Draft Budget Docs Include Medicare Expansion, Rx Pricing Reforms

Inside Health Policy

June 24, 2021 10:40 am

Draft Senate fiscal 2022 budget resolution documents circulating on Capitol Hill Monday call for making the increased Affordable Care Act premium tax credits permanent, dropping the Medicare eligibility age to 60, extending Medicare coverage to include hearing, vision and dental care, expanding graduate medical education and allowing the government to negotiate drug prices, but some lobbyists question whether the policies could make it past the finish line. Still, Senate Majority Leader Chuck Schumer (D-NY) over the weekend tweeted his support for adding Medicare hearing, vision and dental benefits.

The draft Senate fiscal 2022 budget resolution documents include several hot-button health policies, such as permanently increasing ACA premium tax credits, as initially expanded by the American Rescue Plan, at a cost of $163 billion over 10 years; adding Medicare dental, hearing and vision coverage at a cost of $299 billion over 10 years, most of which would go to paying for dental care; lowering the Medicare eligibility age to 60 at a cost of $200 billion during that time; funding for health infrastructure, including $20 billion for graduate medical education; and $15 billion for health equity. The documents say policies to lower drug prices would help pay for the proposals.

But Julius Hobson, senior policy advisor at Polsinelli, noted while Senate Budget Committee Chair Bernie Sanders (I-VT) could craft a draft budget assuming these policies advance under his top-line numbers, the Finance Committee and other authorizing committees would still have to come up with legislative language to put the policies in place. Hobson also noted the draft appears to show $6 trillion in new spending — including for the health provisions — but only lays out $3 trillion in savings. Hobson said he can’t see how such legislation would pass as it’s unlikely that enough Democrats would support a budget proposal of this size.

Former Senate Finance Committee GOP staffer Chris Condeluci, now principal of CC Law and Policy, said in an analysis Monday that he doesn’t expect all the health policies under consideration by Democratic lawmakers and the Biden administration will make it through the reconciliation process.

“[A]s the ‘sausage making process’ grinds forward on Capitol Hill, I would NOT be surprised if these Health Care Reforms (except, making permanent or extending the enhanced premium subsidies) ultimately fall out of the forthcoming ‘reconciliation’ bill,” Condeluci said, referring to reforms such as expanding Medicare by lowering the Medicare eligibility age or adding a Medicare buy-in program; drug pricing reforms; and Medicaid changes. Medicaid changes, however, appear to be absent from the draft budget documents.

However, one beneficiary advocate is cautiously optimistic about adding Medicare hearing, vision and dental coverage benefits, in part because Schumer is unlikely to back policies that won’t go anywhere. Schumer on Sunday tweeted, “There is a gaping hole in Medicare that leaves out dental, vision, and hearing coverage. This is a serious problem. I’m working with @SenSanders to push to include dental, vision, and hearing Medicare coverage in the American Jobs and Families Plans.” Yet Schumer made no reference to prescription drug policies as pay-fors.

The draft fiscal 2022 budget resolution background document says, “It is past time to stop treating dental, vision and hearing care like anything except the essential health services that they are.”