart the system and without reducing benefits. But it requires management. And it requires actually looking at and making things better,” he said.
President Joe Biden has gone on the attack over Social Security and Medicare.
In speeches and tweets this week, Biden and his White House have singled out particular Republican senators – notably including Sen. Mike Lee of Utah, Sen. Rick Scott of Florida and Sen. Ron Johnson of Wisconsin – over proposals from those senators that could affect the retirement and health care programs.
The Republican senators have responded forcefully, accusing Biden of deceiving the public about where they stand. Here is a fact-check of the exchanges.
Biden and his White House targeted Lee on Wednesday over a video clip of Lee saying, “I’m here right now to tell you one thing that you probably have never heard from a politician. It will be my objective to phase out Social Security, to pull it up by the roots and get rid of it.” The clip has gone viral on Twitter this week; a second viral clip features Lee saying moments later, “Medicare and Medicaid are of the same sort and need to be pulled up.”
The videos are authentic, though Biden didn’t tell his Wednesday speech audience in Wisconsin they are from more than 12 years ago – an event in 2010, when Lee was running for the Senate but before he was first elected. And as Lee noted in Wednesday tweets responding to Biden, Biden didn’t mention that Lee added at the same 2010 event that current Medicare beneficiaries should have their benefits “left untouched” and that “the next layer beneath them, those who will retire in the next few years, also probably have to be held harmless.”
Still, while Biden could have included more context, he was accurate in saying Lee had called for Social Security to be phased out.
And while Lee said in a tweeted statement on Wednesday that, during his 12 years as a senator, he has not called for “abolishing” Social Security, Medicare or Medicaid benefits, only for “solutions to improve those programs and move them toward solvency,” he has supported benefit cuts. For example, he has endorsed various proposals over the years to raise the Social Security retirement age.
Since last year, Biden has criticized Scott over particular components of what Scott calls his “12 Point Plan to Rescue America.”
In the State of the Union address on Tuesday and in speeches on Wednesday and Thursday, the president referred to a part of Scott’s plan that says, “All federal legislation sunsets in 5 years. If a law is worth keeping, Congress can pass it again.” Biden correctly asserted that “all federal legislation” would include Social Security and Medicare, which do not currently require congressional re-approval.
Scott responded by accusing Biden of being dishonest and confused. Scott argued on Twitter on Wednesday that while his plan does say that “all” federal legislation should sunset in five years and become subject to a new vote by Congress, “This is clearly & obviously an idea aimed at dealing with ALL the crazy new laws our Congress has been passing of late.”
But the plan itself doesn’t say that.
The plan’s official text, which remains online on a dedicated website, says “all federal legislation,” period, should be sunset in five years – not all recent legislation, all crazy legislation or all legislation except for the laws that created Social Security and Medicare. When Senate Minority Leader Mitch McConnell rejected Scott’s plan last year, McConnell too said that the plan “sunsets Social Security and Medicare within five years.”
Last year, Biden sometimes overstated the support for Scott’s sunset proposal among congressional Republicans, which appears very limited. Biden has been more precise in his speeches this week, attributing the proposal to Scott himself or accurately saying in the State of the Union that “some” Republicans – “I’m not saying it’s a majority” – support it.
Biden may have created an inaccurate impression, however, by mentioning the sunset proposal during the section of the State of the Union in which he discussed the battle over the debt ceiling. There is no indication that House Republicans are pushing this proposal as part of the current debt ceiling negotiations with the Biden administration, and House Speaker Kevin McCarthy has, more generally, said cuts to Social Security and Medicare are “off the table” in these negotiations.
Scott, in turn, has tossed a false claim into the debate with Biden this week by repeatedly accusing the president of having cut billions from Medicare in last year’s Inflation Reduction Act. The Inflation Reduction Act did not cut Medicare benefits; rather, it allowed the government and seniors to spend less money to buy prescription drugs – and, in fact, simultaneously made Medicare benefits more generous to seniors. The claim of a Medicare cut was repeatedly debunked last year, when Scott and a Republican campaign organization he chaired used it during the midterm elections.
On Friday afternoon, the day after McConnell told a Kentucky radio station that Scott’s proposal will be a “challenge” for Scott’s own 2024 re-election campaign in a state with a large population of seniors, Scott announced he is introducing a new bill that would make it more difficult for Congress to make any cuts to Social Security and Medicare and that would send the Inflation Reduction Act’s $80 billion in Internal Revenue Service funding to Social Security and Medicare instead.
This week and in numerous previous speeches, Biden has castigated Johnson for saying last year that Medicare and Social Security should be treated as discretionary spending, which Congress has to approve every year, rather than as permanent entitlements.
Biden has accurately cited Johnson’s remarks this week. Here’s what Johnson told a Green Bay radio show in August: “We’ve got to turn everything into discretionary spending, so it’s all evaluated, so that we can fix problems or fix programs that are broken, that are going to be going bankrupt. Because, again, as long as things are on automatic pilot, we just continue to pile up debt.” When Johnson faced criticism for those remarks at the time, he stood by them and said that was his consistent longtime position.
Johnson, however, claimed Wednesday that Biden was “lying” when the president discussed Johnson’s comments shortly after saying that some Republicans want to “cut” Social Security. Johnson has repeatedly said that his proposal to require annual approval for Social Security spending, and to “fix” and “save” Social Security in light of its poor fiscal shape at present, does not mean that he wants to put the programs on the “chopping block” or even to “cut” it.
“The Democrats have been accusing me, since the first time I ran for office, of wanting to end Social Security, wanting to cut it, wanting to gut it, wanting to – I’ve never said that. I’ve always been consistent: I want to save it,” he said in a radio interview this week.
It’s impossible to definitively fact-check this particular dispute without Johnson specifying how he wants to “fix” and “save” the program. His office did not respond to a CNN request for comment.
White House deputy press secretary Andrew Bates noted in an email to reporters on Thursday that, though Johnson accused Biden this week of lying about his stance on Social Security, Johnson also said in interviews this week that Social Security is a “legal Ponzi scheme” and that “Social Security might be in a more stable position for younger workers” if the government had proceeded with Republican President George W. Bush’s controversial and eventually abandoned proposal in the mid-2000s to allow workers born after 1949 to divert a portion of their Social Security payroll taxes into private accounts in which they could buy into the stock market and make other investments.
Florida Sen. Rick Scott has emerged as Joe Biden’s top Republican foil in the days since the president’s State of the Union address, with the White House seizing on a year-old Scott proposal that even GOP leaders recognized at the time as politically toxic.
As a spending fight looms in Washington and Biden moves toward his 2024 reelection bid, the White House is attempting to make Scott the poster child for the president’s accusations that Republicans are seeking to cut entitlement programs, including Social Security and Medicare.
Scott has responded by accusing Biden of lying, airing a misleading ad that alleges Biden cut Medicare and lambasting the president in a barrage of television interviews.
Biden traveled Thursday to Florida – where Scott was a health care executive and two-term governor – on the latest leg of his post-State of the Union tour.
The trip was designed in part to stoke a fight with Scott after Biden in his speech Tuesday night seized on the first-term senator’s proposal to sunset all federal programs – including Social Security and Medicare – every five years unless Congress extends those programs.
Biden’s assertion that some Republicans are seeking to change entitlement programs was met with jeers from Republican lawmakers, who have said spending cuts should be part of any proposal to raise the debt ceiling.
The president continued pressing that message Wednesday in Wisconsin, telling union workers, “A lot of Republicans, their dream is to cut Social Security and Medicare.” He waved a pamphlet with Scott’s proposal as he spoke.
Ahead of Biden’s speech Thursday in Tampa, White House aides placed copies of Scott’s proposal on every seat.
In an interview with CNN’s Kaitlan Collins on Thursday, Scott said Biden has misrepresented the proposal he put forward ahead of the 2022 midterm elections while serving as head of the National Republican Senatorial Committee, the campaign arm of the Senate GOP.
“Nobody believes that I want to cut Medicare or Social Security. I’ve never said it,” Scott said.
Scott said his proposal is intended to eliminate wasteful spending and help ensure the government can “figure out how to start living within our means.”
“I want to make sure we balance our budget and preserve Medicare and Social Security, and I’ve been clear all along. So what I want to do is get rid of wasteful programs that we never review up here,” he said.
But Scott’s proposal would sunset all federal legislation – including the two entitlement programs – every five years and require Congress to pass them again.
Long before he was a US senator, Scott had first-hand experience dealing with America’s federal health care programs – and it became the source of much criticism as he entered the political arena.
In the 1980s, Scott founded Columbia Hospital Corporation by purchasing a pair of distressed Texas hospitals. He later merged his company with Hospital Corporation of America to create Columbia/HCA, becoming the largest for-profit hospital chain at the time and gaining notoriety on Wall Street for what appeared like cost-cutting in an industry with ballooning expenses.
In 1997, federal agents unveiled a sweeping investigation into Columbia/HCA that would roil the company for years. On the day the FBI swooped in to seize records from 35 of its hospitals across six states, Scott shrugged off the probe. “It’s not a fun day, but … government investigations are a matter of fact today in health care,” he said on CNN.
The investigation would unearth what the US Department of Justice later called the “largest health care fraud case in U.S. history.” According to a press release, Columbia/HCA schemed to defraud Medicare, Medicaid and TRICARE, the military’s health care program, of hundreds of millions of dollars. The company pleaded guilty to criminal conduct, including charges related to fraudulent Medicare billing and paying kickbacks to doctors, and it ultimately agreed to pay $1.7 billion in fines, damages and penalties.
Scott was pushed out as CEO amid the turmoil. He was never charged with a crime, though much of the alleged financial abuses took place during his watch. His time in the corporate world made Scott a wealthy individual, which he would lean on in 2010 when he decided to kickstart a political career by entering the race for Florida governor.
Scott’s time at the helm of Columbia/HCA was the subject of negative ads from both Republicans and Democrats, but he fended them off with a self-funded campaign that flooded the airwaves with a jobs-focused message. He told the St. Petersburg Times that “mistakes were made” at his former company and that he had “learned hard lessons,” but he also said during a debate that he was “proud of the company I built.” Regardless of the controversy, the little-known Scott defeated a GOP favorite for his party’s nomination, and Floridians narrowly elected him governor that fall.
Marching to the beat of his own drum, Scott declined to be sworn in with his class in January 2019. Instead, he waited until his term as governor had ended and flew to Washington for a separate ceremony. For a time, it made him the country’s most junior senator, but he nevertheless soon found himself in party leadership.
Scott and other Republicans are aggressively pushing back against Biden’s assertions that the GOP is seeking to cut spending on entitlement programs.
However, Republican leaders have long recognized Scott’s proposal to sunset all federal programs after five years as rocky political terrain.
The tense relationship between Scott and Senate Minority Leader Mitch McConnell burst into public view during the 2022 election cycle as Republicans sought to retake the Senate.
Scott, as NRSC chairman, released a platform called “Rescue America,” which would have subjected all federally elected officials to a term limit of 12 years and closed the Department of Education, amid a slew of other initiatives. It would also have required millions of low-income and middle-class Americans to pay income taxes, which was later dropped in a revised version of the plan.
And, in what Democrats immediately recognized as an opening to accuse Republicans of attempting to undercut popular programs, Scott’s plan proposed sunsetting all federal legislation in five years – unless Congress extended it.
McConnell quickly disavowed Scott’s plan, seeking to make clear that the Florida senator did not speak for Senate Republicans.
“Let me tell you what would not be a part of our agenda,” McConnell said at a news conference last March. “We will not have as part of our agenda a bill that raises taxes on half the American people, and sunsets Social Security and Medicare within five years.”
Their frosty relationship did not improve as the 2022 election cycle continued, as the two battled over which candidates to support in primaries and in the general election, and Republicans ultimately fell short of winning a majority.
After the election, Scott challenged McConnell for the top Senate Republican post but lost.
The Florida senator said last week that he saw McConnell’s decision to remove him from the Senate Commerce Committee as retribution.
“He didn’t like that I opposed him because I believe we have to have ideas – fight over ideas,” Scott said on “CNN This Morning.”
When pressed Thursday by CNN’s Collins about why his proposal left open the opportunity for the government to cut funding for Social Security and Medicare, Scott repeatedly referenced a policy proposal from then-Sen. Biden in 1975 to sunset federal legislation periodically.
Scott said Biden’s old proposal does less to protect entitlements for seniors than the senator’s plan from last year because “he proposed it year after year after year to reduce Medicare and Social Security. Year after year. I’ve never done that. I don’t believe in that.”
Asked Thursday about the 1975 proposal mentioned by Scott, White House press secretary Karine Jean-Pierre said, “A bill from the 1970s is not part of the president’s agenda.”
“The president ran on protecting Medicare and Social Security from cuts. And he reiterated that in the State of the Union,” she said.
A new ad from Scott released this week in advance of the president’s visit to Florida says that “Joe Biden just cut $280 billion from Medicare” – a claim that was previously debunked when Scott and the NRSC made it in 2022.
Biden’s Inflation Reduction Act is expected to reduce Medicare prescription drug spending by the federal government by $237 billion, according to the most recent Congressional Budget Office estimate, because the law allows the government to spend less money to buy drugs from pharmaceutical companies and not because it cuts benefits to seniors enrolled in Medicare. The law makes Medicare’s prescription drug program substantially more generous to seniors while also saving them money.
Scott, in his interview with Collins, also defended his recent call for Biden to resign, labeling him “a complete failure.” He said his resignation calls did not specifically stem from Biden’s use of his proposal as an avenue to attack Republicans but expressed his displeasure with the president’s repeated references to his plan.
“He lies about what I want to get done, and I don’t appreciate it,” Scott said.
The White House, in a statement of administration policy announcing opposition to two Republican measures to end the emergencies, said the national emergency and public health emergency authorities declared in response to the pandemic would each be extended one final time to May 11.
“This wind down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the (public health emergency),” the statement said.
The statement added, “To be clear, continuation of these emergency declarations until May 11 does not impose any restriction at all on individual conduct with regard to COVID-19. They do not impose mask mandates or vaccine mandates. They do not restrict school or business operations. They do not require the use of any medicines or tests in response to cases of COVID-19.”
The statement came in response to a pair of measures before the House that would end the public health emergency and the Covid-19 national emergency.
The White House weighed in because House Democrats were concerned about voting against the Republican legislation to end the public health emergency that is coming to the floor this week without a plan from the Biden administration, a senior Democratic aide told CNN.
“Democrats were concerned about the optics of voting against Republicans winding down the public health emergency, absent an understanding of whether and how we intended to do so from the White House,” the aide said. “As soon as we saw this bill, it obviously concerns the White House. So, it was important for them to weigh in.”
The administration argues that the bills are unnecessary because it intends to end the emergencies anyway. The White House also noted the passage of the measures ahead of May 11 would have unintended consequences, such as disrupting the administration’s plans for ending certain policies that are authorized by the emergencies.
The White House said it would extend the Covid-19 emergencies one final time in order to ensure an orderly wind-down of key authorities that states, health care providers and patients have relied on throughout the pandemic.
A White House official pointed to a successful vaccination campaign and reductions in Covid cases, hospitalizations and deaths as a rationale for lifting the emergency declarations. The official said a final extension will allow for a smooth transition for health care providers and patients and noted that health care facilities have already begun preparing for that transition.
The administration is actively reviewing flexible policies that were authorized under the public health emergency to determine which can remain in place after it is lifted on May 11.
The aide told CNN that it will be up to every member to decide what is best for their district and how they will vote on the legislation this week. Declaring an end to the public health emergency will also end the border restriction known as Title 42, which will also likely set up a showdown on Capitol Hill.
The public health emergency has enabled the government to provide many Americans with Covid-19 tests, treatments and vaccines at no charge, as well as offer enhanced social safety net benefits, to help the nation cope with the pandemic and minimize its impact.
“People will have to start paying some money for things they didn’t have to pay for during the emergency,” said Jen Kates, senior vice president at the Kaiser Family Foundation. “That’s the main thing people will start to notice.”
Most Americans covered byMedicare, Medicaid and private insurance plans have been able to obtain Covid-19 tests and vaccines at no cost during the pandemic. Those covered by Medicare and private insurance have been able to get up to eight at-home tests per month from retailers at no charge. Medicaid also picks up the cost of at-home tests, though coverage can vary by state.
Those covered by Medicare and Medicaid have also had certain therapeutic treatments, such as monoclonal antibodies, fully covered.
Once the emergency ends, Medicare beneficiaries generally will face out-of-pocket costs for at-home testing and all treatment. However, vaccines will continue to be covered at no cost, as will testing ordered by a health care provider.
State Medicaid programs will have to continue covering Covid-19 tests ordered by a physician and vaccines at no charge. But enrollees may face out-of-pocket costs for treatments.
Those with private insurance could face charges for lab tests, even if they are ordered by a provider. Vaccinations will continue to be free for those with private insurance who go to in-network providers, but going to an out-of-network providers could incur charges.
Covid-19 vaccinations will be free for those with insurance even when the public health emergency ends because of various federal laws, including the Affordable Care Act and pandemic-era measures, the Inflation Reduction Act and a 2020 relief package.
Americans with private insurance have not been charged for monoclonal antibody treatment since they were prepaid by the federal government, though patients may be charged for the office visit or administration of the treatment. But that is not tied to the public health emergency, and the free treatments will be available until the federal supply is exhausted. The government has already run out of some of the treatments so those with private insurance may already be picking up some of the cost.
The uninsured had been able to access no-cost testing, treatments and vaccines through a different pandemic relief program. However, the federal funding ran out in the spring of 2022, making it more difficult for those without coverage to obtain free services.
Pfizer and Moderna have already announced that the commercial prices of their Covid-19 vaccines will likely be between $82 and $130 per dose – about three to four times what the federal government has paid, according to Kaiser.
The public health emergency has also meant additional funds for hospitals, which have been receiving a 20% increase in Medicare’s payment rate for treating Covid-19 patients.
Also, Medicare Advantage plans have been required to bill enrollees affected by the emergency and receiving care at out-of-network facilities the same as if they were at in-network facilities.
This will end once the public health emergency expires.
But several of the most meaningful enhancements to public assistance programs are no longer tied to the public health emergency. Congress severed the connection in December as part of its fiscal year 2023 government funding package.
Most notably, states will now be able to start processing Medicaid redeterminations and disenrolling residents who no longer qualify, starting April 1. They have 14 months to review the eligibility of their beneficiaries.
As part of a Covid-19 relief package passed in March 2020, states were barred from kicking people off Medicaid during the public health emergency in exchange for additional federal matching funds. Medicaid enrollment has skyrocketed to a record 90 million people since then, and millions are expected to lose coverage once states began culling the rolls.
A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.
Many who are disenrolled from Medicaid, however could qualify for other coverage.
Food stamp recipients had been receiving a boost during the public health emergency. Congress increased food stamp benefits to the maximum for their family size in a 2020 pandemic relief package.
The Biden administration expanded the boost in the spring of 2021 so that households already receiving the maximum amount and those who received only a small monthly benefit get a supplement of at least $95 a month.
This extra assistance will end as of March, though several states have already stopped providing it.
Congress, however, extended one set of pandemic flexibilities as part of the government funding package.
More Medicare enrollees are able to get care via telehealth during the public health emergency. The service is no longer limited just to those living in rural areas. They can conduct the telehealth visit at home, rather than having to travel to a health care facility. Plus, beneficiaries can use smartphones and receive a wider array of services via telehealth.
These will now continue through 2024.
This story has been updated with additional details.
The Biden administration wants to make it easier for women to access birth control at no cost under the Affordable Care Act, reversing Trump-era rules that weakened the law’s contraceptive mandate for employer-provided health insurance plans.
The proposed rule, unveiled Monday by the departments of Health and Human Services, Labor and Treasury, would remove an exemption to the mandate that allows employers to opt out for moral convictions. It would also create an independent pathway for individuals enrolled in plans offered by employers with religious exemptions to access contraceptive services through a willing provider without charge.
The proposed rule would leave in place the existing religious exemption for employers with objections, as well as the optional accommodation for contraceptive coverage.
The administration crafted the proposed rule keeping in mind the concerns of employers with religious objections and the contraceptive needs of their workers, a senior HHS official told CNN.
“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” the official said, stressing that there should be no effect on religiously affiliated employers.
Students at religiously affiliated colleges would have access to the expanded accommodation, just like workers in group health plans where the employer has claimed the exemption.
Now that the proposed rule has been announced, the public will have the opportunity to comment during the next few months. Officials expect there to be many thousands of public comments, and it will be “many months” before the rule could be finalized.
HHS expects the proposal would affect more than 100 employers and 125,000 workers, mainly through providing the proposed independent pathway for employees to receive no-cost contraception.
Women using that pathway would obtain their birth control from a participating provider, who would be reimbursed by an insurer on the Affordable Care Act exchanges. The insurer, in turn, would receive a credit on the user fee it pays the government.
“If this rule is finalized, individuals who have health plans that would otherwise be subject to the ACA preventive services requirements but have not covered contraceptive services because of a moral or religious objection, and for which the sponsoring employer or college or university has not elected the optional accommodation, would now have access,” Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said in a news release.
How many people benefit, however, would depend on whether women and their health care providers know the independent pathway exists and whether providers and insurers are willing to set it up.
“We’ll just have to see how widely that information is spread and in what way to providers and individuals,” said Laurie Sobel, associate director for Women’s Health Policy at the Kaiser Family Foundation, noting that the proposed rule would not require data collection to show the pathway’s takeup.
But the Planned Parenthood Federation of America cheered the initiative.
“Employers and universities should not be able to dictate personal health care decisions and impose their views on their employees or students,” said Alexis McGill Johnson, the group’s CEO. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”
The requirement to provide no-cost contraception is not in the Affordable Care Act itself. Instead, HHS under former President Barack Obama included it as one of the women’s preventive services that all private insurance plans must offer without charge.
The mandate was controversial from the start, sparking lawsuits from religiously affiliated employers and closely held companies that said it violated their beliefs. Exemptions and accommodations have been available for such employers.
The Trump administration, however, weakened the mandate. Under the rules issued in 2018, entities that have “sincerely held religious beliefs” against providing contraceptives are not required to do so. That provision also extends to organizations and small businesses that have objections “on the basis of moral conviction which is not based in any particular religious belief.”
The rules also include an optional accommodation that lets objecting employers and private universities remove themselves from providing birth control coverage while still allowing their workers and dependents access to contraception. But the employer or university has to voluntarily elect the accommodation, which risks leaving many without access.
The Trump administration changes were temporarily blocked after a Pennsylvania district court judge issued a nationwide injunction in 2019. But the following year, the Supreme Court ruled that the administration could expand exemptions for employers who have religious or moral objections to covering contraception.
At the time, the National Women’s Law Center estimated that the ruling would impact about 64.3 million women in the United States with insurance coverage that included birth control and other preventive services without out-of-pocket costs.
Employers are not required to notify HHS if they have a moral objection. The agency estimates about 18 employers have claimed that exemption and around 15 employees are affected.
Still, if the rule is finalized, senior HHS officials say it is “plausible” there could be potential lawsuits brought by religiously affiliated employers – similar to what has been seen in the past.
“There’s no new obligation on them to participate in any sort of process. This is simply an additional channel for employees in those employer health plans to receive access to contraceptive services,” another senior HHS official said.
The contraceptive mandate has taken on increased importance now that the Supreme Court has overturned Roe v. Wade, allowing many states to impose severe restrictions on abortion access.
The Biden administration in turn has focused on continuing access to birth control at no cost. The Health, Labor and Treasury department secretaries last year met with health insurers and issued guidance underscoring Obamacare’s contraceptive coverage requirements for private insurance under the Affordable Care Act.
“Now more than ever, access to and coverage of birth control is critical as the Biden-Harris Administration works to help ensure women everywhere can get the contraception they need, when they need it, and – thanks to the ACA – with no out-of-pocket cost,” HHS Secretary Xavier Becerra said in a news release.
This story has been updated with additional information.
Senior citizens and other Social Security recipients will start getting a heftier monthly benefit next month due to an 8.7% annual cost-of-living adjustment aimed at helping them cope with high inflation.
The increase, the largest in more than 40 years, will boost retirees’ monthly payments by more than $140 to an estimated average of $1,827 for 2023.
The adjustment is the highest that most current beneficiaries have ever seen because it is based on an inflation metric from August through October, which was also around 40-year highs. Inflation has cooled somewhat since then, though prices remain elevated.
“I’m sure everyone is anxiously awaiting because prices are still high,” said Mary Johnson, a Social Security and Medicare policy analyst at The Senior Citizens League, an advocacy group. “Just shopping for food to feed people during the holidays is going to be a huge challenge.”
Many senior citizens depend heavily on Social Security. Some 42% of elderly women and 37% of elderly men rely on the monthly payments for at least half their income, according to the Social Security Administration.
Just when the beefed-up payment will arrive depends on recipients’ ages and birth dates. Those who received Social Security before May 1997 get their monthly benefit on the 3rd of each month. For more recent retirees, those whose birth dates are the 1st through the 10th of the month receive it on the second Wednesday, while those born on the 11th to 20th and the 21st to 31st of the month are paid the third and fourth Wednesdays, respectively.
Even though recipients received a sizable adjustment for this year, inflation ate away at the boost.
The increase fell short of actual inflation by an average of more than $42 – or 46% – every month or roughly $508 for the year, Johnson said.
Many retirees have been forced to turn to their savings or public assistance. One-third of seniors reported signing up for food stamps or visiting a food pantry over the past 12 months, compared with 22% in 2020, according to recent surveys by The Senior Citizens League. Also, 17% have applied for assistance with heating costs, compared with 10% in 2020.
This is not a new problem. Benefits have not kept up with the rising cost of living for years, even with the annual adjustments.
As of March, inflation has caused Social Security payments to lose 40% of their buying power since 2000, according to a study released earlier this year by the league. Monthly benefits would have to increase by $540 to maintain the same level of buying power as in 2000.
Senior citizens will also see their Medicare Part B premiums drop in 2023, the first time in more than a decade that the tab will be lower than the year before, the Centers for Medicare and Medicaid Services announced in the fall. It’s only the fourth time that premiums are declining since Medicare was created in 1965.
The standard monthly premiums will be $164.90 in 2023, a decrease of $5.20 from 2022.
Also, spending was lower than projected on other Part B items and services, which resulted in much larger reserves in the Part B trust fund, allowing the agency to limit future premium increases.
The big annual adjustment could end up hurting some seniors, Johnson said.
For instance, the resulting increase in income could push them above the thresholds for certain government benefits, such as Medicare Extra Help, Medicaid, food stamps and rental assistance, leaving them eligible for less or no aid. Or they could have to pay more for their Medicare Part B premiums, which are adjusted for income.
Also, they could have to start paying taxes – or owe higher levies – on their Social Security benefits if their income rises above a certain level.
Further, the increase could leave Social Security’s finances on even shakier ground. The combined trust funds that pay benefits to retirees, survivors and the disabled will be depleted by 2035 and only able to distribute roughly three-quarters of promised payments unless Congress addresses the program’s long-term funding shortfall, according to the most recent Social Security trustees’ report.
A congressional investigation found that the US Food and Drug Administration’s “atypical collaboration” to approve a high-priced Alzheimer’s drug was “rife with irregularities.”
The report, released Thursday, was the result of an 18-month investigation by two House committees. It is sharply critical of Biogen, maker of the medication Aduhelm.
The report says Biogen set an “unjustifiably high price” for Aduhelm to “make history” for the company, and thought of the drug as an “unprecedented financial opportunity.” Biogen priced Aduhelm at $56,000 per year, even though its actual effects on a broad patient population were unknown.
More than 6.5 million people in the US live with Alzheimer’s, and that number is expected to grow to 13.8 million by 2060, according to the Alzheimer’s Association. The disease is the sixth leading cause of death in the United States. There is no cure, and effective treatments are extremely limited. Before Aduhelm’s approval in June 2021, the FDA had not approved a novel therapy for the condition since 2003.
The investigation found that Biogen planned an aggressive marketing campaign to launch the drug, intending to spend more than $3.3 billion on sales and marketing between 2020 and 2024 – more than 2½ times what it spent to develop Aduhelm.
Dementia, including Alzheimer’s, is one of the “costliest conditions to society,” according to the Alzheimer’s Association. In 2022 alone, Alzheimer’s and other dementias cost the US $321 billion, including $206 billion in Medicaid and Medicare payments, the association says.
Aduhelm’s cost to patients and to Medicare would be significant, the new report says. It was one of the key factors behind a big increase in Medicare premiums in 2022, according to the Centers for Medicare and Medicaid Services.
In anticipation of “pushback” from providers and payers, the report says, Biogen also prepared a narrative to sell the value of the drug.
The Committee on Oversight and Reform and the Committee on Energy and Commerce found that the collaboration between the FDA and Biogen in the approval process of the drug “exceeded the norm in some respects.”
Biogen had initially discontinued Aduhelm’s clinical trials in March 2019 after an independent committee found that it probably would not slow the cognitive and functional impairment – the decline in memory, language and judgment – that comes with Alzheimer’s. But in June 2019, the FDA and Biogen started a “working group” to see whether the effort could be saved.
The investigation found that the FDA and Biogen engaged in at least 115 meetings, calls and substantive email discussions from July 2019 to July 2020, including 40 meetings to guide Aduhelm’s potential approval. There may have been even more meetings, but the committees say the FDA failed to follow its own documentation protocol.
The agency then collaborated with Biogen to draft a document used to brief an independent advisory committee that met in November 2020. The trial results were mixed, with only one showing a small benefit to patients.
At that meeting, none of the committee’s members voted to say that the studies presented strong evidence that the drug was effective at treating Alzheimer’s.
The meeting was unusual, according to one former FDA adviser who had sat on the committee for several years. Dr. Aaron Kesselheim told CNN in 2021 that the relationship between the FDA and the company was out of the ordinary.
“There was a strange dynamic compared to the other advisory committee meetings I’ve attended,” the professor at Harvard Medical School said. “Usually, there’s some distance between the FDA and the company, but on this one, the company and the FDA were fully in line with each other in support of the drug.”
When the FDA approved the drug, Kesselheim and two other members of the advisory committee resigned in protest. He later labeled it “probably the worst drug approval decision in recent US history.”
The FDA often follows the independent committee’s recommendations, but in this case, it changed course and used its accelerated approval pathway, which sets a different standard of proof that a treatment could work.
The committee members said senior FDA leadership told them that the shift in how the drug would be approved came after an FDA expert council meeting in April 2021 provided “unfavorable feedback” for the traditional approval process, according to the new report.
The FDA also approved the drug for “people with Alzheimer’s disease,” a far broader population than was studied in Biogen’s clinical trials.
Internal documents from the company said that Biogen accepted this broader indication “despite internal reservations about the lack of evidence of clinical benefit for patients at disease stages outside of the clinical trials and an unknown safety profile,” the report says. Leaders expressed concern that the company could lose credibility, and it developed a communications strategy to deal with the “anticipated fallout,” the report says.
The committees recommended that the FDA document all of its meetings with drug sponsors, establish a protocol for briefing documents and advisory committees, and update its guidance for how Alzheimer’s drugs are developed and reviewed.
The committees also recommended that companies clearly communicate safety and efficacy concerns to the FDA and consider the value assessments made by outside experts when setting drug prices.
“The American people rely on FDA for assurance on the safety and efficacy of the medications they take. The number of patients and families impacted by Alzheimer’s disease will continue to increase, and it is crucial that FDA and drug companies adhere to established procedures and conduct themselves with the transparency necessary to earn public trust,” the report says.
The FDA said in a statement that its “decision to approve Aduhelm was based on our scientific evaluation of the data contained in the application, which is described in the approval materials.”
The agency says it is reviewing the committees’ findings and recommendations and says its own review found that the interactions with Biogen were appropriate.
“It is the agency’s job to frequently interact with companies in order to ensure that we have adequate information to inform our regulatory decision-making. We will continue to do so, as it is in the best interest of patients. That said, the agency has already started implementing changes consistent with the Committee’s recommendations.”
Biogen said in a statement Thursday that it has been working “cooperatively” with the investigation.
“Biogen has been committed to researching and developing treatments for Alzheimer’s disease for more than a decade. We have been focused relentlessly on innovation to address this global health challenge, and have adapted to both successes and setbacks,” it said. “Biogen stands by the integrity of the actions we have taken.”
When Democratic Sen. Raphael Warnock and Republican Herschel Walker met to debate in the already contentious Georgia Senate race, all the focus was on how personal allegations against Walker would roil the first – and likely only – debate in the campaign.
The allegations that Walker paid for a woman to terminate her pregnancy and then, two years later, encouraged the same woman to have the procedure a second time, however, were just a blip in the hour-long contest, which instead centered on Warnock’s ties to President Joe Biden, the vast differences between the two candidates on abortion and even, however briefly, Walker’s use of what appeared to be a sheriff’s badge.
Walker continued to deny the allegations about him – calling them “a lie” – and Warnock, as he has on the campaign trail, did not engage on the controversy, instead choosing to question his Republican opponent’s relationship to the truth.
“We will see time and time again, as we have already seen, that my opponent has a problem with the truth,” Warnock said. “And just because he says something doesn’t mean it’s true.”
For Walker, the debate was as much about touting his own candidacy as it was about tying Warnock to Biden, who was invoked early and often. His effort, in the closing moments, to assuage fence-sitting voters about his readiness to serve also included a jab at Warnock and Biden.
“For those of you who are concerned about voting for me, a non-politician, I want you to think about the damage politicians like Joe Biden and Raphael Warnock have done to this country,” Walker said.
Here are five takeaways from Friday’s debate:
Biden wasn’t on the stage Friday night, but Walker tried repeatedly to convince viewers that the Democratic President was ostensibly there with his Democratic opponent.
From the outset of the event, Walker repeatedly invoked Biden, hoping to tie his Democratic opponent to the President’s low approval ratings.
“This race isn’t about me. It is about what Raphael Warnock and Joe Biden have done to you and your family,” Walker said at the top of the debate.
Later, when pressed on voter fraud in the 2020 election, he added, “Did President Biden win? President Biden won, and Sen. Warnock won. That’s the reason I decided to run.”
He then synthesized his point: “I am running because he and Joe Biden are the same.”
Warnock did little to distance himself from Biden, even at times touting the legislation he passed with the President’s help. But during a question on foreign policy, he took the chance to note a specific time he stood up to the Biden administration.
“I am glad we are standing up to Putin’s aggression and we have to continue to stand up, which is why I stood up to the Biden administration when it suggested we should close the Savanah Combat Readiness Training Center,” Warnock said. “I told the President that was the exact wrong thing to do at the exact wrong time. … We kept that training center open.”
Walker went back to his message in response: “He didn’t stand up. He had laid down every time it came around.”
“It is evident,” said a somewhat exasperated Warnock, “that he has a point that he tried to make time and time again.”
Headed into the debate, the focus was on how Walker – and arguably less predictably, Warnock – would address the accusations that the Republican candidate allegedly paid for a woman to terminate her pregnancy and then, two years later, encouraged the same woman to have the procedure a second time.
Walker did what he has done repeatedly as the allegations roiled an already contentious Senate race: Label the allegations a lie.
“As I said, that is a lie,” Walker said in response to a question from the moderator. “I put it in a book, one thing about my life, I have been very transparent. Not like the senator, he has hid things.”
Walker added: “I said that is a lie and I am not backing down. And we have Sen. Warnock, people that would do anything and say anything for this seat. But I am not going to back down.”
CNN has not independently verified the allegations about Walker.
Warnock, as he has done previously, did not address the allegations, instead choosing to let Walker fight them off without pushing them himself.
Instead, the senator took a broad approach, focusing on Walker’s “problem with the truth” and less on the specific allegations.
The candidates also clashed on abortion rights more generally, with Walker insisting he did not support a federal ban, in contrast to past statements, and pointing to the state’s restrictive “heartbeat” law. The law prohibits abortions as soon as early cardiac activity is detectable, which can be as early as six weeks, before many women know they are pregnant.
“On abortion, I’m a Christian. I believe in life. Georgia is a state that respects life,” Walker said.
The Georgia law makes exceptions for cases of rape or incest, pending a timely police report, and in some cases where the pregnant person’s health is at risk.
Before the Supreme Court’s ruling overturning Roe v. Wade, state law had allowed abortions up to 20 weeks.
Warnock, who supports abortion rights, repeated an argument he’s made on the trail: “A patient’s room is too narrow and small and cramped for a woman, her doctor and the US government. … I trust women more than I trust politicians.”
Walker then shot back, invoking Warnock’s support for the Black Lives Matter movement against police brutality.
“He told me Black lives matter… If Black lives matter, why are you not protecting those babies? And instead of aborting those babies, why aren’t you baptizing those babies?,” Walker said.
Warnock, as he did throughout the debate, didn’t directly answer Walker’s provocation. Instead, he repeated his position.
“There are enough politicians piling into the rooms of patients,” the senator said, “and I don’t plan to join them.”
Georgia is one of 12 states not to expand Medicaid and currently has an estimated 1.5 million uninsured residents.
Walker, when asked by the moderator if the federal government should step in to make sure everyone has access to health care, began a confusing non-response.
“Well, right now, people have coverage for health care. It’s according to what type of coverage do you want. Because if you have an able-bodied job, you’re going to have health care,” he said. “But everyone else – have health care is the type of health care you’re going to get. And I think that is the problem.”
Walker continued to say that Warnock wants people to “depend on the government,” while he wants “you to get off the government health care and get on the health care he’s got.”
To note: Warnock, as a US Senator, is on a government health care plan.
Walker also gave a puzzling response to Warnock’s attack on his opposition to federal legislation capping the price of insulin for people with diabetes.
“I believe in reducing insulin, but at the same time, you have to eat right,” Walker said. “Unless you have eating right, insulin is doing you no good. So you have to get food prices down and you got to get gas prices down so they can go and get insulin.”
Warnock responded by telling viewers who require the drug that Walker was, in effect, blaming them for their struggles accessing it.
Warnock, on the subject of his pledge to close the Medicaid gap, was asked how he would pay for it.
“This is not a theoretical issue for me,” he replied, invoking the story of a nurse in a trauma ward who lost coverage when she became sick and, as he put it, died “for lack of health care.”
“Georgia needs to expand Medicaid,” Warnock continued. “It costs us more not to expand. What we’re doing right now is we’re subsidizing health care in other states” – a reference to the state’s refusal to accept federal funds that residents already pay into.
The debate within the debate over Warnock’s support for police, in which the senator pointed to his support for legislation that backed smaller departments, was briefly derailed when Walker pulled out what appeared to be a police badge.
The moderator quickly admonished Walker, reminding him that props were not allowed onstage.
“You have a prop,” the surprised moderator said. “That is not allowed, sir.”
Moments earlier, Warnock – in response to Walker’s claims that he has “called (police officers) names” and caused “morale” to plummet – said that his opponent “has a problem with the truth.”
Warnock then hit Walker with a callback to a more than two-decade-old police report in which the Republican discussed exchanging gunfire with police and a subsequent false claim from Walker that he previously served in law enforcement.
“One thing that I haven’t done is I haven’t pretended to be a police officer and I’ve never, ever threatened a shootout with police,” he said.
Warnock also argued that his support for greater scrutiny of police didn’t undermine his support for law enforcement.
“You can support police officers, as I’ve done, through the COPS program, through the invest-to-protect program, while at the same time, holding police officers, like all professions, accountable,” he said.
Millions of Americans are at risk of losing their Medicaid coverage in coming months, but residents in Arizona, Arkansas, Idaho, New Hampshire and South Dakota will be the first to bear the brunt of the terminations.
States have been barred by Congress from winnowing their Medicaid rolls since the Covid-19 pandemic began. That prohibition ends on Saturday, and some states are moving much more swiftly than others to kick off those deemed ineligible for the public health insurance program for low-income Americans.
That worries advocates, who say speed will result in eligible residents being incorrectly terminated. Also, it could hamper shifting those who no longer qualify to other types of coverage.
“This is the fable of the tortoise and the hare,” said Joan Alker, executive director of the Georgetown UniversityCenter for Children and Families. “Taking time is absolutely going to result in a better outcome for eligible children and families to remain covered. So speed is a big concern.”
The five states will start cutting off coverage in April, followed by 14 more states in May and 20 additional states plus the District of Columbia in June. All states must complete their redeterminations over the next 14 months.
Around 15 million people could be dropped from Medicaid, according to various estimates, though several million folks could find coverage elsewhere. Others may still be eligible but could be terminated for procedural reasons, such as not completing renewal forms. Those at risk include at least 6.7 million children, according to a Georgetown analysis.
Medicaid enrollment has ballooned since March 2020, when lawmakers passed the Families First Coronavirus Response Act, which prevented states from involuntarily removing anyone from coverage. In exchange, Congress boosted states’ federal Medicaid match rates by 6.2 percentage points.
The provision was initially tied to the national public health emergency, but lawmakers changed that as part of the federal spending bill that passed in December. In addition to being able to start conducting terminations in April, states will receive an enhanced federal match through the rest of this year, though it will phase downover time.
More than 92 million Americans were enrolled in Medicaid and the Children’s Health Insurance Program in December, up 31% since February 2020, according to the most recent data available from the Centers for Medicare and Medicaid Services.
Reviewing the eligibility of all those enrollees will be a monumental task for state Medicaid agencies, many of which are also contending with slim staffing. To gear up, they are hiring new employees, temporary workers or contractors or bringing back retirees, according to a recent survey conducted by Georgetown and the Kaiser Family Foundation.
Most states can automatically renew coverage for at least some of their enrollees using other data, such as state wage information. But agencies must get in touch with others in their Medicaid programs, which proved challenging even prior to the pandemic. Most states are using multiple methods to update enrollees’ contact information, including working with insurers that provide Medicaid coverage to residents.
If notices sent by mail are returned, states must make good faith attempts to contact enrollees through at least two other methods before cutting them off. And states have to adhere to additional requirements to continue to qualify for the enhanced match. If they don’t, CMS also could suspend their terminations, require they take corrective action or impose monetary penalties.
Of the roughly 15 million people who could lose Medicaid coverage, about 8.2 million will no longer qualify, according to a Department of Health and Human Services analysis released in August. Some 2.7 million of these folks would qualify for enhanced federal subsidies for Affordable Care Act policies that could bring their monthly premiums to as low as $0.
Some 6.8 million people, however, will be disenrolled even though they remain eligible.
Though the federal government has given states more than a year to conduct the eligibility reviews and terminations, some plan to move much more quickly.
Idaho, which has been monitoring enrollees’ eligibility throughout the pandemic, plans to complete its reevaluations by September, which it touts as one of the fastest timelines in the country.
Of the nearly 450,000 Idahoans in the program, about 150,000 of them either don’t qualify or haven’t been in touch with the state in the past three years. The state began sending notices in February to those who face termination. People have 60 days to respond before they are removed.
Those that are not eligible have 60 days from their termination date to enroll in Idaho’s state-based Obamacare exchange, Your Health Idaho. The exchange receives information nightly from the state Medicaid agency about residents who no longer qualify for public coverage but may be eligible for federal subsidies for Affordable Care Act policies.
The exchange is reaching out to those folks weekly while they still have Medicaid and then every 15 days during the two-month special enrollment period via various methods, including mail, email and text messages, said Pat Kelly, Your Health Idaho’s executive director.
The exchange works with 900 agents, brokers and enrollment counselors who can help folks sign up for policies. And it plans to start an advertising campaign this monthhighlighting the hefty subsidies.
“We have to really help Idahoans know and understand that low-cost options are available, and most importantly, that it’s comprehensive health insurance that they can get for $0 a month,” Kelly said.
Still, advocates in Idaho are concerned that the state’s push to unwind quickly will result in eligible residents losing coverage.
Many people are not aware that they once again need to prove that they qualify, and the state agency is understaffed and underfunded, said Hillarie Hagen, health policy associate at Idaho Voices for Children. Renewal letters may not make it to enrollees, and those who need help may not be able to get through to customer service.
“We are very concerned about families, and particularly children, losing health coverage without their knowledge – that they will find out when they show up to the doctor,” Hagen said.
Aware that many people don’t know they’ll have to renew their eligibility, Arizona’s Medicaid agency last summer sent text messages and letters and made robocalls to enrollees, asking them to update their contact information. It is also working with community partners, health care providers, pharmacies and insurers. And it’s ramping up another text campaign since the prior one was so successful, said Heidi Capriotti, public information officer for the Arizona Health Care Cost Containment System.
While the state can automatically redetermine the eligibility of about 75% of its Medicaid participants, it still has to connect with about 670,000 residents who could lose coverage because they are no longer eligible or they haven’t responded to the agency’s requests. The state plans to take 12 months to assess whether its enrollees still qualify.
South Dakota will start terminating Medicaid enrollees in April, though some low-income adults may become eligible again in July, when the state’s Medicaid expansion program begins.
Voters approved the broadening of Medicaid to low-income adults at the ballot box in November, over the objections of the Republican governor and legislature.
Nearly 152,000 residents were enrolled in Medicaid in January, an increase of more than 30% from March 2020, according to the state’s Department of Social Services. But more than 22,000 people appear to be ineligible currently.
The agency said in an FAQ that it will prioritize reviewing folks who are most likely to be ineligible because they no longer meet a coverage group or their income has increased, among other reasons.
Those who are not eligible will be disenrolled with 10-days’ notice. If they appear eligible for expansion in July, they’ll receive a notice about it when they are terminated and sent a reminder in June.The agency is encouraging any enrollees who are determined to be ineligible to reapply after Medicaid expansion takes effect.
But that three-month gap can wreak havoc on low-income residents’ health, said Jen Dreiske, deputy director of South Dakota Voices for Peace, which is working with the state’s immigrants and refugees to inform them of the unwinding. These folks may have to go without their heart medication or their cancer treatment. They may also be afraid to go to the doctor because of the cost.
“Why can’t we just wait until July 1?” Dreiske said. “Our concern is that people are going to get sick or die because they’re not going to be able to access the health care that they so desperately need.”
But it could take some work to regain health coverage.
“For a lot of people, this can be a very disruptive period of time,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “There is a significant time and paperwork burden being placed on families – a lot of them very low income, a lot of them medically vulnerable.”
States are now free to terminate the Medicaid coverage of residents they deem ineligible. States had been barred from involuntarily removing anyone for the past three years as part of an early congressional Covid-19 pandemic relief package, causing enrollment in Medicaid and the Children’s Health Insurance Program to balloon to more than 92 million people.
Of the roughly 15 million people who could lose Medicaid coverage over the next 14 months, about 8.2 million would no longer qualify, according to a Department of Health and Human Services analysis released in August.
Some 2.7 million of these folks would qualify for enhanced federal subsidies for Affordable Care Act policies that could bring their monthly premiums to as low as $0.
Another 5 million are expected to secure other coverage, mainly through employers.
Some 6.8 million people, however, will be disenrolled even though they remain eligible for Medicaid.
Check out Obamacare policies:Folks who lose their Medicaid coverage can shop for health insurance plans on the Affordable Care Act exchanges.
Those whose annual incomes remain below 150% of the federal poverty level – $20,385 for a single person and $41,625 for a family of four in 2023 – can obtain enhanced federal assistance to lower their premiums to as little as $0 a month. That beefed-up subsidy is in place through 2025.
Many people with higher incomes can find subsidized policies for $10 or less.
State Medicaid agencies are tasked with easing residents’ transfer from Medicaid to the Obamacare marketplaces, but the smoothness of the process will vary greatly by state. Once someone is determined to no longer qualify for Medicaid, the agency must assess his or her eligibility for Affordable Care Act coverage and transfer the resident’s information to the exchange.
Some states that run their own Obamacare exchanges are taking extra steps to ensure their residents remain covered. Rhode Island, for instance, is automatically enrolling certain people in marketplace coverage. It’s also paying the first two months of premiums for some residents who actively select policies.
Those who lose Medicaid coverage and live in the 33 states covered by the federal marketplace, healthcare.gov, can apply for Affordable Care Act policies through a special enrollment period that runs through July 2024. State-based exchanges have their own deadlines, with some mirroring the federal exchange and others providing much shorter windows.
Navigators and insurance brokers can help consumers select plans.
Historically, very few people who lose Medicaid coverage wind up in Obamacare plans. About 4% of adults who were terminated from Medicaid enrolled in exchange policies in 2018, according to the Medicaid and CHIP Payment and Access Commission.
The coverage differs too. Those that switch to the marketplacemay have to find other doctors that are in their insurers’ networks and may face out-of-pocket costs.
Consider job-based coverage: A number of people who are terminated from Medicaid may already be covered by their employers, particularly those who started new jobs during the pandemic. Others have the option of obtaining coverage through work, though it will almost certainly be more expensive than Medicaid since it will likely entail premiums, deductibles and copays.
Workers may find they can afford coverage for themselves but not for their families. If the premiums for family policies cost more than 9.12% of household income, spouses and children may be able to get subsidized coverage on the Affordable Care Act exchanges.
Employees should contact their human resources departments to sign up. Typically, they’ll have to enroll within 60 days of losing Medicaid, but those who are terminated from the program between now and July 10 will have until early September to sign up.
See if you or your children remain eligible for Medicaid: Millions of Americans who still qualify for Medicaid may lose coverage for procedural reasons. For example, they may have moved so they don’t receive the redetermination notices. Or they may not return the necessary paperwork to prove their eligibility.
So it’s crucial that folks update their contact information with their state agencies and reply to the letters they receive about renewing their Medicaid eligibility.
“When you get that packet in the mail, respond to it promptly,” Corlette said.
Those who are dropped have 90 days to submit their renewal paperwork to their state agency, which is required to reinstate them if they are found eligible. Beyond that time period, people may reapply. In most states, your coverage can be made retroactive for up to three months if you were eligible and received Medicaid-covered services.
Parents who no longer qualify and are terminated should check if their children remain eligible. As many as 6.7 million kids are at risk of losing Medicaid coverage, according to Georgetown’s Center for Children and Families.
Nearly three-quarters of the children projected to be dropped will remain eligible for Medicaid orCHIPbut will lose coverage mainly because of administrative issues. Black and Latino children and families are more likely to be erroneously terminated, according to the center.
Undeterred by a growing number of lawsuits, the Biden administration on Friday released revised guidance for Medicare’s new drug price negotiation program.
The latest guidance outlines how the Centers for Medicare and Medicaid Services will negotiate with drugmakers to reach agreement on a maximum fair price for a selected medicine, the agency said. It was informed by public input on the initial guidance the agency released in March, which explained how it will select the drugs and how the negotiations will be conducted.
The program, which was authorized by the Inflation Reduction Act that congressional Democrats passed last year, has prompted a fierce backlash from the pharmaceutical industry. Two drug manufacturers and two industry groups have filed lawsuits, arguing the measure is unconstitutional.
But the administration is not backing down from implementing its historic new power. It intends to keep its timeline of announcing the first 10 drugs that will be selected for negotiation by September 1. CMS and the drugmakers will negotiate during 2023 and 2024. The prices will be effective starting in 2026.
“The Biden-Harris Administration isn’t letting anything get in our way of delivering lower drug costs for Americans,” Secretary of Health and Human Services Xavier Becerra said in a statement. “Pharmaceutical companies have made record profits for decades. Now they’re lining up to block this Administration’s work to negotiate for better drug prices for our families. We won’t be deterred.”
The initial set of drugs will be chosen from the top 50 Part D drugs that are eligible for negotiation that have the highest total expenditures in Medicare. CMS will consider multiple factors when developing its initial offer, including the drugs’ clinical benefits, the price of alternatives, research and development costs and patent protection, among others.
If drugmakers don’t comply with the process, they will have to pay an excise tax of up to 95% of the medications’ US sales or pull all their drugs from the Medicare and Medicaid markets. The pharmaceutical industry contends that the true penalty can be as high as 1,900% of sales.
CMS said it received more than 7,500 comments on its initial guidance from patient groups, drug companies, pharmacies and others.
The changes it is making are aimed at improving transparency while keeping confidentiality in mind, as well as fostering “an effective negotiation process,” the agency said.
They include revising the confidentiality process to state that CMS will release information about the negotiations when it publishes the explanations of the prices. Also, drug companies may publicly discuss the negotiations – the prior secrecy requirement had been a point of contention among manufacturers that was mentioned in the lawsuits. And they won’t be required to destroy data relating to the negotiations.
In addition, CMS will hold patient-focused listening sessions to provide drug companies and the public more opportunities to engage with the agency. The sessions – which will give patients, caregivers and others the chance to share input on how a medication addresses unmet needs, how it impacts specific populations and what therapeutic alternatives exist – will be held in the fall for the first round of drugs.
Merck, Bristol Myers Squibb, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, and the US Chamber of Commerce have all recently filed lawsuits in federal courts across the US. They each argue the program is unconstitutional in various ways.
The challengers also say that the negotiation provision will harm innovation and patients’ access to new drugs.
Among the arguments are that the program violates the Fifth Amendment’s “takings” clause because it allows Medicare to obtain manufacturers’ patented drugs, which are private property, without paying fair market value under the threat of serious penalties.
Plus, the negotiations process violates the First Amendment, the challengers say, because it coerces manufacturers into saying that they agree to the price that the government has dictated and that it’s fair.
Another argument is that the process violates the Eighth Amendment by levying an excessive fine if drugmakers refuse to negotiate and continue selling their products to the Medicare market.
Merck expects its diabetes drug Januvia to be among the drugs named in September and its blockbuster cancer treatment Keytruda and diabetes drug Janumet to be subject to negotiation in the future. Bristol Myers Squibb believes its blood thinning medication, Eliquis, will be subject to negotiations this year, and its cancer medication, Opdivo, will be selected in a subsequent round.
The changes in the revised guidance did not allay the complaints of the pharmaceutical industry. PhRMA said that transparency remains “severely limited,” patients’ views are not being taken into account and Medicare beneficiaries could have less access to drugs.
“The very few substantive changes to the final guidance demonstrate CMS saw this as a box checking exercise, not an opportunity to mitigate the negative impacts this price setting policy will have on patients or the broader health care sector,” PhRMA said in a statement.
“The approach CMS took in this final guidance confirms what we claimed in our lawsuit – Congress’ unconstitutional shortcuts taken in the law have given the administration far too much flexibility to set prices at their whim without any oversight or accountability to anyone,” the group continued.
The Biden administration will “vigorously defend” the drug price negotiation program, said CMS Administrator Chiquita Brooks-LaSure.
“We feel the law is on our side,” she said in a call with reporters Friday.
This story has been updated with additional information.
Americans’ Social Security checks will get a lot smaller in 2034if lawmakers don’t act to address the pending shortfall, according to an annual report released Friday by the Social Security trustees.
That’s because the combined Social Security trust funds – which help support payouts for the elderly, survivors and disabled – are projected to run dry that year. At that time, the funds’ reserves will be depleted, and the program’s continuing income will only cover 80% of benefits owed.
The estimate is one year earlier than the trustees projected last year. About 66 million Americans received Social Security benefits in 2022.
Medicare, meanwhile, is in a more critical financial condition. Its hospital insurance trust fund, known as Medicare Part A, will only be able to pay scheduled benefits in full until 2031, according to its trustees’ annual report, which was also released Friday.
At that time, Medicare, which covered 65 million senior citizens and people with disabilities in 2022, will only be able to cover89% of total scheduledbenefits.Last year, Medicare’s trustees projected that the hospital trust fund’s reserves would be depleted in 2028.
Immensely popular but long troubled, Social Security and Medicare are on shaky financial ground in large part because of the aging of the American population. Fewer workers are paying into the program and supporting the ballooning number of beneficiaries, who are also living longer. Also, health care is becoming increasingly expensive.
Social Security has two trust funds – one for retirees and survivors and another for Americans with disabilities.
Looking at them separately, the Old-Age and Survivors Insurance Trust Fund is projected to run dry in 2033, at which time Social Security could pay only 77% of benefits, primarily using income from payroll taxes. The date is one year earlier than estimated last year.
The Disability Insurance Trust Fund is expected to be able to pay full benefits through at least 2097, the last year of the trustees’ projection period.
Merging the two trust funds would require Congress to act, but the combined projection is often used to show the overall status of the entitlement.
Social Security’s projected long-term health worsened over the past year because the trustees revised downward their expectations for the economy and labor productivity, taking into account updated data on inflation and economic output.
However, the long-term projection for Medicare’s hospital trust fund’s finances improved, mainly due to lowered estimates for health care spending after the height of the Covid-19 pandemic. Also, the program is projected to take in more income because the trustees estimate the number of covered workers and average wages will be higher.
Regardless, the bottom line remains that Medicare is not bringing in enough money to pay the costs it is expected to incur, said Cori Uccello, senior health fellow at the American Academy of Actuaries.
“It’s still not a time to become complacent,” she said. Insolvency “is still less than a decade away.”
The trustees’ reports are the latest warnings to Congress that they will have to deal with the massive entitlement programs’ fiscal problems at some point soon. But addressing their issues is politically challenging. Elected officials arehesitant to suggest any changes that could lead to benefit cuts, even though that could reduce their options in the future.
“With each year that lawmakers do not act, the public has less time to prepare for the changes,” the trustees warned in a fact sheet.
The programs’ shortfalls are back in the spotlight this year as President Joe Biden and House Republicans battle over how to address the nation’s debt ceiling drama and mounting budget deficits. GOP lawmakers want to cut spending in exchange for resolving the borrowing limit, while the White House has said it will not negotiate.
In a memorable moment in his State of the Union address in February, Biden garnered public acknowledgment from congressional Republicans about keeping Social Security and Medicare out of the debt discussions.
But “not touching” Social Security means a hefty cut in benefits within a decade or so.
“Change is inevitable because without changes to current law, both Social Security and Medicare Hospital Insurance would go insolvent, subjecting program participants to sudden and severe payment cuts,” said Charles Blahous, senior research strategist at the Mercatus Center at George Mason University and former Social Security and Medicare trustee. “The outstanding question is whether change will be tolerably gradual, or instead highly damaging because it is too long delayed.”
Though Biden has repeatedly vowed to protect Social Security, his latest budget proposal did not include a plan to stabilize its finances.
However, his proposal did call for extending Medicare’s solvency by 25 years or more by raising taxes on those earning more than $400,000 a year and by allowing the program to negotiate prices for even more drugs.
Spending on the entitlement programs is also projected to soar and exert increased pressure on the federal budget in coming years.
Mandatory spending – driven by Social Security and Medicare – and interest costs are expected to outpace the growth of revenue and the economy, according to a Congressional Budget Office outlook released in mid-February.
This story has been updated with additional information.
