Build
Back Better Is a Health Care Bill Now
Only two provisions in a once-sprawling
social spending package have survived; they would lower prescription drug
prices in Medicare and insurance premiums for millions of Americans.Top of Form
Democrats
have promised prescription drug price reform for years and could bring it to
fruition with the latest social spending package.Credit...Saul Loeb/Agence France-Presse — Getty Images
By Margot
Sanger-Katz
July 15, 2022
WASHINGTON — President Biden and
Democrats in Congress had hoped to pass a broad domestic policy package that
would expand the social safety net, raise taxes on corporations and the
wealthiest Americans, and tighten regulation of climate-changing pollutants.
But the decision by Senator Joe Manchin of West Virginia to withdraw his support from other aspects of an
already-shrunken package this week leaves nothing but health care on the table.
But even if what was once a sidecar of
sorts to the so-called Build Back Better Act is now the only vehicle left on
the road, it would still have a substantial impact on the lives of many
Americans. And unlike other provisions that faced a mixed political reception,
the central health care proposal that remains is enormously popular with the
public — including Republicans.
That
piece is prescription drug price reform, which Democrats have been promising
for years and many Americans tell pollsters they want. The bill would take
several whacks at the price of drugs — directly regulating prices for a group
of expensive medications purchased by Medicare and punishing drug companies
that raise prices too fast on existing medicines for all Americans.
The
legislation under discussion would also expand Medicare’s prescription drug
benefit, increasing financial help for poorer seniors and eliminating the
program’s current unlimited cost sharing, which leaves some beneficiaries facing more than $10,000 a year in medication costs.
No one on Medicare would be asked to pay more than $2,000 a year for
prescription drugs under the legislation, a significant benefit to patients who
take expensive medications for serious diseases like cancer and multiple
sclerosis.
The prescription drug provisions are
unusual in that they offer Americans tangible benefits — lower drug prices,
more financial protections — while actually saving the federal government
money. That’s because the bill essentially puts the savings on the back of the
pharmaceutical industry, which will have to accept lower prices for some of its
big sellers.
Defenders of the industry in Congress,
and the drug companies themselves, argue that the change could thwart
innovation and cost jobs. Such arguments have staved off drug price reforms in
the past. But previous rounds of negotiation suggest that this package is
likely to have enough votes to pass the Senate.
Mr. Manchin has also signaled his
support for another health provision that has received less attention in recent
reports of the emerging deal. He said he was open to an expansion of premium
subsidies that lower the price of insurance for Americans who buy their own
coverage, rather than get it through the government or a job.
Those
subsidies were already expanded as part of Congress’s
pandemic relief bill last year, but the expansion will expire in December
unless new legislation continues them.
The
subsidies are important to many Democratic lawmakers because they are seen as
fulfilling the promise of the Affordable Care Act. The extra money lowers premiums for nearly every American who buys
a health plan through the Obamacare marketplaces, making certain plans free for
lower-income Americans and offering financial support for higher-income people
who previously received no help paying for insurance.
In a statement on Friday supporting the
measures in which he called on the Senate to pass the legislation before its
August recess, Mr. Biden said Democrats had “come together” and “beaten back
the pharmaceutical industry.”
“This will not only lower the cost of
prescription drugs and health care for families,” he added, “it will reduce the
deficit and help fight inflation.”
But for Democrats who had hoped for
social spending on programs other than health care, the price of extending the
Obamacare subsidies may disappoint. A slightly outdated estimate suggests they
will cost the federal government nearly as much to extend as the drug-pricing
provisions would save — $220 billion over
a decade, compared with about $288 billion in savings.
Mr.
Manchin has said he might be open to considering climate and tax provisions in
the fall. If he is also hoping for deficit reduction, there may be less money
to spend than some lawmakers expected.
Understand
What Happened to Biden’s Domestic Agenda
‘Build
Back Better.’ Before being elected president in 2020, Joseph
R. Biden Jr. articulated his ambitious vision for his administration under the
slogan “Build Back Better,” promising to invest in clean energy and to ensure that
procurement spending went toward American-made products.
A
two-part agenda. March and April 2021: President Biden
unveiled two plans that together formed the core of his domestic agenda: the American Jobs Plan, focused on
infrastructure, and the American Families Plan, which included a
variety of social policy initiatives.
A
$6 trillion budget. June 2021: President Biden proposed a $6 trillion budget for 2022. The
proposal detailed the highest sustained levels of federal spending since
World War II, with the goal of funding the investments in education,
transportation and climate initiatives articulated in the two plans.
The
Infrastructure Investment and Jobs Act. Nov. 15, 2021: President Biden signed a $1 trillion infrastructure bill into law, the
result of months of negotiations. The president hailed the package, a
pared-back version of what had been outlined in the American Jobs Plan, as
evidence that U.S. lawmakers could still work across party lines.
The
Build Back Better Act. Nov. 19, 2021: The House narrowly passed a $2.2 trillion social spending bill intended
to fund a package of initiatives from the
American Families Plan and the American Jobs Plan. But on Dec. 19, 2021,
Senator Joe Manchin III, Democrat of West Virginia, said he would not support
the bill as written, dooming his party’s drive to pass it.
A
new attempt. July 15, 2022: Efforts to revive the bill, in a much smaller form, ahead of the midterm
elections were dealt a severe blow when Mr. Manchin told Senator Chuck Schumer,
the majority leader, that he was unwilling to support funding for climate or energy
programs or raising taxes on wealthy Americans and
corporations.
