Summary
With the Biden Administration’s soft deadline of having a compromise on infrastructure solidified by Memorial Day, this could be the last week of consequential negotiations before the White House shifts to the Democrat-only budget reconciliation track. The White House and Senate Republicans remain far apart on fundamental issues – price tag, scope, and most crucially, pay-fors. Senate Republicans most recently rejected the White House’s $1.7 trillion infrastructure offer – about $500 billion less than Biden’s initial proposal and nearly a trillion more than Senate Republicans’ top number. They have also maintained that pay-fors oriented around increasing the corporate tax rate are a nonstarter.
Beyond this, lawmakers will soon turn their attention to the President’s forthcoming fiscal year (FY) 2022 full budget request. The Office of Management and Budget’s (OMB) detailed budget proposal will kick off the appropriations process – a process that will look quite different this year with the return of “earmarks” (formally known as “community project funding”). Additionally, discretionary spending beginning FY 2022 is not subject to statutory spending caps.
Of additional note, the Supreme Court is scheduled to issue formal Opinions today and may rule on the Affordable Care Act (ACA) lawsuit (Texas v. California). Oral arguments on the case in November suggested the Court would allow the rest of the ACA to stand even if it finds the individual mandate to be unconstitutional (details).
President’s FY 2022 Budget
OMB is expected to release its full FY 2022 budget request to Congress this Friday, May 28. Budget toplines released in April gave legislators a broad sense for the White House’s health care priorities – a request which totaled at $131.7 billion for HHS and focused on public health modernization; research on diseases such as cancer, Alzheimer’s, and diabetes; supports for mental health and substance use disorder; gun violence; health equity; maternal mortality; and the intersection of health and the environment. Additional detail on the Administration’s vision for executing on each of these priorities is expected in the full request.
Members of Congress will also have the opportunity to glean more information on the public health- and research-focused components of the HHS budget in a set of hearings with the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) on Tuesday and Wednesday of this week, respectively. Legislative direction on improvements to maternal and mental health – a White House priority – will become clearer after Tuesday’s markup of multiple maternal and mental health bills in the Senate Health, Education, Labor and Pensions (HELP) Committee.
The President’s Budget is also expected to include additional detail on his envisioned new biomedical research agency, the Advanced Researched Projects Agency for Health (ARPA-H). Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) have expressed strong support for ARPA-H and suggested it may be included in a forthcoming Cures 2.0 package (April 2020 white paper here). Once the Administration’s plans on ARPA-H are revealed, movement on a new Cures 2.0 package may materialize in the next several weeks.
Notably, the forthcoming budget request is no longer expected to include detail on major health care reform initiatives that were features of President Biden’s campaign: a federal public option program and drug pricing reform. The omission of these items is reportedly intended to curb criticisms that the Administration is spending too excessively on new initiatives. Forgoing these priorities in the President’s FY 2022 Budget appears to signal some hesitancy among White House officials to pursue Democrat-only legislation, especially as Biden’s infrastructure proposal will likely move through budget reconciliation.
Senate Floor Activity
The Senate is slated to vote on the confirmation for Chiquita Brooks-LaSure as the Centers for Medicare & Medicaid Services (CMS) Administrator as soon as tomorrow after attempts from Senate Republicans to stall her nomination over the Biden Administration’s revocation of Texas’s Medicaid waiver. Brooks-LaSure is expected to be confirmed.
This week, the Senate will continue consideration of the U.S. Innovation and Competition Act (S. 1260) (formerly known as the “Endless Frontier Act”) – a bipartisan bill aimed at increasing the United States’ technological competitiveness. It includes funding to expand the capacity of the National Science Foundation (NSF) and the National Institutes of Standards and Technology (NIST) in various areas, including biotechnology, medical technology, genomics, and synthetic biology. Under the new amendment proposed by Senate Majority Leader Chuck Schumer (D-NY), the bill would expand the 5G broadband network, a pressing need amid the increased demand for telehealth and remote working and learning during the COVID-19 pandemic.