WASHINGTON (AP) – Democrats are debating how to divide what may be a smaller portion of health care spending in President Joe Biden’s home policy bill, pitting the needs of older people who cannot afford their dentures to the fate of uninsured persons. income earners in the South.

“There is always a battle as to where you put your priorities,” Rep. Jim Clyburn, the No. 3 Democratic House leader, said on Wednesday. which means that people with enough wealth will get both dental (and) vision care while poor people will be denied. … I don’t know if this is a very good choice.

Clyburn explained that more than 100,000 of his compatriots in South Carolina are still uninsured because Republicans in charge of the state government have refused to extend Medicaid to low-income working adults under the law. on affordable care.

Health care is at the heart of Biden’s $ 3.5 trillion domestic policy bill, which touches everything from taxes to climate change, from child care to community college.

When budget screws are enforced, entire proposals may disappear from legislative wishlists, or they may be allowed for a shorter period, a fiscal tactic akin to wading in water rather than swimming.

So far nothing has been dropped from Democrats Health Care Program, which includes new dental, vision and hearing coverage under Medicare, richer grants that lower premiums for “Obamacare” plans, a federal workaround to expand Medicaid in a dozen states still denying coverage, Improved postpartum medicaid for low-income women, and a permanent extension of the popular children’s health insurance program.

The health care upgrades represent a major overhaul of federal programs spanning more than 145 million Americans and part of the Democratic political legacy.

“The elements of healthcare are the tip of the spear, the most important, the most popular and the most politically salient, and we just have to get there,” said Brad Woodhouse, executive director of Protect Our Care. The rights group, which urges Democrats to go further, sponsored a teleconference with lawmakers on Wednesday.

The story continues

The plan was to pay for improved health care with savings from allowing Medicare to negotiate the prices of the more expensive prescription drugs. But there is a dilemma. As with the overall price of the legislation, Democrats disagree over Medicare negotiations. A Senate bill still in the works may not go as far as the measure pending in the House.

And there’s one more thing to consider: Biden is pushing for a major expansion of long-term home care services under Medicaid, an alternative to institutional placement in nursing homes.

Tensions are brewing between Senate Budget Chairman Bernie Sanders and some House Democrats. The Vermont independent is pushing hard to get expanded health insurance benefits for dental, vision and hearing care topped the list, but veteran House Democrats who worked to push through and preserve the law on the health of the Obama era see its improvement as an unfinished business that is their calling to be accomplished.

Under the umbrella of the Obama law, closing the so-called Medicaid coverage gap has become a rallying cry for black and Latino lawmakers, as well as for advocates for the poor. Some 2 million people in states denying the Medicaid expansion of the Health Act earn too much to qualify for Medicaid and too little to qualify for HealthCare.gov plans. Three in 5 are black or Hispanic. Texas and Florida, states Democrats would like to return, could see the biggest coverage gains if the federal government steps in.

The intra-party political dynamic differs from the House to the Senate. While many House Democrats represent districts that would benefit from closing the Medicaid coverage gap, only three Democratic senators come from states that have yet to expand their programs. It is about the Senses. Tammy Baldwin of Wisconsin and Georgians Raphael Warnock and Jon Ossoff. They represent a fragment of the Democratic Senate caucus, but also the advantage that gives Democrats control of the equally divided chamber. Warnock, who faces re-election next year, has made closing the Medicaid gap his signature issue.

Advocates fear that lawmakers will scale back the Medicaid fix to save money and only apply it for a brief period of several years, leaving it to a future Congress to make the change permanent.

“If the policy is not permanent, it is important that it extend long enough for the federal Medicaid program to be operational,” said Judy Solomon of the Center on Budget and Policy Priorities, a nonprofit that defends the rights of low-income people. Medicaid is one of the more complex government programs and splicing a new federal component for a limited number of states could take a long time.

For now, Democrats hope they don’t have to slice and carve out their healthcare ambitions to accommodate new budget constraints.

“Obviously, negotiations are ongoing,” said Rep. Lauren Underwood, D-Ill. “I’m sure these critical healthcare topics have been discussed. I think what we know for sure is that you can’t “build back better” without protecting people’s health care and reducing out-of-pocket costs, period.