NEW SPENDING BILL, SAME OLD PROBLEMS — The latest version of Democrats’ $1.75 trillion social spending package revives a series of big proposals, including drug price negotiation and a paid leave plan. Yet for all the last-minute changes, Democrats still haven’t solved their biggest and most stubborn problem: How to get all this to Biden’s desk. What’s new: The House package unveiled Wednesday includes the compromise drug pricing plan that Democrats hammered out in recent days, which most notably would allow Medicare to directly negotiate the prices of some of its costliest drugs. The negotiation power would phase in, starting in 2025 with the 10 most expensive medicines and increasing to the top 20 by 2028. The bill also envisions penalizing drug makers for hiking prices faster than inflation and capping out-of-pocket spending on insulin for Medicare beneficiaries and private insurance enrollees. Importantly, centrist Sens. Kyrsten Sinema (D-Ariz.) and Bob Menendez (D-N.J.) signed off on the deal. But while progressives will also back the proposal, it’s a far cry from the sweeping negotiation provision that they’d hoped would apply to hundreds of drugs — and that House Democrats passed just a couple years ago. Democrats’ paid leave provision is also back from exile, albeit in scaled-down form. The plan would grant four weeks of leave, marking a small victory for Speaker Nancy Pelosi and other advocates who had pushed for adding the proposal back in. What’s old: Joe Manchin (D-Va.) is still a staunch opponent of paid leave, meaning it’s likely dead on arrival in the Senate. And even if that’s removed, it remains unclear whether there are 50 Democratic votes for the bill — and when the vote might happen. On Wednesday, fresh off Democrats’ brutal electoral loss in Virginia, Manchin argued the political setback meant Democrats should hold off on advancing the bill. Others, like Sen. Richard Blumenthal (D-Conn.), saw it as evidence of a need to move faster. As for the official House schedule, it offered this verdict on whether a vote was imminent: "???" DEMS’ NEW DRUG DILEMMA: WHAT TO DO WITH THE SAVINGS — Now that Democrats have their long-sought drug price overhaul, some are already plotting how to spend the savings the new provisions will create, POLITICO’s Alice Miranda Ollstein reports. While the Congressional Budget Office has yet to weigh in on the drug pricing plan, Democrats involved in crafting the proposal are confident it will end up saving the government in the range of hundreds of billions of dollars. That’s sparked a push from outside advocates to plow that sum right back into other health care ideas initially dropped from the bill — in particular, the addition of dental benefits for traditional Medicare beneficiaries. But top Democrats are already shutting that idea down. House Budget Chair John Yarmuth (D-Ky.) and Ways and Means Chair Richard Neal (D-Mass.) both cast doubt on the possibility, and Energy and Commerce Committee Chair Frank Pallone (D-N.J.) told the Rules Committee Wednesday that the savings weren’t tied to paying for any specific program. The extra money could still prove useful, though. Neal said lawmakers are discussing putting it toward funding Democrats’ revived paid family and medical leave plan, though no final decisions have been made yet. | 
