“Our colleagues are committed to voting for the transformative Build Back Better Act, as currently written, no later than the week of November 15,” Rep. Jayapal said in a statement Friday night, addressing the agreement they had reached before the vote. “All of our colleagues have also committed to voting tonight on the rule to move the Build Back Better Act forward to codify this promise,” she added. They did do that, they passed the rule to move the bill forward, but there’s still this caveat hanging out there that is the CBO.
As a reminder, here’s some of what’s left in the BBB plan, the one those Democrats keep chipping away at. There’s another year’s worth of expanded, monthly Child Tax Credit payments of as much as $300 per child, that program from the COVID-19 relief bill Biden got passed in March that has reduced childhood hunger. The original plan was to make that permanent, then to extend it through 2025, and now mainstream Democrats are fighting to keep one more year of it.
There’s also universal pre-K for three- and four-year-old children. The goal is to provide $400 billion for pre-K and to lower the cost of childcare, holding family spending on it for most families at no more than 7% of income. A third key family program is paid family and medical leave, which has been dropped from up to 12 weeks of paid leave to four weeks and then dropped entirely by the White House. The House, however, put the program back into their bill at four weeks. It’s on thin ice right now.
One big win, though it’s a small provision, is that it will cap the cost of insulin at $35 a month, for insured people, anyway. That’s for everyone with insurance, both Medicare and private insurance. It would take effect immediately. In addition to that, it includes a cap on out-of-pocket prescription drug costs for Medicare enrollees at $2,000/year, with a smoothing proposal that will allow seniors to pay a monthly installment to cover those costs, rather than each time they fill their prescriptions.
It has a number of other health care provisions that will make insurance under the Affordable Care Act even more affordable and, as of now, provide a means for the 2 million people left in the Medicaid gap in states that refused expansion under the ACA to get free or extremely low-cost Obamacare coverage. It would also punish non-expansion states by reducing payments they get in Medicaid Disproportionate Share Hospital payments and federal funding for uncompensated care pools—the two programs that reimburse hospitals and providers for providing care to the uninsured. That theoretically wouldn’t hurt the low-income people or the hospitals in those states, because they would now have private insurance to cover their care. The bill would also provide health coverage for new moms on Medicaid for a full 12 months after giving birth.
It would permanently fund the Children’s Health Insurance Program, and require states to keep children in the program for a full 12 months regardless of fluctuations in household income. Families at this income level often teeter in and out of qualifying for the program. This change would ensure stable coverage for kids, even as their families’ income rises above the income threshold throughout the year.
The $400 billion Biden wanted for home- and community-based care for disabled and elderly people has been cut down to $150 billion, but it’s still in there. It would help keep people who don’t need the level of care that requires they be in a nursing home at home, and it would raise wages for those homecare workers, hopefully growing that workforce and thus shortening the waiting list for these services. There’s also Medicare coverage for hearing care, which is new, but coverage for vision and dental is out, although there’s been talk of making the coverage of all three – mandatory under Medicaid, so low-income seniors would at least have that.
The bulk of the spending in the bill, $550 billion of it, goes to fighting climate change, including tax credits for clean energy production and the manufacture of clean energy technology components. It increases tax credits for the purchase of electric cars and clean technology like solar panels, as well as their manufacture. The original mix of carrots (tax credits and grants) and sticks (fines and penalties for delaying the transition to clean energy production) is pretty much all carrots now. However—and this is fairly big—the House text includes a fee for oil and gas operators per metric ton of released methane. It also includes the sweetener of $775 million in grants, rebates, and loans to oil and gas operators to help reduce and monitor methane emissions.
So, yeah. Big, important stuff that would be very good to have passed before the end of the year. If for no other reason than to make sure that the monthly child tax credit payments don’t dry up. The reality for House Democrats, including the Sabotage Squad, is that the Senate is going to make changes anyway and the CBO score will be subject to those changes. Just getting the damned thing moving, building momentum, and not giving Manchin and Sinema time to derail it on the Senate side is going to be the key to salvaging the plan.