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  • Washington Highlights

    House Begins Mark-ups of the Build Back Better Act


    Brett Roude, Legislative Analyst
    Christa Wagner, Manager, Government Relations
    Jason Kleinman, Senior Legislative Analyst, Govt. Relations
    Allyson Perleoni, Director, Government Relations

    During the week of Sept. 7, committees of jurisdiction in the House of Representatives began to mark-up portions of the Build Back Better Act, a human infrastructure plan that includes parts of President Biden’s American Jobs Plan and American Families Plan. Lawmakers have been drafting the Build Back Better Act per reconciliation instructions in the fiscal year (FY) 2022 budget resolution, allowing the Senate to pass the legislation by a simple majority and without being subject to the filibuster [refer to Washington Highlights, Aug 27].

    While mark-ups will continue into the following week, several portions of the bill released to date include key academic medicine priorities highlighted in an Aug. 27 letter the AAMC sent to congressional leaders, including investments in the health care workforce, health care coverage, health equity, research infrastructure, pandemic preparedness, and immigration reform.

    The House Ways and Means Committee began its mark-up on Sept. 9 and 10, and considered provisions to provide 12 weeks of paid family and medical leave for all workers and to authorize Medicare to provide dental, hearing, and vision coverage for beneficiaries. The committee will continue its mark-up on Sept. 13, at which point additional health provisions and revenue generators are expected to be considered.

    The Energy and Commerce Committee willmark-up its portions of the legislation begin to mark-up its proposal on Sept. 13, which includes several policies to expand access to health care coverage, lower prescription drug prices, and address public health infrastructure.

    The bill would address the Medicaid coverage gap by expanding premium tax credits to allow people in non-Medicaid expansion states with incomes below 100% of the federal poverty level to enroll in subsidized plans in the Marketplace from plan years 2022–2024, and then create a federal Medicaid program in these states beginning in 2025. It also includes a maintenance of effort requirement to incentivize current Medicaid expansion states to maintain Medicaid coverage at current eligibility levels.

    Additionally, the Energy and Commerce proposal would permanently extend funding for the Children’s Health Insurance Program (CHIP), which is currently set to expire at the end of FY 2023. It also provides 12-months continuous coverage for children enrolled in both Medicaid and CHIP. The legislation would also provide 12 months of continuous Medicaid eligibility to postpartum women, building on the existing state plan option included in the American Rescue Plan Act (P.L. 117-2) [refer to Washington Highlights, March 12]. Additionally, it would require states to provide full Medicaid benefits to pregnant and postpartum women.

    The legislation contains a number of additional investments in programs to reduce maternal morbidity and mortality. Among these are grant funding to address social determinants of health for pregnant and postpartum individuals, investments in the maternal health workforce, and funds for research and surveillance to improve maternal health outcomes.

    To address high prescription drug prices, the proposal includes the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) [refer to Washington Highlights, April 23]. It would require the Health and Human Services (HHS) Secretary to negotiate prices with drug manufacturers, require drug manufacturers that increase prices faster than inflation to pay back that excess amount to the government, and cap out-of-pocket costs for Medicare Part D beneficiaries at $2,000 per year.

    The reconciliation bill also includes provisions to address public health infrastructure, including a $7 billion investment in physical infrastructure improvements for public health departments and health care facilities, and $10 billion for hospital infrastructure, including construction and modernization projects to increase capacity, with priority to applicants addressing preparedness or cybersecurity threats.

    Included in the legislation is an AAMC-endorsed proposal to provide $1 billion in supplemental funding to medical schools to construct new branch campuses and assist current regional medical campuses in enhancing their facilities in underserved areas [refer to Washington Highlights, May 5]. The committee would also provide $6 billion for the Teaching Health Center Graduate Medical Education program, including funding for development grants.

    The bill would also provide $16 billion in pandemic preparedness investments to be used to update public health laboratories and Centers for Disease Control and Prevention infrastructure, to create a vaccine confidence grant program, to support public health disease surveillance, and to enhance the Strategic National Stockpile.

    The Energy and Commerce provisions also include $3 billion to establish the Advanced Research Projects Agency for Health (ARPA-H), an initiative championed by President Biden. The legislation would direct the HHS Secretary to appoint an ARPA-H director responsible for coordinating the agency’s work with other HHS research agencies. While the measure does not indicate that the new agency would reside within the National Institutes of Health (NIH), it does include language indicating that ARPA-H funds should “supplement and not supplant appropriations” for NIH. The House of Representatives previously approved a $3 billion investment in ARPA-H as part of the fiscal year 2022 appropriations bill to fund the National Institutes of Health [refer to Washington Highlights, July 16].

    On Sept. 9 and 10, the House Education and Labor Committee marked-up their portion of the Build Back Better Act, which includes provisions related to higher education. The legislation would increase the minimum Pell Grant award by $500, provide tuition-free community college, and allow Deferred Action for Childhood Arrivals and Temporary Protected Status recipients to receive federal student aid.

    The Education and Labor Committee legislation also includes $2 billion in funding over seven years for qualifying minority serving institutions (MSIs) — including historically Black colleges and universities, Hispanic serving institutions, and tribal colleges and universities — to improve their research infrastructure. To be eligible, MSIs cannot be classified as very high research activity institutions. Separately, an additional $7 billion would be provided to MSIs to make a degree more affordable for students at their institutions.

    The House Science, Space, and Technology Committee favorably reported an amended version of its reconciliation provisions by a party line vote of 21-17. For the National Science Foundation (NSF), the committee bill includes $3.4 billion for research infrastructure improvements through FY 2031. A total of $1 billion of those funds would be reserved for academic research facilities modernization, of which $300 million should be distributed to MSIs. The bill also includes an additional $7.6 billion for NSF research and development initiatives through FY 2031.

    The House Veterans’ Affairs Committee and the House Judiciary Committee also are expected to mark-up their portions of the package during the week of Sept. 13.

    Once all of the committees of jurisdiction have approved their legislation, the House Budget Committee and House Rules Committee will consider the bill before it is voted on by the full House. After the reconciliation package advances the House, the Senate will begin its consideration.