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Sen. Bernie Sanders. Photo: Al Drago/Bloomberg via Getty Images

Senate Democrats are debating lowering the Medicare eligibility age as part of the $3.5-trillion "soft" infrastructure package, at the risk of jeopardizing centrist support for a measure being pushed by Sen. Bernie Sanders (I-Vt.).

Why it matters: Giving Americans over age 60 access to Medicare would force Democrats to either add an estimated $200 billion to their overall infrastructure price tag or cut other progressive priorities currently in the package.

  • Medicare expansion wasn’t in the initial agreement that Democrats reached — and President Biden endorsed — last week.
  • But progressives haven’t given up hope it could be included, in some form, in a final infrastructure package. Critics will argue that expanding Medicare eligibility is a backdoor to government-run health care or "Medicare for All."
  • Lowering the Medicare age would all but guarantee a brutal fight with hospital associations, adding another powerful lobbying group — along with the pharmaceutical industry — in opposition to any deal.

The intrigue: The true cost of Sanders' ambitious plan to expand the social safety net is difficult to determine, in part, because Senate Democrats haven’t been precise about how long they plan to fund new programs.

  • The actual costs could be between $5 trillion and $5.5 trillion over 10 years, if all the changes are made permanent, according to the Committee for a Responsible Federal Budget (CRFB), a budget watchdog group.
  • For example, the cost of the Child Tax Credit, which was included for one year in the $1.9 trillion coronavirus relief bill Biden signed into law in March, could cost up to $1.5 trillion over 10 years.
  • Giving elements different durations would allow Democrats to present an overall price tag that differs, in reality, from the long-term cost of their package.

Between the lines: While Biden didn’t initially run on expanding access to Medicare, he agreed to support lowering the age from 65 to 60 in April 2020, when his campaign worked on a unity platform with Sanders' team.

  • Earlier this year, a group of 150 House Democrats urged the president to include Medicare expansion in his Build Back Better agenda.
  • Biden did propose covering dental, vision and hearing costs in his budget, which carried over to the current infrastructure framework. That has an estimated $370 billion price tag and is in the current $3.5 trillion soft infrastructure framework.
  • The debate about how to expand Medicare could be punted to the Senate Finance Committee after the full Senate agrees to top-line numbers in a budget resolution.

Be smart: Democrats are bracing for an official “score” from the Congressional Budget Office that's significantly higher than their advertised price tag — $3.5 trillion.

  • The CBO won’t be able to provide accurate numbers, though, until Democrats agree to the specific proposals included in the package.

Go deeper

Oct 28, 2021 - Politics & Policy

Plan B for soaking the rich

Illustration: Sarah Grillo/Axios

Millionaires be warned: Democrats are looking for creative ways to tax the wealthiest Americans to pay for their $1.75 trillion social safety net expansion, lawmakers and aides tell Axios.

Why it matters: The nation’s 700 billionaires may have dodged a bullet when Sen. Joe Manchin (D-W.Va.) effectively killed a plan to tax just their unrealized capital gains. But Manchin has told colleagues he's open to hitting all the country’s richest families and individuals with higher taxes.

The progressive promise

Rep. Mark Pocan, who says, "I trust the president." Photo: Bill Clark/CQ Roll Call

House progressives say they're willing to stop holding the bipartisan infrastructure bill hostage based on a presidential promise.

Why it matters: A key sticking point for progressives supporting the $1.2 trillion bipartisan infrastructure bill was their requirement the Senate first pass the nearly $2 trillion social safety net expansion they favor. Now, they say senators only have to promise they'll do so before they support the BIF.

Oct 27, 2021 - Politics & Policy

Scoop: Manchin waffles on billionaire tax

Sen. Joe Manchin addresses the Economic Club of Washington today. Photo: Drew Angerer/Getty Images

Sen. Joe Manchin (D-W.Va.) is telling colleagues he has deep concerns about a proposed “billionaire tax” but is waiting for more details before making a final decision, people familiar with the matter tell Axios.

Why it matters: The senator's doubts reveal an uncomfortable truth for the White House and congressional leaders as they race to finish — and pay for — their nearly $2 trillion social spending and climate package: A tax solution designed to satisfy Sen. Kyrsten Sinema (D-Ariz.) isn't necessarily acceptable to Manchin.