Progressives ramp up Medicare expansion push in Congress

Progressives are ramping up their push to expand Medicare in an upcoming legislative package, with the goal of lowering the eligibility age and adding new benefits.

The Congressional Progressive Caucus made its case to White House counselor Steve Ricchetti in a meeting Tuesday, saying they want eligibility to kick in at 60 instead of 65 and coverage extended to dental, vision and hearing.

Sen. Bernie Sanders (I-Vt.) is also vocally pushing the group’s proposals, saying too many seniors “can’t chew food properly” because they don’t have dental coverage.

But the campaign faces headwinds from a slew of health care priorities competing for a limited amount of dollars, as well as concerns from the industry and moderate Democrats who worry about lowering the Medicare age.

Advocates and congressional aides say adding new benefits has a significantly better chance of making it into the Democratic-only package than lowering the eligibility age.

Changing the age is more politically controversial, as it opens up the debate about moving toward “Medicare for All.”

Rep. Pramila Jayapal (D-Wash.), the chairwoman of the Congressional Progressive Caucus, said the White House is not opposed to adding the Medicare provisions, and is even supportive, provided the votes are there in both chambers.

“As long as we can get to 218 votes and 50 votes in the Senate, they’re excited about it,” Jayapal told The Hill.

But she said she has also been pressing the White House for more public support.

“We’ve been asking them to continue to push for that, to make it a real priority, and mostly we get positive answers,” she said.

The White House budget request for fiscal 2022 includes a call to lower the Medicare age and add dental, hearing and vision benefits, but those proposals were notably left out of President Biden’s $1.8 trillion American Families Plan, prompting questions about whether expansion is a top priority for the administration.

“We knew it wasn’t gonna be in there,” Jayapal said. “But I think the main thing is, can we get it in there? I mean, the president proposes and we write.”

The health care industry is opposed to lowering the Medicare eligibility age, seeing it as a step toward more government-run coverage and away from private coverage.

The Partnership for America’s Health Care Future, a group including pharmaceutical companies, hospitals and insurers, is running ads against lowering the Medicare age, as part of a seven-figure ad buy.

“What sounds too good to be true usually is. As analysis tells us, what seems so simple would actually result in the largest and most costly overhaul of Medicare,” Chip Kahn, CEO of the Federation of American Hospitals, said last month.

In addition to the cost to taxpayers, hospitals worry that Medicare pays lower rates to medical providers than private insurers do, which industry leaders warn could lead to damaging cuts.

The Committee for a Responsible Federal Budget estimates that lowering the Medicare age to 60 would cost $200 billion over 10 years. Adding dental, vision and hearing would cost another $358 billion over 10 years, the Congressional Budget Office estimated in 2019.

Allowing Medicare to negotiate drug prices could provide savings of up to roughly $500 billion to help pay for these measures, but it is also possible that proposal will be scaled back, depending on moderate Democratic concerns.

“It’s largely a question of how much can be squeezed into the overall reconciliation package, given the other discussions about revenue and total size,” said a senior Democratic aide. “Lowering the Medicare age can get expensive in a hurry, especially with the changes that would be needed to ensure it doesn’t have higher premiums or worse benefits than what the ACA provides older low-income Americans.”

The proposal from progressives is competing with other health care priorities, like extending Affordable Care Act (ACA) subsidies and expanding Medicaid in states that have so far refused to do so.

Sanders told reporters last month that “there are millions of older workers who would like to get Medicare but they can’t, which is why we’ve got to lower the age.”

Asked if adding dental, vision and hearing benefits is a higher priority than lowering the age, Sanders said then: “They’re both very, very important.”

Senate Majority Leader Charles Schumer (D-N.Y.) tweeted his support last month.

“There’s a gaping hole in Medicare that leaves out coverage for dental, vision, and hearing—this is a serious problem,” he wrote. “I’m working with @SenSanders to push to include dental, vision and hearing Medicare coverage in the American Jobs and Families Plans.”

But Schumer’s tweet made no mention of lowering the Medicare age to 60.

Sen. Joe Manchin (D-W.Va.), a key swing vote, told The Washington Post in April that he opposes lowering the Medicare eligibility age. “No, I’m not for it, period,” he said.

House Ways and Means Committee Chairman Richard Neal (D-Mass.) also raised some potential concerns on Wednesday with the idea, but added that “we have to take a look at it.”

“A lot of the folks that you might want to cover, they already have health insurance” through private insurers, he said, while also pointing to questions about cost.

He said he has had “at least a cursory conversation” with some members of the Congressional Progressive Caucus about the idea.

Jayapal, however, is highlighting that it is not only progressives who are backing the idea.

More than 155 House Democratic lawmakers signed a letter in May calling for lowering the Medicare age; adding dental, vision and hearing benefits; and lowering drug prices to produce savings to pay for the plan.

The signers included moderates like Reps. Jared Golden (D-Maine) and Conor Lamb (D-Pa.).

Jayapal said she has had “multiple meetings just on this topic” with White House officials. Ricchetti was open to the health care proposals in Tuesday’s meeting, she said, and “it’s been even more positive than that with others in the White House, Klain and others,” referring to White House chief of staff Ron Klain.

Asked to comment, a White House official noted that President Biden backed expanding Medicare benefits in his speech to Congress in April and in his budget request, but did not directly answer whether the White House supports including those measures in the reconciliation bill.

In further momentum for adding dental, hearing and vision coverage, Rep. Lloyd Doggett (D-Texas) on Tuesday plans to announce a bill to add those benefits to the Medicare program, with about 75 co-sponsors.

“This bill offers more care from Medicare responding to basic dental, hearing, and vision impairments for seniors and individuals with disabilities,” Doggett said. “It fulfills the original purpose of Medicare—to assure dignity—helping those who have difficulty seeing, hearing, or eating.”