As Democrats attempt to unite around a final budget reconciliation package – otherwise known as President Biden’s Build Back Better Plan – seniors advocates are keeping a close eye on key provisions affecting older Americans.  The Democrats’ plan included adding dental, vision, and hearing coverage to Medicare — and allowing the Medicare program to negotiate prescription drug prices with Big Pharma. We spoke to Dan Adcock, director of government relations and policy here at the National Committee, about what is likely to happen to those key provisions for American seniors.

Q: Is it still realistic that the Democrats’ final reconciliation bill will include dental, vision, and hearing coverage for Medicare beneficiaries?  

A: It’s hard to know at this point.  Benefits improvements may be scaled back, especially if prescription drug reforms are weakened.  Democrats had planned to use savings from prescription drug reform to pay for some of these expansions, but now those reforms may not be as robust and produce fewer savings. There are other ways to pay for Medicare expansion, such as higher taxes on the wealthy and big corporations included in the budget reconciliation bill approved by the House Ways and Means Committee. But how this revenue will be used in the final spending bill is still uncertain.  

Q: If Medicare expansion is pared back, which of the new coverages would likely survive?

A:  For months, the odds-on favorite was dental benefits. But the problem is that a dental benefit will take longer to implement. It could take anywhere from 3-5 years to design and put into effect.  From a policy standpoint, that’s a laudable objective, but from a political standpoint, it creates a problem. Vision and hearing coverage would be easier to assemble and get off the ground – maybe just a year or two.  

Q: Are there any workarounds for getting a dental benefit up and running sooner? 

A: Some centrist Democrats have proposed giving beneficiaries dental vouchers in lieu of a formal benefit.  The problem with that is that dentists could raise prices for their services so that the net out-of-pocket expense for seniors would still be high, even with the vouchers.  The voucher plan might also deprive CMS of money and administrative bandwidth to develop a fuller dental benefit in the future. For these reasons, we don’t support vouchers.  However, in the meantime, Medicare could expand existing coverage for dental care considered “medically necessary,” so that more dental procedures would be covered moving forward.

Q:  Seniors’ advocates have pressed very hard for Medicare to be allowed to negotiate prescription drug prices, but the fate of that provision in the reconciliation bill is unclear? 

A: I would say that Medicare price negotiation is not dead, but is on ‘life support.’ The final reconciliation package is unlikely to have full-on negotiation.  But we and other seniors’ advocates are still pushing for it. And we are encouraging our members and supporters to contact their members of Congress to demand Medicare price negotiation.  Unfortunately, Big Pharma has been pulling out all the stops to stop Medicare negotiation, and the industry wields outsized power on Capitol Hill. Centrist Democrats, especially in the Senate, may not vote for a final package if it contains price negotiation.  

Q: Without Medicare price negotiation, what kind of drug cost reform can we still expect? 

 A:  We expect to at least see something resembling the Grassley-Widen bill (first introduced in the previous Congress), which would cap drug price increases at the rate of inflation and peg some prices to what other countries pay for drugs.  These reforms would not be as effective as Medicare negotiation, but they would definitely lower what seniors pay for prescription drugs.  Given that many seniors can’t currently afford their medications, these other reforms would be a step in the right direction and provide some much-needed relief.  

 Q: When do you think the reconciliation package will actually be finalized and brought to the floor for a vote? 

A: I think it’s unlikely to be this week.  The hold-up is that Democrats need a bill that can pass both the House and Senate.  Leadership is trying to ascertain what centrists will support in the end. The problem is that some centrists have said what they’re against in the reconciliation package, but not what they’re for. Until that is made apparent, it will be hard to bring a final bill to the floor.