She and Sen. Joe Manchin (DW.Va.), who met with the president the same day, delivered what a source described as a sobering message to the White House on the fate of the reconciliation and its $ 3.5 trillion price tag, which they both say is too high. The social spending plan is designed to pass without GOP votes through budget reconciliation, meaning Biden will need to win all 50 Democratic Senate votes to get passed.

“As committed, Kyrsten is working directly in good faith with her colleagues and President Biden on the proposed budget reconciliation plan,” said John LaBombard, spokesperson for Sinema, who declined to discuss the measure. on prescription drugs. “Given the size and scope of the proposal, while these discussions are ongoing, we are not offering detailed comments on any proposed element of the package.”

Sinema’s concerns about the prescription drug component combined with Manchin’s more public opposition to the current reconciliation bill cast significant doubt on Biden’s ability to secure the votes to pass his national signing initiative.

Biden and Manchin left their Wednesday meeting at a dead end, according to two sources briefed on the conversation. The West Virginia Democrat said he couldn’t back a $ 3.5 trillion package, a detail first reported by Axios. But the disagreements between the two went beyond that. When discussing the size of the bill, Biden also touched on the need to win progressive votes, implying any significant change could cost him support on the left.

Manchin also pressured Biden to first move the bipartisan infrastructure bill passed by the Senate as they reached agreement on the reconciliation package, the two sources said. Biden said it was a no-go, telling Manchin that the infrastructure bill couldn’t go any further without a pledge from Manchin to move forward on reconciliation. Manchin did not offer the engagement, the two sources said, describing the back-and-forth as respectful but straightforward.

Sam Runyon, a spokesperson for Manchin said: “Senator Manchin does not disclose details of his private meetings. “

Although Manchin and Sinema have made it clear, both publicly and privately, that they are willing to negotiate on the party line’s social spending proposal, their opposition to the current version has angered fellow Democrats who see a unique opportunity to pass through major national legislation. The reconciliation bill would boost child care, paid family leave and expand health insurance while spending potentially historic sums to fight climate change.

“The last two kilometers of the marathon are always the toughest, but there is still a strong conviction and unity to finish this thing and do something historic,” said John Podesta, former adviser to President Barack Obama and one one of the most prominent advocates of aggression. climate action through the reconciliation bill. “I think the real question is how big, not if.”

The negotiating changes in drug prices that Sinema is speaking out against are a major component of the funding envisaged by the bill. Democrats are counting on them to raise up to $ 700 billion over 10 years to fund the party bill’s ambitious agendas. Using an ax could endanger the health care reform components of the social spending plan, such as a proposal by Sen. Bernie Sanders (I-Vt.), and supported by Biden, which would extend Medicare coverage to hearing, dental and vision.

Measuring prescription drug prices is also one of the biggest things the White House advocates. In speeches this summer, Biden stressed that the proposal was popular among the electorate.

“The president, his cabinet and senior White House officials are continuously engaged in discussions with a wide range of members on the Build Back Better program,” said Andrew Bates, White House spokesperson. “And good progress is being made. We urgently need to lower taxes for working families and lower the costs of prescription drugs, education, health care, child care, and care for older Americans; and pay for it by restoring fairness to our tax code.

Sinema is one of Congress’ top recipients of pharmaceutical industry donations, according to an analysis by Kaiser Santé news. The Arizona senator is not the only Democrat worried about the party’s approach to drug negotiations. A trio of centrist members of the House voted against measure in the Energy and Trade Committee this week and a fourth voted against in the Ways and Means Committee.

Representative Kathleen Rice (DN.Y.) was one of those centrists. In a letter sent to the Alliance for Retired Americans advocacy group two days after the vote, the congresswoman said she supported “the goals” of the Democratic bill to allow Medicare to negotiate lower drug prices. Unlike his previous votes in favor, however, Rice wrote, his committee vote was not on a “clean, stand-alone bill.”

“Instead, the HR 3 drug pricing language was being used as a tool to offset the cost of a $ 3.5 trillion reconciliation bill,” Rice wrote in the letter, obtained by POLITICO. “This bill has no chance of becoming law, as Democrats in the Senate have declared that a bill with such a price will not have the votes to pass in their chamber.”

Rice’s office did not respond to a request for comment.

The Democratic leadership faces a tight, self-imposed deadline to resolve these differences. House leaders have pledged to hold a vote on the Senate infrastructure bill by September 27, which is designed to run in tandem with the reconciliation package. But with threatening progressives to withhold their votes if the party line’s package remains uncertain, it is not clear whether the infrastructure bill can pass. House and Senate centrists expect the total price of $ 3.5 trillion for the package to decline. They are also unhappy with the pace imposed by the White House and Democratic leaders.

“The way we do it so quickly puts the House in a position where individual members of the House are really not going to be involved in the choices about what we fund,” said Rep. Scott Peters (D-Calif.), L ‘one of four House Democrats to vote against the prescription drug pricing measure being considered by two committees this week. “The bipartisan bill took five and a half months; we’re trying to make a bigger bill – a three and a half billion dollar bill – in five weeks. “

Peters argued that his proposal was better suited to gain broad support. This would limit the number of drugs Medicare would be able to negotiate over, provide a monthly cap of $ 50 on insulin costs, and generate lower out-of-pocket costs for seniors who need it most. But progressives blasted centists for seeking major changes to a key pillar of the package, saying it is both less ambitious and threatens all other healthcare reforms.

“There should be accountability mechanisms here against people going outside the box at this point on such a fundamental issue that gets 80-90% approval in a lot of these districts,” said Faiz Shakir, Sanders policy adviser. “These three candidates are expected to face major challenges. ”

Peters replied that he “will focus on the campaign next year. Right now, our focus is on lowering prescription drug prices.

Marianne LeVine and Natasha Korecki contributed reporting.