The Build Back Better plan, President Biden’s $1.75 trillion social spending program, has had a rollercoaster ride. In November, Democrats reached an agreement to include the most significant drug price reform in decades in the bill. In late December, the bill was deemed “mostly dead” after Sen. Joe Manchin, a 50-50 full Senate vote, said he would not support it.
Now congressional Democrats have launched a resuscitation bid to push the bill forward – or at least a few pieces of it – in the law.
Last week, President Biden said the legislation may need to be split into several pieces. “I think we can split the pack, get as much as we can now, and come back and fight for the rest later,” Biden said at a press conference.
But House Speaker Nancy Pelosi stressed that despite the need to scale back some of the original bill’s ambitions, she hopes it will still maintain core elements of the Democratic agenda.
“What the president calls ‘chunks,’ hopefully will be a major piece of legislation in the future. It may be more limited, but it’s still important,” Pelosi said.
Those recovered pieces have yet to be detailed, but lawmakers have suggested they would include some of the health care provisions set out in the original plan. This includes subsidies for insurance premiums as well as the ability for Medicare to negotiate prescription drug prices – the most important aspect of the original drug reform proposal, which drew much scorn from the industry. .
Climate protections also remain a priority, with Manchin expressing optimism that he could potentially support clean energy provisions in the bill. But the scaled-down version could leave out programs that would fund housing or expand Medicare to cover hearing.
“The starting point now is what the Democrats agreed to in November 2021: on Part D, 10 drugs to start, a tax penalty for price increases faster than inflation, a $2,000 cap on elderly or disabled and the insulin payment cap,” noted Terry Haines. , founder of health consultancy Pangea Policy. “Little has changed since then.”
The White House has said it is focused on finding a package that could guarantee the 50 Senate Democratic votes. Meanwhile, House Majority Leader Steny Hoyer said on Tuesday he expected a “meaningful” version of the bill to pass later this year.
“Joe Manchin has indicated that he supports a lot of this legislation,” Hoyer explained. “I am convinced that Build Back Better will pass. It will not pass because we sent it to the Senate, of course. It will be changed, but that is the legislative process.
Jon Bigelow, executive director of the Coalition for Healthcare Communication, agreed that Democrats may still have a chance to sway Manchin toward some provisions — and drug pricing is high on that list.
“Manchin did not object to the drug price cap provisions,” Bigelow noted. “In fact, he came out strongly in favor of Medicare drug price negotiations.”
Industry experts await a new version of Build Back Better — possibly with a new name – to meet well before the looming mid-term elections. Some say it could emerge as early as February.
“Going into the midterms, Democrats desperately need to show they are doing things that make a real, positive difference for average Americans,” Haines said.
“Regulating drug prices is high on Democrats’ BBB wish list because it addresses that need,” he continued. “The drug price action is a rare trifecta politically: the action is hugely popular with the public, it unifies Democrats, and it’s hard for Republicans to criticize effectively.”