By Edward-Isaac Dovere, Arlette Saenz and Tami Luhby, CNN
(CNN) — President Joe Biden is preparing a package of health care measures that he would aim to pass in a second term, with announcements starting this week centered on cutting prescription drug prices.
Biden and aides see the potential to transform health care coverage and cost for millions of Americans and, along the way, give the president a full-throated, forward-looking argument on an issue that has consistently delivered for Democrats in recent election cycles. They believe former President Donald Trump made that much easier by suddenly renewing his calls to repeal and replace the Affordable Care Act – giving them a strong contrast point with the GOP front-runner.
Expected to be part of the president’s proposed agenda: expanding the provisions cutting prices for insulin and other drugs, which were enacted for Medicare enrollees last year as part of the Inflation Reduction Act, and further strengthening the Affordable Care Act by making permanent the enhanced federal premium subsidies that have helped about 10 million people afford coverage on the Obamacare exchanges. The beefed-up assistance is set to expire after 2025.
Aides and advocates are also looking at potential workarounds to provide access to Obamacare coverage in the 10 remaining states that have not expanded Medicaid, now that North Carolina made the move early this month. That alone would make roughly 3.5 million more Americans eligible for Medicaid, according to independent estimates, mostly in deep-red states, but with top 2024 presidential battleground states Wisconsin and Georgia on the list too.
Aides to Trump were themselves caught by surprise when he announced over Thanksgiving weekend his plans to get rid of Obamacare, and many Republicans have ducked any response to it since. But Trump dug in again over the weekend in Iowa, telling a rally that Obamacare “will never be any good.” Florida Gov. Ron DeSantis followed suit, saying on NBC’s “Meet the Press” on Sunday that he would “replace and supersede” the Affordable Care Act with a “better plan” that would be unveiled next year.
Also in discussion in the West Wing: a renewed push for a public option, which would create a government-run health care plan that could compete for customers with private insurance companies. Running in 2020, Biden proposed a public option that would allow people to buy into a program that his campaign at the time said would be similar to Medicare. But he has not talked about it in office – to the point that more moderate senators and activists in the party’s left flank have pushed him to do more.
Believing health care will boost Biden’s appeal to seniors and younger voters – and is a tangible countermeasure to dismay about rising prices through inflation – West Wing aides had been percolating for weeks with plans to make it a focus of Biden’s State of the Union address next year. Trump’s unexpected promise to repeal Obamacare has accelerated their timeline – with Biden expressing surprise in conversations with aides that Trump opened up this conversation again, according to aides.
Much of the White House’s thinking builds on proposals that didn’t make it out of congressional negotiations over the American Rescue Plan Act, the Inflation Reduction Act and other legislation from Biden’s presidency. In particular, they want to broaden the drug price reduction measures beyond Medicare enrollees so all Americans could benefit.
But West Wing aides and top allies in Congress believe they are set to take back more than just scraps.
“We’ve learned a lot in the last couple of years about how important health care is and lowering health care costs are to the American people,” a senior Biden adviser told CNN late last week. “And this is an area of deep resonance and frankly a deep contrast between us and really extreme Republicans who still want to get rid of the Inflation Reduction Act and have voted against these provisions.”
To date, neither Biden nor his reelection campaign has laid out concrete proposals for a second term, keeping the focus on attacking Trump, touting past accomplishments and higher-minded arguments about preserving American democracy. Even the “finish the job” line from Biden’s reelection announcement video in the spring has almost disappeared from campaign material.
“We have to be ever vigilant because Republicans have never given up their efforts to kill the ACA, as demonstrated by the fact that we had heard arguments that it was safe, they weren’t really focused on it,” the Biden senior adviser said. “And then, of course, over the weekend and through the week, the former president really zeroed in on it.”
Health care, aides argue, allows the White House and Biden reelection campaign to tout Biden’s record, call for more action and attack Trump all at once – plus connect it to the massively potent issue of abortion rights, by talking about it as a matter of reproductive health.
“Every presidential election is about the future and the vision of that candidate, whether you’re an incumbent or you’re a challenger or you’re a former president who is a challenger,” said John Anzalone, the Biden pollster whose numbers help inform the weekly political meetings of top White House aides. “Joe Biden has something to say about what he’s done, he has something to say about what he’s going to do, and he has something to say about what the opposition will do to take all of that away.”
Biden is also hoping to benefit from timing. The Centers for Medicare & Medicaid Services and several major drug companies are negotiating the prices of 10 costly drugs in Medicare. Final decisions about the price cuts are expected to be announced in September – just as early voting starts next fall, though the new prices don’t take effect until 2026.
Biden will also look to tout another provision from the Inflation Reduction Act that reduces out-of-pocket costs for drugs whose prices have risen faster than inflation. Together, Biden campaign aides are confident that these measures will continue to boost the president’s standing among voters over 65 years old, who trended back toward Democrats in 2020 and the 2022 midterms, and in a broader way, push back on inflation attacks by showing he is directly addressing costs.
House Democrats join in
Biden’s plans will parallel efforts from Democrats in the House and Senate, particularly those facing tough races. In one competitive district held by a Democrat, for example, Minnesota Rep. Angie Craig already has introduced a bill that would expand the $35 cap on insulin dosages to all Americans.
“It’s funny to me that my bill passed with bipartisan support last Congress, but all of a sudden there’s no Republican support to be found,” Craig told CNN. “The former president and Republican politicians have made it clear they want to take Americans’ health care away, and we’ll be sure to amplify that message.”
Similar bills have been strategically doled out by House Democratic leadership to other incumbents largely in tough districts. The bills include one to extend all Medicare negotiated drug prices to the commercial market and to provide a year of continuous Medicaid eligibility for adults to prevent them from moving on and off coverage.
But since being in the minority means Democrats will not be able to get any of those bills up for votes, the focus will be less on actual legislating than on talking up what they have proposed – and railing against Republicans for opposing capping drug prices. As a House Democratic leadership aide put it, “There’s plenty of receipts.”
“The playbook is already written,” the aide told CNN. “It’s just a matter of us taking the bait that Donald Trump is leaving for us and talking not just about protecting the ACA but (expanding) the provisions that are helping keep costs down.”
Beginning discussion on those bills was the focus of a meeting House Democratic Whip Katherine Clark of Massachusetts hosted with her deputies and several dozen colleagues Thursday. The meeting had already been on the schedule to discuss how to promote the current open enrollment period to sign up for Obamacare back in their districts, but Trump’s comments led to a raucous revamp of the agenda – with cheers and applause breaks as they talked about going after Republicans on health care again.
“When we capped insulin costs to $35 per month for seniors, the GOP unanimously voted no. When we lowered premiums, they voted no. When we expanded coverage, they voted no,” Clark told CNN.
Part of the challenge facing Biden and Democrats heading into 2024 is getting people to realize what they’ve already done to lower prescription drug prices and expand coverage while convincing skeptical Americans the policies are working for them.
A recent KFF health tracking poll found most Americans are not aware of the prescription drug provisions in the Inflation Reduction Act, even though Biden has repeatedly heralded the measures. Only 32% of adults in KFF’s latest poll said they were aware that there’s a federal law that requires the federal government to negotiate the price of some drugs for Medicare enrollees, though this is up from 25% in July.
About a quarter of those surveyed were aware that there are federal laws that cap the cost of insulin at $35 a month for Medicare enrollees, which took effect this year, and place an annual limit on out-of-pocket prescription drug costs for those with Medicare.
Affordability of health care was the second-most important topic voters want to hear discussed in next year’s election, trailing only inflation, according to the survey.
Biden campaign sees ‘an anvil around Republicans’ necks’
The Biden campaign moved quickly to capitalize on Trump’s recent comments about Obamacare, including rushing out a new ad focused on health care.
While preparing for a speech on supply chains last week, Biden told aides he wanted to include lines about how people would lose coverage if Obamacare were repealed, the senior adviser said, and he returned to the topic at a fundraiser in Denver the following evening. Some 40 million people are covered by the Affordable Care Act, the senior Biden adviser said.
“Meanwhile, Donald Trump announced the latest idea in his campaign – he wants to get rid of the Affordable Care Act,” Biden said. “If Trump gets his way, it’s all gone. All gone.”
Repealing and replacing the ACA was a key platform of Trump’s first run for the White House in 2016, but he failed to do so. In the time since, health care as an issue helped Democrats flip the House in 2018, and many Republicans backed off talking about a law that has grown in popularity. It now has a favorable view among nearly 60% of all Americans, according to KFF.
North Carolina Gov. Roy Cooper, a Democrat, credited the extra funding incentives that Biden helped put into legislation in 2021 to encourage Medicaid expansion for why he was able to get his state’s Republican-controlled Legislature to expand the program. That’s made nearly 600,000 people newly eligible for coverage in a state that the Biden campaign has already identified as its top target to flip blue in 2024. On a call last week with reporters organized by the Biden reelection campaign, Cooper called Trump’s recent comments “clueless” on both policy and political levels.
“Donald Trump insists on fighting these old political battles that are an anvil around Republicans’ necks,” Cooper said. “It was hard for me to believe that Donald Trump is actually bringing up this ACA threat once again, but … we’ve got to believe him because he tried it before and almost succeeded.”
Brad Woodhouse, a longtime Democratic strategist who is often in touch with top White House staff as president of the Obamacare-promoting group Protect Our Care, said he is excited to see health care expanded, but also to use it as a wedge in the presidential election.
Woodhouse recalled the then-vice president’s infamous hot mic moment to then-President Barack Obama on the day they celebrated the passage of Obamacare.
“Millions of people with lower drug costs, millions of people paying less for their health care, millions of people with expanded health care,” Woodhouse said, “that’s a BFD, to paraphrase a person.”
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