Democrats Seek to Bridge Gaps Over Medicare, Medicaid Expansion


July 2, 2021 2:14 pm

Democratic leaders are moving ahead with plans to expand the two massive U.S. public health insurance programs even as their rank and file have yet to unite over how to do so.

House Budget Committee Chair John Yarmuth (D-Ky.) told reporters he isn’t sure there’s widespread support in his own party for lowering the age to qualify for Medicare, the federal health insurance program for the disabled and those aged 65 years or older. Democrats are considering that provision as part of major legislation designed to ride on a budget bill this year.

“That has about 75% support in the caucus,” Yarmuth said, adding he’s readying a budget reconciliation package for coming weeks. 

Democratic leaders are eyeing the budget bill as a vehicle to pass their party’s major priorities without depending on support from Republicans. Failing to find agreement on health priorities could leave Democrats without major wins to bring to their constituents ahead of next year’s midterms.

House Energy and Commerce Committee Chair Frank Pallone (D-N.J.) said his panel is crafting a bill aimed at extending “guaranteed coverage” to people in the 12 states that haven’t elected to expand their Medicaid programs under the Affordable Care Act.

“I want to provide coverage for those people that are in red states that have not expanded,” Pallone said about coverage for Medicaid, the federal health insurance for low-income people.

Pallone declined to offer details. Some Democrats in the 12 holdout states are proposing a new tier of the ACA marketplace plan, or government-run insurance, available to people who make too much to qualify for Medicaid—but too little to qualify for subsidies for private insurance.

Others are suggesting allowing counties or cities to expand access within their boundaries, a move that could help major population centers.

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Getting ‘Creative’

One major concern with using the budget process to extend insurance to those in this “Medicaid gap” is a potential limit on how long the coverage would last, Rep. Colin Allred (D-Texas) said.

“I don’t know how we could get something long-term, but we’re trying to get creative,” he said. “This pandemic has highlighted the need to give people coverage.”

Progressives in the House have pushed to include Medicare expansion–both lowering the age and adding dental, vision and hearing coverage—but not closing the Medicaid gap. Rep. Mark Pocan (D-Wis.), whose home state hasn’t expanded its Medicaid program, said the issue is most pressing for only a minority of Democrats.

“Lets face it: most of these states don’t have a lot of Democratic members of Congress,” he said.

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Pocan said expanding Medicare to more Americans and bolstering its benefits would help people in every state, making it an easier sell for the caucus.

Moderate Democrats have championed Medicaid expansion over growing Medicare. Members of the centrist New Democrat Coalition have been advocating for new incentives to encourage states to take the added federal dollars to extend their public health insurance, a congressional aide familiar with their discussions said.

In the Senate, progressives are also pushing to expand Medicare.

Sen. Bernie Sanders (I-Vt.), chairman of the Senate Budget Committee, has been rallying Democratic senators around adding benefits to Medicare this year.