“I just don’t want to see us make the mistake of not having the legislative text,” she added. “Let’s do them both together. Let’s get it right. Let’s make sure there are no misunderstandings, because there have been too many misunderstandings.”
Democrats are coalescing around a measure that would extend monthly tax credit payments to families with children, create a federally guaranteed prekindergarten program and expand financial assistance for child care, home health care and worker training and housing. But a number of provisions remain in flux, including a push to expand Medicare to cover dental, vision and hearing benefits, a priority for Mr. Sanders and other liberals.
As it stands, passage of the bill, which is also expected to include roughly $500 billion for climate and environmental provisions, could technically achieve Mr. Biden’s ambitious promise for lowering U.S. emissions, though many potential obstacles would remain, according to an analysis by Rhodium Group, an independent policy research firm. Those provisions would include about $300 billion in tax incentives to promote renewable energy and electric vehicles.
Lawmakers have also scaled back their ambitions for providing health coverage for poor adults whose states chose not to expand Medicaid, and are considering a more temporary fix. While negotiations continue, several people familiar with the discussions said the package may include three years of funding for poor residents of those states to get federal assistance buying health plans under the Affordable Care Act.
The plans would be effectively free, and would come with subsidies to lower deductibles and other forms of cost sharing. An estimated 2.1 million poor Americans are uninsured in those states, mostly in the South, and insuring them has been a key priority for lawmakers like Representative James E. Clyburn of South Carolina, the No. 3 House Democrat, and Senators Raphael Warnock and Jon Ossoff of Georgia. It has also been a priority for Ms. Pelosi, who views the measure as key to cementing the framework of the Affordable Care Act.
The compromise has disappointed some lawmakers and advocates who had hoped for a permanent coverage expansion — and for those who thought a federal Medicaid program would provide better safeguards for low-income patients than health exchange plans.
Reporting was contributed by Jonathan Weisman, Margot Sanger-Katz, Coral Davenport and Catie Edmondson.