A handful of conservative Democrats in the House and two in the Senate are refusing to sign off on an annual $350 billion boost to social spending to enact President Joe Biden’s Build Back Better social and economic plan. The move deliberately pits vulnerable communities against each other—millions of chronically underserved people—apparently just because they can. Greg Sargent and Paul Waldman of The Washington Post wanted to quantify that when it came just to health care, so they asked the Kaiser Family Foundation’s Larry Levitt about the choice the saboteurs are trying to force: help seniors by expanding Medicare with dental, vision, and hearing treatment, or extend Medicaid coverage in the 12 Republican states that continue to refuse to do so under the Affordable Care Act.

Levitt told them that 62 million seniors and disabled people on Medicare could benefit from expanded services. There are about 2.2 million people in 12 states stuck in the coverage gap—they make too little to qualify for subsidies on the ACA marketplace and too much to get traditional Medicaid. The majority of that 2.2 million are in the South and are people of color.

“These are all poor, uninsured adults,” Levitt said. “Fifty-nine percent are people of color. The Medicaid gap is not only the biggest hole in the ACA; it also raises fundamental questions of equity.” It’s pitting that priority against the priority of making sure older Americans can actually eat a variety of nutritious foods—that they have the teeth that allow them to do so—and can function in society because they can hear and see. “Health care for seniors or health care for poor people is a difficult trade-off for Democrats,” Levitt added.

It’s an unnecessary trade-off. Because the nation can afford to take care of everyone, it should be the number-one principle of elected Democrats: no person left behind.

To emphasize that point, Rep. Mark Pocan of Wisconsin contrasted the free-for-all that is annual defense spending versus expanding health care.

In fact, the House authorized a whopping $768 billion defense budget for 2022—one year, $768 billion.  That’s after President Biden ended the 20-year war in Afghanistan. Even had the initial goal of Sen. Bernie Sanders and fellow progressives of a $6 trillion, 10-year budget for Build Back Better survived, annual spending on the programs wouldn’t have reached defense spending levels.

That defense budget passed with 181 Democratic votes—every single one of the Sabotage Squad of conservative Democrats in the House voted for that obscene amount of money to be poured into the Pentagon in the next year.

“The spending number is one way of measuring the legislation’s reach, but it completely obscures the human impact,” Jonathan Cohn, author of a history of the ACA, told Sargent and Waldman. “Every one of those dollars goes to a program that addresses a specific need, whether it’s poverty level families who need basic health coverage or seniors who can’t pay for dental care.”

“Cost matters,” Cohn continued, “but so should the cost of inaction.”

The cost of inaction can be measured in human lives. That’s the message the Congressional Progressive Caucus (CPC) is trying to elevate. “We have been told we can either adequately fund a small number of investments or legislate broadly, but only make a shallow, short-term impact,” they wrote in a letter to Speaker Nancy Pelosi. “We would argue this is a false choice.” 

“It is important to remember that different strategies affect different populations of people, and across our districts, our constituents are grateful we are fighting for them on a multitude of issues that will be transformative for working families, seniors, students, and children, they wrote. “We cannot pit childcare against housing, or paid leave against home- and community-based care.”

The CPC is thus far holding firm. “We have no intention of backing down,” Rep. Pramila Jayapal CPC chair, said on a call with advocates Tuesday night. “A lot of people have asked: ‘Isn’t something better than nothing?’ And the answer, quite simply, is no. Because when it comes down to something rather than nothing, it’s the same people who are forced to settle for nothing over and over and over again.”

Shafting those same people once again is a betrayal. And it could be sacrificing future Democratic majorities in Congress and another Democrat in the White House.