What is the mandate for the expansion of Medicare?

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One of the most controversial provisions of the Build Back Better Reconciliation Bill that is making its way through Congress is the Medicare benefit extension championed by Sen. Bernie Sanders (I-Vt.). Sanders said that the expansion of benefits to include coverage of dental, hearing and vision services at no additional cost to beneficiaries is “non-negotiable” for him. But the reality is that the senator from Vermont has no political mandate to demand this costly policy right now. As lawmakers strive to reduce the overall size of the bill so that it can be passed by Congress, they should prioritize the most urgent public investments of President Biden’s agenda now and pursue a comprehensive plan to strengthen Medicare going forward.

In the 2020 Democratic presidential primaries, voters had a choice between President Biden’s vision of expanding the Affordable Care Act and Senator Sanders’ vision of Medicare for All. They decisively chose Biden. Then when President Biden offered his US Jobs and Family Packages – which served as a model for the Build Back Better bill – neither included Medicare extension for current beneficiaries. The policy was only added at the insistence of Sanders who, as chairman of the Senate Budget Committee, was responsible for drafting the resolution that allowed Biden’s agenda to pass through the obstruction-proof reconciliation process.

Not only was Medicare expansion not on Biden’s agenda, it’s not even clear how the expansion under discussion would meet the wishes of Sanders supporters. Medicare for All’s main promise was to extend the coverage that Medicare beneficiaries currently enjoy to the millions of working families who do not have access to affordable health care. It puts a strain on gullibility to think that the crowds of young voters who supported Sanders’ campaign to give them access to Medicare would really prioritize giving more generous benefits to affluent seniors who already have care. subsidized health care benefits, especially when most Medicare beneficiaries already have coverage for dental, hearing, and vision services through Medicare Advantage or additional policies. Strengthening ACA by expanding Medicaid would be a real and much more gradual step towards universal health care.

The proposed expansion by Sanders, which would cost more than $ 800 billion over the decade after benefits were fully implemented, is particularly problematic in the context of the financial challenges Medicare already faces. The Medicare Hospital Insurance Trust Fund, which funds Medicare Part A, is expected to run out in just five years, while the rest of Medicare consumes a growing chunk of general revenue. Even though the expansion was offset by programmatic savings resulting from changes such as direct negotiation for prescription drugs or neutral payments at the site, using these savings to fund extension of benefits now leaves it to policymakers. policies less options to pay for promises Medicare has already made.

Since Sanders never came up with a credible plan to sustainably fund his healthcare program, his congressional colleagues should think carefully before pursuing a haphazard expansion of benefits regardless of program finances. At the very least, any expansion of benefits should be fully covered by income based premiums to ensure that it does not divert limited resources from other useful programs. A recent poll of voters in battlefield states commanded by the Progressive Policy Institute support this approach, with expansion plurality supporters preferring to fund the policy with premiums paid by beneficiaries rather than higher taxes or debts.

Alternatively, lawmakers should consider creating a ‘Commission on the Future of Medicare’ to take a holistic look at the challenges medicare faces in the 21st century.st century. The commission could be funded by the reconciliation bill and would be tasked with examining how benefit and / or payment structures could be improved, whether coverage should be extended to other populations not currently eligible for Medicare, and how the program can be funded on a sustainable basis. By answering these questions that advocates of Medicare expansion have so far failed to resolve, the commission could give progressives a reasonable path forward in future campaigns and legislative efforts.

The Build Back Better bill presents a unique opportunity to make critical public investments in working families and the future of our economy. When lawmakers already have to make tough decisions about which Biden’s worthwhile priorities will be slashed or knocked out of the package for adapt to their budget constraints, the last thing they should do is siphon limited resources for their defeated rival’s parish project. Congress should not consider expanding Medicare until it has a comprehensive plan to secure the future of the program without eviction other major investments.


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