Dems weigh ditching Medicare expansion and paid leave in eleventh hour of social spending talks

Democrats are haggling over whether to drop two of the most popular elements of their social spending bill as negotiations reach the zero hour, according to a half-dozen sources close to the discussions.

While high-level talks on the $1 trillion-plus package are ongoing, lawmakers, staffers, advocates and lobbyists said that a plan to expand Medicare with dental, vision and hearing benefits for tens of millions of seniors — as well as a pitch to guarantee paid family and medical leave to all U.S. workers — is now in danger of getting cut from the bill entirely.

Democratic sources addressed the current status of the talks candidly on condition of anonymity, amid conflicting reports from those involved that speak to the closely guarded and sensitive nature of the back-and-forth as the party pushes for a deal in the next few days. President Joe Biden and Democratic leaders are racing to lock in centrist Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.) without alienating other major players, including Medicare-expansion proponent Sen. Bernie Sanders (I-Vt.).

One senior Democratic aide said discussions on Medicare and paid leave were “in flux” as negotiations continued through the weekend. The White House and Senate leadership aides, meanwhile, denied that the provisions were on their way out. "This is untrue, on both counts,” said Andrew Bates, a White House spokesperson.

The threat to these two centerpieces of the bill comes as Democrats push for an agreement on a framework for the broader social spending measure as soon as possible. Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer have said they want a deal by the end of this week, though Manchin and the White House still don’t see eye to eye on a topline number for the bill; Manchin has consistently said he supports $1.5 trillion.

Paid leave and Medicare expansion may not fit in a package that conforms to Manchin’s preferred price tag.

On the health care front, the party had originally pushed for scaled-down versions of all its priorities — including temporary expansions of Medicaid, Medicare benefits and Obamacare subsidies — after resistance from centrists in the House and Senate had forced the cutting of more than $1 trillion from the package.

The proposed new Medicare benefits have always been vulnerable, given their $350 billion price tag and a wave of lobbying against them from the health care industry. Those lobbying against the Sanders-backed expansion include private insurance companies and dentists whose profits would take a hit if more seniors enrolled in traditional Medicare and didn’t have to buy supplemental private plans to cover their dentures, hearing aids and glasses.

Many Democrats also saw the Medicare benefits as a threat to the effort to expand Medicaid to millions of uninsured low-income people in conservative states, given that the two provisions were competing for the same limited dollars.

In recent weeks, Biden had pitched lawmakers on converting the dental benefit — by far the most expensive and logistically challenging of the three Medicare expansions eyed for the bill — into an $800 annual voucher for care. Progressives, who have fought for decades against conservative efforts to convert Medicare into a voucher program, were critical of that idea but acknowledged it could be a way to get aid to seniors sooner, given that the original House legislation would not have rolled out the dental benefit until 2028.

Some lawmakers also floated ditching dental and focusing solely on vision and hearing care, while others argued for just a few years of all three, confident that the benefits would prove so popular that a future Congress would be forced to extend them.

Yet even those scaled-back versions have yet to garner enough support from centrist holdouts in the Senate, bolstering projections that the entire Medicare-expansion plank could get axed entirely.

Sanders insisted to POLITICO on Saturday that the benefits are “not coming out.”

“The expansion of Medicare to cover dental, hearing and vision is one of the most popular and important provisions in the entire bill,” he said. “It’s what the American people want.”

Sanders and other progressives already saw the benefits expansion as a significant concession, given they had originally pushed to lower the Medicare eligibility age from 65 to 60. Now, they say dropping the expansion entirely risks losing their votes for the broader bill.

“We obviously want vision, dental and hearing to be covered,” Rep. Ilhan Omar (D-Minn.) told reporters Friday. “My biggest worry is that we’ve had our set of five priorities and we’ve always said we will support a package that has these five priorities. Once you start taking away some of the priorities, then things get a little dicey.”

As for paid leave, the White House informed lawmakers last weekend that it wanted to drastically pare down those provisions in Democrats’ party-line social spending package. Though the administration first proposed 12 weeks of paid family and medical leave for all workers funded at $225 billion, the president is now supportive of four weeks of paid leave for lower-income workers funded at $100 billion, five sources familiar with the conversations said Friday.

That’s nearly one-fifth of what the House approved for paid leave earlier this year: $494 billion. It’s even less than what the Senate has been pushing since this summer: $300 billion.

The benefits, disbursed on an income-based scale, would expire after an estimated three to four years, one source said — a nonstarter for most paid leave advocates, who say that the benefit’s permanence is critical to encouraging employers and states to participate in the program.

“A temporary paid leave program is insufficient,” said Molly Day, executive director of Paid Leave for the United States. “It is imperative that the final bill meets the desperate needs of working families with a permanent federal framework.”

The U.S. is the only wealthy nation without a national paid leave policy. Just 23 percent of private-sector workers have access to paid family leave, according to the Bureau of Labor Statistics. Seventy-seven percent have access to paid sick leave.

The White House said Friday morning that it was considering cutting paid leave from the package, one source familiar with the conversations said.

Now, paid leave advocates are up in arms over what they see as an unwillingness by the White House to fight hard enough for even the slashed version of a reform that Biden campaigned heavily on, particularly as the U.S. recovers from a public health crisis that disparately affected women.

“It is inconceivable and unconscionable to me that there is any risk for a paid leave being on the chopping block, considering the ongoing pandemic, the women’s jobs crisis, the care tsunami, the birth rate issues — all of the combined and overlapping crises deepening racial and gender inequality,” said Dawn Huckelbridge, director of Paid Leave for All. “The fact that something this administration has run on and Congress has championed would not be a priority to me is unbelievable.”

The White House has mostly deferred the blame for the paid leave cutbacks to Manchin, one source familiar with the conversations on the Hill said. Manchin himself has yet to go on record about whether the policy is a priority for him.

“I want to know whether [Biden] is putting his weight behind [paid leave] when he’s behind closed doors with Sen. Manchin and others that he’s negotiating with,” said Vicki Shabo, who studies paid leave at New America.

A spokesperson for Manchin did not respond to a request for comment Friday.

Burgess Everett contributed to this report.

CORRECTION: An earlier version of this report misidentified the state that Rep. Ilhan Omar represents. She is a representative from Minnesota.

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