Summary
Wrapping up the first major legislative initiative of the Biden-Harris Administration and Democrat-controlled Congress, the House is expected to pass the $1.9 trillion American Rescue Plan Act of 2021, amended and approved by the Senate along party lines over the weekend, tomorrow (March 9) ahead of the March 14 expiration of federal unemployment benefits. With respect to the health-related provisions, the Senate-cleared package maintains most of the legislative language approved by the House in their substitute amendment. The changes consist of revisions to funding levels, reallocation of funding to specified programs, and the exclusion of certain provisions approved by the House (WHG summary).
Infrastructure
In the wake of his first major legislative victory, President Joe Biden is looking ahead to infrastructure, the next phase of the “two-step plan” he outlined on his first day in office. He is expected to unveil this “economic recovery” plan in the coming weeks. Last Congress, House Democrats advanced the Moving Forward Act (H.R. 2) – a $1.5 trillion package to rebuild the country’s infrastructure and create jobs. The package would provide $30 billion for health care infrastructure, including $10 billion set aside for the construction and modernization of hospitals and medical facilities. In addition, the package would provide over $100 billion to fund broadband-related programs, a pressing infrastructure need to support the country’s increased reliance on telehealth and virtual learning during the COVID-19 pandemic.
The legislative path for a comprehensive infrastructure package is not yet clear, as Sen. Joe Manchin (D-WV) said, in a recent interview, he would not support Biden’s infrastructure package if Republicans are not included in the process. For now, we believe that Manchin’s statements reflect his preferences regarding initial phases of the process but do not completely rule out consideration of budget reconciliation later on. If reconciliation is not an option, the package would face substantial obstacles to passage due to likely robust Republican opposition, especially given Manchin’s own suggestion that the package be offset predominantly by tax increases.
This week, Senate Health, Education, Labor and Pensions (HELP) Committee Chairwoman Patty Murray (D-WA) is expected to reintroduce the Public Health Infrastructure Saves Lives Act, which would establish a program at the Centers for Disease Control and Prevention (CDC) to award to award formula and competitive grants to support core public health capabilities at state, territorial, and local health departments. The program would provide $750 million in FY 2022, increasing investments incrementally to $4.5 billion by FY 2026.
Dovetailing with this announcement, the Senate HELP Committee will hear from stakeholders tomorrow (March 9) about their experiences on the frontlines of the COVID-19 response. The panel will offer different perspectives from a community health center, health system, state health department, and pandemic preparedness and response expert. With FY 2022 appropriations top of mind, witnesses will likely highlight the need for significant investments in public health infrastructure – an issue that the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Issues (Labor-HHS-Education) discussed a few weeks ago. The Q&A portion is also likely to cover how the soon-to-be-enacted COVID-19 relief package will support public health activities, particularly mass vaccination campaigns.
Mental Health and Substance Use Disorder
On Thursday (March 10), the House Appropriations LHHS Subcommittee will examine increased mental health services and substance use disorder treatment needs exacerbated by the COVID-19 pandemic. Members will hear from a diverse panel of mental and behavioral health care providers and policy experts. Their discussion is likely to touch on the use of funding included in the COVID-19 relief package to address mental health and substance use disorder.
Health and Economic Equity
As part of the House Ways and Means Committee’s work to address the role that racism, ableism, and other social, structural, and political determinants have in perpetuating health and economic inequity, the Committee will convene a hearing on Wednesday (March 10) to examine Health Profession Opportunity Grants (HPOG). Through the Administration for Children and Families, HPOGs are awarded to organizations to provide health care education and training to recipients of the Temporary Assistance for Needy Families (TANF) program and other individuals with low incomes.
Cabinet Confirmations
Tomorrow, the Senate is scheduled to vote, and likely confirm, the nominations of Marcia Fudge and Merrick Garland to serve as the Secretary of Housing and Urban Development and the Attorney General, respectively. A vote on the nomination of Xavier Becerra, Biden’s pick to lead the Department of Health and Human Services, has not yet been scheduled.