Medicare expansion hangs in the balance as Democrats race towards a deal

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A major expansion of Medicare that Democrats proposed as part of the Build Back Better initiative is in danger of being trimmed or even taken out of the legislation as lawmakers scramble to make a deal.

In their original $3.5 trillion budget proposal, Democrats included a revision of Medicare that would add coverage for dental, hearing and vision. The plan was expected to cost around $350 billion over a decade.

But now, those parts of the expansion may be dropped as lawmakers look to trim the overall cost and rework pieces of the legislation to appease centrist Democratic Sens. Joe Manchin, D-W. Va., and Kyrsten Sinema, D-Ariz.

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“About the expansions — we are negotiating and talking about that,” Manchin told CNN Wednesday, adding that he’s concerned about the country’s deficit and pending insolvency of Medicare trust funds.

“In good conscience, I have a hard time increasing benefits … when you can’t take care of what you have,” he said. “So that’s the difference, and that’s the discussions we’re having.”

A sticking point

The expansion has become a major sticking point in talks for the bill. Sen. Bernie Sanders, I- Vt., has said that the new benefits must be included in legislation. He also demanded that the bill allow Medicare to negotiate lower drug prices with pharmaceutical companies.  

“Bottom line is that any reconciliation bill must include serious negotiations of Medicare and the pharmaceutical industry to lower the cost of prescription drugs,” Sanders told reporters on Tuesday, adding that a “serious reconciliation bill must include expanding Medicare to cover dental, hearing aides and eyeglasses.”

Some 62.8 million Americans, most over the age of 65, are enrolled in Medicare as their main form of health insurance. The program, which began in 1965, has never included dental, vision or hearing coverage for elders.

Roughly half of beneficiaries didn’t have any dental coverage in 2019, and percentages are even higher for people on Medicare who are Black, Hispanic and low-income, according to the Kaiser Family Foundation.

That can mean major costs for dental care: The average out-of-pocket spend among Medicare beneficiaries who went to a dentist was $874 in 2018, according to Kaiser. The top 20% of those beneficiaries spent more than $1,000 out-of-pocket for dental care.

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