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WASHINGTON -- After months of negotiation, President Biden announced on Thursday that he and congressional Democrats had agreed on the , which included scaled-down additions to the Medicare and Medicaid programs, as well as changes to the Affordable Care Act.

"After hearing input from all sides and negotiating in good faith with Senators [Joe] Manchin [D-W.V.] and [Kyrsten] Sinema [D-Ariz.], congressional leadership, and a broad swath of members of Congress, President Biden is announcing a framework for the Build Back Better Act," the White House said in a statement. "President Biden is confident this is a framework that can pass both houses of Congress, and he looks forward to signing it into law."

For months, Manchin and Sinema had been the biggest roadblocks to getting the bill through Congress, with Manchin objecting to the bill's original $3.5 trillion price tag and specific provisions related to climate change and the coal industry, while Sinema about her objections. Senate Democrats, who preside over a Senate divided 50-50 between Democrats and Republicans -- with Vice President Kamala Harris acting as a tie-breaker -- need all of their Democratic colleagues on board in order for the bill to pass under a Senate rule known as "reconciliation."

The new framework, now estimated to come in at $2 trillion or slightly less, includes healthcare provisions such as:

• Making changes to the Affordable Care Act. The framework will reduce premiums for more than 9 million Americans who buy insurance through the Affordable Care Act's insurance exchanges by an average of $600 per person per year, according to the White House. "For example, a family of four earning $80,000 per year would save nearly $3,000 per year (or $246 per month) on health insurance premiums," according to a . "Experts predict that more than 3 million people who would otherwise be uninsured will gain health insurance."
• Closing the Medicaid "coverage gap." The framework includes Affordable Care Act premium tax credits for up to 4 million uninsured people in states that have not expanded Medicaid. While a 40-year-old in the coverage gap would currently have to pay $450 per month for benchmark coverage -- which could be more than half of their income -- under the framework they would pay no premium.
• Adding hearing benefits to Medicare. Only 30% of seniors over the age of 70 who could benefit from hearing aids have ever used them, the statement noted, adding, "The Build Back Better framework will expand Medicare to cover hearing services, so that older Americans can access the affordable care they need." Missing from the proposal, however, was the addition of dental and vision benefits to Medicare, which had long been discussed.
• Improving homecare benefits in the Medicaid program. Currently, there are 800,000 Medicaid recipients on waiting lists for homecare, and families paying for it out-of-pocket spent around $5,800 per year for 4 hours of homecare a week, the White House noted. The framework will "permanently improve Medicaid coverage" for this service, according to the release, which didn't specify how that would be accomplished, and "will improve the quality of caregiving jobs, which will, in turn, help to improve the quality of care provided to beneficiaries."

One major provision dropped from the bill would have given the Medicare program the authority to negotiate drug prices. "There is one reason, and one reason only, not to move on Medicare price negotiation: the political power of Big Pharma," Robert Weissman, JD, president of the consumer group Public Citizen, said in a statement following the framework's release. "Failing to take this opportunity to end Big Pharma price-gouging will mean Americans will continue to go without medicines they need: one in four Americans report rationing or skipping prescriptions because of high prices. It will mean that many of those who do find a way to pay for needed medications will face economic insecurity."

"Similarly, Americans overwhelmingly support improving Medicare to cover the health services that everyone needs, including dental and vision care," Weissman added. "Failing to deliver on campaign promises and use this moment to expand Medicare to cover dental and vision will leave millions of seniors unable to get the dental and vision care they need. The numbers are stark: 70% of seniors who had trouble eating because of their teeth had not been to the dentist in the past year; also, 40% of seniors with vision troubles had not had an eye exam in the past year."

The patient advocacy group Families USA had similar comments. "Despite the months of debate and hard work that went into crafting this framework, it falls far short of what families across America need to truly build back better," executive director Frederick Isasi, JD, MPH, said in a statement. "Not allowing Medicare to negotiate prescription drug prices and the lack of a new dental benefit for people who are covered under Medicare is unacceptable, and must be addressed before either chamber of Congress votes on the bill."

In a speech in the East Room of the White House late Thursday morning, President Biden acknowledged that much was left on the table. "No one got everything they wanted, including me," he said. "But that's what compromise is; that's consensus. And that's what I ran on. I've long said compromise and consensus are the only way to get big things done in a democracy."

He also touted the provision to improve homecare benefits. "Quite frankly, what we found is that this is more popular -- or as popular -- as anything else we're proposing because the American people understand the need. It's a matter of dignity and pride for our parents."

The bill still will need to be passed by both the House and Senate; some progressive Democrats want the vote on the bill .

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