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On October 28, the House Rules Committee unveiled draft text for the Build Back Better Act (H.R. 5376), following President Joe Biden's release of a proposed framework for the Democratic compromise package. The scaled-back reconciliation package includes a temporary extension of the expanded Affordable Care Act (ACA) tax credits advanced under the American Rescue Plan Act (ARPA) and tax credits to help those in the so-called Medicaid gap purchase exchange plans; a new Medicare hearing benefit; $150 billion for home and community-based services; one-year continuous eligibility requirements for children and postpartum women; permanent extension of the Children's Health Insurance Program (CHIP); a repeal of the Trump administration's drug rebate rule; and a slew of other health care provisions aimed at bolstering the public health workforce, making investments in health care infrastructure, and providing access to high-quality care.

House Democrats are pushing to get the package finalized and voted on this week, along with the Senate-passed bipartisan infrastructure package that has been held up by House progressives during negotiations on the larger spending package. To meet that tight timeline, Democrats worked over the weekend to reach agreement on whether to add progressive priorities including modified drug pricing provisions and paid leave, although the drug pricing provisions appear to have more momentum.

As it stands, the framework leaves out progressive Democrats' key request to add Medicare dental and vision benefits, to give Medicare power to negotiate drug prices, and to provide paid family and medical leave, among other non-health items. Influential moderate Senator Joe Manchin (D-WV) opposed the family leave provisions as well as expansion of Medicare benefits, but the draft package as it now stands seems adequate: "We negotiated a good number that we worked off of, and we're all dealing in a good faith," Manchin told reporters. The bill needs all 50 Democratic senators to pass, and the party had to make cuts to satisfy moderate Democrats, specifically Manchin and Senator Kyrsten Sinema (D-AZ).

House Energy & Commerce Chair Frank Pallone (D-NJ) told reporters he is still trying to get drug pricing provisions into the bill and Senate Finance Committee Chair Ron Wyden (D-OR) said "we're staying at it" and that it was "too important" to exclude. Sen. Sinema, who has been viewed as one of the biggest obstacles to passing Medicare negotiation, has sought to limit negotiations to Part B physician-administered drugs that aren't under patent protections, which reflects a bill proposed by moderate House Democrat Scott Peters (D-CA); however, Wyden and others want to include Part D — the prescription drug benefit — because "that's where seniors live and they see it in line at the pharmacy counter." It remains to be seen if lawmakers can reach a deal to satisfy both Sinema and the many Democrats who want to go further on drug price negotiation.

• For more information: Build Back Better Act (H.R. 5376) draft text; President Biden's Build Back Better framework overview, fact sheet, and microsite.

Additional information is available in the attached Tax Alert.

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Health care provisions in BBB Act