Summary
Infrastructure
The “two-track” strategy for infrastructure will continue to take shape this week. The Senate will transform the $973 billion bipartisan framework for traditional infrastructure endorsed by President Biden into legislation. The House will take up Democrats’ INVEST in America Act (H.R. 3684), a $715 billion package that would reauthorize surface transportation programs expiring September 30 and provide funding for other transportation and drinking water infrastructure needs. Given the bipartisan deal on infrastructure in the Senate, this House vote may ultimately be symbolic and will serve as a marker for negotiations with the Senate.
Track 1: Bipartisan Traditional Infrastructure
| Biden-Endorsed Bipartisan Infrastructure Framework | House Democrats’ INVEST in America Act (H.R. 3684) (likely dead on arrival in Senate) | |
| Price Tag (over 5 years) | $973 billion | $715 billion |
| Key Components | Transportation, water, and broadband | Transportation and water |
Meanwhile, the budget reconciliation package focused on “human infrastructure” is underway, with lawmakers pushing for various health care reforms. The exact sequencing of the two packages – e.g., bipartisan package followed by budget reconciliation package, or vice versa – remains to be seen.
Track 2: Potential Components of Democrats’ Budget Reconciliation Package (Human Infrastructure & Health Care)
| American Jobs Plan
(proposals excluded from bipartisan framework) |
· $400 billion for home and community-based services
· $180 billion for research and development · $300 billion for manufacturing · $30 billion for medical countermeasures manufacturing, research and development, and related biopreparedness and biosecurity · $100 billion for workforce development · $213 billion for affordable housing |
| American Families Plan ($1.8 trillion) | · $200 billion to make permanent the temporary increase in ACA premium tax credits
· $45 billion for nutrition · $225 billion for child care · $225 billion for paid leave · $506 billion for education |
| Drug Pricing Reform | · H.R. 3 and/or Senate Finance Committee Chairman Ron Wyden (D-OR)’s principles for drug pricing reforms, including:
o HHS negotiation (Medicare and/or commercial market) o Medicare Part D redesign o Inflation rebates for Medicare Part B and Part D drugs o Rebate reform |
| Medicare Expansion | · Add hearing, dental, and vision benefits to traditional Medicare
· Lower the age of Medicare eligibility to 60 |
| Medicaid Gap Coverage | · COVER Now Act would allow counties in states that have not expanded Medicaid to establish demonstration projects to expand Medicaid
· Other financial incentives to persuade holdout states to expand Medicaid · Federal public option |
FY 2022 Appropriations: USDA, FDA
On Wednesday, the House Appropriations Committee is scheduled to mark up the fiscal year (FY) 2022 Agriculture-Rural Development-Food and Drug Administration (FDA) funding bill, which was approved by the Appropriations Subcommittee last Friday by a voice vote. The $26.55 billion appropriations legislation billion (a 10 percent increase above FY 2021), which also includes “community project funding” (i.e., earmarks) provides:
- Nutrition Assistance – Nearly $106 billion for the Supplemental Nutrition Assistance Program (SNAP); $6 billion for Women, Infants, and Children (WIC), $26.9 billion for various child nutrition programs, and $45 million for the Summer EBT program.
- FDA – Roughly $3.5 billion for the agency, including $72 million to address the opioid crisis, medical supply chain surveillance, rare cancers, and inspections; and $50 million to accelerate medical product development pursuant to the 21st Century Cures Act.
- Broadband – $165 million for rural broadband.
Regulatory Update
On the Medicare payment front, the first of the calendar year (CY) proposed payment updates cleared the Office of Management and Budget (OMB) last week – the CY 2022 Home Health Prospective Payment System. The proposed rule to update payment parameters for the Affordable Care Act (ACA) marketplaces also cleared OMB review. Both may be released imminently.