Senate Budget Committee Chairman Bernie Sanders (I-Vt.) said on Tuesday that a deal on President Biden’s spending bill must expand Medicare and include a plan to lower the cost of prescription drugs.

“Bottom line is that any reconciliation bill must include serious negotiations on the part of Medicare with the pharmaceutical industry, lower the cost of prescription drugs. That’s what the American people want,” Sanders said. 

He added that a “serious reconciliation bill must include expanding Medicare to cover dental, hearing aids and eyeglasses.”

Sanders’s decision to draw red lines, while speaking with reporters on Capitol Hill, underscores the headache facing Democratic leadership as they try to reach a deal that can unify their various factions.  

Sanders warned in a tweet over the weekend that the Medicare expansion provision couldn’t be dropped. But Sen. Joe Manchin (D-W.Va.), speaking to reporters on Monday, reiterated he doesn’t support expanding Medicare amid concerns about the program’s solvency. 

“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.

Sanders declined to comment on Monday about Manchin’s comments.

President Biden has warned that getting a deal that includes expanding Medicare to cover hearing, vision and dental would be a “reach.”

In addition to potentially dropping Sanders’s plan to expand the benefits covered by Medicare, negotiators are discussing limiting Medicare’s power to negotiate lower prices for only a handful of drugs, instead of the broad spectrum of medications that Sanders wanted covered.

The broader plan is opposed by a group of moderates, including Sen. Kyrsten Sinema (D-Ariz.).