Predictions for Medicare under a Democratic Majority Senate and Executive Administration

By Rebecca Molesworth | January 18, 2021

With the Georgia Senate runoff election in the rearview, we now know that Democrats will lead with small majorities in both the House and Senate for the first two years of the Biden administration. With control of both houses, it is likely that Congress will support some or all of President-elect Joe Biden’s initiatives. So, what does that mean for Medicare and the post-acute care industry?

Among others, President-elect Biden’s campaign platform included two issues that could significantly impact Medicare legislation:

  • Increased access to coverage
  • Lowering the Medicare eligibility age to 60

Increased Healthcare Coverage and Medicare

Among other efforts to shore up the Affordable Care Act (ACA), Biden has floated the idea of providing a public insurance option through the healthcare exchange. This program could be an expansion of Medicare or a separate but similar program for Americans of all ages. It’s noteworthy that creating a new public option would require an act of Congress, which would likely not have been possible with a majority-Republican Senate. With both chambers of Congress led by Democrats, the likelihood of a new public healthcare coverage program increases dramatically.

That said, even with majorities in both the House and Senate, there’s no guarantee that such a bill would pass. According to Fierce Healthcare, “The Obama administration tried to add a public option to the [ACA]. However, while the House passed a version of the ACA with a public option, it wasn’t able to get enough support in the Senate.” This year, with Vice President Kamala Harris casting the tie-breaking vote in the Senate, we may see a different outcome, but it’s still not a certainty.

Expanding Medicare Coverage to Younger Americans

That said, Biden’s plan to lower the age of Medicare eligibility to 60 could also help accomplish the goal of increasing coverage across the country. As Tricia Neuman, senior vice president and executive director of the Kaiser Family Foundation’s Medicare policy program told Forbes, “It is hard to know for sure what the effects would be without specific legislation, but it seems clear that lowering the age of eligibility would reduce the number of uninsured Americans in a fairly straightforward way, targeting those who face relatively high premiums in the marketplace because of their age […] Lowering the age of Medicare eligibility would give older adults a direct pathway to get health coverage under Medicare unless they choose to opt-out for an employer plan or other source of coverage.”

With a majority Democrat House and Senate, Biden’s initiative to expand Medicare to people as young as 60 may become a reality. However, we should keep in mind that the Democrats’ majority in the Senate is incredibly thin. Even a single defecting majority party vote could mean the end of this effort. The question then is, can we expect Democrats to go against their own administration – and why?

According to NPR, Republicans are not the only ones fighting against expanded Medicare. A lot of hospitals are expected to push back against it, as well. With the emergence of value-based payment models, hospitals are already looking at dwindling reimbursements and costly updates to old processes. Increasing the number of Americans covered by Medicare could further impact their reimbursement rates, making this initiative highly unattractive to most organizations in the acute care industry. Thus, there’s a chance that hospitals could make their voices heard and potentially sway some congress members’ votes away from Medicare expansion.

With majorities in the House and Senate, we can be sure that at least some form(s) of President-elect Biden’s campaign initiatives will become a reality. We may see a public option for insurance coverage through the Affordable Care Act, and we may see Medicare eligibility for people as young as 60. We know that both of these initiatives are important to the Biden administration, but how they will hold up with slim majorities in Congress is still a matter of speculation.


While much is still uncertain about the efficacy of Biden’s healthcare agenda, one thing is for certain: Even with a majority in both the house and senate, there is no guarantee that anything will pass. The majority makes it more likely, but won’t be enough to block a filibuster. To increase the chance of enacting these initiatives, the Biden administration will need to gain bi-partisan support. It will be interesting to see if history repeats itself, with an aggressive push to pass as much legislation in the first two years of Biden’s term, as happened in the beginning of the Obama administration, or if Democrats will pursue a more conservative, middle-ground approach. While such an approach may result in fewer bills passing, it may also mean less recoil and Senate turnover in 2022.

The next few weeks and months will be crucial as more appointments are passed and finalized. Check back for more information on how these developments will impact Medicare beneficiaries and their providers. Let us know what questions you have or impacts you’re already seeing. Send me a note to


About the Author:

Rebecca Molesworth, Vice President, Product Management

With more than 20 years’ experience working with healthcare information technology companies, Rebecca brings a breadth of knowledge and a passion for innovation to Trella Health as the Vice President of Product Management.   Before joining Trella Health, Rebecca served as the Senior Director of Data Intelligence for Medecision, accountable for data management, reporting and analytics for the portfolio. Throughout her career, her passion for improving patient outcomes through technology and data has grown. By unifying all stakeholders in the ecosystem, she strives to help patients receive the highest quality and most cost-efficient care.   Rebecca graduated from the University of Michigan with an MHSA in Health Management and Policy and has won innovation awards at several of her previous companies. She continued to foster and grow her analytics, data, and interoperability skillsets during the ARRA, HITECH, and PPACA Federal policy implementations.   At Trella Health, she’s excited to drive meaningful change and improve transparency in healthcare by creating market-driven solutions.