The Build Back Better plan, President Biden’s $1.75 trillion social spending package, has been on a rollercoaster ride. In November, Democrats reached a deal to include the most significant drug pricing reform in decades in the bill. By the end of December, the bill was deemed “mostly dead” after Senator Joe Manchin, an integral vote in the 50-50 Senate, said he wouldn’t support it.
Now, congressional Democrats have started a resuscitation attempt to push the bill — or at least a few chunks of it — into law.
Last week, President Biden said the legislation might need to be broken up into pieces. “I think we can break the package up, 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 emphasized that despite the need to scale down some of the original bill’s ambitions, she hopes it will still maintain the core parts of the Democrat agenda.
“What the president calls ‘chunks,’ I would hope would be a major bill going forward. It may be more limited, but it is still significant,” Pelosi said.
Those salvaged pieces haven’t been detailed yet, but lawmakers suggested they will include some of the healthcare provisions laid out in the original plan. That includes subsidies for insurance premiums as well as allowing Medicare to negotiate prescription drug prices — the most significant aspect of the original drug reform proposal, which has elicited plenty of industry scorn.
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 Democrats agreed to in November 2021: On Part D, 10 drugs to start, tax penalty for price increases faster than inflation, $2,000 cap for seniors or those with disabilities and the insulin pay cap,” noted Terry Haines, founder of healthcare consultancy Pangaea Policy. “Not a lot has changed since then.”
The White House has said it is focused on pursuing a package that can secure all 50 Senate Democratic votes. Meanwhile, House Majority Leader Steny Hoyer said on Tuesday that he expected a “significant” version of the bill to pass later this year.
“Joe Manchin has indicated he’s supportive of much of this legislation,” Hoyer explained. “I’m of the belief that Build Back Better is going to pass. It won’t pass as we sent it to the Senate, obviously. It will be changed, but that’s 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 certain provisions — and drug pricing sits near the top of that list.
“Manchin has not objected to the provisions limiting drug prices,” Bigelow noted. “In fact, he has spoken out strongly in favor of Medicare negotiations on drug prices.”
Industry experts expect a new version of Build Back Better — possibly with a new name — to come together well before the looming midterm elections. Some say it may emerge as early as February.
“Going into the midterms, Democrats desperately need to show they’re doing things that make a real, positive difference for average Americans,” Haines said.
“Drug pricing regulation is at the top of Democrats’ BBB wish list because it fills that need,” he continued. “Drug pricing action is a rare trifecta politically: Action is very popular with the public, it unifies Democrats and it’s difficult for Republicans to criticize effectively.”