Progress on President Biden's human infrastructure bill, called the Build Back Better (BBB) Act, stalled in 2021 after Sen. Joe Manchin (D-W. Va.) said he would not vote for the existing version of the bill. The wide-ranging package contains several health care initiatives, including extending the American Rescue Plan’s (ARP) exchange plan subsidy increases, adding new Medicare benefits, expanding Medicaid coverage in non-expansion states, prescription drug pricing reforms, new investments in home and community-based services, policies to improve equity and strengthen mental health parity, and provisions to bolster the provider workforce.
While Manchin's opposition appears to have killed the current version of BBB, it is possible Democratic leadership will pursue a scaled-down version ahead of Biden's State of the Union address March 1. This means policies that Manchin has raised concerns about, such new Medicare benefits and Medicaid expansion, could be left out. Other policies where Democratic lawmakers have struggled to reach an agreement also could be sidelined or scaled back, such as giving Medicare negotiating authority over prescription drug prices (more on that to come). It's also important to remember any new version of BBB would need to be re-approved by the House.
If a revised BBB leaves out any health policies or Congress ultimately fails to pass a new version, lawmakers also could seek to incorporate individual policies into other legislative packages. For example, the ARPs enhanced exchange subsidies are set to end in 2022, and if Congress does not act to extend that funding as part of BBB, lawmakers likely will face pressure to do so by the end of the year.