How did healthcare fare in the State of the Union?
Analysis on the 2023 State of the Union
Biden takes victory lap on healthcare policy
As many commentators discussed after President Biden’s State of the Union Address, decorum appears to have gone out the window in Washington. I will say this about it: I didn’t think saying something about Medicare would get as strong a reaction that it did. More on that in a moment.
If you recall from last year, President Biden was trying to rally support for his Build Back Better plan which included several changes to Medicare and the Affordable Care Act. Though Build Back Better never passed, some of its provisions made it into law through other means.
For example, the President was able to get his wish when Congress capped the cost of insulin for Medicare patients at $35 a month and allowed Medicare to “negotiate” ten drugs per year beginning in 2026. Both of those were passed in the Inflation Reduction Act.
Those were two bold policy proposals. He didn’t propose anything new last night.
Last night, twenty-eight minutes into his speech, he praised those victories and criticized Republicans who have threatened to repeal the Inflation Reduction Act. He said he would veto any such legislation.
He took time to celebrate the elimination of the “family glitch” in the Affordable Care Act and other legislation which allowed for more Americans to receive subsidies on the program. He called for those changes to be made permanent and to expand Medicaid programs to more Americans.
He also took a few moments to praise the end of surprise billing in the No Surprises Act, a statement which raised eyebrows for me given his administration keeps trying to change the law with regard to how physicians are reimbursed.
As I predicted on the FLATLINING Podcast last week, he waved the banner of victory for what he was able to accomplish with healthcare for two reasons. First, because he is probably going to announce he is running for re-election, and second because he knows he cannot get anything else done with a divided Congress.
Perhaps the President is satisfied with the elimination of the family glitch, capping insulin, and Medicare drug price fixing. After all, he and others in government would argue the current debt ceiling crisis is a far more pressing issue than trying to pass legislation on a public option.
When President Biden began to discuss the debt ceiling, he repeated a campaign remark that was popular in the 2022 midterms and has been repeated by Democrats in Congress and members of his administration: Republicans want to cut Social Security and Medicare.
This sparked a very vocal uproar from Republicans last night. In my opinion, the President seemed surprised and tried to tell people to contact his office for the proof. As Ron and I have discussed on the podcast, we were not aware of any member of the GOP going on the record saying “I think we should cut Social Security and Medicare.”
Sure, it might be the logical conclusion to saying you want to cut spending, as President Biden’s economic advisor Jared Bernstein said on FOX News Sunday last weekend. Speaker Kevin McCarthy and others in Republican leadership had openly said though that it was off the table.
During the break between the State of the Union and the Republican response, I think I found what some Democrats, including President Biden, have been pointing to as “proof” that the GOP wants to cut entitlements. Senator Rick Scott (R-FL) has a policy platform that includes this: “All federal legislation sunsets in 5 years. If a law is worth keeping, Congress can pass it again.” That would require “re-upping” Social Security and Medicare every five years since they are in fact laws and they are included in the word “all.”
For all of the President’s goodwill and bipartisan efforts in the first fifteen minutes of his speech, he torpedoed any shot at good-faith negotiations about spending by taking the platform of one Senator, who is outside the platform of his party and who has been openly challenging Senate Minority Leader Mitch McConnel, and said: “the whole GOP believes this.”
At the beginning, I said decorum went out the window and it did because of both sides. Someone in the President’s speech writing team should have known better than to equate that to the whole GOP when the leadership has said “it's off the table.” I would also say that the response from Republicans in the House chamber was justified but it then spiraled out of control from there. Even the Speaker wasn’t pleased with Majorie Taylor Greene and others and was noticeably shushing them.
Back to healthcare: The President may think he can score political points by making sweeping generalizations about the GOP and maybe he can with the progressive base of the Democratic party, but I think he did himself more of a favor by talking up some of his healthcare victories. I would have like to have seen more proposals for what the Democratic party could offer Americans ahead of the 2024 election, but perhaps that will come later in the year.
The Republican Response
I had high hopes for Arkansas Governor Sarah Huckabee Sanders. Sadly, I don’t think the GOP has learned its lesson from the disappointing results of the midterms.
As I said on the FLATLINING Podcast last week, Republicans can quite possibly win on the culture war issues, if they stop talking about COVID-19. Fortunately, I heard nothing about the pandemic from the governor last night. Points there.
Where I would take points away is the amount of time spent reminding Americans about the preceding president. I agree with Chris Stirewalt on NewsNation: “The last thing Republicans should have wanted was to remind people about Donald Trump.”
So we heard a lot about Trump, but (not surprisingly) nothing on healthcare. As I said last year when Iowa Governor Kim Reynolds responded to President Biden’s first State of the Union, Republicans are having a very tough time explaining to Americans that they can improve their healthcare.
While President Biden can wave the flag of victory about lowering the cost of insulin, lowering the cost of (a few) prescription drugs, and allowing more people to get health insurance with subsidies (saving them money out of pocket), Republicans have nothing to say.
Rising healthcare costs have been and continue to be one of the most pressing issues for Americans. As I said last year, until Republicans can come up with an adequate response to “Democrats will give you free healthcare,” they can expect to keep losing independents and the middle.
Matthew Handley is a Manager of Healthcare Consulting at Fulcrum Strategies and the co-host of the FLATLINING Podcast. You can follow him on Twitter: @radioHandley.