President Joe Biden’s administration is facing pressure from lawmakers and advocates to close a major gap in its COVID-19 strategy that has left home testing out of reach for Medicare beneficiaries.

Under the U.S. Relief Program Act, Medicaid and Children’s Health Insurance plan enrollees are eligible for free home testing for COVID-19.Families who now have private health insurance can be reimbursed For home testing under the Centers for Medicare and Medicaid Services policy Effective this month.

While the actions could make it easier for hundreds of millions of U.S. residents to get tested at home, they exclude 64 million Medicare beneficiaries who are particularly vulnerable to the novel coronavirus because of their older age or disabilities.Another Biden plan is to distribute 1 billion home tests by postal service For those with health insurance, lawmakers and advocates, that alone is not enough.

As the pandemic continues, a growing number of congressional Democrats are urging the administration to find a way to offer home testing for Medicare enrollees.

“We strongly recommend that you expand your Medicare coverage to Medicare,” Sen. Debbie Stabenow (R-Mich.) and 18 other Senate Democrats wrote in an article. letter Monday with Health and Human Services Secretary Xavier Becerra. Under the current policy, Medicare enrollees “may incur substantial out-of-pocket costs,” the senators wrote.

Signatories to the letter include a number of influential Democrats, including Stabenow, who chairs the Democratic Conference Policy Committee and the Senate Agriculture Committee, as well as conference vice chairmen Elizabeth Warren (Mass.) and Mark Warner (Mass.), who also chair the Intelligence Committee. Virginia) .

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Eleven of the 19 senators who sent the letter were Democrats on the finance committee with jurisdiction over Medicare, including health subcommittee chairmen Stabenow, Warren and Warner. Only Chairman Ron Wyden (D-Ore.) is missing.

The letter was joined by leaders of powerful Senate panels such as Banking Committee Chairman Sherrod Brown (D-Ohio), Foreign Relations Committee Chairman Robert Menendez (DN.J.), Armed Forces Chairman Jack Reed (DR.I.) and Budget Committee Chairman Bernie Sanders (I-Vt.). In addition to Reed, all of these people are also members of the Finance Committee.

The push by Senate Democrats comes amid recent pressure from members of the House of Representatives, including a letter to more than 100 lawmakers write to becerra Thursday.

“We urge HHS to ensure Medicare beneficiaries have continued free at-home testing for COVID-19 through the Medicare program,” wrote Representatives Tom Malinowski (DN.J.), Kim Schrier (D-Wash.) and other lawmakers. Two Republicans signed the deal with dozens of Democrats: Rep. Brian Fitzpatrick (Pennsylvania) and Peter Mayer (Michigan).

New Jersey Democrats Bill Pascrell and Scott Peters delivered a separate letter to Biden on Jan. 14. “Without similar benefits offered through health insurance plans, nearly 20% of the population would have to pay for COVID-19 testing out of pocket, and therefore should not be expected to be tested with the same desired frequency,” they wrote.

Leading voices on Capitol Hill are also urging the Biden administration to address the testing coverage gap.

“While Medicare beneficiaries can get COVID tests for free, they have to go through a hoop to get them,” said AARP lobbyist Andrew Scholnick. “We believe CMS can find a way to offer free home testing,” he said.

“This really needed to happen a few months ago. It’s frustrating,” said Natalie Keene, senior staff attorney at Aging Justice. “We hope the government is working on a solution and we hope they roll it out as soon as possible.”

Increasing Medicare coverage for home testing without new legislation could be tricky.The program is generally does not include Over-the-counter medical products, although some Medicare Advantage plans offer them as supplemental benefits.

Advocates argue that there may be a solution to the problem.

Commonwealth Fund health insurance vice-president Gretchen Jacobson said the government could be “creative”. “They can do what they’re currently doing for everyone with four free tests. You can give people on traditional Medicare a gateway to additional testing based on your Medicare ID or something like that.”

One lobbyist working on the issue argues that Medicare could cover home testing under the ongoing public health emergency declaration. For example, CMS could allow clinicians and pharmacists to bill Medicare for home testing, the lobbyist said, declining to be named as discussions with the administration continue.

So far, CMS has not disclosed policies, if any, that may be under consideration. “While home testing is not covered by original Medicare at this time, testing remains a critical tool to help mitigate the spread of COVID,” a spokesperson wrote in an email. “We will continue to explore the best ways to provide critical resources. The best way to ensure the safety and health of Medicare beneficiaries.”

Meanwhile, health plans are delaying the government’s use of insurance to cover COVID-19 testing for non-medical reasons, saying HHS?? should not repeat the approach in Medicare and Medicare Advantage.

“It just doesn’t work,” said Ceci Connolly, president and CEO of the Alliance of Community Health Plans, which represents nonprofit health insurers, including some Medicare Advantage carriers. “For the government, expanding a program that is currently not working could cost a lot of money in the coming weeks and months and could really be confusing and frustrating for a lot of people,” she said.

Instead, Connolly said, the federal government needs a comprehensive national testing strategy that prioritizes testing of people who have not been vaccinated, have been exposed to COVID-19, or are particularly vulnerable to becoming seriously ill.