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With the Affordable Care Act now secure in the framework of the nation’s health care programs, Democrats are eager to leap above and beyond.

They want to expand insurance coverage for working-age people and their families, add new benefits to Medicare for older people and reduce prescription drug costs for patients and taxpayers.

But health care is expensive, there’s concern about deficits and with Democrats holding only bare majorities in Congress, a winnowing down of expectations seems likely later this year.

For now, Democrats are savoring Thursday’s Supreme Court decision upholding “Obamacare” for the third time in a decade. The latest challenge to the law had been seen as a stretch by many legal experts, but a 7-2 vote from the conservative court was unexpected.

“I think Democrats once again know they have a moment in time, and they want to make the most of it,” said Kathleen Sebelius, health secretary under President Barack Obama during the passage and implementation of the health law. “I think people are fired up and ready to go.”

There is no shortage of proposals. Some, such as authorizing Medicare to negotiate prescription drug prices, could potentially save hundreds of billions of dollars, depending on how they are structured. But coverage and benefit expansions could cost an equal or even much greater amount.

Complex budget procedures that Democrats plan to use to pass President Joe Biden’s domestic agenda by a simple majority vote in the Senate may also limit the types of proposals that can be considered.

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