Summary
Infrastructure
Democrats continue to be focused on advancing their American Rescue Plan, specifically gearing up to advance President Joe Biden’s roughly $2 trillion American Jobs Plan. This effort proceeds on the heels of the latest jobs report, which showed the U.S. economy added 916,000 jobs in March and the unemployment rate dropped to 6.0 percent (compared to the pre-pandemic level of 3.5 percent). Democrats continue to insist that aggressive action is necessary to shore up the American economy after the damage incurred during the COVID pandemic.
The White House is pushing for significant progress on infrastructure by Memorial Day, while House Speaker Nancy Pelosi (D-CA) has said that she wants to pass the American Jobs Plan, paid for primarily with tax reforms, by July 4.
Ultimately, the timing of an infrastructure package making its way to Biden’s desk for signature will mostly depend on the Senate. The Senate Parliamentarian may rule this week on whether Democrats can revise the fiscal year (FY) 2021 budget resolution to allow for another reconciliation process under its authority. If the parliamentarian rules against Senate Majority Leader Chuck Schumer’s (D-NY) proposal, then Congress will have to adopt an FY 2022 budget resolution with reconciliation instructions, potentially limiting Democrats to one more reconciliation bill during this session of Congress.
Regardless of the legislative maneuvers necessary to advance Biden’s infrastructure proposal, it will likely take several months for lawmakers to draft, negotiate, and pass a multi-trillion-dollar infrastructure package. Many of Biden’s proposals broadly mirror those included in the Moving Forward Act (H.R. 2, 116th) and LIFT America Act (H.R. 1848), which Democrats will likely use as a starting point for their American Jobs Plan legislation. However, what is included (or not included) in Biden’s follow-up proposal on health care and child care reforms, the “American Family Plan,” will add another layer of complexity to negotiations.
President’s Budget
After last week’s delay, the White House may release Biden’s fiscal year (FY) 2022 “skinny” budget this week, which will contain topline discretionary spending priorities, followed by the full budget in May. Notably, under current law, discretionary spending beginning FY 2022 is not subject to statutory spending caps. The President’s budget is likely to shed light on Biden’s fiscal policy and spending priorities for his presidency.
MACPAC
Later this week (April 8 and 9), the Medicaid and CHIP Payment and Access Commission (MACPAC) will convene to vote on draft recommendations regarding the following for its June Report to Congress:
- Revising the rebate amounts for high-cost specialty drugs that are approved through the accelerated pathways program at the Food and Drug Administration (FDA); and
- Improving access to behavioral health services for adults, children, and adolescents.
Notably, commissioners will discuss states’ progress on shifting long-term services and supports from institutional to home and community-based settings (i.e., rebalancing) – an effort that Biden proposed to expand in his American Jobs Plan. Specifically, his plan calls for $400 billion to expand access to home and community-based services (HCBS) under Medicaid and extend the Money Follows the Person (MFP) program, a demonstration program focused on transitioning Medicaid beneficiaries from receiving institution-based services to HCBS. Under current law, MFP is set to expire on September 30, 2023 (P.L. 116-260).
MACPAC will also review draft chapters for its upcoming report on various topics, including dual eligible special needs plans (D-SNPs), electronic health records for behavioral health services, and the non-emergency medical transportation benefit. In addition, commissioners will discuss initiatives to ensure quality in Medicaid and CHIP.