Moderate Democrats Pitch Income Limits on New Medicare Benefits

  • Democrats eye ways to reduce reconciliation bill price tag
  • Medicare benefit expansion would cost $350 billion

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Centrist Democrats are weighing whether new Medicare benefits should go only to lower-income Americans as they look for ways to cut the cost of their party’s sweeping domestic spending bill.

Sen. Joe Manchin (D-W.Va.) told reporters he wants to means-test “everything we can” to reduce the size of the once-$3.5 trillion spending package being debated by congressional Democrats. Other centrists have said new Medicare benefits — vision, dental, and hearing coverage — specifically need to be limited by income.

“We have to have means-testing to bring it in,” Rep. Henry Cuellar (D-Texas) said.

Photo: Andrew Harrer/Bloomberg via Getty Images
A dental hygienist cleans the gums of a patient at a CCI Health and Wellness Services health center in Silver Spring, Md., on April 18, 2017.

Cuellar said he has been in talks with Manchin and Sen. Kyrsten Sinema (D-Ariz.) about the domestic spending package and believes means-testing new programs, including new Medicare benefits, could win their support. The reconciliation process being used for the legislation allows Democrats to advance the bill without Republican votes in the Senate, though all 50 Democrats have to back the proposal.

Rep. Kurt Schrader (D-Ore.), a moderate who voted against the Energy and Commerce Committee’s provision to expand Medicare benefits, said he wants dental coverage to be means-tested.

“There are those who can’t afford this right now, let’s focus it on them,” Schrader said. “It’s less costly to the taxpayer and it gives help to the people who really need it.”

The lawmakers’ comments come as Democrats increasingly concede that not all of their health proposals, which top $1 trillion, will make it into the final package. They are debating which proposals to shelve or trim to appeal to Manchin and Sinema — two crucial votes in the Senate as they aim to advance the package along party lines.

“The Senate’s not going to go along with $3.5 trillion,” Rep. Steve Cohen (D-Tenn.) told reporters Monday.

Caucus Debate

Committee leaders say they’ve made no commitments to shrink any part of their ambitious health care agenda, but are trying to find consensus within their party on items ranging from the new Medicare benefits to extending enhanced Affordable Care Act tax credits.

Senate Finance Chairman Ron Wyden (D-Ore.) told reporters he’s spoken with moderates from his party about means-testing Medicare benefits but declined to say if he supports doing so.

“We’re having that debate within the caucus right now,” he said.

In addition to the Energy and Commerce panel, the Ways and Means Committee also approved a proposal to extend vision, hearing, and dental coverage to Medicare, regardless of a person’s income. The Congressional Budget Office estimated doing so would cost more than $350 billion over 10 years.

The benefits would phase in, with vision starting in 2022, hearing starting in 2023, and dental — the most costly new benefit — starting in 2028.

There were 63 million people on Medicare by July 2021, according to the Centers for Medicare & Medicaid Services. Half of all seniors on Medicare had incomes less than $26,200 in 2016, according to a 2017 report from the Kaiser Family Foundation.

Plan B doctor coverage is already means-tested, with premiums based on income. The monthly charge can range from $148.50 for individuals with incomes of as much as $88,000 to more than $500 for individuals who make more than $500,000 per year.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Sarah Babbage at

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