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No Expanded Medicare

Ask any nurse and they will tell you: dental, vision and hearing care are fundamental aspects of health care. And yet right now, West Virginia Sen. Joe Manchin is a major impediment to finalizing the Build Back Better reconciliation bill in Congress, including a Medicare expansion plan that is wildly popular.

That’s the reporting from various news sources about the latest negotiations about how much to eliminate from President Biden’s Build Back Better plan.

Manchin, the Washington Post and CNN reported Monday, wants to kill the proposal to expand traditional Medicare to include dental, vision, and hearing benefits—long a major gap in Medicare and a source of economic crisis for many seniors.

Older Americans are often of the hidden face of poverty in the United States. It’s the reason why labor and other progressive activists have for decades pushed for social insurance programs to assist them, creating two of the most significant and popular reforms in U.S. history, Social Security and Medicare.

It is impossible to overstate how popular an expansion is across party lines and ideology. The only real opponents are Big Pharma and the for-profit insurance industry.

After passage of Social Security, arguably the most lasting New Deal reform of the 1930s, the poverty rate for seniors declined significantly. But as a Congressional Research Report found, the number of aged poor has increased since the mid-1970s to nearly 5 million people over the age of 65 by 2019.4.9 million people aged 65.

Medical costs are a major reason for the economic hardship and crisis faced by low income seniors, even with the substantial coverage, especially hospitalization, created by the landmark Medicare law of 1965. But the law has a few large holes that the proposed bill would close.

More than 40 percent of Medicare eligible people report putting off or foregoing medical care over the past year due to costs, a Kaiser Family Foundation tracking poll reported earlier this month.

The survey also found that dental care was the single biggest cost problem for those over 65 facing economic hardship: 41% of people over 65 struggle to pay for dental care, and over 30% have difficulty affording hearing or vision care.

Skipping dental care can lead to severe health problems, including heart disease, diabetes, respiratory ailments, even dementia, Alzheimer’s, and death.

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That is why National Nurses United and other healthcare activists have long campaigned for upgrading and expanding Medicare as part of an overall effort to guarantee healthcare for all U.S. residents through Medicare for All.

It’s also why Sen. Bernie Sanders (I-Vt.), with the support of nearly all the Democrats in the Senate and House, proposed including dental, vision, and hearing coverage in the Build Back Better package.

Medicare expansion, of course, is not the only critical program addressed in the legislation Manchin, Sen. Kyrsten Sinema (D-Ariz.), and a handful of corporate Democrats in the House are demanding be shredded. There are no frills.

Lowering prescription drug costs by allowing Medicare to negotiate the rates; extending the federal Medicaid program to some 2.2 million uninsured adults in states where Republican legislators consistently blocked it; making the child tax credit permanent to reduce child poverty; child care support; paid family and medical leave; and climate change action, are also vital.

Surely a nation that spends some $753 billion a year on the Pentagon budget—which equates to $7.5 trillion over the same 10-year period as proposed in the Build Back Better reconciliation bill—can afford to improve living standards for people at home as well as waging war and funding military contractors.

All of the proposed provisions are enormously popular, as numerous polls have documented. The Democrats face a daunting, at best, challenge to maintain their very thin hold on majorities in the Senate and House next November. The reasons are multiple, from voter suppression, to gerrymandered Congressional districts in the many states controlled by Republican legislatures and governors, to the historic record.

Since World War II the President's party has lost an average of 26 seats in the House, and an average of four seats in the Senate. Unless the Democrats can somehow overcome the odds, say hello to Senate Majority leader Mitch McConnell and House Speaker Kevin McCarthy.

One key to saving those majorities would be passage of immensely popular programs that provide a record of achievement to run on.

Medicare expansion should be at the forefront of that promise. Seniors typically vote in greater percentages than all other age groups. Last November, for example, senior voter turnout was highest among those 65 to 74 at 76 percent. That same voting block is typically fertile ground for Republican candidates. Can that be reversed, or at least significantly narrowed?

The October 15 Kaiser poll offers a clue. Medicare expansion also happens to be one of the most positive proposals in the entire bill. Eighty percent of all respondents—including 88% of Democrats, 79% of independents, and even 77% of Republicans—told the Kaiser poll that Medicare is “very” or “somewhat” important to them and their family.


Sens. Manchin and Sinema need to support Medicare expansion to ensure that older Americans receive the full health care they so desperately need—in West Virginia and Arizona as well as the rest of the country. Doing so would both address a health care crisis as well as show the American people that the Democratic Party stands with them.

Deborah Burger