Moderate Sen. Joe Manchin, D-West Virginia’s objections to the nearly $2 trillion social spending bill is forcing Democrats to try to pare down major healthcare policies in the package, which could result in dropping key provisions that close the Medicaid coverage gap and increase residency slots.
Manchin announced his opposition to the Build Back Better Act during a television interview Sunday, sending Democrats scrambling to figure out how to move forward on the legislation.
The legislation included major priorities for healthcare aimed at closing the Medicaid coverage gap, drug price reform, extending enhanced subsidies for the Affordable Care Act (ACA) and adding hearing benefits to traditional Medicare.
But Manchin told Fox News Sunday that he can’t support the package due to concerns about inflation and adding to the national debt.
Some lawmakers are hoping to instead go for a more pared-down package.
Senate Finance Committee Chairman Ron Wyden, D-Oregon, issued a statement Sunday that it is “extremely disappointing to have to drop any major priorities.” But he outlined several healthcare policies that could still be addressed.
Chief among them is drug price reform, as the Build Back Better Act that passed the House earlier this month gives Medicare the power to negotiate over prices for a small subset of drugs in Parts B and D. The legislation also caps out-of-pocket drug costs at $2,000 a year and caps insulin costs at $35.
“Fifty million seniors in Medicare have a lot of bargaining power, and it’s long past due to put it to use,” Wyden said.
He also listed priorities of extending ACA tax credits. The American Rescue Plan Act boosted subsidies on the law’s insurance exchanges but only through the 2022 coverage year. Build Back Better would extend the subsidies through 2025.
However, Wyden’s framework drops several major policies that were in the act. Chief among them is to close the Medicaid coverage gap to extend insurance benefits to eligible residents in states that have not expanded Medicaid under the ACA.
The bill would give eligible residents in the coverage gap subsidies to get coverage on the ACA’s exchanges, but only through 2025.
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Wyden’s framework also does not include other healthcare policies, chief among them a major boost in funding for 4,000 additional Medicare-supported graduate medical education (GME) slots.
The senator’s office did not return a request for comment as of press time on whether the GME slots could be included in a pared-down package.
Senate Majority Leader Chuck Schumer has pledged to bring up the legislation for a vote early next year even if it appears likely to fail.
Manchin said Monday on West Virginia MetroNews that he could be in favor of something similar to Build Back Better if it goes through the committee process.
Democrats are using a procedural tool called reconciliation that enables them to pass budget bills through the Senate via a simple majority and avoid a legislative filibuster. But in a 50-50 Senate, with Vice President Kamala Harris being the tiebreaker, Democrats cannot afford to lose Manchin or any other senator.
Healthcare groups, meanwhile, are making their push to ensure that key policies remain in the package.
"The Build Back Better Act would take historic steps toward alleviating the physician shortage, diversifying the physician workforce, improving access to care for people in underserved urban and rural communities, strengthening public health infrastructure, and addressing long-standing health inequities,” said Association of American Medical Colleges (AAMC) President and CEO David Skorton and Chief Public Policy Officer Karen Fisher in a statement.
The AAMC is hoping to preserve the additional GME slots.