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Many progressives have started lining up behind an emerging social and environment bill that’s neither as big nor as bold as they wanted, thanks to an outnumbered but potent band of party moderates who’ve enjoyed a disproportionate say in shaping the measure. Democrats rolled past unanimous Republican opposition in August and pushed a 10-year, $3.5 trillion fiscal blueprint of the plan through Congress. With talks continuing, the actual package — it reflects President Joe Biden’s hopes for bolstering health care, family services and climate change efforts — seems likely to be around half that size. Prized initiatives like free community college and fines against utilities using carbon-spewing fuels are being jettisoned, and others are being curtailed. (Fram, 10/27)

Democrats are considering payment reductions for private Medicare Advantage plans to help offset the cost of a multitrillion-dollar budget bill, according to three sources with knowledge of the talks, triggering a lobbying fight from the insurers. The insurance industry is closely watching lawmakers’ search to pay for a sweeping jobs and social spending bill expected to cost around $2 trillion over a decade. The House version of the bill didn’t include any changes to the Medicare Advantage program, and the Senate has not yet introduced its own text, but lobbyists are concerned about the threat of payment cuts. (Clason, 10/26)

Democrats are coalescing around a plan to offer a few years of subsidized private insurance to uninsured people with lower incomes in states that refused to expand Medicaid. The latest idea is an attempt to save a pillar of the party’s health care agenda as members rush to broker final agreements on their sweeping social spending package. The plan is more amenable to the private insurance industry and comes days after Sen. Joe Manchin (D-W.Va.) expressed opposition to the party’s preferred proposal: to create a new federal program that mirrors Obamacare’s Medicaid expansion. (Ollstein, 10/26)

One Senate Democrat could block an effort by his colleagues to extend health care to millions of poor people in a dozen states. For West Virginia Sen. Joe Manchin, his opposition is a matter of fairness. Taxpayers in his state – and in the 37 other states that have expanded Medicaid eligibility under the 2010 Affordable Care Act – pick up 10% of the cost to cover low-income residents who are covered by the law. Why then, he argues, should the federal government now pay for 100% of the cost in the states that have refused the 90-10 split – as Democrats are proposing to do in the massive social spending bill pending in Congress. (Groppe, 10/26)

Democratic leaders scrambling for an infrastructure vote this week to boost two Democratic gubernatorial candidates hit a brick wall Tuesday, when the head of the Congressional Progressive Caucus said liberals will oppose the popular public works bill until a larger benefits package is finalized. Rep. Pramila Jayapal (D-Wash.) emerged from an hourlong meeting with Speaker Nancy Pelosi (D-Calif.) amplifying her long-held position: Progressives won’t support the bipartisan infrastructure bill, known as the BIF, before there’s agreement on every detail of the social spending package at the heart of President Biden’s domestic policy agenda. (Lillis and Wong, 10/26)

KHN: Medicare Plans’ ‘Free’ Dental, Vision, Hearing Benefits Come At A Cost 

When Teresa Nolan Barensfeld turned 65 last year, she quickly decided on a private Medicare Advantage plan to cover her health expenses. Barensfeld, a freelance editor from Chatham, New York, liked that it covered her medications, while her local hospitals and her primary care doctor were in the plan’s network. It also had a modest $31 monthly premium. She said it was a bonus that the plan included dental, hearing and vision benefits, which traditional Medicare does not. (Galewitz, 10/27)

As a diabetes doctor in Baltimore, Sally Pinkstaff saw her patients struggle to pay for insulin. They told her they would take half the normal amount, delay doses, even skip entire months. She would try to help them by adjusting their prescriptions — and sometimes by giving them cash. Then, after she received a diagnosis of smoldering multiple myeloma, she began to see firsthand what it meant to depend on a costly drug. Her disease, a type of blood cancer, is often treated with an oral medication, Revlimid, that can keep the disease at bay for years. At first, the insurance from her medical practice charged her a $50 co-payment a month. But when she retired and went on Medicare, the first bill was nearly $4,000, and she became the patient who stopped taking her medicine for a month. (Sanger-Katz, 10/27)

KHN: KHN Campaign Contributions Tracker: Pharma Cash To Congress

Every year, pharmaceutical companies contribute millions of dollars to U.S. senators and representatives as part of a multipronged effort to influence health care lawmaking and spending priorities. Use this tool to explore the sizable role drugmakers play in the campaign finance system, where many industries seek to influence Congress. Discover which lawmakers rake in the most money (or the least) and which pharma companies are the biggest contributors. Or use our search tool to look up members of Congress by name or home state, as well as dozens of drugmakers that KHN tracks. (Lucas and KHN staff, 10/26)

KHN: Pharma Campaign Cash Delivered To Key Lawmakers With Surgical Precision 

The Biden administration and Congress are embroiled in high-stakes haggling over what urgent priorities will make it into the ever-shrinking social spending bill. But for the pharmaceutical industry there is one agenda: Heading off Medicare drug price negotiation, which it considers an existential threat to its business model. The siren call to contain rising drug costs helped catapult Democrats to power, and the idea is popular among voters regardless of their politics. Yet granting Medicare broad authority to intervene in setting prices has nonetheless divided the party. (Knight, Pradhan and Lucas, 10/27)