WASHINGTON (AP) – Medicare has been following a simple policy for over 55 years: the covered benefits are the same whether you are rich, poor, or in the middle.
But as Democrats try to develop dental benefits for the program, one idea calls for caps based on income. The so-called “need test” has generated internal opposition from many Democratic legislators as well as older age groups such as the AARP.
Nonetheless, a senior Democratic aide in Congress says income caps still exist as President Joe Biden tries to rally disparate Democrats to pass comprehensive social and environmental legislation that will become their hallmark in next year’s midterm elections. The assistant spoke on condition of anonymity to address internal discussions. The White House did not respond to requests for comment.
Another alternative to Medicare would include charging higher premiums from the upper middle class and wealthy seniors for a new dental plan – an approach that’s already being applied to outpatient insurance and prescription drug coverage and isn’t getting as much political opposition. It is unclear if the Democrats are also looking at this.
Medicare is the government’s flagship health insurance program, reaching over 60 million seniors and people with disabilities. But it lacks dental, visual and auditory protection – a gap that independent Vermont Senator Bernie Sanders has set out to fill. A law passed by the committee in the House of Representatives will include new benefits in the program.
But Biden and the Democrats have been criticized for spending too much money on their Build Back Better package, and especially for providing child tax, educational and health benefits to people who could afford to pay as they pleased. The Medicare Means Test appears to have started with a set of policy theses published earlier this year by centrist Senator Joe Manchin, DW.Va., outlining his terms of support for Biden’s legislation.
Under the heading Family and Health, Manchin wrote “needs based on funds checks / new spending formulas.” His office did not respond to requests for comment.
Meanwhile, progressive Sanders sees Medicare as the backbone of a future public health insurance program that will cover all Americans, regardless of age or income. His office did not comment on the revenue-cap dispute.
One of the most decisive aspects of testing funds is the American Dental Association, which has called for dental benefits that will cover seniors who are three times the federal poverty line, or about $ 39,000, which is roughly half of Medicare recipients.
“We’re not opposed to Medicare dental benefits (but) we believe it should focus on poor and disadvantaged seniors,” said Michael Graham, the group’s chief lobbyist.
Dentists, like doctors, are concerned that Medicare charges fees for their services. “Dentists need to be paid appropriately so they don’t waste money,” Graham said.
The Dental Association’s position has been rebuked by the AARP.
“We are concerned that groups like the American Dental Association, which you might think would like to provide people with dental insurance, are offering alternatives that would deprive millions of people of medical coverage,” said David Sertner, director of policy for AARP.
“Means-tested benefits are not a starter for us,” added Sertner.
Equally adamant is House Ways and Means chairman Richard Neal, Massachusetts, whose committee approved the expansion of Medicare benefits. “I don’t support any Medicare means testing,” said Neil, one of the top aides to House Speaker Nancy Pelosi.
When asked about the means to test any extended Medicare benefits, Senate Health Committee member Tina Smith, Minnesota, said, “Medicare is a fundamental benefit everyone is looking forward to, and I think it should.”
Biden may have to take a public stand as Democrats try to close the deal. As a general principle, the president does not rule out revenue caps for certain government programs, said White House spokeswoman Jen Psaki.
“Testing funds, I think, always has a bad connotation,” Psaki said earlier this week. “And we’re actually talking about an income ceiling. So we’re talking about targeting and focusing the president’s proposals in some areas on the people who need help the most … and not about providing that help, helping … people with higher incomes who may not need that help. “
However, there is no precedent under Medicare for limited-income benefits, said health policy expert Larry Levitt of the Kaiser Family Foundation.
“It has always been believed that using Medicare as a universal program creates political resilience,” Levitt said. “Once you start limiting Medicare benefits to lower income recipients, she may lose some of her political support.”
AP author Alan Fram contributed to this report.