Biden goes on offense over entitlement reform, setting up 2024 battle with Trump

President Joe Biden highlighted and hit back against comments from former President Donald Trump Monday suggesting openness to entitlement reform, vowing to a largely retirement age crowd in New Hampshire that he would block any efforts to cut Medicare or Social Security.

“Many of my Republican friends want to put Social Security and Medicare back on the chopping block again. Many of them are trying to cut Social Security and Medicare or raise the retirement age again. I will stop them,” Biden said.

On a visit to New Hampshire, a state with one of the country’s oldest populations, Biden outlined a health care agenda that he says contrasts sharply with Republicans, who have pledged to repeal the Affordable Care Act and eliminate caps on out-of-pocket drug costs.

Biden’s aides believe health care is a potent, if sometimes overlooked, issue for voters as the general election gets underway. And the president was quick to point out Trump’s own words on the matter in an interview with CNBC earlier Monday.

“Even this morning, Donald Trump said cuts to Social Security and Medicare on the table. When asked if he’d change his position, he said, quote, ‘There’s a lot you can do in terms of cutting,’” Biden said.

He misquoted part of Trump’s remarks to CNBC on the matter, then corrected himself: “Tremendous amount of things you can do,” he said, quoting Trump.

Biden continued, “I’m never gonna allow that to happen. I won’t cut Social Security and I won’t cut Medicare. …I will protect and strengthen Social Security, Medicare and make the wealthy to begin to pay their fair share.”

In his fiscal 2025 budget, released Monday, the president reissued his plan to strengthen Medicare’s hospital insurance trust fund. The measure, first proposed in last year’s budget, would increase the net investment income tax rate on earned and unearned income above $400,000 to 5%, up from 3.8%.

Also, the tax would be levied on the owners of certain pass-through firms who include business income on their personal tax returns and aren’t currently subject to the tax. In addition, the plan would dedicate the revenue from the tax, which was created by the Affordable Care Act, to Medicare’s hospital insurance trust fund. And it would funnel some savings from the proposed Medicare drug reforms into the trust fund.

Without any changes, Medicare’s hospital insurance trust fund, known as Medicare Part A, will only be able to pay scheduled benefits in full until 2031, according to the latest Medicare trustees’ annual report. At that time, Medicare, which covers nearly 67 million senior citizens and people with disabilities, will only be able to cover 89% of total scheduled benefits.

Biden, however, has yet to offer a detailed proposal to address the looming shortfall in Social Security’s trust fund. His latest budget reiterated his principles of not cutting benefits, asking higher-income Americans to pay more in taxes and improving benefits for lower-income seniors and people with disabilities.

Social Security’s combined trust funds are set to run dry in 2034, at which time the program’s continuing income from taxes will only be able to cover 80% of benefits owed, according to the most recent Social Security trustees report.

Laying out the differences

The remarks signified a renewed effort by the president to draw a contrast with his predecessor in an effort to court the older voters he will need in November.

And four years to the day after the World Health Organization declared a pandemic, Biden said that Trump “failed the most basic of any duty a president owes to the American people: the duty of care,” he said, calling that “unforgivable.”

Hours after his administration released its budget wishlist, Biden said his proposed budget would “help in a big way” toward lowering the cost of health care.

Biden said he would work in a second term to expand some of his drug pricing provisions, including extending a $35 monthly cap on the price of insulin — currently only for Medicare recipients — to all Americans.

And he said he was calling on Congress to make permanent the enhanced federal premium subsidies for Affordable Care Act coverage that are set to expire at the end of next year.

That was a sharp contrast, he said, with Republicans, whom he accused of trying to slash Social Security and Medicare.

Biden also invoked the Republican Sen. John McCain as he referenced the late senator’s vote in 2017 that ended Republicans’ efforts to repeal and replace the signature health care bill.

“John loved New Hampshire, and he still drives my predecessor crazy - even though he’s long gone, that’s John,” he said.

A winning issue for Democrats

Democrats have successfully messaged on the issue in the past several election cycles, and the relative popularity of the law known as Obamacare has made for a natural opportunity to have Biden appear alongside his former boss, Barack Obama, in campaign videos.

And even as the president called on Congress on Monday to pass new laws that would expand a cap on out-of-pocket drug costs, allow Medicare to negotiate the prices of more drugs, and extend Obamacare premium subsidies, there is little chance the GOP-controlled House will take them up before November.

That made Monday’s stop in New Hampshire an opportunity to draw a sharp contrast with Trump and his fellow Republicans. Biden won the Granite State by a 7-point margin in 2020, though polls show a tighter contest this year. It was Biden’s first trip to the state since its primary contest in January, which he won despite his name not appearing on the ballot.

In a state where a fifth of the population is over 65, lowering health care costs and expanding access to care hold outsize significance. Biden is expected to continue a line of attack he began during his State of the Union address last week.

In his speech, Biden called the 14-year-old Obamacare “still a very big deal” — a nod to his profanity-laced description of the law the day it was signed. And he vowed to bar Republican attempts to repeal it.

“I’m not going to let that happen. We stopped you 50 times before, and we’ll stop you again,” Biden said.

Late last year, Trump said Republicans should “never give up” on trying to repeal the landmark Obama-era health reform law, adding that he was “seriously looking at alternatives.”

The Biden campaign quickly seized on those comments and has accused Trump of harboring a “vendetta” against the law because of his personal animus toward Obama, Biden’s predecessor.

For Democrats, being able to campaign in defense of the Affordable Care Act is a dramatic reversal of fortune from a decade ago. GOP presidential and congressional candidates successfully ran against the legislation for years after its passage. Yet as more Americans sign up for coverage through the law’s exchanges, it has become even more embedded into the nation’s health care system.

Fifty-nine percent of Americans said they had a favorable view of the law as of February, according to the most recent polling from KFF, formerly the Kaiser Family Foundation.

Another KFF poll from December found that Democratic voters were more than twice as likely as their GOP peers to say that the future of the health reform law is a “very important” issue for the 2024 presidential candidates to discuss. Overall, 49% of voters said the issue is “very important,” but breaking it down by party, 70% of Democratic voters felt that way, while only 32% of Republican voters did.

For Biden, the past three years have seen steady efforts at trying to bring down the cost of drugs. One of the president’s most frequently touted accomplishments is capping the out-of-pocket cost of insulin at $35 a month for Medicare enrollees. He has vowed to expand the cap for all Americans if reelected.

Little awareness of Biden’s drug price initiatives

In his State of the Union, the president went after not only Republicans for resisting his drug pricing efforts but also pharmaceutical companies, calling out “Big Pharma” three times in his speech. It was an effort at publicizing the 2022 measure that empowered Medicare to negotiate drug prices for the first time. Polls show the publicity is needed.

Most Americans are not aware of the prescription drug provisions in the 2022 Inflation Reduction Act, even though Biden has repeatedly heralded these measures as evidence of his work to lower drug prices, one of Americans’ biggest complaints.

Only 32% of adults in KFF’s poll from December said they were aware there’s a federal law that requires the federal government to negotiate the price of some expensive drugs for Medicare enrollees, though that was up from 25% in July.

The administration and drugmakers are negotiating the prices for 10 costly drugs, including those that treat heart disease, certain cancers and diabetes, among other conditions. The negotiated prices will be announced by September 1 and take effect in 2026. The drugmakers and industry groups have filed lawsuits in federal courts across the US in hopes of stopping the effort, contending that the program is unconstitutional.

And, despite Biden calling attention to the benefit, only about a quarter of those surveyed by KFF were aware there is a federal law that caps the cost of insulin for Medicare enrollees, which took effect in 2023.

Another provision of the Inflation Reduction Act places an annual cap on the out-of-pocket costs in Medicare Part D drug plans. Enrollees will spend no more than about $3,300 for brand name drugs this year. A $2,000 annual cap on out-of-pocket drug spending will kick in in 2025.

Fewer than a quarter of adults knew about the federal law that limits out-of-pocket drug costs for Medicare beneficiaries, according to KFF’s poll.

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