A handful of conservative Democrats in the House and two in the Senate are refusing to sign off on an annual $350 billion boost to social spending to enact President Joe Biden’s Build Back Better social and economic plan. The move deliberately pits vulnerable communities against each other—millions of chronically underserved people—apparently just because they can. Greg Sargent and Paul Waldman of The Washington Post wanted to quantify that when it came just to health care, so they asked the Kaiser Family Foundation’s Larry Levitt about the choice the saboteurs are trying to force: help seniors by expanding Medicare with dental, vision, and hearing treatment, or extend Medicaid coverage in the 12 Republican states that continue to refuse to do so under the Affordable Care Act.

Levitt told them that 62 million seniors and disabled people on Medicare could benefit from expanded services. There are about 2.2 million people in 12 states stuck in the coverage gap—they make too little to qualify for subsidies on the ACA marketplace and too much to get traditional Medicaid. The majority of that 2.2 million are in the South and are people of color.

“These are all poor, uninsured adults,” Levitt said. “Fifty-nine percent are people of color. The Medicaid gap is not only the biggest hole in the ACA; it also raises fundamental questions of equity.” It’s pitting that priority against the priority of making sure older Americans can actually eat a variety of nutritious foods—that they have the teeth that allow them to do so—and can function in society because they can hear and see. “Health care for seniors or health care for poor people is a difficult trade-off for Democrats,” Levitt added.

It’s an unnecessary trade-off. Because the nation can afford to take care of everyone, it should be the number-one principle of elected Democrats: no person left behind.