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Sen. Joe Manchin (D-W.Va.) is privately saying he thinks Congress should take a “strategic pause” until 2022 before voting on President Biden’s $3.5 trillion social-spending package, people familiar with the matter tell Axios. Why it matters: Manchin’s new timeline — if he insists on it — would disrupt the plans by House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Chuck Schumer (D-N.Y.) to vote on the budget reconciliation package this month. (9/19)

Reps. Jim Clyburn and John Yarmuth both said Sunday that there is a chance Congress will not vote in time to meet the Sept. 27 deadline for the bipartisan infrastructure bill. House Speaker Nancy Pelosi set a date of Sept. 27 for the infrastructure bill the Senate passed in August, which some progressives in the party only agreed to support if the $3.5 trillion budget reconciliation bill was voted on as well. Appearing on CNN’s “State of the Union,” Clyburn (D-S.C.) , the House majority whip, said that the passage of the infrastructure bill may not be doable in the time frame since the reconciliation package won’t be done by that time. (Crummy, 9/19)

The White House has a new headache as it struggles to get its multitrillion-dollar party-line spending bill passed: Sen. Kyrsten Sinema's objections to drug pricing reforms that are already struggling to make it through the House. The Arizona Democrat is opposed to the current prescription drug pricing proposals in both the House and Senate bills, two sources familiar with her thinking said. They added that, at this point, she also doesn’t support a pared-back alternative being pitched by House Democratic centrists that would limit the drugs subject to Medicare negotiation. (Barron-Lopez, 9/19)

Senator Bernie Sanders of Vermont, the chairman of the Senate Budget Committee, predicted Sunday that Democrats will "come together" to pass the $3.5 trillion social spending package under consideration in Congress, even as two key Senate Democrats remain steadfast in their opposition to the plan's cost. "I expect, because of the pressure of the American people, we're going to come together again and do what has to be done," Sanders, an independent who votes with the Democrats, said in an interview on "Face the Nation." Democratic-led House committees completed work last week in crafting their respective portions of the massive $3.5 trillion package, which includes President Biden's plans for universal pre-K, expanding Medicare, child and elder care, and the environment. (Quinn, 9/19)

Dental work for seniors on Medicare. An end to sky’s-the-limit pricing on prescription drugs. New options for long-term care at home. Coverage for low-income people locked out of Medicaid by ideological battles. Those are just some of the changes to health care that Democrats want to achieve with President Joe Biden’s massive “Build Back Better” plan. The $3.5 trillion domestic agenda bill touches almost all aspects of American life, from taxes to climate change, but the health care components are a cornerstone for Democrats, amplified during the COVID-19 crisis. (Alonso-Zaldivar and Mascaro, 9/19)

Trapped in his California house by worsening paralysis, Ady Barkan has a fervent wish: that Congress spend $400 billion so more poor and disabled Americans can get home health aides of their own. “Home care is keeping me alive. I don’t think I could tolerate my paralysis if I were isolated in a nursing home instead of surrounded by the love of my children and wife every day,” Barkan wrote to The Washington Post, in a message the ALS patient typed using eye movement. “But millions of disabled people and their families aren’t as lucky as me.” (Diamond, Roubein and Goldstein, 9/19)

Working women, whose child care duties vastly expanded during the pandemic, are bracing for a new hit to their incomes and careers as the resurgent coronavirus jeopardizes plans to keep kids in school full time. After 18 months of shutdowns, online learning and canceled summer camps, the return to classrooms was supposed to be a turning point for women, whose participation in the labor force plunged to its lowest level in more than three decades during the pandemic. But as Covid-19 cases rose in the summer, more than 40,000 women dropped out of the labor force between July and August, even as Americans flocked back to work, government data shows. Men returned to the job over that period at more than three times that rate. (Cassella, 9/18)

For the cadre of progressive groups fighting to bring down drug prices in a big way, this week was a massive setback. The broad coalition, which includes consumer advocates, employers, and labor unions, was blindsided Wednesday when a trio of moderate House Democrats formally opposed Speaker Nancy Pelosi’s sweeping drug pricing package — a consequential move, since Democrats’ razor-thin majority means that even three opponents could force leadership to water down or abandon an otherwise popular policy. (Florko and Cohrs, 9/18)

Private insurers are set to win big if House Democrats' plan to close the Medicaid expansion coverage gap passes Congress. The proposal, which passed a key committee this week, would create a new federal Medicaid look-alike program in non-expansion states, with its administration to be outsourced to managed care organizations and other third parties by the Health and Human Services Department through a bidding process. Managed-care organizations, which deliver Medicaid benefits on the behalf of states, already cover 54 million people, nearly 70% of Medicaid beneficiaries, according to the Kaiser Family Foundation. (Hellmann and Tepper, 9/17)

A key Senate panel is expanding its plans to punish drug makers that hike prices faster than inflation, according to an internal Senate document described to STAT. The policy, which is being considered as part of Democrats’ efforts to include drug pricing reforms in a sweeping government spending package, has the potential to change the way drug makers set launch prices for drugs, and how they choose to adjust prices over time. (Cohrs, 9/20)

The arbiter of Senate procedural rules said Sunday that Democrats’ plan to provide a pathway to citizenship for millions of immigrants living in the country illegally couldn’t be included in a wide-ranging $3.5 trillion proposal expanding the safety net and responding to climate change. The decision from the office of Senate parliamentarian Elizabeth MacDonough said that the plan to legalize a group including young immigrants, farmworkers, essential workers and those living in the U.S. on humanitarian grounds didn’t comply with the chamber’s rules. (Hackman and Hughes, 9/19)

Haitian migrants seeking to escape poverty, hunger and a feeling of hopelessness in their home country said they will not be deterred by U.S. plans to speedily send them back, as thousands of people remained encamped on the Texas border Saturday after crossing from Mexico. Scores of people waded back and forth across the Rio Grande on Saturday afternoon, re-entering Mexico to purchase water, food and diapers in Ciudad Acuña before returning to the Texas encampment under and near a bridge in the border city of Del Rio. (Lozano, Gay and Spagat, 9/19)