Congressional Update: How Will the Infrastructure Legislation Impact Healthcare?‎


By AMRPA Headquarters posted 08-09-2021 17:35

By Kristen O’Brien, JD, Vice President, McDermott+ Consulting

This week, Senate Budget Committee Chairman Bernie Sanders (D-VT) released the text of the FY 2022 $3.5 trillion budget resolution. The budget resolution is the framework that outlines the spending and savings numbers that the various House and Senate Committees are required to work within to develop the partisan infrastructure reconciliation package. Notably, the focus is what and how much can be spent, which is the main driving focus for healthcare stakeholders. AMRPA is closely watching if Medicare or other healthcare cuts will be used to support the large spending package.

What some find most surprising in this budget resolution is that the Senate Finance Committee is required to save at least $1 billion. The Senate Finance Committee will have to find savings to fund these proposals and other non-healthcare proposals within the Committee’s very large jurisdiction. Specifically, the Committee can find savings in Medicare prescription drug negotiation, but how much savings are politically possible remains uncertain.  This may mean the Committee looks to sequestration and other Medicare cuts, although this remains to be seen.

The Senate Health, Education, Labor, and Pension (HELP) Committee, on the other hand, can spend up to $726 billion. Although HELP has some health care jurisdiction, it is rather limited compared to the Finance Committee. Healthcare items that may be addressed include funding for pandemic preparedness; investments in primary care (Community Health Centers, National Health Savings Corps, etc.); and investments in health equity. Some of the many non-health provisions that may be included are Universal Pre-K; tuition-free community college; increasing the maximum Pell grant award; and workforce development and training.

The $3.5 trillion is spread amongst several committees; below are the other Senate Committees with the largest allocations:

  • $135 billion for the Committee on Agriculture, Nutrition, and Forestry
  • $332 billion for the Committee on Banking, Housing, and Urban Affairs
  • $198 billion for the Committee on Energy and Natural Resources
  • $107 billion for the Committee on the Judiciary

It also important to recognize that raising the debt limit is excluded from this package. That means that we have the debt limit problem needing to be resolved in a separate legislative vehicle – that will need 60 votes to clear the Senate – in the same general timeframe as the partisan human infrastructure package. The most likely vehicle is a Continuing Resolution (CR) that will be required to fund the government past the end of the current fiscal year, which ends on September 30.

Politically speaking, this sets up a fight in the fall between Democrats and Republicans over fiscal responsibility. Should they be unable to reach a deal, we could face a potential government shutdown. The CR could become a second vehicle for other items that don’t get included in the human infrastructure package. That could include addressing the Medicare sequester, extension of certain waivers made under the Public Health Emergency (PHE) like telehealth, and other Medicaid and Medicare policies.

The House is expected to interrupt its August recess and return to vote on the budget resolution, most likely the week of August 23. Once the joint resolution passes both houses, the real work -- and opportunity for advocacy -- will happen as the committees craft the long-awaited provisions for the human infrastructure package.