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    Biden, in Midterm Campaign Pitch, Focuses on Social Security and Medicare

    MIAMI GARDENS, Fla. — President Biden pressed his argument on Tuesday that a Republican victory in next week’s midterm congressional elections would endanger Social Security and Medicare, bringing his case to the retirement haven of Florida, where the politics of the two programs resonate historically.During a whirlwind one-day swing through vote-rich South Florida, Mr. Biden took credit for legislation he pushed through Congress to curb the cost of prescription drugs for Medicare recipients and asserted that Republicans plan to undermine the foundations of the two major government programs benefiting older Americans.“They’re coming after your Social Security and Medicare, and they’re saying it out loud,” Mr. Biden told a crowd at his first full-fledged campaign rally since Labor Day. By contrast, he boasted that Social Security just approved an 8.7 percent increase in benefits, the largest in four decades. “The checks are going to go up and the Medicare fees are going to go down at the same time. And I promise you: I’ll protect Social Security. I’ll protect Medicare. I’ll protect you.”The president has turned increasingly to stark warnings about Social Security and Medicare in the closing days of the campaign, banking on a traditional Democratic issue to galvanize older voters, who tend to turn out more reliably during midterm elections than other generations. Republicans complain that such “Mediscare” tactics unfairly distort their position and reflect desperation by Democrats on the defensive over inflation, which is near a 40-year high.As he presented Republicans as the party of radicalism during his stops on Tuesday, Mr. Biden chastised some of its prominent figures for not taking an attack early Friday on Speaker Nancy Pelosi’s husband seriously and spreading conspiracy theories about it.More on Social Security and RetirementEarning Income After Retiring: Collecting Social Security while working can get complicated. Here are some key things to remember.An Uptick in Elder Poverty: Older Americans didn’t fare as well through the pandemic. But longer-term trends aren’t moving in their favor, either.Medicare Costs: Low-income Americans on Medicare can get assistance paying their premiums and other expenses. This is how to apply.Claiming Social Security: Looking to make the most of this benefit? These online tools can help you figure out your income needs and when to file.“Look at the response of Republicans, making jokes about it,” Mr. Biden said at an earlier fund-raising reception for former Gov. Charlie Crist, who is seeking to reclaim his old office. “The guy purchases a hammer to kneecap” the woman who stands second in line to the presidency, he said of the assailant, and some Republicans brushed it off. “These guys are extremely extreme,” he said.The president’s trip to Florida opened a final week of campaigning before next Tuesday’s vote, but it did not go without its bumps. Mr. Biden, who at 79 is the oldest president in American history, fumbled at one point during his first talk of the day, confusing the American war in Iraq with the Russian war in Ukraine. While trying to correct himself, he then misstated how his son Beau, who served in the Delaware Army National Guard in Iraq, died in 2015.“Inflation is a worldwide problem right now because of a war in Iraq and the impact on oil and what Russia is doing,” Mr. Biden told a crowd at O.B. Johnson Park in Hallandale Beach. “Excuse me, the war in Ukraine,” he said. To explain, he told the audience, “I think of Iraq because that’s where my son died.” Then he seemed to catch himself again and sought to amend his words one more time. “Because, he died,” he said, apparently referring to his belief that Beau’s brain cancer stemmed from his service in Iraq and exposure to toxic burn pits.In addition to Florida, Mr. Biden’s travels this week are expected to take him to New Mexico, California, Pennsylvania and Maryland. With anemic approval ratings, the president is avoiding some of the most competitive states, like Arizona, Georgia and Ohio, where Democrats are not eager to have him at their side. But he will join former President Barack Obama on Saturday in Pennsylvania, where Mr. Biden was born, to bolster John Fetterman’s campaign for Senate, one of the hottest and tightest races in the country.Florida would seem to be fertile territory for Mr. Biden, given that the Inflation Reduction Act, which he signed into law after it passed on party-line votes this summer, caps out-of-pocket prescription drug expenses for Medicare recipients, limits the cost of insulin and empowers the government to negotiate lower prices with pharmaceutical companies, longtime goals of many older Americans. “We beat Big Pharma,” Mr. Biden said on Tuesday.But when national Democrats talk about states where they believe they have good prospects next week, Florida does not make the list. Even though statewide races have been close in recent cycles, Democrats have felt burned by narrow losses and have been reluctant to invest the sizable amounts of money required in a state with so many media markets only to be disappointed again.In addition to Mr. Crist, who is seeking to oust the incumbent Republican governor, Ron DeSantis, Mr. Biden appeared with Representative Val B. Demings, the Democratic challenger to Senator Marco Rubio. Mr. DeSantis leads by roughly nine percentage points and Mr. Rubio by about seven percentage points, according to an aggregation of polls by the political data website FiveThirtyEight.Democrats chose a modest arena at Florida Memorial University, a historically Black college, for the rally, assembling a far smaller crowd than typically mustered by former President Donald J. Trump, a Florida resident.Addressing a largely Black audience, Mr. Biden boasted of his nomination of Justice Ketanji Brown Jackson and other diverse appointees. “Guess what? I promised you I would have a Black woman on the Supreme Court,” he said. “She’s on the Supreme Court. And she’s smarter than the rest of them.”He went after some Republicans by name. He called Mr. DeSantis “Donald Trump incarnate.” He accused Representative Kevin McCarthy of California, the would-be new speaker, of being “reckless and irresponsible.” And he assailed Republicans like Representative Marjorie Taylor Greene of Georgia, the onetime QAnon follower who has worked to push the party to the right, for criticizing his effort to forgive some student loan debt while having their own Covid-19 loan debt forgiven.The president appeared most irritated by attacks on him over inflation. In Hallandale Beach, he pointed to his efforts to limit health care costs for seniors. “They talk about inflation all the time,” he said. “What in God’s name?” He added: “If you have to take a prescription and it cost you an arm and a leg and I reduce that, you don’t have to pay as much. That reduces your cost of living. It reduces inflation.”To bolster his contention that Republicans are aiming to undercut Social Security and Medicare, Mr. Biden once again cited a legislative agenda put forth by Senator Rick Scott of Florida, the chairman of the Senate Republicans’ campaign arm, that has been disavowed by other Republicans, most notably Senator Mitch McConnell of Kentucky, the party’s leader in the upper chamber. Mr. Scott’s legislative agenda called for “sunsetting” all federal legislation every five years, meaning programs like Social Security and Medicare would expire unless reauthorized by Congress.Before the president’s trip to Florida, Mr. Scott said on Sunday that his position had been twisted and that “I don’t know one Republican” who favors cutting Social Security payments or cutting Medicare benefits.“I believe we’ve got to preserve them and make sure that we keep them,” Mr. Scott told Dana Bash on “State of the Union” on CNN. “What I want to do is make sure we live within our means and make sure we preserve those programs. People paid into them. They believe in them. I believe in them. I’m going to fight like hell to make sure we preserve Medicare and Social Security.” More

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    As Midterms Near, Biden Warns Republicans Seek to Dismantle Democratic Legislation

    The president told MSNBC that G.O.P. lawmakers could undo Democrats’ legislative victories if they regained control of Congress.WASHINGTON — President Biden warned on Friday that Republicans could upend legislative victories achieved under his administration and a Democratic Congress if the G.O.P. were to win control of Congress in November’s midterm elections.“They don’t have a platform other than to tear down what I’ve been able to do, we’ve been able to do.” Mr. Biden told an MSNBC news anchor, according to NBC News. “And I don’t know what they’re for.”He also vowed to veto a federal abortion ban if Republicans regain majorities of Congress and seek to pass such legislation. G.O.P. candidates have sought to avoid the subject as polls show a majority of voters support abortion rights.“The president has to sign it. I’ll veto it,” he said.Democrats pulled out a recent series of legislative victories heading into campaign season, after passing sweeping health, climate and tax legislation earlier this year. Those include an infusion of funding into America’s semiconductor industry to counter China and expanded medical benefits for veterans who were exposed to toxins from burn pits on military bases and a gun safety package.“These last several weeks all I’m doing is saying here’s what we’re for, here’s what they’re for and make a choice and vote,” Biden said in the interview with the MSNBC journalist Jonathan Capehart. “And I think people are going to show up and vote like they did last time.”The State of the 2022 Midterm ElectionsBoth parties are making their final pitches ahead of the Nov. 8 election.Where the Election Stands: As Republicans appear to be gaining an edge with swing voters in the final weeks of the contest for control of Congress, here’s a look at the state of the races for the House and Senate.Biden’s Low Profile: President Biden’s decision not to attend big campaign rallies reflects a low approval rating that makes him unwelcome in some congressional districts and states.What Young Voters Think: Twelve Americans under 30, all living in swing states, told The Times about their political priorities, ranging from the highly personal to the universal.In Minnesota: The race for attorney general in the light-blue state offers a pure test of which issue is likely to be more politically decisive: abortion rights or crime.Most recently, Mr. Biden vowed to wipe out up to $20,000 in student loan debt, which he touted on the campaign trail on Friday, noting that the program has received 22 million applications since it opened last week.But that plan was dealt a blow with a ruling by an appeals court Friday on a case brought by several Republican-led states. And a number of Republicans in Congress have targeted some of the administration’s key legislative measures..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-1hvpcve{font-size:17px;font-weight:300;line-height:25px;}.css-1hvpcve em{font-style:italic;}.css-1hvpcve strong{font-weight:bold;}.css-1hvpcve a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.Several House Republicans, including the top G.O.P. member of the committee that oversees entitlement programs such as Medicare and Medicaid, said they would back repealing the law that reduced prescription drug costs for seniors if their party took control of the House in November.Mr. Biden has previously warned that Republicans pose a threat to Social Security and Medicare, as Democrats paint the fate of America’s social safety net programs as a central campaign issue. He has also promised to continue to push forward on Democratic priorities in the next two years, like codifying abortion rights, strengthening gun control laws and instituting police reform, all measures that would be nonstarters with Republican majorities in the House and Senate.“What do you think they’re going to do?” Mr. Biden said at an event last month, criticizing a plan drafted by Senator Rick Scott, Republican of Florida, that would allow Social Security and Medicare to “sunset” if Congress did not extend the programs with new legislation.In his MSNBC interview, Mr. Biden dismissed polls that showed that the majority of voters disproved of his handling of the economy. A recent New York Times/Siena College poll found Republicans have an edge among likely voters going into November, with many voters citing worries about the economy, an issue on which Republican candidates have heavily campaigned.Mr. Biden has kept a low profile on the campaign trail, choosing to avoid rallies and instead touting his legislative victories in smaller events. He reiterated on Friday to MSNBC that he intends to seek re-election in 2024, though he said he had not made a formal decision. More

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    Biden Says Social Security Is on ‘Chopping Block’ if Republicans Win Congress

    WASHINGTON — President Biden warned on Tuesday that Republicans posed a threat to Social Security and Medicare, amplifying an effort by Democrats to make the fate of America’s social safety net programs a central campaign issue ahead of November’s midterm elections.The comments were part of a push by Democrats across the country to steer the political conversation away from soaring prices and growing recession fears and remind anxious voters that some Republicans have been calling for restructuring or scaling back entitlement programs that retirees have relied on for decades.The strategy is a return to a familiar election-year theme. Although Mr. Biden, who spoke from the White House’s Rose Garden, offered few details about how he would preserve the benefits, he insisted that if Republicans regained control of Congress they would try to take them away.“What do you think they’re going to do?” Mr. Biden asked, brandishing a copy of a plan drafted by Senator Rick Scott, Republican of Florida, that would allow Social Security and Medicare to “sunset” if Congress did not pass new legislation to extend them.A spokesman for Mr. Scott said the senator was fighting to protect Social Security and Medicare.The criticism has put Republicans on the defensive, with many arguing that their policies would ensure that Social Security and Medicare do not run out of money.The State of the 2022 Midterm ElectionsWith the primaries over, both parties are shifting their focus to the general election on Nov. 8.A Focus on Crime: In the final phase of the midterm campaign, Republicans are stepping up their attacks about crime rates, but Democrats are pushing back.Pennsylvania Governor’s Race: Doug Mastriano, the Trump-backed G.O.P. nominee, is being heavily outspent and trails badly in polling. National Republicans are showing little desire to help him.Megastate G.O.P. Rivalry: Against the backdrop of their re-election bids, Gov. Greg Abbott of Texas and Gov. Ron DeSantis of Florida are locked in an increasingly high-stakes contest of one-upmanship.Rushing to Raise Money: Senate Republican nominees are taking precious time from the campaign trail to gather cash from lobbyists in Washington — and close their fund-raising gap with Democratic rivals.Despite suggestions of their imminent demise, Social Security and Medicare are unlikely to be altered as long as Mr. Biden is in power. Top Republicans including Senator Mitch McConnell of Kentucky, the minority leader, have said that Mr. Scott’s proposal is a nonstarter.But decades of political squabbling have left the programs in limbo.Tens of millions of aging Americans rely on Social Security and Medicare to supplement their income and health care expenses. The finances of Social Security and Medicare have been on unstable ground for years, and Congress has been unable to come together to find a solution to secure the solvency of the programs..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-ok2gjs{font-size:17px;font-weight:300;line-height:25px;}.css-ok2gjs a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.Government actuaries said in June that the health of the social safety net programs improved slightly last year, because of the strength of the economic recovery, but that shortfalls were still looming.Mr. Biden did not offer a specific proposal for the programs on Tuesday beyond keeping them out of the hands of Republicans. He also took aim at Senator Ron Johnson, a Wisconsin Republican who is facing re-election and has suggested that all federal spending, including for Social Security and Medicare, should be reviewed annually by Congress.“He wants to put Social Security and Medicare on the chopping block every single year in every budget,” Mr. Biden said. “If Congress doesn’t vote to keep it, goodbye.”Mr. Johnson said on Twitter on Tuesday that he wanted to save Social Security, Medicare and benefits for veterans, and that Democrats were telling “lies” about his proposals.“The greatest threat to these programs is the massive, out-of-control deficit spending enacted by Biden and Dems in congress,” Mr. Johnson said.The Social Security Old-Age and Survivors Insurance Trust Fund, which pays retiree benefits, will be depleted in 2034, at which time the fund’s reserves will run down and incoming tax revenue will be enough to cover only 77 percent of scheduled benefits. Medicare’s hospital trust fund, which does not affect benefits that cover doctor visits and prescription drugs, improved last year but is expected to encounter a shortfall in 2028.Concerns about the solvency of the programs come as retirees are grappling with the highest levels of inflation in four decades. Social Security payments are expected to increase by around 9 percent next month when a cost-of-living adjustment that is pegged to inflation is announced.Those increases are usually somewhat offset by an increase in Medicare premiums for doctors’ visits, but Mr. Biden said those premiums would not rise this year.Senators like Bernie Sanders, independent of Vermont, and Elizabeth Warren, Democrat of Massachusetts, called earlier for expanding Social Security and extending its solvency by raising taxes on the rich. More

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    Covid-19 Relief Bill Fulfills Biden’s Promise to Expand Obamacare, for Two Years

    #masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutGuidelines After VaccinationAdvertisementContinue reading the main storySupported byContinue reading the main storyPandemic Relief Bill Fulfills Biden’s Promise to Expand Obamacare, for Two YearsWith its expanded subsidies for health plans under the Affordable Care Act, the coronavirus relief bill makes insurance more affordable, and puts health care on the ballot in 2022.President Biden after delivering remarks on the Affordable Care Act in November. The changes to the health law would cover 1.3 million more Americans.Credit…Amr Alfiky/The New York TimesMarch 8, 2021WASHINGTON — President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.The bill, which will most likely go to the House for a final vote on Wednesday, includes a significant, albeit temporary, expansion of subsidies for health insurance purchased under the act. Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.The changes will last only for two years. But for some, they will be considerable: The Congressional Budget Office estimated that a 64-year-old earning $58,000 would see monthly payments decline from $1,075 under current law to $412 because the federal government would take up much of the cost. The rescue plan also includes rich new incentives to entice the few holdout states — including Texas, Georgia and Florida — to finally expand Medicaid to those with too much money to qualify for the federal health program for the poor, but too little to afford private coverage.“For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition. The bill, he said, would “make a big dent in the number of the uninsured.”But because those provisions last only two years, the relief bill almost guarantees that health care will be front and center in the 2022 midterm elections, when Republicans will attack the measure as a wasteful expansion of a health law they have long hated. Meantime, some liberal Democrats may complain that the changes only prove that a patchwork approach to health care coverage will never work.“Obviously it’s an improvement, but I think that it is inadequate given the health care crisis that we’re in,” said Representative Ro Khanna, a progressive Democrat from California who favors the single-payer, government-run system called Medicare for All that has been embraced by Senator Bernie Sanders, independent of Vermont, and the Democratic left.“We’re in a national health care crisis,” Mr. Khanna said. “Fifteen million people just lost private health insurance. This would be the time for the government to say, at the very least, for those 15 million that we ought to put them on Medicare.”Mr. Biden made clear when he was running for the White House that he did not favor Medicare for All, but instead wanted to strengthen and expand the Affordable Care Act. The bill that is expected to reach his desk in time for a prime-time Oval Office address on Thursday night would do that. The changes to the health law would cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.Representative Frank Pallone Jr. of New Jersey, who helped draft the health law more than a decade ago and leads the House Energy and Commerce Committee, has called it “the biggest expansion that we’ve had since the A.C.A. was passed.”But as a candidate, Mr. Biden promised more, a “public option” — a government-run plan that Americans could choose on the health law’s online marketplaces, which now include only private insurance.“Biden promised voters a public option, and it is a promise he has to keep,” said Waleed Shahid, a spokesman for Justice Democrats, the liberal group that helped elect Representative Alexandria Ocasio-Cortez and other progressive Democrats. Of the stimulus bill, he said, “I don’t think anyone thinks this is Biden’s health care plan.”Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.Senators Bill Hagerty and Chris Coons at the Capitol on Saturday during a series of votes on amendments to the relief bill.Credit…Anna Moneymaker for The New York TimesThe Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.The Coronavirus Outbreak More

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    Pandemic Relief Bill Fulfills Biden’s Promise to Expand Obamacare, for Two Years

    #masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyPandemic Relief Bill Fulfills Biden’s Promise to Expand Obamacare, for Two YearsWith its expanded subsidies for health plans under the Affordable Care Act, the coronavirus relief bill makes insurance more affordable, and puts health care on the ballot in 2022.President Biden after delivering remarks on the Affordable Care Actin November. The changes to the health law would cover 1.3 million more Americans.Credit…Amr Alfiky/The New York TimesMarch 8, 2021Updated 8:30 p.m. ETWASHINGTON — President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.The bill, which will most likely go to the House for a final vote on Wednesday, includes a significant, albeit temporary, expansion of subsidies for health insurance purchased under the act. Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.The changes will last only for two years. But for some, they will be considerable: The Congressional Budget Office estimated that a 64-year-old earning $58,000 would see monthly payments decline from $1,075 under current law to $412 because the federal government would take up much of the cost. The rescue plan also includes rich new incentives to entice the few holdout states — including Texas, Georgia and Florida — to finally expand Medicaid to those with too much money to qualify for the federal health program for the poor, but too little to afford private coverage.“For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition. The bill, he said, would “make a big dent in the number of the uninsured.”But because those provisions last only two years, the relief bill almost guarantees that health care will be front and center in the 2022 midterm elections, when Republicans will attack the measure as a wasteful expansion of a health law they have long hated. Meantime, some liberal Democrats may complain that the changes only prove that a patchwork approach to health care coverage will never work.“Obviously it’s an improvement, but I think that it is inadequate given the health care crisis that we’re in,” said Representative Ro Khanna, a progressive Democrat from California who favors the single-payer, government-run system called Medicare for All that has been embraced by Senator Bernie Sanders, independent of Vermont, and the Democratic left.“We’re in a national health care crisis,” Mr. Khanna said. “Fifteen million people just lost private health insurance. This would be the time for the government to say, at the very least, for those 15 million that we ought to put them on Medicare.”Mr. Biden made clear when he was running for the White House that he did not favor Medicare for All, but instead wanted to strengthen and expand the Affordable Care Act. The bill that is expected to reach his desk in time for a prime-time Oval Office address on Thursday night would do that. The changes to the health law would cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.Representative Frank Pallone Jr. of New Jersey, who helped draft the health law more than a decade ago and leads the House Energy and Commerce Committee, has called it “the biggest expansion that we’ve had since the A.C.A. was passed.”But as a candidate, Mr. Biden promised more, a “public option” — a government-run plan that Americans could choose on the health law’s online marketplaces, which now include only private insurance.“Biden promised voters a public option, and it is a promise he has to keep,” said Waleed Shahid, a spokesman for Justice Democrats, the liberal group that helped elect Representative Alexandria Ocasio-Cortez and other progressive Democrats. Of the stimulus bill, he said, “I don’t think anyone thinks this is Biden’s health care plan.”Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.Senators Bill Hagerty and Chris Coons at the Capitol on Saturday during a series of votes on amendments to the relief bill.Credit…Anna Moneymaker for The New York TimesThe Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.The Coronavirus Outbreak More

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    After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

    President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More