Agonizing choices as Dems debate shrinking health care pie

WASHINGTON (AP) — Democrats are debating how to divide up what could be a smaller serving of health care spending in President Joe Biden's domestic policy bill, pitting the needs of older adults who can't afford their dentures against the plight of uninsured low-income people in the South.

“There's always a battle of where you place your priorities,” Rep. Jim Clyburn, the No. 3 House Democratic leader, said Wednesday. “We don’t means-test Medicare, which means that pretty wealthy people will be getting both dental care (and) vision care while poor people will be denied. ... I don’t know that that's a real good choice.”

Clyburn explained that more than 100,000 of his fellow South Carolinians remain uninsured because Republicans in charge of state government have refused to expand Medicaid to low-income working adults under the Affordable Care Act.

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

When budget screws get applied, entire proposals can disappear from legislative wish lists, or they can get authorized for a shortened time period, a fiscal tactic akin to wading in the water as opposed to swimming.

For now, nothing has been dropped from Democrats' health care agenda, which includes new dental, vision and hearing coverage under Medicare, richer subsidies that reduce premiums for “Obamacare” plans, a federal work-around to expand Medicaid in a dozen states still refusing, improved post-partum Medicaid coverage for low-income women, and a permanent extension of the popular Children's Health Insurance Program.

The health care upgrades amount to a major renovation of federal programs covering more than 145 million Americans and part of the Democratic...