President Joe Biden endorsed splitting up large parts of his $1.75 trillion Build Back Better Act to pass separately after centrist concerns doomed passing the package overall late last year.
The president and key congressional leaders were open to the piecemeal approach this week, but it remains unclear what parts of the massive package will advance. The package passed the House late last year and included massive healthcare items including extending enhanced Affordable Care Act exchange subsidies and closing the Medicaid coverage gap.
“I am confident we can get pieces, big chunks of the build back better law signed into law,” Biden said during a press conference Wednesday marking the one-year anniversary of his presidency.
Centrist Sen. Joe Manchin, D-West Virginia, said late last year that he could not support the full package due to concerns over inflation and government spending.
The remarks were a major setback for Democrats hoping to approve the package at the tail end of 2021. But Democrats are now hoping to regroup and pass the legislation in separate pieces.
House Majority Leader Steny Hoyer, D-Maryland, conceded the legislation it passed last year likely won’t get through the Senate, which is split 50-50 with Vice President Kamala Harris the tie-breaking vote.
“I think obviously there are some things in the bill that we pass that apparently can’t pass the Senate,” he told reporters Wednesday. “I am hopeful we can pass Build Back Better in a form that the Senate will adopt or can adopt.”
He added that Democrats can pass the package but “not necessarily in a form that sent it over there but in a form that will make an extraordinary difference to the American people.”
The legislation would have a huge impact on the healthcare industry, especially as it calls for major reforms to drug prices that include giving Medicare the power to negotiate with drugmakers for prices for a small subset of Part B and D drugs. Other reforms include a cap on out-of-pocket drug costs and a $35 out-of-pocket cap for insulin costs.
It remains unclear which healthcare provisions would survive through Congress in this piecemeal approach. Biden said there is strong support for the energy and environment provisions in the bill but declined to specify what could drop off.
“I am not going to negotiate against myself on what should and shouldn’t be in it,” he said.