Limiting Medicare benefits deepens rift among Hill Democrats

People will not feel that there is any acceptance of them. said the Speaker of House Appropriations, Rosa DeLoro (Democrat).

The idea of ​​media testing has re-emerged This week in a set of demands made by Senator Joe Manchin to Senate Majority Leader Chuck Schumer, where Set his criteria for a $1.5 trillion package. While many Democrats reject the idea, health industry groups such as the American Dental Association argue that limiting the scope of expanding coverage frees up money for other party health priorities.

“If you have scarce federal dollars, that’s where you want to put your money,” said Michael Graham, senior vice president of government affairs for the dental group, which is pushing Congress to introduce the new dental benefit only to people with incomes under 300 in the United States. cent of the federal poverty line — or about $39,000 a year.

Since traditional Medicare will pay dentists for much less services than private insurance, group members will lose money if Democrats offer Tens of millions of seniors qualify for a government-sponsored plan.

Health insurance premiums are already tied to income, with wealthy seniors paying more for Part B and Part D coverage. But critics of Manchin’s approach argue that imposing more income thresholds adds burdens to the middle class and affects more beneficiaries each year. legislators They balance other cost controls, such as financing new benefits for just a few years or gradual introduction.

While there are valid arguments for not subsidizing the wealthy, means testing could end up limiting new benefits for older, sicker patients — exacerbating the risk pool and creating new ones, said Lauren Adler, associate director of the USC-Brookings Initiative for Health Policy. . Financial pressures on the program. There is also the additional administrative burden of checking the entry of seniors each year to determine their eligibility, and the possibility that some lower-income people are unaware or unable to demonstrate that they qualify.

“There is a simple element to simply benefiting everyone,” he said. “In retirement, your income fluctuates more than when you work, and distributions from retirement accounts can be one-time windfalls. If you kick people out of the program and then allow them to reapply next year, the amount of money you save may be too low to outweighs the added complexity.”

Debate over media testing plays the role of Democrats Struggling to stress a range of healthcare priorities In Social Expenditure Bill HR 5376 (117). With the total cost potentially dropping to $1.5 trillion over a decade, the arguments for centrists are getting louder.

“Let’s put in place a targeted program for those who really need it,” said Representative Kurt Schrader (D-Orr), one of several House lawmakers allied with Manchin. “We can’t afford, and it’s not reasonable, to give money to people who earn $400,000 or $500,000 a year.”

It was a means test for Medicare considered several times During the financial clashes between former President Barack Obama and Republican congressional leaders, they eventually refused. In fact, no person in the 56 years of the program has been excluded from any wealth-based benefits.

Senate Finance Chief Ron Wyden (D) confirmed, In the wake of Manchin’s demands, there is an active discussion among Democrats in the upper chamber who have not yet finished their own version of the package.

“We have colleagues who give a variety of opinions about when [the dental, vision and hearing benefits] You should start, who is covered and how much.

The American Dental Association aims to obtain leadership role influence the outcomeBuy digital ads, send tens of thousands of emails to Capitol Hill, and hold Zoom meetings with lawmakers and staff.

“We understand where the progressives are, and we’re not likely to move them,” Graham said. We also understand where the Republicans are: they will vote against them [the social spending bill] regardless. So our focus is on the moderate Democrats. They’re telling us our plan makes sense, but they’re also waiting to see what the Senate will do.”

Adler compared the current battle of dentists to the failed attempts of the American Medical Association to prevent the creation of Medicare more than half a century ago.

“Once you have a long-term program in place, it becomes part of the status quo,” he said. “That’s the same basic premise. If this becomes a popular product for seniors, it will become difficult for dentists not to take Medicare patients.”

Progressive lawmakers who have already lowered their ambitions over the spending bill argue that Medicare testing will be worse than some of the other cost-cutting ideas under consideration, including a gradual splitting of benefits over several years and requiring seniors to pay a higher percentage. of the cost of major dental procedures.

“None of them are good,” said Melissa Burroughs of the human rights advocacy group Families USA. “Starting the program later is not ideal, and cost-sharing may be better. But we are better able to live with that from an appalling precedent for means-testing.”

Critics of the idea also argue that limiting the program to poorer seniors makes the whole community less invested in maintaining the program, making it more likely to be reduced or phased out in the coming years.

“Some things in our society have to be global,” said Rep. Ro Khanna (D-CA), a senior member of the POLITICO Progressive Caucus.

However, some Democrats on the fence may see means testing as a less painful option than eliminating other parts of the social spending package, such as expanded subsidies to cover the Affordable Care Act.

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

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