The impetus for the message was concern about Biden’s address to a joint session of Congress this coming Wednesday, when he will formally introduce the “American Family Plan.” The proposal is supposed to represent the second half of Biden’s economic agenda, and until recently, the assumption was that health care would figure prominently in it.

Some of these actions were right out in the open. When House Democratic leaders on Thursday reintroduced their prescription drug legislation, Speaker Nancy Pelosi (D-Calif.) went out of her way to say that it “will be a top priority for House Democrats to be included in the American Families Plan.”

One letter, written by Rep. Lauren Underwood (D-Ill.) and signed by 29 colleagues, mentioned specifically the importance of acting “at the first legislative opportunity.” That would likely mean including health care in a sprawling, all-purpose piece of legislation Democrats will have to pass on their own, through the budget “reconciliation” process in which Republicans can’t block bills with the filibuster.

Other signals were sent through private channels, among them a virtual meeting on Friday that leaders of progressive organizations requested with White House officials. At the meeting, they formally presented a letter signed by 45 groups and unions calling on the administration to include their health care priorities in the American Family Plan.

“We delivered that letter directly to the White House at a meeting on Friday,” Alex Lawson, executive director of Social Security Works, told HuffPost. “I also know our effort is not the only effort. There are letters coming from the House and the Senate, as well as letters from other organizations and unions, demanding we do health care in the next reconciliation package.”

These reforms, which translate into thousands of dollars in savings for some insurance buyers, are precisely the Affordable Care Act improvements that House leaders and their allies now want to make permanent.

“The American Families Plan and the speech on Wednesday will not represent the totality of every priority item for him and every item on his agenda that he wants to move forward as president,” Psaki said Friday.

That may all be true. At the same time, a president’s time is limited. So are votes in Congress and the money available to pay for new programs. Given the long list of initiatives that Democrats hope to enact, few and maybe none are going to get as much focus and funding as their fiercest champions would prefer.

But they are dedicated to pursuing their long-term goal of creating a “Medicare for All” system, with a single government program covering everybody. They believe that improving the Medicare benefit package and allowing more people to enroll would represent the most direct steps along that path, and it’s where those progressive groups that met with the White House on Friday would like to see policy go as well.

By the same token, Pelosi and her allies have already endorsed adding dental, visual and hearing benefits to Medicare, because they know the lack of those benefits causes real hardship for many seniors. They don’t have a problem with, and in many cases endorse, allowing more people to join Medicare.

But they also think reducing the Medicare eligibility age is a difficult lift politically. The idea has policy complications, especially related to its potential effects on employer coverage. It also provokes opposition from powerful health industry groups that see expansions of Medicare, with its lower payment rates, as threats to revenue.

The two sides are closer when it comes to drug policy, in part because Pelosi and House progressives already hashed out a deal that the House as a whole passed in 2019 and has left both ideological camps feeling good about it.

But that would likely depend, in part, on getting drug pricing reforms as ambitious as those in H.R. 3 back through the House, where the Democratic majority is smaller than it was last time. The same reforms would also have to pass the Senate, where Democrats don’t have a single vote to spare and the pharmaceutical lobby holds a great deal of sway, especially over senators in states like Delaware and New Jersey, where drug manufacturers have a large presence.

This content was originally published here.

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