Biden Challenges McCarthy: Show Me Your Plan

Biden Challenges McCarthy: Show Me Your Plan

Biden will meet with McCarthy Wednesday
Kyle Mazza/NurPhoto
By Yuval Rosenberg and Michael Rainey
Tuesday, January 31, 2023

Good Tuesday evening. The White House has announced that it will be ending the coronavirus public health emergency in May, and it previewed President Joe Biden’s approach to a closely watched meeting Wednesday with House Speaker Kevin McCarthy (R-CA).

Here’s what’s happening.

White House Previews Agenda for Biden-McCarthy Meeting

Reporters keep asking President Biden if he’ll negotiate with House Speaker Kevin McCarthy (R-CA) over raising the debt limit.

"Show me your budget, I'll show you mine," Biden said Monday by way of answering the question. "Show me his budget!" he reiterated on Tuesday.

The two men are scheduled to meet Wednesday for the first time since Republicans took control of the House, and while McCarthy has been pressing for the White House to engage in talks about spending cuts. In response, Biden and Democrats have asked McCarthy to lay out just what kind of cuts he wants.

Biden is reportedly prepared to make the same demand in person on Wednesday. According to a memo reportedly distributed by senior White House aides, the president will press McCarthy for a budget and details about the spending cuts he wants. He’ll also ask the speaker to commit to avoiding a default on the nation’s debt.

The memo, written by National Economic Council Director Brian Deese and Office of Management and Budget Director Shalanda Young, reportedly says the White House will release Biden’s budget on March 9 and challenges McCarthy to also release a comprehensive budget plan.

"It is essential that Speaker McCarthy likewise commit to releasing a budget," the memo reportedly says, "so that the American people can see how House Republicans plan to reduce the deficit – whether through Social Security cuts; cuts to Medicare, Medicaid, and Affordable Care Act (ACA) health coverage; and/or cuts to research, education, and public safety – as well as how much their Budget will add to the deficit with tax cuts for the wealthiest Americans and large corporations, as in their first bill this year."

ABC News reports that the memo also indicates that Biden will ask if McCarthy "commit to the bedrock principle that the United States will never default on its financial obligations" and whether he agrees with "former presidents, including Presidents Trump and Reagan, that it is critical to avoid debt limit brinksmanship."

McCarthy responded in a statement: "Mr. President: I received your staff’s memo. I'm not interested in political games. I'm coming to negotiate for the American people."

US Covid Emergency to End in May

President Biden plans to end the emergency federal response to Covid-19 on May 11, the White House told Congress Monday evening, as public health officials shift toward treating the viral infection as a seasonal illness.

The Office of Management and Budget said that two emergencies declared by the Trump administration early in 2020 — the Covid-19 national emergency set to expire on March 1 and the public health emergency (PHE) set to expire on April 11 — would be coming to an end. "At present, the Administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date," OMB said in a statement. "This wind-down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE."

House Republicans had lined up votes this week on measures to end the health emergency and on Tuesday they pressed the White House to terminate the declaration immediately. The White House rejected the idea, saying that the health care system needs time to adjust as it returns to pre-Covid rules and regulations. "[A]n abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans," OMB said.

The emergency declaration allowed millions of people to remain on Medicaid as states were barred from removing beneficiaries, while billions in extra funds were provided to care for Covid patients. The emergency touched private insurers and medical service providers, as well, and the cost of many medical goods and services was reduced following the emergency declarations. Starting in May, much of that will change.

"People will have to start paying some money for things they didn’t have to pay for during the emergency," Jen Kates of the Kaiser Family Foundation told CNN. "That’s the main thing people will start to notice."

The details of what will change are complex. Some Medicare and Medicaid participants will face out-of-pocket costs for at-home Covid testing and all treatments, but vaccines will remain free. Those with private insurance will face a variety of possible new charges, including for vaccines and care delivered by out-of-network providers. Those without insurance, who had been able to access free vaccines, testing and treatment during the pandemic, have already started paying again for many of those services, since federal funding ran out last spring.

In addition, hospitals will lose a 20% boost to the Medicare payment rate for treating Covid patients, while Medicare Advantage plans will once again be allowed to charge Covid patients for out-of-network care.

The biggest change may be seen in Medicaid enrollment. About 15 million people could lose their Medicaid health coverage as states reduce their enrollment levels. Some of those may qualify for coverage through the Affordable Care Act, but millions are expected to lose coverage entirely.

The end of the national emergency will also end the use of Title 42 policy at the border, OMB said. Title 42 allows the federal government to deport migrants rapidly due to health concerns, and its use has been subject to litigation that will be rendered moot after May 11.

Poll of the Day: More Americans Say US Providing Too Much Aid to Ukraine

President Joe Biden said Monday that the United States will not be providing F-16 fighter jets to Ukraine, despite reports that some Pentagon officials are pushing for it.

The decision, reportedly rooted in a desire to avoid a direct confrontation with Russia, comes after the U.S. and Germany last week agreed to provide tanks to Ukraine. It also comes as a growing share of Americans say the United States has provided too much support for Ukraine, according to new polling from the Pew Research Center.

Since Russia first invaded Ukraine nearly one year ago (on February 24, 2022), Congress has approved more than $113 billion in military, humanitarian and economic aid for the Ukrainian government and its allies, according to a recent tally by the Committee for a Responsible Federal Budget. Most of that money, nearly $70 billion, has been allocated for defense needs.

While 31% of poll respondents told Pew that the United States is providing the right amount of aid — and 20% want to see more assistance — just over a quarter (26%) say that the U.S. has sent too much aid, up 6 percentage points since September and 19 percentage points since shortly after the invasion.

The shift has largely been driven by Republicans, who increasingly say the U.S. has done too much. "Today, 40% of Republicans and Republican-leaning independents hold this view, up from 32% in the fall and much higher than the 9% who held this view in March of last year," Pew finds. "There has also been an increase in the share of Democrats who say the U.S. is providing too much support to Ukraine. Still, only 15% of Democrats and Democratic-leaning independents currently say this, up from 5% last March."

The Pew survey was conducted January 18-24 among 5,152 U.S. adults.

US Health Care System: High Cost, Poor Performance

You may already know this sad fact about US health care: We spend more than any other high-income country but get worse outcomes. That shocking truth is no longer surprising, but a new report by The Commonwealth Fund think tank details some of the many ways U.S. health care underperforms that of peer countries.

The many failings of the U.S. health care system documented in the report include:

* The highest per capita spending on health care in the industrialized world ($11,912 in 2022);

* The highest health care spending as a percentage of GDP (17.8% in 2021):

* The lowest life expectancy at birth (77 years in 2020);

* The highest death rates for treatable conditions;

* The highest maternal and infant mortality;

* An obesity rate (42.8% in 2019) nearly twice the OECD average;

* The highest death rate from Covid-19 (3,253 per 1 million people);

* The only wealthy country that does not guarantee health coverage.

The bottom line: "Americans are living shorter, less healthy lives because our health system is not working as well as it could be," said lead author Munira Gunja, a senior researcher for The Commonwealth Fund's International Program in Health Policy and Practice Innovation. "To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population."

Number of the Day: $0

We told you yesterday about the new rules governing overpayments in the Medicare Advantage system that are expected to produce an estimated $4.7 billion in clawbacks over 10 years from private insurers who overcharge for care — a development seen as a victory for federal oversight and accountability. But Fred Schulte of Kaiser Health News notes a less savory aspect of the new rules: The Centers for Medicare & Medicaid Services also said that it would largely ignore any overbilling that occurred before 2018 as it audits accounts.

"Medicare Advantage plans for seniors dodged a major financial bullet Monday as government officials gave them a reprieve for returning hundreds of millions of dollars or more in government overpayments — some dating back a decade or more," Schulte writes. "[I]n a surprise action, CMS announced it would require next to nothing from insurers for any excess payments they received from 2011 through 2017."

The precise value of the overpayments the insurers will be able to keep is unknown since audits going back to 2011 have not been completed.

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