WASHINGTON – Democrats, grappling with what to cut from their economic package and safety net, face escalating divisions over healthcare as competing factions on Capitol Hill fight to keep their priorities out of the cutting block.

As President Joe Biden seeks to slash his $ 3.5 trillion price tag by more than $ 1,000 billion, House leaders tend to prioritize extending the Obamacare grant increase in the US bailout and to close the Medicaid coverage gap in states that have not expanded the program.

“I feel very much of an owner of the Affordable Care Act,” said President Nancy Pelosi, D-Calif., Who enacted the bill in 2010 and passed it as part of her legacy.

For House Majority Whip Jim Clyburn, DS.C., a key figure who helped propel Biden to the White House, Medicaid is paramount. About 100,000 residents of his conservative state are falling into a vacuum.

“My priority is Medicaid and the coverage gap,” Clyburn said in an interview.

Representative Suzan DelBene, D-Wash., Leader of the 95-member NDP coalition, urged party leaders to limit health care provisions to ACA and Medicaid changes while leaving expanded Medicare benefits for another day. .

That doesn’t suit Sen. Bernie Sanders, I-Vt., Who has made Medicare a red line and – like every other senator in the 50-member Democratic caucus – holds a deciding vote.

“There is really something fundamentally wrong when, in the richest country in the history of the world, there are millions of old people with rotten teeth in their mouths, unable to hear what their grandchildren say, and study after study suggests that dementia is accelerated because people are isolated from their community because they cannot hear, ”he told reporters.

“So for me it’s not negotiable,” he said. “This is what the American people want.”

Representative Pramila Jayapal, D-Wash., Said that was also the position of the Congressional Progressive Caucus, which she chairs. Jayapal recently showed the group’s strength by torpedoing an infrastructure vote in an attempt to leverage centrists over the safety net bill.

The dispute is one of many challenges Democrats face as they seek to reduce the package and unify their weak majorities behind a bill the party hopes to make its flagship achievement of the time – and campaign. in the midterm elections next year. Biden’s falling numbers in the polls forced him to grab a victory, which Democrats want as soon as this month.

Pelosi said the programs would be phased out in some cases and expiration dates would be shifted to accommodate the price bracket in others. Progressives see this as an invitation to incorporate one version of their policies into the final bill.

Senior assistants say many unknowns will shape healthcare decisions. The first is where the overall level of spending ends. The second is how much savings the party can find, which largely depends on whether the bill allows Medicare to negotiate drug prices. Committees and policy makers are still waiting for leadership advice on these issues.

“I have no idea what Sinema wants”

Financial limits, while self-imposed, are sobering.

ACA and Medicaid policies would cost $ 200 billion each, estimated Marc Goldwein, a policy expert on the Non-partisan Committee for a Responsible Federal Budget. Additional Medicare benefits would cost around $ 300 billion, with dental care being the most expensive, he said, while warning that the numbers could change depending on their structure.

Expanding long-term and community care would cost around $ 150 billion. It’s a priority for Sen. Bob Casey, D-Pa., Supported by Senate Health Committee Chair Patty Murray, D-Wash.

Goldwein said, “Add that and it’s $ 850 billion.” Referring to Senator Joe Manchin, the centrist Democrat from West Virginia, he said, “Let’s say the Manchin red line is $ 1.7 trillion. I don’t know, but let’s just say. It’s half – just for health care. It’s very complicated on all kinds of fronts.

Under the budget resolution, what Democrats can spend depends in part on how much money they raise in the finance committee, which has jurisdiction over health care and tax policy and must save money. a billion dollars.

A Medicare policy to negotiate drug prices could bring in up to $ 450 billion. Manchin said he supported the idea. The big question mark is centrist Sen. Kyrsten Sinema, D-Arizona, whose office has refused to confirm or deny reports that she opposes the proposal.

Some Democratic aides believe the party should include politics and challenge it to vote against. A collaborator said that given the great popularity of the policy and Sinema’s own campaign pitch in 2018 to bring down drug costs, it would be difficult for him to kill him in the light of day.

Sinema – a former Green Party activist turned business-friendly Democrat – upset her colleagues on Capitol Hill by refusing to tell them what she would be willing to support.

When asked on Tuesday if he had a clear idea of ​​what Sinema wants, House Budget Committee Chairman John Yarmuth, D-Ky., Replied curtly: “I have no idea what Sinema wants.

“I can’t get into his head. And I don’t want to, ”he said.