Summary
Infrastructure and Budget Reconciliation
Lawmakers are back home on recess this week. The Senate will be in session on September 13 and the House will return next week to vote on the $3.5 trillion budget resolution for fiscal year (FY) 2022, unlocking the partisan path for President Biden and congressional Democrats to advance their legislative agenda. Whether the House will also vote on the Senate-approved infrastructure bill next week remains to be seen. The ongoing standoff between House Democratic leaders and nine moderate House Democrats over which legislation to advance first – budget reconciliation or bipartisan infrastructure – has raised questions about the exact vote sequence.
In an attempt to appease the nine moderate House Democrats who warned they will not vote for the budget resolution until the House first passes the Senate-approved infrastructure bill, House Speaker Nancy Pelosi (D-CA) is pushing to move forward simultaneously with the bipartisan infrastructure bill and the $3.5 trillion budget resolution unlocking reconciliation. She has directed the House Rules Committee to “explore the possibility of a rule that advances both the budget resolution and the bipartisan infrastructure package.” However, the nine Democrats are not budging. “It’s very important that we don’t back off of this path which is voting first on infrastructure and then consider the budget resolution. There’s enough of us who really feel strongly that we’re going to hold to our guns here and find a solution,” said Rep. Gottheimer, who is leading the group. Ultimately, we do not anticipate the intraparty skirmish in the House will derail Democrats’ plans for budget reconciliation since it is essential to advancing their legislative agenda.
In addition to major health coverage reforms – such as addressing the Medicaid expansion coverage gap; extending the temporary to Affordable Care Act (ACA) premium subsidies; and expanding Medicare to include dental, vision, and hearing benefits – the budget reconciliation package is expected to address health issues amplified by the COVID-19 pandemic. We could see some of the ongoing legislative work (notably bipartisan and detailed below) make its ways into the partisan budget reconciliation package. Committees have until September 15 to draft their respective bills that meeting the spending targets outlined in the $3.5 trillion budget resolution – at least $1 billion in deficit reduction for the Senate Finance Committee (SFC) and $726 billion in spending for the Senate Health, Education, Labor and Pensions Committee (HELP).
Ongoing bipartisan legislative work includes:
- Access to Mental Health Care: SFC Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) are developing bipartisan legislation to address barriers to mental health care. They recently invited SFC members to submit policy recommendations to address the behavioral health workforce shortage, improve care integration and coordination, expand access to telehealth services, and address gaps in care for children (more details here). The deadline for committee-level input is August 31. SFC leaders also indicated that a separate request for public- and private sector stakeholder input would be announced later this month.
- Pandemic Preparedness – Senate HELP Committee Chair Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) are crafting bipartisan legislation on public health infrastructure and medical preparedness and response. The bill intends to reflect lessons learned from the COVID-19 pandemic and include strategies for bolster federal public health and medical preparedness and response systems and programs and strengthening the pipeline of medical countermeasures (more details here).
- Workforce Development – Senate HELP Committee leaders are also working on bipartisan legislation to update and expand workforce training programs, including in the health care and public health sectors, and improve programs authorized under the Workforce Innovation and Opportunity Act (WIOA) (more details here). House Education and Labor Committee Chairman Bobby Scott (D-VA) and Ranking Member Virginia Foxx (R-NC) are also working on a bipartisan package to reauthorize WIOA.
Prescription Drug Pricing
Prescription drug pricing reforms are imperative to generating savings – “hundreds of billions”, according to Democrats’ blueprint – for major health care reforms in budget reconciliation. Last week, President Biden called on Congress to allow Medicare to negotiate prices, impose inflation rebates, cap out-of-pocket (OOP) costs, and import drugs from Canada. We could see the Biden Administration unveil additional details this week on its plan to lower prescription drug prices through regulation, which will likely depend in part on how Congress acts on this issue.
Biden’s recent executive order on competition mandates the Department of Health and Human Services (HHS) to submit to the White House “a plan to continue the effort to combat excessive pricing of prescription drugs and enhance domestic pharmaceutical supply chains, to reduce the prices paid by the Federal Government for such drugs, and to address the recurrent problem of price gouging” by August 23. In the proposed rule rescinding the Most Favored Nations model, the Administration referenced the executive order and the ensuing HHS plan and detailed that the agency is currently exploring opportunities to:
- Promote value-based care for beneficiaries;
- Address the high cost of Part B drugs, manufacturers’ pricing, and the resulting growth in Part B spending; and
- Modernize the Medicare program to improve the quality and cost of care for beneficiaries.