House Democrats are cobbling together a $3.5 trillion domestic policy package, which includes billions of dollars for hospital infrastructure, building up the health workforce, addressing the nursing shortage and boosting insurance coverage.
The House Energy and Commerce and Ways and Means committees, which share jurisdiction over healthcare spending and programs, passed their provisions of the bill this week along party lines, with the chamber hoping to pass the full “Build Back Better Act” by the end of the month.
“Today, the Energy and Commerce Committee passed transformational legislation that invests in the American people, responds to the challenges of our time, and builds a better future for generations to come,” Energy and Commerce Chairman Frank Pallone (D-N.J.) said in a statement.
Republicans argue the package is too expensive and are frustrated Democrats are using a process that negates the need for bipartisan support.
In the Senate, Democratic leaders are still working on a package that can gain the support of all 50 members of the party. Sen. Joe Manchin, a moderate Democrat from West Virginia, is a key vote and has said he won’t support a $3.5 trillion bill, meaning whatever passes the House might be trimmed down.
Here are some key provisions in the House proposals that would impact the healthcare industry:
Infrastructure
Leaders of safety net hospitals in particular say their facilities are in desperate need of upgrades because they were originally built for smaller populations.
The Greater New York Hospital Association called for at least $100 billion, but only $10 billion was included in the bill that passed out of the Energy and Commerce committee this week. That funding will be prioritized for projects that increase capacity, update facilities for “communities of need,” prepare for public health emergencies or natural disasters and protect against cybersecurity threats.
The bill also includes:
- $10 billion in grant funding for Federally Qualified Health Centers to renovate, remodel, expand or construct facilities.
- $500 million to support the improvement, renovation or modernization of infrastructure of behavioral healthcare centers and teaching health centers.
Health workforce
The pandemic has shown the limits of the healthcare workforce, especially in rural and underserved parts of the country. There are shortages of healthcare workers nationwide, especially nurses, and the problem is expected to worsen in the coming years as the population of the U.S. gets older.
The bills that passed the House committees include:
- A new program that would fund 1,000 scholarships per year for medical students from rural and underserved communities if they agree to practice in those communities after graduating.
- 1,000 new residency slots per year, beginning in 2026, for medical schools that commit to providing cultural competency training, training in the community and increased mentorship for students.
- $1 billion in grant funding for medical schools in underserved areas, which can be used for recruiting and retaining of students, including people from racial and ethnic backgrounds underrepresented among medical students, people from rural areas and low-income individuals. The funding could also be used to develop curriculum that emphasizes care for rural and underserved populations, constructing medical schools in areas that don’t have one, hiring faculty, or modernizing or expanding facilities.
- $1 billion to increase the number of faculty and students at nursing schools, with a priority for people from rural areas or underrepresented racial or ethnic groups. Schools providing care in underserved areas would be prioritized.
- $6 billion in payments for teaching health centers to establish new graduate medical education programs or maintenance or expansion of existing programs.
- $300 million for loan repayment assistance for registered nurses and advanced practice registered nurses who commit to working at facilities with a critical shortage of nurses or to teaching at a nursing school.
Pandemic preparedness
Public health departments say they have been underfunded by states and the federal government for decades, hampering their response to COVID-19. While President Joe Biden as called for at least $30 billion in public health funding, Congressional Democrats facing competing priorities included about half of that.
- $16 billion in funding that would be dedicated to shoring up the country’s pandemic response, including $5 billion for renovating, expanding and modernizing state and local public health labs and CDC labs and $8 billion for replenishing the Strategic National Stockpile and strengthening supply chains.
- Of that, $1.25 billion would go toward enhancing and strengthening public health surveillance in hospitals and other health facilities.
Healthcare coverage
After Democrats passed the Affordable Care Act in 2010, they lost control of Congress and their chance to make any tweaks to the law. When Democrats regained majorities this year in the Senate and White House, they vowed to “build on” the ACA. The bills passed this week would:
- Permanently expand Affordable Care Act subsidies to people with incomes at 400% of the federal poverty level or higher and make subsidies more generous for low-income people. The COVID-19 relief package passed by Congress earlier this year made these changes only for two years.
- Provide coverage to more than 2 million low-income adults who live in the 12 states that have not accepted the ACA’s Medicaid expansion. Initially, those people would become eligible for ACA subsidies. Beginning in 2025, they would be eligible for a new federal Medicaid-lookalike program that will be administered by managed care organizations in non-expansion states.
- $10 billion annually for state reinsurance programs to reduce premiums, deductibles or other out-of-pocket costs.
- Require that states provide Medicaid coverage to incarcerated people 30 days before their release.
Maternal and child health
Black women are three times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention. Several provisions of bills passed this week address maternal health with a large focus on health disparities, including several proposals from Rep. Lauren Underwood (D-Ill.) The bills would:
- Require states provide 12 months of full Medicaid and Children’s Health Insurance Program benefits to postpartum women. Require states provide 12 months of continuous eligibility to children enrolled in CHIP instead of kicking them off due to income changes.
- Include $1 billion for addressing maternal mortality, including grant programs aimed at improving social determinants of health, diversifying the health workforce, addressing mental health and substance use disorders, and reducing discrimination and bias in healthcare.
- Permanently fund the Children’s Health Insurance Program, which currently needs to be reauthorized by Congress every few years, occasionally causing delays in funding to states.
- Provide coverage of vision, dental and hearing benefits in Medicare.
Drug pricing
The House Ways and Means Committee this week passed a provision that would allow Medicare to negotiate with drug companies for lower prices on prescription drugs. That same provision failed to pass the House Energy and Commerce committee after three moderate Democrats voiced concerns about the potential impact on the development of new drugs. The House will need to reconcile those differences before holding a vote on the full package. The nonpartisan Congressional Budget Office estimated a similar version of that policy would save the federal government about $450 billion over ten years. Because the House bill counts on those savings to pay for part of the package, it could eventually be trimmed down if Democrats don’t come to an agreement on drug pricing.
“While I’m disappointed that we were unable to advance price negotiation out of the Committee today, lowering the cost of prescription drugs remains a top priority for Democrats,” Pallone said. “The most effective way to rein in skyrocketing drug costs is to finally give Medicare the ability to negotiate lower prices, and I’m confident it will be part of the final Build Back Better Act.”