Politico got it right: “Democrats’ social spending proposal represents a sweeping expansion of the health safety net … .”

Despite claims that negotiations among Democrats are leading to a smaller and less radical proposal, the latest version of the “Build Back Better” tax-and-spend bill still represents a massive government expansion in health care.

As a matter of fact, almost all of the original health care provisions in the $3.5 trillion package remain in place and a full-blown government takeover remains in sight.  

Specifically, the bill still expands government subsidies to Obamacare exchange plans and the rich; undercuts private, employer-based coverage; undermines non-Obamacare options; expands the size and scope of an overextended Medicaid program; and puts new obligations on an outdated Medicare program.

The “new” items in the bill aren’t really “new.” They are the same old policies masquerading as something “new,” and they don’t make the bill any more appealing.

The bill replaces plans to create a new government-run, “public” option with a plan to push more people into Medicaid-like plans through the Obamacare exchanges. It replaces plans to add dental, vision, and hearing benefits to traditional Medicare with a plan to offer only hearing benefits that are already available outside of traditional Medicare. And it replaces plans to have the government set prescription drug prices based on prices set by other countries with plans for the secretary of health and human services to set price controls through so-called negotiations.  

The consequences of the legislation—intended or unintended—remain the same. The package of policies will drive out private coverage options, undermine the existing safety net, and leave taxpayers holding the bag.  

Policies such as lowering the threshold for individuals with employer coverage to qualify for government subsidies; linking the subsidies to coverage only sold through the government-run exchanges; and extending subsidies to enroll more people into Medicaid-like plans through the government exchanges will lock more in Obamacare, where the government is in charge.

Policies such as lifting income limits on qualifying for subsidies in the exchange or to enroll in existing safety-net programs, such as Medicaid, and imposing new mandates on the states and restricting their ability to manage the programs based on the needs of their residents, and not the federal government, will weaken state flexibility and overstretch an already overburdened program.   

Budget gimmicks, by either delaying the start dates or abruptly cutting off benefits, as would be done with expansion of the Obamacare subsidies, manipulates the true cost of the proposal.

Furthermore, arbitrary government price controls, as would be done with prescription drugs, or capping premiums, means people will get less access and less coverage or someone (i.e., taxpayers) will be left to fill in the gap.

All in all, the bill continues to paper over the problems of Obamacare with more money and more regulation instead of reforms that empower patients and families, not the government.  

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