One potential casualty of the negotiations taking place among the Democrats is an expansion of Medicare that would add dental, vision and hearing benefits. The provision is favored by progressives, but at $350 billion over 10 years, it is one of the costliest pieces of the bill. Worse, the new benefits wouldn’t begin until 2028, providing little immediate political benefit.
However, Senator Bernie Sanders and some other liberals have called the Medicare expansion non-negotiable.
The progressives argue Congress still can control costs by authorizing the new Medicare benefits for only a few years, in the belief that they would prove so popular that future Congresses would have to renew them.
Meanwhile, centrists like Sen. Manchin are insisting that any benefits be means-tested so they're limited to the poorest Americans — a non-starter for many on the left who say it would undermine a basic tenet of social insurance. And depending how low Manchin and others force down the total cost of the bill, the Medicare expansion could be dropped entirely.
Another issue that is in jeopardy is lowering the costs of prescription drugs.
Democrats in the House can only afford to lose 6 votes from their own members if they are to pass the legislation and already at least 3 members are opposed to the current plans for reducing drug prices.
Rep. Scott Peters (D-Calif.), one of those opposed, said last week he’s in talks with Senate Democrats and the White House about how to craft a new drug pricing proposal.
Peters has suggested only subjecting drugs to negotiations in Medicare Part B—those administered in a doctor’s office or other medical facility—and removing the tax on companies that won’t lower prices.
Peters said he fears the current proposal would harm the pharmaceutical industry’s ability to invest in new medicines. It should be noted that some major pharmaceutical companies are located in Peters’ Congressional district and there are lots of voters who work for those companies.
Over in the Senate, Senator Sinema has rejected progressives on efforts to lower prescription drug costs and Senator Bob Menendez (D-N.J.), whose state contains the headquarters of more major pharmaceutical companies than any other, has also expressed opposition to current plans.