Summary
Infrastructure
The Senate pushes to wrap up infrastructure this week before adjourning for summer recess. A vote on final passage of the nearly $1 trillion bipartisan infrastructure package (including $550 billion in new spending) has not yet been scheduled but is expected in the coming days. In the legislative text released last night, the health-related pay-fors are:
- Extending the Medicare sequester by one year through fiscal year 2031. Congress temporarily suspended the sequestration of Medicare from May 2020 through December 2021 (L. 117-7).
- Requiring manufacturers to refund Medicare for the unused amounts of medication in a single-dose vial administered under Medicare’s Part B, beginning January 1, 2023. Refunds would be deposited into the Supplementary Medical Insurance (SMI) Trust Fund, which funds Part B and Part D. While the SMI Trust Fund is statutorily programmed to be funded through a combination of beneficiary premiums and general revenue transfers, this implies that beneficiary premiums will increase to the extent costs increase under Parts B and D. Costs are expected to increase as additional baby boomers continue aging into Medicare, especially through 2029.
- Delaying implementation of the Trump-era Medicare Part D rebate rule until January 1, 2026.
The infrastructure package does not use the Provider Relief Fund to offset its costs. However, the package would rescind unobligated COVID-19 appropriations from other accounts, such as economic injury disaster loan (EIDL) subsidies, pandemic relief for aviation workers, and the Education Stabilization Fund. The House-approved INVEST in America Act (H.R. 3684), which passed mostly along party lines, will be used as the vehicle for the Senate bipartisan infrastructure package.
Budget Reconciliation
After infrastructure, Senate Majority Leader Chuck Schumer (D-NY) plans to bring up the $3.5 trillion fiscal year (FY) 2022 budget resolution that will establish reconciliation instructions, setting the guidelines for Democrats to pursue their legislative priorities – including making premium tax credit enhancements permanent; adding dental, vision, and hearing; drug pricing reform; and closing the Medicare expansion coverage gap.
Appropriations
The Senate Appropriations Committee will begin to mark up its fiscal year (FY) 2022 spending bills, starting with the funding for Agriculture, Rural Developments, Food and Drug Administration, and Related Agencies. The House passed funding for these agencies as part of a seven-bill minibus (H.R. 4502), which also included funding for Labor, Health and Human Services, and Education.
Senate HELP Markup
Tomorrow, the Senate Health, Education, Labor and Pensions (HELP) Committee is expected to advance at an executive session a slate of bipartisan bills related to suicide prevention, access to assistive technology, and reasonable accommodations for pregnant workers. Given the bipartisan, bicameral support for these relative noncontroversial bills, we could these bills make their way to President Biden’s desk for signature in the fall. The executive session will not be webcast.
- Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act (S. 1543) would require state, tribal, and local educational agencies that receive grant funding for priority mental-health needs, including through the Project AWARE State Education Agency Grant Program, to establish and implement evidence-based suicide awareness and prevention training policies. The House passed a substantively identical bill (H.R. 586) in May.
- Suicide Prevention Lifeline Improvement Act (S. 2425) would increase funding for the suicide prevention hotline and authorize a pilot program on innovative technologies (e.g., social media, texting, and email) for suicide prevention. The House passed a nearly identical bill (H.R. 2981) in May. The main difference is the authorized funding amounts for the hotline – in the House bill, $50 million for each of fiscal years (FYs) 2022 through 2024; and in the Senate bill, $113.6 million for each of FYs 2022 through 2024.
- 21st Century Assistive Technology Act (S. 2401) would increase access to assistive technology services (e.g., mobility aids, hearing aids, voice recognition programs) for individuals with disabilities of all ages through grants to state agencies, nonprofits, and other public organizations. There is no House companion bill.
- Pregnant Workers Fairness Act (S. 1486) would prohibit employment practices that discriminate against making reasonable accommodations for qualified employees affected by pregnancy, childbirth, or related medical conditions. The House passed an identical bill (H.R. 1065) in May (315-101).