Democrats jostle over health care priorities for scaled-back package

Jockeying is intensifying over a range of competing health care priorities as Democrats shrink their social spending package in an attempt to shore up enough support to advance the legislation.

​​Sen. Bernie Sanders (I-Vt.) is pushing for expanding Medicare to include dental, vision and hearing benefits, saying the provisions are “not negotiable.”

But House Majority Whip James Clyburn (D-S.C.) says that expanding Medicaid for low-income people living in the 12 GOP-led states that have so far declined the expansion should take precedence, noting that Medicare includes coverage for “millionaires and billionaires.”

Sen. Joe Manchin (D-W.Va.), a key centrist vote, has also expressed concern with expanding Medicare benefits, saying he wants to shore up the finances of the current Medicare program before expanding it.

Speaker Nancy Pelosi (D-Calif.), meanwhile, has prioritized a third health care move: extending enhanced financial assistance to help people afford premiums under the Affordable Care Act (ACA), a key part of her legacy.

With the overall size of President Biden’s Build Back Better package shrinking, Democrats are searching for ways to fit in all of the health care priorities, leading to tensions in the party over the differing initiatives.

Democrats are discussing making the Medicare, Medicaid and ACA provisions all temporary as a way to save money and avoid completely eliminating any one of them. But even with this approach, lawmakers have indicated there are still contentious debates that need to be worked out.