Senate Democrats Unveil $1 Trillion Health Care Agenda for Fall

Bloomberg Government

August 10, 2021 7:09 am

By Alex Ruoff | August 9, 2021 2:48PM ET

Senate Democrats laid out an ambitious plan to expand public health insurance programs Monday, with a price tag that could hit more than $1 trillion.

Democratic leaders released text of their budget resolution, setting up President Joe Biden’s $3.5 trillion economic plan. Roughly a third of that plan will consist of expanding Medicare’s benefits and lowering the program’s eligibility age, extending the Obamacare expansion achieved earlier in the year, expanding home and community-based care programs, and preparing for the next pandemic, according to a memo released Monday.

The lofty costs for all these items will likely mean some will be temporary, and some could be dropped completely.

“This is all a jigsaw puzzle more complicated than you can ever imagine to design health care expansion policies, and then create revenues and budget savings to pay for them,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “The less revenues and savings you create, the less you can spend.”

Here’s how the costs break down, all over 10 years:

  • Expanding Medicare’s benefits to include dental ($238 billion), vision ($30 billion), and hearing ($89 billion), for a total of $358 billion;
  • Home and community-based care expansion of up to $400 billion;
  • Closing the Medicaid gap for $100 billion;
  • Preparing for the next pandemic, for $30 billion;
  • Addressing the provider shortage, for $50 billion; and
  • Lowering the Medicare eligibility age to 60, for a cost of $200 billion.

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Cost Trade-Offs

Democrats have vowed to offset about half of the $3.5 trillion economic package with other provisionsand have eyed offsetting much of the health-care spending by empowering the government to negotiate with drugmakers.

“We will save taxpayers hundreds of billions by requiring that Medicare negotiate prescription drug prices with the pharmaceutical industry, and we will use those savings to expand Medicare by covering the dental care, hearing aids and eyeglasses that seniors desperately need,” Sen. Bernie Sanders (I-Vt.), chairman of the Senate Budget Committee, said in a statement Monday.

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This also means that some of these health care priorities may squeeze out others. Sen. Bob Casey (D-Pa.), who has introduced sweeping legislation to expand Medicaid’s home-care offerings, said he’s negotiating with his colleagues over how much of the reconciliation package will be dedicated to home and community-based care.

“I want to make this as expansive as possible, but there’s going to be some compromises,” Casey said.

One senior Senate Democratic aide cautioned that the framework released Monday isn’t binding and lawmakers could exclude some of the provisions listed in it. Lowering the Medicare eligibility age is among those items likely to be cut to reduce spending levels, the aide said.

Ways to Save

Democrats have a laundry list of health-care items that can pay for their agenda:

  • Repealing a Trump-era rebate rule, saving roughly $130 billion;
  • Empowering the government to negotiate with drugmakers (similar to H.R. 3), which could save up to $456 billion; and
  • Medicare Advantage reforms, a savings of up to $150 billion.

Chris Meekins, a health-care policy research analyst at Raymond James, noted that Democrats could also expand the budget window in their reconciliation package from 10 years to 15 years to reap savings from further expanding the Medicare sequester, which are planned cuts to federal spending.

Meekins said Democrats might also offset the home and community-based care provisions with tax reforms, putting the final cost of Democrats’ health agenda closer to $450 billion—if lowering the Medicare eligibility age is also excluded.

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Estimates for the cost of expanding Medicare’s benefits and the savings from H.R. 3 come from the Congressional Budget Office.

President Joe Biden pledged to spend $400 billion on home and community-based care. Meekins of Raymond James provided an estimate for closing the Medicaid gap and addressing the provider shortage. The Committee for a Responsible Federal Budget provided the estimate for lowering the Medicare eligibility age.

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

To contact the editors responsible for this story: Anna Yukhananov at; Alexis Kramer at