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House Committees Mark Up, Advance Build Back Better Act

September 17, 2021

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

The House Energy and Commerce, Ways and Means, Veterans’ Affairs, and Judiciary Committees each completed marking up and approving provisions of the Build Back Better Act on Sept. 15. This follows the release of draft text and the start of committee markups during the week of Sept. 6 [refer to Washington Highlights, Sept. 10].

Following committee markups, AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, issued a press statement commending the committees for including many of academic medicine’s key health infrastructure priorities in the approved reconciliation text. “The proposed funding provided for these programs will help diversify the physician workforce, increase access to care for people in underserved urban and rural communities, take steps to prepare the nation to respond to public health emergencies, and address long-standing health inequities,” they stated.

The Ways and Means Committee advanced a provision that would create a new Pathway to Practice Training Program, providing scholarships for tuition and other fees to underrepresented and economically disadvantaged students planning to attend medical school, or a student participating in a postbaccalaureate program with the intention of applying to medical school. As terms of participating in the scholarship program, a student would be required to practice a year in a medically underserved area after residency for each year they receive the scholarship. The program would also provide 1,000 new Medicare-supported graduate medical education (GME) slots to teaching hospitals that achieve recognition by the Accreditation Council for Graduate Medical Education for certain training activities related to health equity.

The House Energy and Commerce and Ways and Means bills both included a number of provisions to expand access to care to low-income individuals. Both bills addressed the Medicaid coverage gap in non-expansion states by temporarily expanding premium tax credits to individuals with incomes below 100% of the federal poverty level in 2022-2024. The Energy and Commerce Committee bill would then establish a federal Medicaid program 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.  

The Energy and Commerce bill permanently extends the Children’s Health Insurance Program (CHIP). It also requires 12 months of continuous eligibility for children in Medicaid and CHIP, which the AAMC, along with 215 other organizations, urged Congressional leadership to include in the package in a Sept. 14 letter. Additionally, the Ways and Means bill permanently extends the premium tax credits that were included in the American Rescue Plan [refer to Washington Highlights, March 12].

During the Energy and Commerce markup, several committee members expressed their support for the president’s proposed Advanced Research Projects Agency for Health (ARPA-H). Republicans, however, expressed disappointment that the bill includes a $3 billion provision to establish ARPA-H through reconciliation, which they characterized as a partisan process, rather than through a bipartisan process. Health Subcommittee Chair Anna Eshoo (D-Calif.) stated that the committee will hold hearings on the initiative, but the reconciliation package provided an opportunity to fund the initiative.

Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) both mentioned the effort to authorize ARPA-H through their Cures 2.0 legislation, which they hope to introduce later in September [refer to Washington Highlights, July 23]. The House-passed FY 2022 Labor, Health and Human Services (HHS), Education, and Related Agencies spending bill also includes $3 billion for ARPA-H but establishes the new entity within the National Institutes of Health rather than HHS.

In addition to the workforce provisions in the original bill [refer to Washington Highlights, Sept. 10], the Energy and Commerce Committee also adopted a provision that would provide $250 million for the Children’s Hospitals GME program, in addition to the other workforce provisions previously introduced. The approved Energy and Commerce bill also provides $2.5 billion total in fiscal years (FYs) 2022-2027 to support public health approaches to reducing community violence, including through hospital-based violence intervention programs.

The Energy and Commerce Committee failed to advance its drug pricing provision. Three Democrats — Reps. Kurt Schrader (D-Ore.), Scott Peters (D-Calif.), and Kathleen Rice (D-N.Y.) — joined all Republicans on the committee in opposing the legislation. However, the Ways and Means Committee did advance the provision to lower drug prices, which will move forward as part of the package to the House Budget Committee. The drug pricing provision would require the HHS Secretary to negotiate prices with drug manufacturers, require drug manufactures 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.

On Sept. 13, the House Committee on Veterans’ Affairs (VA) also approved its reconciliation provisions, which would provide 700 new health care residency positions at VA medical centers through FY 2029. Also on Sept. 13, the House Judiciary Committee advanced their reconciliation proposal, including immigration reform provisions that would allow an estimated 8 million individuals in the US in an undocumented or temporary status to apply for permanent residency (such as recipients of Deferred Action for Childhood Arrivals). To be included in the final reconciliation package, the Senate parliamentarian must rule that this proposal has a direct fiscal impact.

The House Budget Committee and House Rules Committee will consider the bill before it is voted on by the full House, though the timeline for additional House and Senate action is unclear after a number of moderate House and Senate Democrats expressed concerns over the overall price tag and individual components of the effort. President Biden met separately with Senators Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.) on Sept. 15 to discuss the path forward on the reconciliation measure as well as Senate-passed legislation to invest in “traditional” and transportation infrastructure [refer to Washington Highlights, Aug. 13].

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