Framework for $3.5T Senate package seeks to close Medicaid gap, add new Medicare benefits and tackle drug prices

Senate Democrats want to give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare and close a Medicaid coverage gap in a new $3.5 trillion infrastructure package.

Democrats unveiled on Monday their budget resolution for the package, the first step to passing the legislation in the Senate.

The budget resolution, set to be considered in the chamber this week, outlines ambitious and long-held Democratic healthcare policies that the final legislation is likely to include.

The policies included in the resolution include:

  • Adding dental, hearing and vision benefits to Medicare.
  • Giving Medicare the power to negotiate lower drug prices. Sen. Bernie Sanders, I-Vt., a leading negotiator on the package, tweeted Monday that the savings from drug price negotiations will help pay for other parts of the package such as adding the new benefits to Medicare.
  • Creating a new federal program to cover Americans who would be eligible for Medicaid if their state had expanded the program under the Affordable Care Act. Several senators have proposed legislation to create a separate, Medicaid-like program to cover these residents.
  • Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,” the resolution said. A roughly $1 trillion bipartisan infrastructure package originally included investments for home care, but that money didn’t make it into the final package to be considered this week.
  • Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

Democrats in the House and Senate aim to pass the $3.5 trillion package via reconciliation, a procedural move that allows budget bills to move through the Senate via a simple majority and avoid a legislative filibuster.

Each committee will craft and pass its own part of the package and then the Senate will bundle them together for final passage, which is likely to occur after the nearly monthlong August recess.

The Senate is expected to pass this week a roughly $1 trillion bipartisan infrastructure package that would delay until 2026 a controversial Part D rebate rule and restart Medicare sequester cuts that were on pause during the pandemic.

House Speaker Nancy Pelosi has said that she wants to pass the bipartisan infrastructure package and the $3.5 trillion legislation at the same time.

The hospital advocacy group Federation of American Hospitals praised most of the health proposals, including making the enhanced ACA subsidies permanent and closing the Medicaid gap. 

FAH President Chip Kahn said in a statement that the best way to close the Medicaid gap is to build on the ACA and not to create a separate program, as legislation endorsed by several Democrats aims to do.

Kahn also cautioned Democrats against raising the corporate tax rate to help pay for the package. 

"Raising the corporate tax rate is the wrong prescription at the wrong time," he said. "It punishes the very domestic companies still recovering from the ongoing pandemic, and which we count on to grow the economy and create jobs."