Led by Jayapal, Broad Coalition of 156 House Dems Demands Medicare Expansion in Infrastructure Bill

Rep. Pramila Jayapal, chair of the Congressional Progressive Caucus, led an ideologically broad coalition of 156 House Democrats on Thursday in demanding the addition of Medicare expansion to a forthcoming infrastructure package, arguing the proposal "would provide immediate and substantial relief" to millions of people across the United States.

"We are asking for you to prioritize the expansion and improvement of Medicare in the American Families Plan," the lawmakers wrote in a letter (pdf), referring to the second prong of President Joe Biden's two-part infrastructure plan.

"Lowering the Medicare age would provide immediate coverage for millions of older adults who are still uninsured or underinsured."
--Letter

Signed by nearly 70% of the House Democratic caucus--including conservative Reps. Conor Lamb of Pennsylvania and Jared Golden of Maine--the letter to Biden and Vice President Kamala Harris expresses support for lowering the Medicare eligibility age and expanding the popular program's benefits to include dental, hearing, and vision.

Though Biden campaigned on lowering the Medicare eligibility age to 60, the president omitted the proposal from his $1.8 trillion American Families Plan, prompting backlash from Jayapal, Sen. Bernie Sanders (I-Vt.), and other progressive lawmakers.

"Lowering the Medicare age would provide immediate coverage for millions of older adults who are still uninsured or underinsured," the House Democrats wrote Thursday, pointing to a 2020 study showing that reducing the eligibility age from 65 to 60 would enable an additional 23 million people to gain insurance through the program.

Dropping the eligibility age to 55, according to the same study, would extend Medicare coverage to more than 40 million people.

"Expanding Medicare to these age groups is critical for addressing inequities in health coverage and access, as communities of color and low-income individuals are disproportionately more likely to be uninsured," the letter reads.

The House Democrats also urged Biden to fight for a provision empowering Medicare to negotiate prescription drug prices, another campaign promise that the president has yet to act upon. The lawmakers cited estimates showing that permitting Medicare to negotiate drug prices--which it is barred from doing under current law--would save the federal government $450 billion over the next decade.

"The United States spends, by far, more on prescription drugs than any other country, despite Medicare Part D being the largest purchaser in the world," the letter reads. "We request that the savings achieved by robust Medicare drug-price negotiations be used to make critical expansions and improvements to Medicare, alongside other bold investments in health coverage and affordability."

While leaving out any expansion of Medicare, Biden's American Families Plan calls for a permanent extension of billions of dollars in Affordable Care Act subsidies that were approved by Congress earlier this year--a victory for the private insurance industry.

On Twitter, Jayapal wrote that the Medicare improvements proposed in the new letter would constitute "the largest expansion of healthcare in America in over a decade."

"It's unusual to get this much support on a healthcare proposal, but it shows just how important and transformative expanding Medicare would be for Americans across the country," Jayapal added. "I'm proud to help lead this effort."

Read the full letter:

Dear President Biden and Vice President Harris:

Thank you for your leadership in prioritizing the well-being of families and older adults throughout the United States. We write to ask that the American Families Plan put forth a critical investment in healthcare to bolster the security of our country's economy and families. By prioritizing the inclusion of robust drug-pricing provisions, we can produce enormous federal savings and use it to sustainably expand health coverage, equity, and access.

As we emerge from the Covid-19 pandemic--the nation's most acute healthcare crisis in the last century--now more than ever, we must ensure that families and older adults are equipped with the health coverage they need. Medicare is one of the most popular and foundational federal programs in the United States. You have previously expressed commitments to expanding Medicare eligibility, improving its benefits package, and empowering Medicare to negotiate with pharmaceutical companies. As part of the American Families Plan, we respectfully request that you fulfill your commitment to expand and improve Medicare by including the following key provisions in the package:

• Expand Medicare by lowering the eligibility age.
• Improve Medicare benefits to include dental, vision,hearing, and an out-of-pocket cap.
• Empower Medicare to negotiate drug prices for all Americans.

Lowering the Medicare age would provide immediate coverage for millions of older adults who are still uninsured or underinsured. Researchers at Stanford University found that there is a sudden jump in the diagnosis of cancer among individuals who reach the age of 65 due to the fact that many older adults delay care for financial reasons until they have Medicare coverage. Their study also concluded that individuals ages 61-64 "often lack insurance as a result of early retirement, pre-existing conditions hindering renewal, the high cost of private insurance and other causes." Additionally, up to 25% of adults in this age group become uninsured or have experienced a gap in medical coverage prior to becoming eligible for Medicare. Lowering the Medicare eligibility age to 60 could enable an additional 23 million people to access Medicare coverage. Meanwhile lowering the Medicare eligibility to 55 could expand Medicare coverage to over 40 million people. Expanding Medicare to these age groups is critical for addressing inequities in health coverage and access, as communities of color and low-income individuals are disproportionately more likely to be uninsured.

There is also a critical need to improve the traditional Medicare benefit to include dental, vision,and hearing. According to the Commonwealth Fund, among Medicare beneficiaries, "75% of people who needed a hearing aid did not have one; 70% of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43% of people who had trouble seeing did not have an eye exam in the past year." Poor oral health, vision loss, and hearing impairment have been independently linked to numerous negative health outcomes, such as diabetes, cardiovascular issues, depression and dementia. Lastly, research shows that half of older adults who live alone don't have enough money to cover even their basic needs. Therefore, it's past time that we place an out-of-pocket spending cap to traditional Medicare, just as we have already for Medicare Advantage plans and other private insurance plans.

Expanding and improving Medicare is not only good and critically-needed policy, it also has support from overwhelming bipartisan majorities of the American people. According to a recent Gallup poll, 65% of Americans, across party lines, are in favor of lowering the Medicare eligibility age. Another poll found that 79% of polled older voters want a routine dental, vision and hearing benefit added to Medicare.

To pay for Medicare expansion, we believe Medicare and the federal government must finally be able to negotiate with pharmaceutical companies to lower the high price of prescription drugs. The United States spends, by far, more on prescription drugs than any other country, despite Medicare Part D being the largest purchaser in the world. The Congressional Budget Office estimated Medicare could save over $450 billion and increase revenue by $45 billion over the next decade by requiring Medicare to negotiate with pharmaceutical companies. Therefore, we request that the savings achieved by robust Medicare drug-price negotiations be used to make critical expansions and improvements to Medicare, alongside other bold investments in health coverage and affordability.

Medicare has the largest network of providers in the country and is one of the most affordable and accessible health insurance programs. Lowering the eligibility age and improving its benefits package would provide immediate and substantial relief for millions of individuals throughout the United States, as well as much-needed long-term security. Now is a historic opportunity to also make an important expansion of Medicare that will guarantee health care for millions of older adults and people with disabilities struggling with the health and economic realities of the Covid-19 pandemic. Therefore, we are asking for you to prioritize the expansion and improvement of Medicare in the American Families Plan. We strongly support this investment and stand ready to help your administration make it a reality.