On Thursday, October 28, the White House released an updated framework for the “Build Back Better Act” (H.R. 5376), a scaled-back version of the budget reconciliation legislation originally advanced by several House committees of jurisdiction in September.
The $1.75 trillion social spending package framework includes the creation of a Medicare hearing benefit, an extension of expanded Affordable Care Act (ACA) insurance subsidies, the creation of subsidized insurance plans for individuals residing in states that have not expanded their Medicaid programs, and an expansion of home and community-based care. It would also repeal the Trump Administration’s prescription drug rebate rule, but does not include price negotiation for prescription drugs.
Notably, the revised framework excludes Medicare dental and vision benefits, which were included along with hearing in the original package. The benefits were cut from the White House framework after pushback from some dental groups and amid concerns about the bill’s overall price tag. Still, some Democrats have insisted Medicare coverage for dental and vision services is essential and are looking for ways to work the provisions back into the final bill or create an alternative “pilot program” for expanded dental coverage.
The updated framework provides vital investments in federal research agencies, proposing $100 million in new funding for the National Institutes of Health (NIH), including $75 million to expand research capacity at MSIs and diversify the scientific workforce. Unfortunately, the revised bill does not include investments to establish the president’s proposed Advanced Research Projects Agency for Health (ARPA-H), though separate legislation has been introduced to create the initiative.
Importantly, the legislation would provide a total of $3.5 billion for the National Science Foundation (NSF), including $700 million to fund research and training awards and efforts to increase workforce diversity, well as $700 million for infrastructure and equipment improvements, including at academic research facilities. The bill would also include $1.5 billion for the NSF to establish a new Directorate for Technology, Innovation, and Partnerships.