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On the Hill: Infrastructure Legislation Released

Over the weekend, the Senate released much-anticipated legislative language for a $1.2 trillion bipartisan infrastructure package. The bill, which is more than 2,700 pages, includes investments in physical infrastructure, including public transit, broadband, and clean drinking water.

As anticipated, the legislation includes no major health care policies. However, it does list several health care changes to help pay for $550 billion in new spending, including:

  • $205 billion in repurposed COVID-19 relief funds. Of note, lawmakers did not repurpose money from the Provider Relief Fund in this legislation — those funds remain intact;
  • $49 billion in savings from a three-year delay in implementing the Medicare Part D rebate rule, issued by the Trump administration, impacting pharmacy benefit managers;
  • $8.7 billion in savings from extending the 2 percent Medicare sequester cut through fiscal year (FY) 2031. The sequester cut is suspended through the end of this year due to COVID-19. The same law that extended the most recent sequester suspension also extended the length of the sequester through FY 2030. The bipartisan infrastructure legislation both extends the sequester by one year and increases the amount of the sequester to 4 percent for the first six months of FY 2031; and
  • $3 billion in savings from lowering Medicare spending caused by unused, leftover medications packaged in single-use vials.

On Monday, lawmakers began voting on amendments to the legislation, but Senate leadership must reach procedural and timing agreements for the bill to advance to the Senate floor. The floor process for this legislation will consume most of the week; the Senate could hold a final vote as early as Thursday.

‘Human Infrastructure’ Legislation

Meanwhile, the administration and congressional Democrats continue to push for passage of a $3.5 trillion FY 2022 budget resolution to address President Joe Biden’s “human infrastructure” priorities, including health care policies not captured in the bipartisan infrastructure bill.

The budget resolution sets forth the top-line spending numbers for committees to use when developing policies under the budget reconciliation process. Senator Majority Leader Chuck Schumer (D-N.Y.) is expected to focus on the budget resolution immediately following passage of the bipartisan physical infrastructure bill.

Reconciliation bills are not subject to a filibuster and can pass the Senate with a majority vote. Schumer last week indicated he has the votes needed to pass the budget resolution without Republican support.

340B Amendment in Proposed HHS Budget

The House last week considered several FY 2022 appropriations bills, including legislation to fund the Department of Health and Human Services.

Two champions of the 340B Drug Pricing Program, Reps. Abigail Spanberger (D-Va.) and David McKinley (R-W.V.), offered an amendment in support of covered entities harmed by pharmaceutical manufacturers unlawfully restricting access to 340B-priced drugs through contract pharmacies. The Spanberger-McKinley amendment passed by a voice vote as part of a package of dozens of bipartisan amendments.

Although the amendment has no budgetary or legal force, it speaks to Congress’ support of essential hospitals and covered entities on the 340B contract pharmacy issue.

Congressional Schedule

The House is on recess and will remain in a district work period through Sept. 19; however, House committees may be active during this time. House Majority Leader Steny Hoyer (D-Md.) announced lawmakers might be called back to Washington, D.C., for votes.

Meanwhile, the Senate remains in session this week, with its recess scheduled Aug. 7 to Sept.  12. It is likely Schumer will push back the start of August recess to pass the infrastructure package and FY 2022 budget resolution.


About the Author

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

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