Democrats Mull Dropping Expanded Medicare, Medicaid in Unity Bid

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Dems need to cut the $3T price tag of the wishlist in half.


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Two significant elements of Democrats’ ambitious health agenda, expanding Medicare and Medicaid, face an uphill battle after a key party moderate signaled his opposition Monday.

Sen. Joe Manchin (D-W.Va.) said Monday he doesn’t want to expand Medicare benefits without first protecting the rest of the program from insolvency later this decade.

He also rebuffed legislation to extend coverage to millions of Americans in states that have refused to expand their Medicaid programs.

Extending federally funded coverage to people in the 12 non-expansion states effectively amounts to a penalty for states such as his that have paid a portion of growing their own safety nets, Manchin told reporters.

“For states that held out to get rewarded with 100% that’s not fair,” he said.


Anna Moneymaker/Getty Images

Sen. Joe Manchin (D-W.Va.) leaves a meeting at the office of Sen. Kyrsten Sinema (D-Ariz.) on Oct. 21, 2021, as Democrats sought consensus on trimming President Joe Biden’s spending legislation.

Expanding the two public health insurance programs were significant, and pricey, elements of the once-$3.5 trillion spending package Democrats (H.R. 5376) are hoping to rally around as soon as this week. Manchin said he wants to cut the total spending down to $1.5 trillion.

Supporters of expanding Medicare’s benefits to include dental, hearing, and vision coverage have been trying to save the provision from cuts or elimination.

The White House has suggested the spending package include $800 vouchers seniors could use to pay for dental services, Rep. Pramila Jayapal (D-Wash.) told reporters last week. Jayapal and other progressives have pushed to add the three new coverage areas to Medicare’s list of defined benefits.

Vouchers would leave many seniors without sufficient coverage and could disappear in coming years, supporters of expanding Medicare say.

“This cannot be a half-hearted attempt to throw a token at the problem,” said Frederick Isasi, executive director of Families USA, a health advocacy organization that’s been aligned with Democrats on defending the Affordable Care Act.

Manchin, who has been negotiating the terms of the spending package directly with President Joe Biden at times over the past few weeks, said he wants to first shore up Medicare’s finances.

“You’ve got to stabilize that first before you do an expansion,” he said Monday.

Drug Pricing Plan Also Trimmed

Democrats may have to pare back their health agenda to accommodate a narrower attempt to lower the cost of medicines in the U.S.

Party leaders are debating limiting their legislation to empower the government to negotiate for better prices to just drugs that lack exclusivity, meaning only those medicines that could already face competition from a generic or biosimilar version.

Such a change would limit how much a drug price negotiation proposal would reduce government spending on medicines. The drug pricing provisions of the spending package have long been meant to offset the cost of the health agenda.

Rep. Scott Peters(D-Calif.), who has opposed broad negotiating power, wrote legislation that also didn’t apply to many new drugs that have patent protections. He said recently his bill would reduce government spending by at least $200 billion, compared with the $458 billion in reduced spending expected from Democrats’ signature negotiation legislation (H.R. 3)

Leslie Dach, chairman of the Democratic-aligned Protect Our Care, told reporters Monday that exempting medicines that don’t have competitors would “basically gut the negotiation promise” Democrats had made.

“That is the key that unlocks lower prices,” Dach said.

Read more: Democrats Set to Scale Back Drug-Price Ambitions in Biden’s Bill

To contact the reporters on this story: Alex Ruoff in Washington at; Erik Wasson (Bloomgerg News) in Washington at

To contact the editor responsible for this story: Robin Meszoly at


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