Democrats have opportunity to be bigger, bolder, in 2021

With control of the Oval Office and both legislative houses, Democrats have an opportunity to make sweeping changes to American health care over the next two years. Representatives Earl Blumenauer, a Oregon representative from the Portland area, and Kim Schrier, from the outskirts of Seattle in Washington, discussed the upcoming year for Democrats at the Federal State of Reform health policy conference on Wednesday.

Blumenauer said that the Georgia runoff elections, which netted Democrats two senate seats in the long-time red state to gain a majority, changed the dynamic of the next two years. Instead of expecting gridlock, the Democrats can instead think bigger and make substantial changes to U.S. health care. A first step to doing this would be by expanding provisions from March’s American Rescue Plan. He said:

“Right now, our focus is trying to take the very real positive developments that were passed in the rescue plan and making them permanent. The reduction that we’ve seen in terms of premium costs, [reducing the cost of] COBRA going forward. We’ve got a chance here to build on that.”

Continuation of Health Coverage (COBRA) is a program that allows workers to keep their health care plans after losing their jobs. Continuation of care often came with high premiums, though, making it unaffordable for many to keep their insurance in between jobs. The American Rescue Plan will provide subsidies to COBRA, giving unemployed individuals free care through September. 


Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.


He later said that Democrats are often “paralyzed” by complexity, choosing not to go forward with good policy decisions due to an obsession with nuance. He cites the lead up to the passing of the Affordable Care Act in 2010, where Democrats were unable to pass a public option despite a large majority in the Senate. 

Blumenauer continued:

“We have narrow margins, we have massive challenges. I think it’s important for us to build on what we have done, but that is not to say that we cannot make some very revolutionary changes. I think this administration is poised to be able to make big changes in terms of the outmoded fee for service model.”

Schrier agrees, saying the pandemic has made it apparent that many changes are needed now. She said:

“There are a lot of our priorities, regarding health care access to health care cost of health care, that have been priorities for a long time but were made acutely necessary by the pandemic and how it’s affected certain communities. [COVID-19] put real attention on child poverty, health care access and on bringing down premiums.”

Though some in her district, which she referred to as a “purple” district, may be weary of large scale changes to their health care such as Medicare For All or a public option. She said: 

“In my district, people are pretty happy with what they have. They’re nervous about giving that up for something that is uncertain right now. Once you have something, it’s very hard to take it away and feel secure about that. So mostly what I hear is that if you have insurance through your job and that’s part of your compensation package, and you’re telling me that will go away? Now I would not only not get that benefit, I would have to pay more in taxes, fees, whatever you call it, to fund a Medicare For All type of program.”

For Democrats this year, finding a balance between making sweeping changes the country may need and maintaining the popular portions of health care  will be a major challenge.