The U.S. Senate passed two bills this week with implications for medicine: a bipartisan infrastructure package that extends Medicare sequestration a year as a funding mechanism; and a budget resolution with a $3.5 trillion spending package that would allow for expansion of Medicare vision, dental and hearing benefits.
However, before the Medicare program can be expanded, congressional Democrats will need to pass separate legislation, which is unlikely to see consideration until later this year.
Although the infrastructure package received bipartisan support, the budget resolution passed along party lines by a 50-49 vote.
Adding a new dental, vision and hearing benefit for original Medicare beneficiaries is one of congressional Democrats’ top health care priorities.
Other health care priorities laid out in the budget resolution include:
- Lowering the eligibility age for Medicare
- Making permanent the temporary Affordable Care Act subsidies enacted last year
- Making in-home care available to more people
Democrats face significant challenges finding enough funding to cover all of the health policy priorities that they want to include in the $3.5 trillion spending package, allowing Medicare to negotiate drug prices and related policies that could be used to offset the significant costs.
The $1 trillion bipartisan infrastructure bill has a mixed outlook for physicians and health care providers.
The good news for medicine: Senators agreed on a package that doesn’t take yet-unused money from the COVID-19 Provider Relief Fund to pay for infrastructure projects. Although the bill rescinds more than $200 billion in other unused COVID-19 relief dollars to offset the cost of the infrastructure package, the provider community successfully convinced lawmakers that they should not use the unspent provider funds as our nation once again faces a surge in COVID-19 cases.
The bad news: Senators also agreed to extend the timeline of the longstanding 2% Medicare sequestration cut several more months, through the remainder of fiscal year 2031, to help pay for the infrastructure package. This means providers will be subject to the sequestration cut into the next decade. The infrastructure bill has no effect on the current moratorium on sequestration cuts that lasts through the end of 2021.
The bill does, however, complicate our ongoing efforts to avert the Medicare payment cuts you face in 2022, by taking away a potential funding source for that fix.
Next Steps
House leaders have already announced that they are calling their members back to Washington, D.C., from their summer recess early to take up the budget resolution during the week of Aug. 23.
Once both chambers have approved the resolution, it will unlock a legislative budget process that will allow Senate leaders to pass a final spending bill with just 51 votes in the Senate, rather than the usual 60-vote hurdle. Democrats are pursuing this legislative pathway to pass their $3.5 trillion spending plan because of the strong opposition from Republicans. Some Democrats also have expressed concern with the overall cost of the plan.
The budget resolution includes few details about what will be in the final Democratic spending plan. Instead, it provides broad information that congressional committees will use to draft their portions of the $3.5 trillion spending package. The budget resolution sets a Sept. 15 deadline for committees to complete work on their pieces of the spending package.