|June 19 - June 26
Federal Advocacy Scan: Infrastructure spending bill caught up in political fight
A tentative agreement between the White House and a group of bipartisan senators, including Maine’s Senator Susan Collins, was announced this week on a nearly $1 trillion infrastructure bill. According to Healthcare Finance News, “If passed, the bill could include tens of billions of dollars for home healthcare, an expansion of federal health benefits and $65 billion for the buildout of broadband infrastructure, seen as a critical component to telehealth.”
After media reports of the bipartisan agreement, President Biden indicated that he would not sign the infrastructure bill without Congress passing another, separate spending bill that would include top health policy priorities to extend Medicare enrollment to those 60 years and older, expand benefits for senior dental care and hearing aids, and prescription pricing reform.
Bipartisan agreement on the infrastructure plan is necessary because any legislation needs at least 10 Republican votes in the U.S. Senate to pass.
Democrats in the U.S. House of Representatives, however, this week introduced their own $1.5 trillion infrastructure bill, which includes upgrades to the nation’s roads, bridges, transit, along with housing and health care provisions. Democrats hold a slim U.S. House majority and cannot lose support of more than a handful of members.
The House Democratic bill (H.R. 3) would invest $30 billion to upgrade hospitals to increase capacity and strengthen care; help community health centers respond to COVID-19 and future public health emergencies; improve clinical laboratory infrastructure; support Indian Health Service infrastructure; and community-based care capacity expansion. Another Democratic priority may be permanently expanding the federal subsidies that make private insurance plans sold on HealthCare.gov and state-run marketplaces more affordable.
How it started
The President had proposed a $2.2 trillion infrastructure plan in late March. The American Jobs Plan initially included infrastructure investments, green energy policy, a jobs program, racial reconciliation language, and a social safety net expansion.—(Maine Fact Sheet, American Jobs Plan)
Although it had been identified as mostly a traditional infrastructure bill, spending associated with transportation only made up around one-quarter of the first proposal. The single largest expense category outside transportation was home care, making home care more accessible under Medicaid, while providing a pay increase for home care providers. Also included was the goal of 100% national broadband coverage and a public health initiative to replace all lead pipes.
Breakdown of the initial plan:
· $621 billion for transportation-related spending
· $400 billion for home care
· $360 billion for government buildings
· $300 billion for manufacturing development
· $180 billion for research and development
· $111 billion for water system development
· $100 billion apiece for workforce, power grid and broadband development
The American Academy of Medical Colleges (AAMC) released a statement in early April supporting the plan the American College of Physicians (statement), and the American Academy of Family Physicians (statement).
“The American Academy of Family Physicians welcomes the release of the American Jobs Plan, which kicks off an important conversation about critical investments necessary to further strengthen our nation’s health care system and address underlying social determinants of health that contribute to health inequities.” —AAFP President, Ada D. Stewart, MD.
The American Hospital Association (AHA) also applauded the initial plan, specifically investments into hospitals' physical infrastructures, digital health and data frameworks, the healthcare workforce, and behavioral health access.
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