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Democrats’ sweeping plans to bolster Medicare and Medicaid benefits have been scaled back amid an assault from industry groups and opposition from centrists like Sen. Joe Manchin III (D-W.Va.), with popular coverage expansions likely to be narrowed in hopes of reaching a deal this week. A proposal to expand Medicare to cover dental, hearing and vision benefits is in danger of falling from the tax-and-spending package rapidly taking shape in Congress. A framework to expand Medicaid to cover Americans in a dozen mostly Southern states has also been reworked. (Diamond, Roubein, Goldstein and Romm, 10/26)

But Manchin on Monday threw cold water on Sanders’s push to expand Medicare, warning the program faces insolvency in 2026. “My big concern right now is the 2026 deadline [for] Medicare insolvency and if no one’s concerned about that, I’ve got people — that’s a lifeline. Medicare and Social Security is a lifeline for people back in West Virginia, most people around the country,” Manchin warned. “You’ve got to stabilize that first before you look at basically expansion. So if we’re not being fiscally responsible, that’s a concern,” he added. (Bolton, 10/25)

Democrats say they’re in striking distance of reaching a long-sought deal on expanding social safety net programs, but still need to resolve a handful of key sticking points. Progressives and key centrist holdouts remain at odds over some top liberal priorities, such as ending America’s status as the only wealthy nation without a national paid parental leave policy and expanding Medicare coverage. (Marcos and Wong, 10/26)

Democrats are sprinting to wrap up negotiations over their social-spending and climate bill, hoping by this weekend to resolve disagreements on issues including tax policy and healthcare. Senate Majority Leader Chuck Schumer (D., N.Y.) said Monday there were three to four open issues. Lawmakers and aides said major policy areas, including the tax increases to pay for the package, Medicare and Medicaid provisions and a paid leave program, remain unresolved. The bill, initially drafted at $3.5 trillion, is now expected to cost between $1.5 trillion and $2 trillion. (Duehren and Peterson, 10/25)

Congress is now considering four weeks of paid family and medical leave, down from the 12 weeks that were initially proposed in the Democrats’ spending plan. If the plan becomes law, the United States will no longer be one of six countries in the world — and the only rich country — without any form of national paid leave. But it would still be an outlier. Of the 185 countries that offer paid leave for new mothers, only one, Eswatini (once called Swaziland), offers fewer than four weeks. Of the 174 countries that offer paid leave for a personal health problem, just 26 offer four weeks or fewer, according to data from the World Policy Analysis Center at the University of California, Los Angeles. (Cain Miller, 10/25)