A Medicare expansion fell, but a drug price reduction plan was added.
How it started: Mr. Biden, backed by leading liberals like Senator Bernie Sanders, the Vermont independent, pushed to expand not only the scope of the Affordable Care Act, but Medicare benefits to cover hearing, dental and vision.
How it shrank: As lawmakers whittled down a $3.5 trillion budget blueprint, the House agreed to spend $165 billion to cover hearing for Medicare, provide insurance for an additional four million people through Medicaid and continue reducing health care premiums for people covered through the Obamacare marketplace.
Where it stands now: The Medicare expansion was among the items dropped in negotiations with Mr. Manchin. In a deal he struck late last month with Senator Chuck Schumer, Democrat of New York and the majority leader, the bill includes a three-year extension of expanded Affordable Care Act subsidies, set to expire at the end of the year, for an additional three years.
Democrats also added a plan aimed at lowering the cost of prescription drugs, fulfilling a longstanding goal of allowing Medicare to negotiate the prices of prescription drugs directly. The legislation would also cap the out-of-pocket amount that Medicare patients can be asked to pay for prescription drugs at $2,000 each year and restrict how much drug companies can increase prices for Medicare.
Hundreds of billions in proposed tax increases were abandoned.
How it started: Democrats had envisioned a sweeping effort to make the tax code more fair that would roll back the tax cuts Republicans pushed through in 2017, vastly increasing what is paid by the wealthiest people and corporations. The House legislation was projected to bring in nearly $1.5 trillion over a decade by substantially increasing taxes on corporations and high earners.
How it shrank: Ms. Sinema objected to increasing most tax rates, throwing her support behind other tax-raising ideas that met with some pushback. She insisted on dropping a proposal aimed at narrowing a tax break for hedge funds and private equity managers that Mr. Manchin had pushed to include in the plan, which would have raised about $14 billion.
Where it stands now: To counter Ms. Sinema’s opposition to tax rate increases, Democrats included a more complicated 15 percent minimum tax on corporations. They also agreed to a 1 percent increase on company stock buybacks, set to go into effect in 2023. And in a bid to crack down on wealthy tax evaders, Democrats plan to invest $80 billion in enforcement at the Internal Revenue Service.