KHN’s ‘What the Health?’: The big Biden budget bill passes the House

Reviewed by Emily Henderson, B.Sc.Nov 23 2021

President Joe Biden's "Build Back Better" social spending bill passed the House last week, but the legislation faces a new and different set of hurdles in the Senate, where it will need the support of every single Democrat, plus approval by the Senate parliamentarian.

Meanwhile, covid-19 is surging again in Europe as well as in many parts of the United States, just as travel picks up for the holidays. And the Supreme Court prepares to hear oral arguments in an abortion case out of Mississippi that could lead to the weakening or overturning of Roe v. Wade — and could upend the political landscape in the U.S.

This week's panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN.

Among the takeaways from this week's episode:

• There are roadblocks ahead in the Senate for the social spending plan. Some moderate Democrats may want to make changes, and parts of the bill could be challenged under tight Senate rules that require bills being passed using the budget reconciliation procedures — which prohibit filibustering — to show that the provisions have an effect on the budget.
• Among the health provisions that could be affected are paid family leave and the restrictions on drug price increases for plans outside of the Medicare program.
• As the bill passed by the House gets scrutinized, some of the smaller provisions that may not have garnered attention initially are now targets of debate and industry lobbying. Among them: a decision to tax vaping products, which some opponents suggest will lead users to continue to use cigarettes instead. Another is a mandate for nursing homes to have registered nurses in place 24/7, even though industry officials say they can't recruit enough staff, which might lead some homes to close.
• If Congress does approve the bill, it's good to remember that passage is not the final word. Industry and advocates will continue to lobby the administration on regulations to implement the legislation, and those who are distressed by the law could take their grievances to court.
• With the decision last week by the Food and Drug Administration and the Centers for Disease Control and Prevention to authorize covid vaccine boosters for all adults, public health messaging on the shots has shifted. While officials were much more nuanced when boosters first became available, they are now pushing hard for everyone to get the extra doses.
• Public attitudes about covid also appear to be shifting, perhaps a result of pandemic fatigue. Where once Americans looked to vaccines to release them from the drudgeries of avoiding covid, many now acknowledge the virus will be around for a long time and are struggling to figure out how to return to a more normal life.

Also this week, Rovner interviews Mary Ziegler of the Florida State University College of Law about the Supreme Court's upcoming oral arguments in the Mississippi abortion case.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Wall Street Journal's "Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say," by Stephanie Armour and Robbie Whelan.

Margot Sanger-Katz: The New York Times' "Everything in the House Democrats' Budget Bill," by Alicia Parlapiano and Quoctrung Bui.

Joanne Kenen: Politico's "VA Stats Show Devastating Covid Toll at Vets' Nursing Homes," by Joanne Kenen, Darius Tahir and Allan James Vestal.

Mary Agnes Carey: KHN's "A Covid Head-Scratcher: Why Lice Lurk Despite Physical Distancing," by Rae Ellen Bichell.

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