Limiting Medicare benefits deepens rift among Hill Democrats

“People won’t feel like there is a buy-in for them. They create real divisions, ”said Rosa DeLauro (D-Conn.), The Chair of the House.

The idea of ​​means testing reappeared This week in a series of demands Senator Joe Manchin made to Senate Majority Leader Chuck Schumer outlining his criteria for a $ 1.5 trillion package. While many Democrats oppose the idea, health industry groups such as the American Dental Association argue that limiting the scope of coverage will free up funds for the party’s other health priorities.

“If you’re on a tight dollar, this is where you want to put your money,” said Michael Graham, senior vice president of government affairs for the dental group, urging Congress to only offer the new dental service to people on incomes below 300 percent of the federal poverty line – or around $ 39,000 a year.

Since traditional Medicare dentists would pay far less for services than private insurance companies, members of the group would lose money if the Democrats Millions of seniors who are eligible for a government sponsored plan.

Medicare premiums are already tied to income, with wealthier seniors paying more for Part B and Part D. Critics of the Manchin approach, however, argue that the imposition of higher income thresholds puts an additional burden on the middle class and affects more beneficiaries every year. Legislator Weigh up other cost controls, such as financing the new services only for a few years or its rollout step by step.

Loren Adler, associate director of the USC-Brookings Initiative for Health Policy, said while there are strong arguments for not subsidizing wealthier people, means testing could limit new benefits to older, sicker patients – worsening the risk pool and creating new ones financial burdens on the program. Add to this the added administrative burden of reviewing seniors’ incomes each year to determine their eligibility and the likelihood that some lower-income individuals may not know or be unable to prove their eligibility.

“It’s easy to benefit everyone,” he said. “In retirement, your income fluctuates even more than it does in your professional life, and distributions from retirement accounts can be a one-time stroke of luck. If you remove people from the program and allow them to reapply next year, you could save so little money that it wouldn’t make up for the added complexity. “

The means test debate unfolds as Democrats struggle to pack a variety of health care priorities into the Social Expenditure Act, HR 5376 (117). With total costs likely to drop to $ 1.5 trillion in a decade, the centrists’ arguments get louder.

“Let’s have a targeted program for those who really need it,” said Rep. Kurt Schrader (D-Ore.), One of several House MPs allied with Manchin. “We can’t afford it, and it’s not wise to give money to people who make $ 400,000 or $ 500,000 a year.”

A means test for Medicare was considered several times during the fiscal clash between former President Barack Obama and the leaders of the GOP Congress, but was ultimately rejected. In fact, no one has ever been excluded from any asset-based benefits in the 56 years of the program.

Senate finance chairman Ron Wyden (D-Ore.) Confirms, following Manchin’s demands that there is an active debate among the House of Lords Democrats who have yet to finalize their own version of the package.

“We have colleagues who give different opinions on when [the dental, vision and hearing benefits] should start with who is covered and to what extent, ”he said.

The American Dental Association aims to a leadership role influencing bottom line, buying digital ads, sending tens of thousands of emails to Capitol Hill, and holding Zoom meetings with lawmakers and employees.

“We understand where the progressives are and we probably won’t move them,” said Graham. “We also understand where the Republicans stand: they will vote against” [the social spending bill] no matter what. So our focus is on the moderate Democrats. They tell us our plan makes sense, but they are also waiting to see what the Senate does. “

Adler compared the current battle of dentists to the American Medical Association’s failed attempts to block Medicare from being founded more than half a century ago.

“Once a program is long-term, it becomes part of the status quo,” he said. “That is the same basic premise. If this becomes a popular product for the elderly, it will be difficult for dentists not to take Medicare patients. “

Progressive lawmakers, who have already scaled back their spending accounting ambitions, argue that testing Medicare would be worse than some of the other cost-cutting ideas under consideration, including rolling out the benefit over several years and obliging seniors to pay a higher percentage paying the cost of major dental work.

“None of them are good,” said Melissa Burroughs of the Families USA advocacy group. “The program that starts later is not optimal, the cost sharing could be better. But we can live better with that than with a terrible means test precedent. “

Critics of the idea also argue that restricting the program to poorer seniors will result in all of society investing less in maintaining the program, making it politically more vulnerable to being scaled back or abolished in years to come.

“Certain things in our society should be universal,” MP Ro Khanna (D-Calif.), A prominent member of the Progressive Caucus, told POLITICO.

Still, some Democrats on the Fence might see means testing as a less painful option than ditching other parts of the social spending package, such as expanded subsidies to cover the Affordable Care Act.

“We need to make sure these programs are targeted to help the people who need it most,” said Rep Stephanie Murphy (D-Fla.).

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