Manchin on collision course with Warren, Sanders

Sen. Joe Manchin (D-W.Va.) is headed for a high-profile battle with the Senate’s leading progressives over whether to expand Medicare eligibility as part of President Biden’s human-focused infrastructure agenda.

Sen. Elizabeth Warren (D-Mass.) on Thursday said she wants to lower the eligibility age, a priority shared by Sen. Bernie Sanders (I-Vt.), as part of Biden’s $1.8 trillion American Families Plan.

But the two progressives face a serious obstacle in Manchin, a key centrist in the 50-50 Senate who opposes making Medicare available to millions more Americans, citing concerns about the long-term solvency of the program.

Warren said during a Washington Post Live event that she has laid out a plan for “lowering the age of Medicare, which by the way is on table right now and something we’re all talking about.” 

“I would like to see us start out by lowering the age of Medicare down to 55,” she said.

The current age of eligibility is 65.

“I would also like to see us right now attack the cost of prescription drugs,” Warren added.

Sanders says he’s been talking directly to Biden about similar priorities.

“What I think needs to be done is that Medicare needs to be expanded to include dental, hearing aids and eyeglasses,” he told The Hill last week, adding that lowering the Medicare eligibility age is “very important.”

Manchin is squarely opposed to lowering the age. 

“No, I’m not for it, period,” he told The Washington Post last week.

The internal Democratic debate over expanded Medicare will only intensify as Senate Majority Leader Charles Schumer’s (D-N.Y.) plan for moving Biden’s infrastructure agenda comes into focus. 

Pressure to include significant health care reform proposals in an infrastructure package will ramp up if there’s any doubt about moving a third legislative package through the budget reconciliation process later in the year to advance any priorities left out of Biden’s American Jobs Plan and American Families Plan, which together carry a price tag of $4.1 trillion.

“Whether it will end up in the final package, we will see. But Bernie Sanders and Elizabeth Warren and lots of others are pushing to include both of these things,” said Roger Hickey, co-founder of the progressive Campaign for America’s Future, referring to proposals for expanding Medicare and lowering the cost of prescription drugs.

“We think it’s important and we’re pushing as hard as we can, and it will just strengthen the whole package,” he said, noting Medicare expansion is “popular in West Virginia with people who voted for [Manchin].”

A key consideration is how many times Schumer will use budget reconciliation this year to bypass a Republican filibuster. If he plans to use three reconciliation vehicles to pass separate parts of Biden’s infrastructure agenda with simple majority votes, there might be an opportunity for Medicare expansion and other health care priorities to pass separately from Biden’s two-part infrastructure agenda.

But Schumer has been vague about such plans, saying only that budget reconciliation is an option without getting into more detail. 

“I’m a little confused about whether or not we get another bite at the apple in September,” Hickey said.

Democrats looking to the White House for clarity on Medicare eligibility aren’t having much success either.

Biden said during the 2020 campaign that he supported lowering Medicare eligibility to 60 but hasn’t pushed the concept vigorously since taking office.

In his joint address to Congress last week, Biden declared that “health care should be a right, not a privilege, in America” and proposed saving hundreds of billions of dollars in federal spending by giving Medicare the power to negotiate lower prescription drug prices. 

He said the money saved could go toward strengthening the Affordable Care Act and expand Medicare coverage benefits “without costing taxpayers one additional penny.”

But Biden has kept talk about expanding Medicare and lowering drug prices separate from his push to pass the American Jobs Plan and the American Families Plan, his two infrastructure components.

This week, he expressed concern about deficit spending, a near certainty if Congress significantly expanded Medicare access without new measures to pay for the added cost.

Another proposal on the table is the Medicare-X Choice Act introduced in February by Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.). The measure would create a public health insurance option for uninsured individuals, families and small businesses, reimbursing doctors at Medicare rates and using the same facilities covered by Medicare.

Activists who favor expanded Medicare eligibility and lower drug costs predict the two issues will draw fierce opposition from powerful interest groups like hospitals and drug companies, which both stand to lose billions of dollars in revenue if the proposals are enacted.

Including those priorities in an infrastructure package could also threaten passage of Biden’s proposal by pitting Manchin against Warren and Sanders.