The American Rescue Plan reduced health insurance premiums for many people by expanding subsidies in the Affordable Care Act marketplaces. Now, President Joe Biden is seeking to make those expansions permanent in the American Families Plan—but he’s not pursuing other important ways of making health care more affordable, and many Democrats want him to change course on that.

Led by Rep. Pramila Jayapal and Sen. Bernie Sanders, a group of congressional Democrats are pushing Biden to include a Medicare expansion in the package, lowering the Medicare eligibility age to 55 or 60. Additionally, they want dental, vision, and hearing coverage covered by Medicare, and they want the government to negotiate prescription drug prices.

Sanders, the chair of the Senate Budget Committee, says he will “absolutely” work to get Medicare expansion into the bill that emerges from Biden’s plan, and Sen. Dick Durbin has also indicated he will work to make that happen. On the other hand, “No, I’m not for it, period,” is the position of Sen. Joe Manchin, the 50th Democratic vote.

Biden has said he plans to tackle health care in a separate bill. “If we have to spend all the way through August working on the jobs and families plan[s], I don’t think we have the time,” Jayapal said. “Everything gets harder heading into the midterms.”

Many employers should want Medicare eligibility brought down to 60 or 55, because employer plans spend more money on those age groups than on other age groups, while Medicare could cover them more cheaply. “If everyone 60-64 who is enrolled in large employer plans switched to Medicare, employer plan costs would drop by 15%,” a KFF analysis found, and “If everyone 55-64 left their employer plans, the costs would decrease by 30%. And if all adults 50-64 left, costs would decrease by 43%.” Granted, some people in those age groups might stick with their employer-provided coverage, so the costs would not fall by that much, but the possibility is there.

In a sensible society, expanding Medicare eligibility would be an absolute no-brainer. When it comes to health care—and so many other important policies—the United States is unfortunately not a sensible society. 

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