WASHINGTON – For over 55 years, Medicare has followed a simple policy: Covered benefits are the same for everyone, regardless of income.

Now, as Democrats attempt to design a dental benefit for the program, one idea being considered is to limit it based on income.

But the “means test” is drawing internal opposition from many Democratic lawmakers, as well as senior citizens’ groups, such as the AARP.

Still, a senior Democratic congressional official, speaking on condition of not being named, said an income limit was still at stake as President Joe Biden tried to rally Democrats divided over social and environmental legislation radical which would be their calling card next year. midterm elections.

The White House did not respond to requests for comment.

Another alternative to Medicare would be to charge higher premiums to upper middle class seniors and wealthy seniors for the new dental plan, an approach that is already being applied to outpatient and prescription drug coverage and is not eliciting. such intense political opposition. It’s not clear if Democrats are looking at this as well.

Medicare is the government’s flagship health insurance program, covering more than 60 million seniors and people with disabilities. But there is a lack of dental, visual and hearing coverage, a gap that independent Vermont Senator Bernie Sanders has made it his mission to fill. Legislation passed by the committee in the House would incorporate the new benefits into the program.

But Biden and Democrats come under fire for overspending on their “Build Better” program, particularly to offer child tax credits, education and health benefits to people who could afford to pay for their own. costs.

The test of Medicare pleas appears to have started with a set of political talking points released earlier this year by centrist Sen. Joe Manchin, DW.Va., representing his terms to support the Biden legislation.

Under the headline “Families and health”, Manchin wrote “needs based on means to test safeguards / formulas on new spending”.

His office did not respond to requests for comment.

Sanders sees Medicare as the foundation for a future government health insurance program that would cover all Americans, regardless of age or income. His office made no comment on the income cap controversy.

Means testing receives some of its strongest support from the American Dental Association, which called for a dental benefit that would cover seniors reaching up to three times the federal poverty line, or about $ 39,000, or about half of Medicare beneficiaries.

“We are not opposed to a Medicare dental benefit, [but] we think it should be focused on poor and low-income seniors, ”said Michael Graham, the group’s lead lobbyist.

Dentists are concerned that Medicare will set prices for their services, as doctors are now.

“Dentists need to be paid appropriately so they don’t lose money,” Graham said.

The dental association’s position drew a rebuke from the AARP.

“It bothers us that groups like the American Dental Association, which you think would want dental coverage for people, are offering alternatives that would deprive millions of people of coverage,” said David Certner, director of policy at the AARP. “Entering a means-tested benefit in Medicare is a failure for us. “

Equally adamant is House Ways and Means president Richard Neal, D-Mass., Whose committee approved the expansion of Medicare benefits.

“I am not supporting any sort of Medicare resource test,” said Neal, one of the senior lieutenants of House Speaker Nancy Pelosi.

When asked about ways to test extended Medicare benefits, Senate Health Committee member Tina Smith, D-Minn., Said: “Medicare is a fundamental benefit that everyone expects, and I think that’s the way it should stay. “

As Democrats grapple with the deal, Biden may find he needs to take a public stand.

As a rule, the president does not rule out income limits for certain government programs, according to White House press secretary Jen Psaki.

“I think testing always has a bad connotation,” Psaki said in the midst of the debate. “And what we’re really talking about here is an income cap. So we’re talking about targeting and focusing the president’s proposals, in certain areas, on the people who need help the most … and not providing that help, that assistance … to people with income. higher, who may not need this help.

But there is no precedent within Medicare for a limited income benefit, said Larry Levitt, health policy expert with the Kaiser Family Foundation.

“The presumption has always been that having Medicare as a universal program creates political sustainability,” Levitt said. “As soon as you start limiting Medicare benefits to low-income beneficiaries only, it could lose some of its political support.”

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