Dems seek to save competing health priorities in potentially pared down $3.5T infrastructure bill

Capitol building in Washington
Moderate Democrats want to slim down a $3.5 trillion infrastructure package, causing consternation among Democrats on which healthcare priorities to keep. (Photo by rarrarorro/iStock/Getty Images Plus/Getty Images)

With moderate Democrats seeking to pare down a major $3.5 trillion infrastructure package, lawmakers and advocates are looking to ensure priorities on maternal and home health and closing the Medicaid coverage gap don’t get cut.

Democratic lawmakers made their case Thursday to preserve $1 billion in maternal health care funding and to close the Medicaid coverage gap in states that have not expanded under the Affordable Care Act (ACA).

“The caucus understands the importance of healthcare,” said Sen. Raphael Warnock, D-Georgia, during a press conference Thursday highlighting legislation on the Medicaid coverage gap. “We believe healthcare is a human right, and I am encouraged by the conversations happening to make sure at the end of the day this is still in the package.”

Warnock has been pushing legislation that creates a program resembling Medicaid’s benefits allowing people who are in states that have not expanded Medicaid under the ACA to sign up for coverage.

Sen. Elizabeth Warren, D-Massachusetts, didn’t say whether the legislation is in danger of being cut from the reconciliation, only that “we are trying to move this thing in the same direction.”

The remarks come as moderate Democrats have balked at the $3.5 trillion price tag for the infrastructure package. Democratic leadership can hardly afford any defections in the House and none in the Senate where they hold a slim 50-50 majority with Vice President Kamala Harris serving as a tiebreaker.

Sen. Joe Manchin, D-West Virginia, wrote in an op-ed in The Wall Street Journal back in September that he couldn’t support the $3.5 trillion figure.

“Instead of rushing to spend trillions on new government programs and additional stimulus funding, Congress should hit a strategic pause on the budget-reconciliation legislation,” he wrote.

Manchin has so far not endorsed a figure that would be more amenable to him, but Democrats can’t afford any defection in the Senate.

Democrats are using a procedural move called reconciliation that enables budget legislation to pass the Senate via a simple majority and avoid a legislative filibuster. The package is likely to garner no support from Republicans.

RELATED: Moderates balk at Medicare drug price negotiation authority pursued by Dems in $3.5T package

The House Energy and Commerce Committee did include legislation to address the coverage gap as part of a markup last week of its provisions in the $3.5 trillion package. The legislation establishes starting in 2025 a federal Medicaid program for the dozen states that have not expanded Medicaid. Residents in those states who are eligible for coverage under the expansion would be able to use the program to get the same benefits as they would in Medicaid.

Meanwhile, Democrats are hoping a slew of bills aimed at improving maternal health will remain in the package in part because they have such a low price tag of $1 billion.

“What we have talked about is not a lot of money in the overall bill,” said Rep. Frank Pallone, D-New Jersey, chairman of Energy and  Commerce, in a press conference Thursday on the maternal health package. “There isn’t any reason to cut back on any of this because it is not a huge amount of money.”

Energy and Commerce passed as part of its legislative markup last week $1 billion in new grants to help expand training to grow the doula and perinatal nursing workforce and grants for new research into how to mitigate the effects of COVID-19 on pregnant and postpartum individuals, amid other funding opportunities.

Energy and Commerce also passed in the markup legislation to expand Medicaid coverage to a year for postpartum individuals.

Lawmakers said the policies are vital to addressing major problems in the maternal health workforce. “We can’t worry about the cost of the legislation because the cost of inaction is too high,” said Rep. Gwen Moore, D-Wisconsin, during the press conference.

Sen. Cory Booker, D-New Jersey, said at the conference that he was part of a larger meeting among moderate and progressive Democrats with President Joe Biden at the White House.

Biden’s reaction was that maternal health was “an enthusiastic priority for him and his team as well,” Booker said.

Efforts to also expand the availability of home care and community-based services got a big boost from Senate Majority Leader Chuck Schumer. Schumer told attendees at a rally held by the Service Employees International Union Thursday that he is committed “to making sure our reconciliation bill delivers these goals.”