Democrats in Congress were thrilled when President Joe Biden signed a landmark climate and health care bill into law last week. But the moment felt bittersweet for some among them, Rep. Debbie Dingell (D-Mich.).

Dingell has been leading calls for a massive new investment in home and community-based services, or HCBS, which is the set of programs and supports that help the elderly and people with disabilities to live independently. The campaign has been personal for Dingell, who speaks frequently of the struggles she faced trying to find and coordinate care for her ailing husband, former Rep. John Dingell (D-Mich.), in his final years.

Eighteen months ago, it looked like that campaign was on the cusp of success when a major HCBS proposal was part of Bidens Build Back Better blueprint for coming legislation. And it wasnt just HCBS getting a White House push. Similarly sweeping proposals for child care and paid leave were also in the plan. Together, they formed a caregiving agenda , with a goal to create for the U.S. something that already exists in most economically advanced countries: a cradle-to-grave guarantee that people will have assistance and care at the most vulnerable periods of their lives.

But with wafer-thin majorities and no realistic prospect of Republican support, Democratic leaders were at the mercy of more conservative members who wanted a smaller, less ambitious bill. The caregiving items were competing for resources alongside other initiatives and the pool of resources kept shrinking with each round of negotiations until finally Sen. Joe Manchin (D-W.Va.) made clear he would withhold his make-or-break 50th yea vote until Democrats dropped everything but the climate and health provisions.