White House drops bid to add dental, vision benefits to traditional Medicare in pared down infrastructure bill

The White House released an updated framework for its trillion-dollar infrastructure package that closes the Medicaid coverage gap and extends enhanced subsidies on the Affordable Care Act’s exchanges.

But it drops expanding dental and vision benefits after centrists called for paring down the overall cost of the package, which originally was proposed for $3.5 trillion. 

The framework also doesn't include legislation to give Medicare the power to negotiate for lower drug prices, but senators say that it would eliminate a rule that gets rid of the safe harbor for Part D drug rebates.

The new framework comes as Congress is hurriedly working to add in details on the package, including what must be taken out to meet the lower price tag.

When the package was first introduced, Democrats hoped to add dental and vision benefits alongside hearing to traditional Medicare. However, the framework released would only cover hearing benefits.

“Only 30% of seniors over the age of 70 who could benefit from hearing aids have ever used them,” the framework said.

There have been concerns over the cost of adding dental benefits. Biden even hinted during a town hall on CNN last week that adding the benefits would be a reach due to concerns from centrists.

The framework does include a provision to close the Medicaid coverage gap for residents in states that have not expanded Medicaid under the ACA, a major priority for the newly elected Democratic Sens. Ralph Warnock and Jon Ossoff of Georgia, which has not expanded Medicaid.

Warnock and Ossoff had pushed for legislation to create a program similar to Medicaid to create coverage for those in the gap. But the framework instead opts for offering premium tax credits to up to 4 million uninsured people.

“A 40-year-old in the coverage gap would have to pay $450 per month for benchmark coverage—more than half of their income in many cases,” the White House said. “The framework provides individuals $0 premiums, finally making healthcare affordable and accessible.”

The coverage gap proposal has gotten pushback from key centrist senators, including Sen. Joe Manchin, D-West Virginia, whose state has expanded Medicaid back in 2014 and was concerned about fairness as states have to cover 10% of the expansion costs now.

Ossoff pushed back on those concerns by noting that currently, residents in his state aren’t getting the healthcare that they pay for.

“Georgians are paying federal taxes but not getting healthcare,” he told Fierce Healthcare on Tuesday. “So as a matter of fairness our constituents are paying for this healthcare but not receiving it.”

The legislation would also boost income-based subsidies for people who buy ACA insurance, reducing premiums for more than 9 million people who buy marketplace coverage by an average $600 per person, the White House said.

“Experts predict that more than 3 million people who would otherwise be uninsured will gain health insurance,” the framework release said.

The American Rescue Plan Act boosted income-based subsidies but only through 2022. The framework release does not specify how long the enhanced subsidies will remain in place if it becomes law.

The exact details of the package could change as lawmakers seek to put the finishing touches on the package.

A key unknown is how the package will tackle drug prices. Democrats are haggling over granting Medicare the power to negotiate for lower prices but also how broad that power should be.

Several Democratic senators said they were disappointed that drug price negotiations got left out of the final framework. 

But Senate Finance Committee Chairman Ron Wyden, D-Oregon, said that efforts on drug prices aren't dead yet. 

"We're staying at it. I've had a number of conversations on that this morning and that is very much an active effort," he said.