The Democrats’ Reconciliation Act encompasses several key health measures, backed by various lawmakers and advocates, building a precarious game of politics jenga if the massive measure needs to be scaled back.

Between the lines: Health care can be a priority for the Democrats. But that doesn’t mean that every member appreciates every topic equally.

Why it matters: While the party continues to charge the total price of its huge reconciliation bill, it’s worth figuring out which guidelines are on the chopping block – and which ones could potentially bring the entire reconciliation bill with them.

There are clear winners of each pillar of the Democrats’ health plan:

  • Seniors benefit from the expansion of Medicare to cover dental, visual and hearing aid benefits.
  • People with low incomes – especially in the south and disproportionately colored people – in non-enlargement countries benefit if the Medicaid gap is closed and they are granted access to health insurance.
  • The Affordable Care Act market participants will benefit if the increased subsidy aid that the Democrats decided earlier this year is extended or made permanent.
  • Older people and Americans with disabilities benefit from expanding their home care options, and their caregivers benefit from a pay rise.
  • Seniors – and possibly anyone faced with high drug bills – will benefit if Medicare is given the power to negotiate drug prices, despite the drug industry’s argument that doing so will result in fewer new drugs.

Yes but: Each of these groups face real problems with access to health care and affordability. But when there is only a limited amount of money on the table – which is there – even sympathetic groups can be left in the dust.

Any policy measure however, it also has powerful political advocates. And when the Democrats have a wafer-thin lead in both the House of Representatives and the Senate, each member has a lot of power.

  • Seniors are disproportionately powerful because of their voting behavior alone. But expanding Medicare coverage is extremely important to progressives – including Senator Bernie Sanders.
  • Closing the Medicaid void is portrayed as a racial equity issue as it disproportionately benefits people with color. And although many Democrats come from expanding states – especially in the Senate – some very powerful states represent non-enlarging states.
  • Those members include Senator Raphael Warnock, who represents Georgia and is up for re-election next year in a highly competitive seat, and Rep. Jim Clyburn, who appears to be responsible for helping President Biden win the 2020 primary.
  • The extended ACA subsidies are due to expire shortly before the mid-term elections next year. Democratic power in the House of Representatives is already incredibly shaky, making extending the extra aid a political no-brainer.
  • The expansion of home care options was one of the few health components of Biden’s original framework for this package. But aside from the president’s interest in this issue, it is very important to the unions because their members receive a raise – and to the Democrats, what is important to the unions is very important.
  • And finally, it has the toughest opponents to give Medicare the power to negotiate drug prices, which theoretically makes it vulnerable to the chopping block. But it also has very high poll numbers and, perhaps more importantly, it produces enough government savings to pay for these other health policies.

The bottom line: “From a political perspective, none of these health care proposals seem very dispensable,” said Larry Levitt of KFF.

  • Most, if not all, can be scaled up to save money.
  • But there are also strong voters for the other components of the bill, dealing with issues such as childcare and climate change, which means that these health interventions don’t just compete with one another.
  • And Levitt points out that “there is always a difference in whether members of Congress stake out positions and are ready to wage nuclear war over them.”