President Joe Biden has admitted that Congress may not pass his roughly $2 trillion social spending bill by Christmas, leaving in flux several major healthcare policies that include boosted Affordable Care Act (ACA) subsidies.
Biden said during a statement Thursday that the administration is continuing discussions with moderate Sen. Joe Manchin, D-West Virginia, who has objected to the size and scope of the package.
“It takes time to finalize these agreements, prepare the legislative changes and finish all the parliamentary and procedural steps needed to enable a Senate vote,” Biden said. “We will advance this work together over the days and weeks ahead.”
Democrats are seeking to pass the Build Back Better Act via a procedural tool called reconciliation that enables budgetary legislation to get through the Senate via a simple majority and avoid a legislative filibuster.
However, the Senate parliamentarian must review every provision of the legislation to ensure it meets reconciliation rules.
Biden said the package is desperately needed to “lower the cost of prescription drugs, healthcare, childcare and elder care.”
The legislation would extend through 2025 enhanced subsidies for the ACA’s insurance exchanges. The American Rescue Plan Act had boosted the subsidies but only through the 2022 coverage year.
The bill also seeks to close the Medicaid coverage gap and give ACA subsidies for eligible people in nonexpansion states.
Other provisions would tackle high drug prices, including setting a $2,000 annual out-of-pocket cap for Medicare Part D drug costs. Medicare would also get the power to negotiate a narrow subset of drugs in Parts B and D, a provision the drug industry has fervently opposed.
Physician advocacy groups have also lauded the expansion of Medicare-supported graduate medical education slots by 4,000. Groups say the boost can help avoid a looming shortage of physicians, and some of the slots are expected to go to rural and underserved areas.