The Hope Reduction Act

Ben discusses the “Inflation Reduction Act,” which was signed into law by President Biden this past week! In last-minute negotiations between Senators Chuck Schumer and Joe Manchin, the Senate finally – after comical failures over and over this past year – passed a VERY scaled-down version of the Build Back Better bill. The “IRA” bill – clearly they intensively focus-grouped that title – is overwhelmingly a package of environmental policies, but does include some healthcare provisions for Medicare recipients.

Joining us today, in a throwback-Monday episode, is Stephanie Nakajima, the Executive Director of Mass-Care: the Massachusetts Campaign for Single Payer Healthcare.


Show Notes

With Gillian on vacation, Stephanie rejoins to co-host this pod! Stephanie is currently the ED of Mass-Care, the Massachusetts Medicare for All organization, and through a massive grassroots effort they recently put M4A questions on the ballot in TWENTY state representative districts. The questions are non-binding, but powerful tools for convincing elected officials to support Medicare for All, if they don’t already.

As any show on the Inflation Reduction Act should, we begin by ridiculing the title of the bill, which has nothing to do with inflation, as well as the “IRA” acronym, which apparently no one thought about?!?

Ben takes a sad walk down memory lane to recap the social provisions that HAD been included in the previous version of this legislation: the Build Back Better bill:

  • A child tax credit up to $300 per child; child care subsidies; and free universal preschool – all out of the IRA;
  • Paid family leave of up to 4 weeks – out;
  • Tripling the earned income tax credit for low-income workers – out;
  • Much of this was paid for by new taxes on the wealthy, and on big businesses

Stephanie talks about the four things the Medicare for All movement pushed for to be included in Build Back Better:

  • Let Medicare negotiate prescription drug costs, which should save billions of dollars and help pay for expanding Medicare in several ways, including;
  • Lowering the eligibility age of Medicare to 60, or as low as we can get it;
  • Giving traditional (public) Medicare enrollees an out-of-pocket cap, like most private insurance has; and finally
  • Adding dental, vision, and hearing benefits to Medicare.

We had success in each of these categories except lowering the age of Medicare under BBB, but did any of this survive under the Inflation Reduction Act? Some!

Here are the healthcare provisions included in the IRA:

  • DOES allow Medicare to negotiate the prices of some prescription drugs – it starts with just 10 drugs in 2025, then increases to 20 drugs in 2029. (Medicare covers over 3,500 drugs – so less than a half of 1% of drugs will be negotiated!)
  • We did NOT win a general out-of-pocket spending cap for Medicare recipients, but we DID win a couple of more specific caps.
    • The bill creates an OOP prescription drug cap of $2,000 for Medicare recipients starting in 2025.
    • The bill also caps insulin spending at $35/mo. Dems tried to extend this insulin spending cap not just to Medicare recipients, but to everyone in the country, but the Senate parliamentarian said they can’t do that through a reconciliation bill (limited to federal spending and income items).
  • Finally, although this wasn’t one of our priorities in the M4A movement, the ACA subsidies that were expanded by the COVID relief bill, but were scheduled to expire at the end of this year, have been extended three more years.

We had won some dental, vision, and hearing benefits under the original BBB bill, but all of that was taken out, so there is no expansion of Medicare benefits under the IRA, unfortunately!

What’s our overall assessment of the IRA? Stephanie says the climate provisions are enough to justify the existence of this bill. Yet it’s such a missed opportunity for Dems to shore up support on one of the issues that consistently ranks among the top concerns of voters: healthcare. Particularly after so many experienced uncertainty and churn the past couple years through job loss, COVID, etc.

But this was primarily an environmental policy bill – is that also a win for the Medicare for All movement? Yes, we think so!

Highlights of the environmental provisions included:

  • More than $300 billion would invested in energy and climate reform, the largest federal clean energy investment in U.S. history (Still falls short of the original $555 B that Dems asked for as part of BBB);
  • Tax credits for individuals if they want to buy solar panels or electric vehicles;
  • Increases taxes for extracted methane and onshore oil and gas extraction; and
  • OF COURSE there are some shitty short-term provisions that Manchin included in the bill, which big oil companies are thrilled with. For example, the Interior Department is required to offer up at least 2 MM acres of federal land and 60 MM acres of offshore land to oil and gas producers for the next decade.

The bill is estimated to cut greenhouse gas emissions by 40% (Biden originally wanted 50%). No small accomplishment!

As Ben discusses, your health outcomes are actually not impacted as much as you’d think by healthcare. Whether you live a healthy, long life, is impacted MUCH more by your environment, by your income level and how you perceive your status in society; your housing security; your experiences of racism, microaggressions, or other forms of bigotry; and so on. So improving environmental health and social determinants of health are major wins for the broader health justice movement, of which M4A is a piece.

Stephanie closes by connecting the dots a bit more directly between the environment and health outcomes:

  • Experts agree: preserving the natural environment is positively correlated with human health outcomes;
  • Much of the bill is targeted at how we mitigate emissions, which eliminate warming:
    • One of the most obvious examples of this is air pollution;
    • It’s estimated that increased heat leads to health conditions like heat stress, heat stroke, cardiovascular disease and more that has cost the US alone close to $263 MM;
    • Soot air pollution causes respiratory ailments that have cost us $820 B, smog pollution up to $7.9 B;
    • Vector-borne diseases that increase mosquitoes and ticks: $860MM – 2.7B;
  • Experts are now considering the fact that children growing up in adverse climate conditions is an adverse childhood event (ACE) — or significant traumatic event that leads to poor health outcomes (mental and physical) later on.

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