White House officials have left key Biden campaign promises on health care out of their coming budget proposal, as the administration focuses on trying to pass what it has already introduced, according to four people briefed on the internal matter.

The White House jettisoned months of planning from agency staff as their initial plan could fuel criticisms that the administration is pushing new spending programs too aggressively. The budget will not include President Biden’s campaign pledge to enact a public option to create a government-run health insurance program, or his pledge to cut prescription drug costs, the people said. The people spoke on the condition of anonymity to describe internal administration deliberations.

The decision to hold back many of Biden’s campaign plans from his first budget proposal reflects the challenges facing the administration as it works to prioritize other spending expansions related to the U.S. economy and social welfare programs.

Biden has proposed more than $4 trillion in new government spending and trillions of dollars in tax hikes to pay for it. The budget deficit last year, meanwhile, was more than $3 trillion, adding to already record levels of debt.

The White House has had multiple discussions with some Senate Republicans about Biden’s roughly $2 trillion infrastructure proposal, but they have not agreed on the scope of any plan or how to pay for it. And some of his proposals have also prompted internal divisions among Democrats, particularly over how to change the corporate tax code. Other ambitious Biden campaign pledges — from raising the estate tax to forgiving significant amounts of student debt — are also expected to be left out of the new budget plan, the people said. The budget is due out at the end of next week.

A White House spokesman confirmed in a statement that the budget would not include major initiatives beyond what had already been released by the administration.

“The President’s budget will focus on advancing the historic legislative agenda he’s already put forward for this year," said Rob Friedlander, spokesman for the White House budget office. "The budget won’t propose other new initiatives but will put together the full picture of how these proposals would advance economic growth and shared prosperity while also putting our country on a sound fiscal course.”

Leaving out some of the president’s campaign pledges could frustrate certain congressional Democrats. The 2020 Democratic presidential primaries featured extensive discussions of health care amid polling that showed it was a top issue for much of the party’s base.

The American Families Plan included a proposal to extend enhanced subsidies through the Affordable Care Act approved by Congress in the coronavirus relief package in March. The number of uninsured Americans would drop by about 4.2 million people if these subsidies are made permanent, according to estimates by the Urban Institute, a centrist think tank.

But that measure falls short of the more expansive public option Biden touted as a centerpiece of his domestic policy platform during the presidential campaign. Biden’s campaign touted that plan as ensuring that 97 percent of Americans would have health insurance.

Biden has called for Congress to approve a plan to allow Medicare to lower spending on prescription drug costs, and also called on Congress to strengthen Medicare, Medicaid, and the Affordable Care Act. The upcoming budget will not include specific policies or cost estimates to advance these measures, but will reiterate the administration’s intention to work with Congress on implementing policies, including the public option, two people familiar with the matter said.

White House press secretary Jen Psaki added in a statement: “The budget document will reiterate the President’s strong call to Congress during his joint address for prompt action to reduce prescription drug costs, and expand and improve health coverage.”

Some advocates remain optimistic Congress could still pass the measure even if the White House leaves it out of its official plans. Alex Lawson, executive director of the group Social Security Works, pointed to House Speaker Nancy Pelosi’s (D-Calif.) support for the measure.

“Lowering drug prices is the most popular part of the Build Back Better plan among Republicans and independents. Everyone hates high drug prices, and the White House has to get in front of it,” Lawson said. “I would also just note: It is the president’s budget request, but the House actually drafts the budget.”