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On the Hill: Cost, Content of Reconciliation Still Unclear

Democrats aim to reach a deal this week on a framework for their “human infrastructure” reconciliation package, but topline spending numbers, social policy priorities, and other key details remain undecided.

While Democratic leaders are pushing for a $2 trillion package, moderate Democrats, including Sen. Joe Manchin (D-W.Va.), are opposed to reconciliation legislation that would exceed $1.5 trillion. Both numbers are far less than the $3.5 trillion mark considered last month by the House. Negotiations on policies to include in the package cannot advance until lawmakers agree on the legislation’s cost.

Policies Under Consideration

House Speaker Nancy Pelosi (D-Calif.) previously indicated prescription drug pricing reforms in the House-passed reconciliation bill are unlikely to become final; Democratic leaders are discussing options to lower prescription drug prices through a more scaled-back approach.

Lawmakers also are continuing to evaluate policies to close the Medicaid coverage gap and build on insurance subsidies for those enrolled in health insurance through Affordable Care Act marketplaces. Due to high associated costs, it is unclear whether the final package will include additional dental, vision, and hearing benefits for Medicare.

In addition, it is not clear whether lawmakers will approve the $10 billion in hospital infrastructure funding in the House proposal — a key priority for essential hospitals. Party leaders are working to reduce the cost and scope of this funding.

Bipartisan Physical Infrastructure Package

Once Democrats agree on the reconciliation framework, the House will vote on the $1.2 trillion bipartisan physical infrastructure bill the Senate passed in August.

After delaying the vote last month, House leadership set an Oct. 31 deadline to vote on the bipartisan measure. The bill previously was delayed due to insufficient support among progressives.

Congressional Schedule

The House Committee on Energy and Commerce Health Subcommittee will hold an Oct. 26 hearing on legislation to support patients, caregivers, and the health care workforce. The association expects its recent letter to lawmakers outlining the workforce needs of essential hospitals to be entered into the Congressional Record during this hearing.

The Senate Committee on the Judiciary will hold an Oct. 28 executive business meeting to mark up the False Claims Amendments Act.

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About the Author

Christina Fagnano is the legislative affairs associate at America's Essential Hospitals.

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