What does it include? Medicaid coverage, and some Medicare expansion

There are no drug pricing provisions, but the White House-backed social spending framework does feature a pared-down expansion of both Medicare and Medicaid coverage.

On Medicaid, the framework would offer four years of subsidized private health insurance on the Affordable Care Act (ACA) exchanges for people with lower incomes living in states that did not expand Medicaid under the health care law.

That means $0 premiums for 4 million people in the “coverage gap,” meaning they don’t earn enough to qualify for ACA subsidies but, since they live in a non expansion state, also make too much to qualify for Medicaid.

Subsidizing coverage is the more industry-friendly way to help people in the coverage gap. The alternative offered by House Democrats in September would have created an entirely new “Medicaid-like” government program.

Not much Medicare: Progressives wanted to expand Medicare to cover dental, vision and hearing benefits. But the framework only would cover hearing. Sen. Bernie Sanders (I-Vt.) said having all three in the bill was non-negotiable; but on Thursday, Sanders did not say he opposes the framework, only that it needs to be improved. The provision also won’t take effect until 2024.

ACA subsidies: The framework does include the extension of enhanced financial assistance to help people afford premiums under the ACA, a key part of Speaker Nancy Pelosi‘s (D-Calif.) legacy.