The Senate has set its eyes on regulating insurance plans for some of the most vulnerable patients in the U.S. — the 12.5 million people eligible for both Medicare and Medicaid.

“They’re a complex group of people with a lot of chronic conditions — mental illness, frailty, disability,” said Jose Figueroa, an internal medicine physician and health policy expert at Brigham and Women’s Hospital. Over a third of these dual-eligible beneficiaries have less than a high school education, and about 90% make less than $20,000 per year.

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Just around 15% of beneficiaries are eligible for both Medicare and Medicaid, but they account for a third of these programs’ spending — around $440 billion — and still don’t receive better health care, Sen. Bill Cassidy (R-La.) pointed out in a JAMA viewpoint published earlier this month. “The root cause of worse outcomes despite spending more money is a lack of coordination of care,” Cassidy wrote.

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