with Alexandra Ellerbeck

Expansions are coming to the Medicare program, if Democrats can achieve one of their biggest health policy goals this year.

But they may have an easier time broadening what the program covers, versus trying to lower its eligibility age.

House Democrats have introduced a bill to include vision, dental and hearing coverage in Medicare.

The legislation, rolled out yesterday, aims to correct a long-standing challenge for seniors and those with disabilities who primarily rely on the traditional Medicare program for coverage: It doesn’t cover dental, hearing or vision care.

“I think many Medicare beneficiaries are shocked when they find out they’re on their own for these costs,” said Eliot Fishman, senior director of health policy for Families USA.

If enrollees want such coverage, they must either switch to a private Medicare Advantage plan or purchase supplemental coverage. Just 53 percent of seniors said they have dental coverage in a poll carried out by the University of Michigan Institute for Healthcare Policy and Innovation. The seniors indicated that having dental coverage was a big reason they enrolled in Medicare Advantage instead of the traditional program; 72 percent said they chose Medicare Advantage at least partly for that reason.

Seventy-six Democrats signed on to the bill from Rep. Lloyd Doggett (D-Tex.), which would initially add preventive dental, hearing and vision care to Medicare’s “Part B” program and later on expand the benefits to cover basic impairments.

“This bill … fulfills the original purpose of Medicare — to assure dignity — helping those who have difficulty seeing, hearing or eating,” Doggett said in a statement.

Progressive Sen. Bernie Sanders (I-Vt.) has also been at the forefront of urging this change.

“Millions of senior citizens have teeth rotting in their mouths, are unable to hear what their children and grandchildren say or can’t read a newspaper because of failing eyesight,” he wrote in a recent Washington Post op-ed, co-written with Rep. Pramila Jayapal (D-Wash.). “It is a cruel irony that older Americans do not have coverage for these benefits at the time when they need it the most.”

Senate Majority Leader Charles E. Schumer (D-N.Y.)  is also on board:

The lawmakers want the legislation included in whatever budget reconciliation package moves through the House and Senate this fall, requiring just Democratic votes to pass. The details are starting to be discussed and negotiated, as the House prepares to get the ball rolling by passing a budget resolution sometime before the August recess. 

That effort is unfolding alongside bipartisan negotiations between the White House and Republicans over an infrastructure deal. Democrats are hoping to throw a bunch of partisan priorities into the separate reconciliation package, including several provisions to expand health coverage in the United States.

The other Medicare change Democrats are eyeing is lowering the eligibility age from 65 to 60.

This change would actually be cheaper than expanding Medicare services. The Committee for a Responsible Federal Budget has estimated that lowering the eligibility age to 60 would cost $200 billion over a decade.

In contrast, folding dental, vision and hearing coverage into the traditional Medicare program could cost $358 billion over the next 10 years — and possibly more. 

That score comes from Congressional Budget Office estimates for H.R. 3, the drug pricing bill the House passed in late 2019, which included the coverage expansions. But Doggett’s more generous bill further reduces what seniors would need to pay out of pocket to access the new services. It treats dental, vision and hearing care the same as existing services covered by Medicare, with no cost-sharing for preventive care and no more than a 20 percent co-pay for other services — an approach that would lead to higher costs for the government.

Lowering the Medicare age might be cheaper, but the industry is already fighting it.

And history has shown that angering the sprawling health-care industrial complex doesn’t help when one is trying to pass legislation.

Liberals acknowledge lowering the Medicare age is a small step toward eventually expanding Medicare to everyone — the “Medicare-for-all” approach so hated by hospitals, pharmaceutical companies and insurance companies, because it probably would mean smaller payments for them.

Partnership for America’s Health Care Future released a self-funded study finding that the federal deficit would rise by nearly $400 billion over a decade if Medicare were expanded to those between 60 and 65. The group, which has been instrumental in sinking Democrats’ hopes of even a public option, also launched a seven-figure ad buy against lowering the Medicare age.

There’s also some concern that lowering the Medicare age wouldn’t do much to improve the nation’s insured rate.

People between 60 and 64 are more likely to have health insurance than younger age groups. According to the Kaiser Family Foundation, two-thirds of adults in the age bracket already have private coverage either through an employer, the individual marketplaces or some other nongroup market. Expanding Medicare to them would raise many tricky questions about how to handle those with private coverage and the employers who provide it.

And switching to Medicare might not financially benefit many older adults, particularly those with lower incomes who are eligible for more subsidies on the ACA marketplaces. “Simply expanding Medicare eligibility does not guarantee premium affordability,” a study by Avalere Health found, according to the Associated Press.

It’s too early to say how all this will play out — many pieces are in motion, and the negotiations probably will continue through the summer and into the fall. Even if Democrats achieve only the benefit expansions — and not lowering the age — they’ll still consider it a win, given how hard it is these days to pass any consequential health-care legislation.

“If it just ends up being dental, vision and hearing, I think for progressives in Congress that would be a huge win,” Fishman said.

Ahh, oof and ouch

AHH: The fight to get Americans vaccinated is going door to door.

“President Biden on Tuesday announced a summer-long effort to reach Americans still resistant to getting vaccinated, including going door-to-door and visiting places of worship, as he fights what growing evidence suggests is evermore entrenched resistance from vaccine holdouts,” The Post's Cleve R. Wootson Jr. and Tyler Pager report.

Biden acknowledged that the administration would be winding down sites that once vaccinated thousands of people a day. Many of those sites have stood empty recently, as those most eager to get the vaccine have already gotten a shot.

As the Biden administration winds down mass-vaccination sites, President Biden explained the plan to shift to community-based vaccination on July 6. (The Washington Post)

“Now we need to go to community by community, neighborhood by neighborhood, and oftentimes, door to door — literally knocking on doors — to get help to the remaining people protected from the virus,” the president said.

Biden also projected the country would reach a target of 160 million Americans fully vaccinated by the end of the week, just a few days after his original goal of reaching the benchmark by July 4. But he warned against becoming complacent, citing concerns over the spread of the delta coronavirus variant, which makes up half of all cases in some parts of the country.

OOF: Data from Israel shows the Pfizer vaccine offers less protection against infection from the delta variant.

Israel reported that the effectiveness of the Pfizer-BioNTech vaccine in preventing symptomatic illness from covid-19 had dropped to 64 percent amid the rapid spread of the delta variant, Reuters reports.

The Israeli government had previously reported that the vaccine was 95 percent effective in preventing infection and symptomatic illness.

Still, the vaccine appears to protect against more serious illness.

The Israeli Health Ministry said it was still 93 percent effective in preventing hospitalizations from the virus, even with widespread prevalence of the delta variant.

A Pfizer spokesperson cited research showing that the antibodies elicited by the vaccine are able to neutralize all tested variants, including delta, although the effect was somewhat reduced compared to previous strains of the virus.

OUCH: Birthday parties may have fueled covid spread.

A new study found that the risk of coronavirus infection increased sharply in families that had a recent birthday, the New York Times’s Margot Sanger Katz reports.

Researchers have struggled to measure the impact of private gatherings on the spread of the coronavirus, but scientists from Harvard, the Rand Corporation and Castlight Health hit on a creative method for pulling back the curtain. Using health insurance claims data, they found that in areas where the virus was widespread, the covid risk in families increased by nearly a third in the two weeks after a family member’s birthday. The effect was even more pronounced when the birthday was that of a child and was the same in both Republican and Democratic areas of the country.

While researchers can’t know for sure whether the families actually held a party, the data suggests a connection.

Mushroom magic

States are embracing psychedelics.

Seven states have passed laws in the last few months decriminalizing their use or allowing research on them, Axios reports. Another 11 states are considering similar measures.

“There's a growing body of research suggesting psychedelic compounds with psychotherapy can be effective for anxiety, depression, post-traumatic stress disorder and substance use disorder where other therapies have failed,” Marisa Fernandez writes. “Amid a national epidemic of opioid abuse and suicides, state legislatures see a greater need to explore new therapeutics.”

In November, Oregon became the first state to legalize psychedelics in licensed facilities and decriminalize them elsewhere; other states advancing pro-psychedelic measures include Texas, Connecticut, New York and California.

Nicotine buzz

A new study lends support to the FDA’s decision to ban menthol cigarettes.

A new study published in Tobacco Control, a BMJ journal, found that smokers of menthol cigarettes had a much harder time quitting than smokers of unflavored cigarettes, Stat News’s Claudia López Lloreda reports.

Use of menthol cigarettes decreased the probability of a smoker being able to abstain for more than a year by 53 percent. The study authors say that the findings lend support to the Food and Drug Administration’s proposal in April to pursue a ban on menthol cigarettes.

Juul is fighting for its life.

“Juul Labs, the once high-flying e-cigarette company that became a public health villain to many people over its role in the teenage vaping surge, has been operating as a shadow of its former self, spending the pandemic largely out of the public eye in what it calls ‘reset’ mode,” the New York Times’s Sheila Kaplan reports. “Now its very survival is at stake as it mounts an all-out campaign to persuade the Food and Drug Administration to allow it to continue to sell its products in the United States.”

The FDA has until Sept. 9 to decide whether to allow Juul products to remain on the market. It will weigh their public health benefit as an alternative to combustible cigarettes against the role of the devices in hooking young people on nicotine.

Major public health organizations, including the American Heart Association and the American Lung Association, have asked the agency to reject Juul’s application. But the company is pushing back hard. It’s continuing to spend millions on federal lobbying and just paid $40 million to settle a lawsuit with North Carolina and avoid a looming jury trial.

Sugar rush