The bombastic announcement by Senator Joe Manchin (DW.V.) that he will not support President Joe Biden’s $ 1.7 trillion social spending agenda jeopardizes important health care provisions. But there could be a way forward in the New Year. Manchin, whose support the Democrats need to pass the House of Representatives version approved last month, contains numerous health directives, including expanding health insurance subsidies under the Affordable Care Act and elements important to providers.
“We’re pretty concerned now,” said Ceci Connolly, president and CEO of the Alliance of Community Health Plans, which supports the expansion of coverage. “It seemed like Build Back Better was going through all of the normal, reasonable deliberations and negotiations in Washington. But now the indication that it may be blown up is very worrying from a healthcare perspective.”
The legislative package is broad and covers a variety of topics such as climate change, paid vacation, health insurance and taxes.
The democratic leaders tried to appease the party’s progressive and moderate camps when they drafted the legislation. The lawmakers of the latter group, in particular Manchin and Senator Krysten Sinema (D-Ariz.), Have proven to be the most difficult to satisfy. Republicans unanimously oppose domestic law and make every vote of Democrats valuable, especially in the evenly-divided Senate.
If the Build‧Back‧Better‧Act is not passed, Democrats will have to find another way to advance their health goals, including expanding improved ACA subsidies for middle and higher incomes before they expire in late 2022. The Build‧Back‧Better‧Act would also make the subsidies for low-wage earners more generous. The bill would also offer health insurance grants to 2.2 million low-income adults living in the 12 states that have not expanded Medicaid under the ACA.
The Democrats’ bill also includes several health policies that are not in themselves controversial, including provisions for health workers such as funding medical education for Medicare graduates, expanded access to home and community services, funding for capital projects in community health centers, and spending for public health care. The legislation would also add hearing aid insurance to Medicare, allow Medicare to negotiate some drug prices, and permanently approve the children’s health insurance program.
Manchin focuses its objections on the cost of the bill and has opposed the expansion of a tax credit for low-income families with children. The Senator also accused the Democrats of using “budget gimmicks” to reduce the bill’s overall cost by temporarily funding programs, though Democrats plan to renew those programs in the future. Manchin previously agreed to the legal framework, which they are now rejecting, according to the White House.
There may be alternative legislative tools that Democrats can use to postpone their health regulations over the next year, including bills to fund government and re-approve prescription drug charges.
“They’re just too persuasive, too popular, and too much agreement on them in the Democratic Group that they will be part of whatever comes through,” said Eliot Fishman, senior director of health policy for Families USA.
According to a Washington Post report on Monday, Manchin told the White House he would accept a $ 1.8 trillion package that extends ACA subsidies but precludes extending the child tax credit.
Senate Majority Leader Chuck Schumer (DN.Y.) announced Monday that the Senate will review the package early in the new year, despite Manchin’s current position. Congress is on hiatus for the rest of the year.
“We just can’t give up,” Schumer wrote in a letter to the Senate Democrats on Monday. “We’re going to be voting on a revised version of the Build Back Better Act passed by the House – and we’re going to keep voting on it until we get something done.”