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Over its nearly sixty years, Medicare’s reach in terms of beneficiary groups and benefits has remained surprisingly stable, not for lack of attempts at expansion. This essay considers several of the most ambitious attempts at Medicare expansion, including adding benefits for prescription drugs, long-term care, and vision, dental, and hearing care. Some failures and some successful, these efforts considered in conjunction illuminate Medicare’s changing identity, drifting gradually yet fundamentally from its social insurance roots. Understanding the winners and losers in the debates over Medicare expansion reveals the changing political economy and collective understanding of Medicare as a cornerstone of the welfare state.

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Elder Law Journal