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Illustration: Sarah Grillo/Axios

As Democrats try to reach a deal on a massive social policy bill, the legislation's health care measures are emerging as key sticking points.

Between the lines: Moderate members have successfully reduced the amount of new spending that the party is aiming to pass, amplifying the tug-of-war between different factions of the party over which health policies to prioritize.

The big picture: Nothing's dead yet, although some big-ticket health items are definitely in hot water.

  • The one upside for Democrats of a lower budget for new spending is that they now have to raise less new revenue — which alleviates some of the pressure to be more aggressive on drug pricing provisions.
  • If the Senate reaches a compromise on allowing Medicare to negotiate drug prices, it'll likely apply to fewer drugs than the House bill and use a domestic benchmark price, instead of pegging U.S. prices to what other countries pay.
  • One optimistic take: When Rep. Kurt Schrader — who voted against the House's drug pricing plan in committee — was asked whether he sees some form of Medicare negotiations making it into the bill, he told STAT's Rachel Cohrs that he'd "bet the ranch on it."

Where it stands: The most vexing policy area appears to be Medicare benefit expansion. Progressives who want the program to cover hearing, dental and vision benefits are running into Sen. Joe Manchin's brick wall of opposition.

  • Manchin has said he's worried about the Medicare program's solvency.
  • Neither side seems to be backing down, although the idea of vouchers has gained momentum over strict benefit expansion. One idea has been to offer $800 vouchers for dental care instead.

Manchin also said yesterday that he's skeptical of Democrats' push to close the Medicaid coverage gap.

  • His concern is that the federal government would pay the full cost of expansion in states that chose not to expand voluntarily, while states that did expand would still have to pick up part of the tab.
  • "For states that held out and be rewarded 100% is not fair," Manchin told reporters yesterday, per Politico.

The bottom line: There's going to have to be a lot of give and take in the coming days if any of Democrats' priorities are going to become law, health care or not.

Go deeper

Nov 29, 2021 - Health

The push to revive an industry-backed medical device rule

Doctors and technicians perform a surgery. Photo: Melina Mara/The Washington Post via Getty Images

A bipartisan group of U.S. House members chided the Biden administration for repealing a rule that would have required Medicare to pay for any medical device deemed a "breakthrough" by the FDA.

The big picture: Medical device manufacturers really wanted the rule enacted, in part, because it would have led to higher sales. Now many members of Congress who receive sizable campaign donations from the industry want the federal government to revive the rule.

Updated 2 hours ago - Politics & Policy

Prosecutors charge parents of Michigan school shooting suspect

Photo: Scott Olson/Getty Images

The parents of a 15-year-old accused of killing four students and wounding seven other people at a Michigan high school have been charged with four counts of involuntary manslaughter, according to court documents.

The latest: Lawyers for James and Jennifer Crumbley told the Detroit News they are "returning to the area to be arraigned," after law enforcement officials announced a search for the Crumbleys had been initiated.

Updated 6 hours ago - Politics & Policy

Omicron dashboard

Illustration: Shoshana Gordon/Axios

  1. Health: Coronavirus variant surveillance varies widely by state — Omicron cases confirmed in 5 U.S. states America probably won't lead the effort to understand Omicron.
  2. Vaccines: Omicron adds urgency to vaccinating world — Omicron fuels the case for COVID boosters — Moderna loses patent battles tied to COVID vaccine.
  3. Politics: Nevada to impose insurance surcharge on unvaccinated state workers — New Jersey GOP lawmakers defy statehouse COVID policy — Oklahoma sues Biden administration over Pentagon vaccine mandate — Omicron travel bans are sign of what's to come.
  4. World: WHO: Delta health measures help fight Omicron — COVID cases surge in South Africa in sign Omicron wave is coming — Germany approves new restrictions for unvaccinated people.
  5. Variant tracker: Where different strains are spreading.

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