President Biden announced this week that the White House and a group of senators have reached an agreement on a bipartisan infrastructure bill that will not contain healthcare measures that were previously considered for inclusion. Twenty-one senators, 11 Republicans and 10 Democrats, have endorsed the bill, although there are still senators that have yet to voice support, including Senate Majority Leader Chuck Schumer (D-NY) and progressive Senator Bernie Sanders (I-VT).

Initially the Biden Administration was adamant that an infrastructure package include a broad range of provisions outside of traditional infrastructure, including healthcare. Previous items that were considered include $18 billion for Veteran’s Affairs hospitals and $400 billion to expand Medicaid beneficiaries' access to home- and community-based care for seniors and the disabled. The compromise agreed upon this week does not include these provisions but does include: $109 billion for roads and bridges, $49 billion for public transit, $25 billion for airports, $73 billion for power infrastructure and much more. However, the agreement notably includes $65 billion for broadband infrastructure, which does impact healthcare to the extent that broadband is vital for rural areas to have greater access to telehealth services.

Since the Senate parliamentarian ruled that Congress can utilize the budget-reconciliation process again during this fiscal year, the Democratic Party can still unite behind their own additional package. If this infrastructure package passes, healthcare may be back on the menu for the Democratic majority. The American Rescue Plan included quite a bit of healthcare-related provisions – most notably changes to ACA marketplace subsidies and the subsidization of COBRA premiums at 100 percent. With the ACA temporarily fortified, the next big topic in the healthcare frontier will be prescription-drug costs. While some Democrats are pushing for drug-price controls to be included in one of the aforementioned plans, others anticipate it may be an entirely separate measure.

House Democrats have already reintroduced H.R. 3, the Elijah Cummings Lower Drug Costs Now Act. The bill would authorize Medicare to negotiate drug prices, require drug makers to pay rebates for increasing prices beyond the rate of inflation, and limit out-of-pocket costs for Medicare beneficiaries to $2,000 per year. The plan would also go beyond government plans and would allow private insurers to benefit from the negotiated prices as a means to reduce costs for all consumers. NAHU submitted written testimony to several House committees with concerns about H.R. 3 and some suggestions on more moderate measures to lower drug costs.

Senate Majority Leader Chuck Schumer  indicated earlier this week that he is willing to work with Sen. Bernie Sanders to include dental, vision and hearing coverage in Medicare. It is currently unclear how many Democrats support that measure. While this is something that could be passed along party lines in the Senate using the reconciliation process, one of the biggest challenges that Democrats will face in passing a measure like this, even with budget reconciliation, is getting all 50 Senate Democrats on board, including moderate Senators Joe Manchin (D-WV) and Kyrsten Sinema (D-AZ).