On the Hill: ‘Human Infrastructure’ Package Makes Headway

President Joe Biden last week announced a $1.75 trillion framework for the Build Back Better Act, the “human infrastructure” reconciliation legislation containing many of the administration’s social policy priorities. The framework reflects negotiations between congressional leaders, the president, and moderate Democrats — namely, Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.).

The House subsequently released updated legislative text for its human infrastructure bill (H.R. 5276). The legislation aims to close the Medicaid coverage gap and, in doing so, would cut disproportionate share hospital (DSH) payments and uncompensated care pools in the 12 states that did not expand Medicaid under the Affordable Care Act (ACA). In these non-expansion states, the bill would enroll individuals who would qualify for expanded Medicaid into zero-premium insurance plans under the ACA’s marketplace through 2025.

To help offset the cost of this new coverage, the legislation would freeze state DSH allotments at 87.5 percent of the 2023 amount in those states; the allotment would remain at this level in perpetuity, with no increases for inflation, until the state expands Medicaid. Additionally, for non-expansion states with uncompensated care pool waivers, the bill would eliminate support for unreimbursed costs of care for patients who otherwise would be eligible for Medicaid if it were expanded. America’s Essential Hospitals sent a letter urging lawmakers to remove these proposed cuts from final legislation.

Of note for essential hospitals, the legislation also would:

• increase by 3 percentage points the Federal Medical Assistance Percentage (FMAP) from 2023 through 2025 in states that expanded Medicaid;
• provide Medicaid coverage for 12 months postpartum;
• provide 12 months continuous eligibility for children in Medicaid and the Children’s Health Insurance Program;
• gradually reduce the 6.2 percentage point FMAP increase in the Families First Coronavirus Response Act until it is eliminated after September 2022;
• require a regular survey of retail community pharmacy drug prices to help determine the national drug acquisition cost;
• allow inmates of a public institution to enroll in Medicaid coverage 30 days before returning to the community;
• discourage state Medicaid programs from rolling back current maintenance of effort requirements;
• provide additional premium and cost-sharing support for individuals who access their insurance through ACA marketplaces;
• invest in programs to improve maternal health outcomes and eliminate disparities in maternal health, including by addressing social determinants of health; and
• strengthen, diversify, and expand the health care workforce, including through the Health Profession Opportunity Grants and the rural and underserved Pathway to Practice Program, among other programs. The association advocated for many of these initiatives in a recent letter to Congress on essential hospital workforce priorities.

The legislation also would make a $150 billion investment in home- and community-based services and would add a hearing benefit to Medicare. It does not include policies to lower prescription drug prices.

Next Steps: Infrastructure Bills

The 1,600-page human infrastructure bill is likely to change. For example, House leadership reportedly is working to add a drug pricing provision, and progressives are hoping to add Medicare dental and vision benefits. Other lawmakers are pushing to include paid family leave.

Meanwhile, the Congressional Progressive Caucus announced support for Biden’s framework. They also indicated lawmakers are likely to vote on human infrastructure legislation as early as this week — meaning they also will support a vote on the $1 trillion bipartisan physical infrastructure bill, which stalled due to ongoing negotiations over the human infrastructure measure. The Senate passed the physical infrastructure legislation in August.

Following House approval, the human infrastructure bill will go to the Senate. The Senate process could take weeks, given the procedural steps necessary to consider reconciliation legislation in the upper chamber. If the Senate makes changes to the House-passed bill, the updated measure will go back to the House for a final vote.

Health Care Workforce, COVID-19 Response Hearings

Last week, the House Committee on Energy and Commerce Health Subcommittee held a hearing on the health care workforce. Lawmakers examined 10 bills, including the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667). This Senate-passed legislation would provide additional education and training to address mental health and well-being among health care providers.

The Senate Committee on Health, Education, Labor, and Pensions will hold a Nov. 4 hearing to examine next steps for the COVID-19 response.