Democrats in Congress are changing their tune on means testing in Medicare, an idea the late Sen. Edward Kennedy (D-Mass.) resisted for decades.
"I think that is reasonable and certainly consistent with the Democratic message that those who are better off in our country should be willing to pay a little more," Senate Majority Whip Dick Durbin (D-Ill.) said Thursday.
The idea of affluence testing is not new — wealthy Medicare recipients already pay higher premiums for doctor visits and prescription drug coverage.
But negotiations to avoid the so-called "fiscal cliff" open the door to new measures that would make Medicare costs more progressive based on income.
Durbin is not the only Democrat who has suggested he would be open to more means testing as part of a final deal.
Last week, Senate Finance Committee Chairman Max Baucus (D-Mont.) called the idea "somewhat attractive" as a bargaining chip for talks on the so-called fiscal cliff.
Sen. Claire McCaskill (D-Mo.) remarked that "Donald Trump may need medication, but he certainly doesn’t need the government to pay for it."
And Congressional Black Caucus Chairman Emanuel Cleaver (D-Mo.) called means testing a good way to bolster Medicare's budget without cutting benefits.
The comments reflect a major shift for Democrats on the issue since 2003, when Kennedy threatened to filibuster the now Medicare prescription drug law after a means-testing amendment passed the Senate.
At the time, Democrats, including House Minority Leader Nancy Pelosi (Calif.), argued that means testing in Medicare would kill the program's promise of equal care at equal charge.
With the introduction of some means-testing measures — wealthier people on Medicare have paid higher premiums for care from doctors since 2007 — Democrats began arguing that the system is progressive enough.
House Energy and Commerce Committee ranking member Henry Waxman (D-Calif.) still holds this view, he said Friday.
"We already have a substantial amount of means-testing in the Medicare program — most significantly, there is no cap on the income subject to the Medicare tax," said Waxman in a statement to The Hill.
"That is the right way to ask the better-off to pay more. And in fact, we also have means testing now of the Part B and Part D premiums. It is a mistake to go further."
This opinion puts Waxman at odds with President Obama, who proposed raising Medicare premiums for wealthy seniors in his budget and during the 2011 debt-ceiling negotiations.
The Congressional Budget Office estimated that Obama's proposed budget measure — raising Part B and D costs by 15 percent for higher-income seniors starting in 2017 — would raise $30 billion.
"Means-testing on Medicare, meaning [on] people like myself … You can envision a situation where, for somebody in my position, having to pay a little bit more on premiums or co-pays or things like that would be appropriate," Obama said in July 2011.
The comment immediately drew backlash from the AARP, which criticized any move that could limit seniors' benefits.
"Seniors pay into Medicare their entire working lives based on the promise that they'll have secure health coverage when they retire," AARP Senior Vice President Joyce Rogers said at the time.
"Applying a means test for their earned benefits would erode the popular support that has sustained these programs for years and made them so effective in helping older households."
Obama has not explicitly mentioned Medicare means testing as part of the current fiscal-cliff discussion.
Recently, White House Press Secretary Jay Carney demurred when asked why not.
"I’m not going to get into the specifics and negotiate line items on what those reforms might look like as part of an overall package," Carney said last month.
"But [Obama] understands that compromise requires both sides to make tough choices."