Two infrastructure bills have significant implications for healthcare and bipartisanship

Congress’ handling of two mammoth bills may well determine the political tone in Washington and whether there will be any room for bipartisanship for the remainder of President Joe Biden’s term.

One of the bills was recently passed by Congress, but the future of the second, much larger bill remains very much in question.

Physical infrastructure

The recently passed bill, which had bipartisan sponsorship, is focused on physical infrastructure, including transportation, water systems, broadband, power grids and other areas. It has no provisions directly pertaining to healthcare. The bill carried a price tag of $1.2 trillion, including $550 billion in new spending, with the remainder, which is baseline spending, subject to regular congressional review.

The Senate passed the bill on Aug. 10 by a wide bipartisan majority vote of 69-30, as 19 Republican senators joined Democrats in supporting the initiative, including Susan Collins (Maine), Lisa Murkowski (Alaska), Rob Portman (Ohio) and Mitt Romney (Utah), but also conservative Senate Minority Leader Mitch McConnell (Ky.). The bill’s passage was widely hailed as a triumph of bipartisanship.

Human infrastructure

The Democrats’ $3.5 trillion human infrastructure spending plan could be a rather different story. It would provide hundreds of billions of dollars for a wide range of progressive priorities, spanning tax credits, climate change, education, housing, healthcare and immigration. Sen. Bernie Sanders (I-Vt.) has described it as “a huge bill .… a complicated bill .… a transformative bill.”^a The health provisions, which progressives consider must-haves, include:

• Enhancing Medicare to cover dental, vision and hearing services
• Expanding home care
• Funding healthcare for the roughly 2 million people living in the red states that have refused to expand Medicaid

Senate Democrats plan to use budget reconciliation, an arcane process that would prevent the Republicans from filibustering and require just 50 votes for passage of the bill, given Vice President Kamala Harris’s tie-breaking role as president of the Senate.

Not surprisingly, Republicans in the Senate are strongly and uniformly opposed to the bill, which means that the Democrats will need to secure the support of every member of their caucus of 50 senators for it to pass. Some moderate Democrats have expressed concerns about the spending plan’s high overall price tag and the potentially large tax increases needed to pay for it. Thus, the fate of the bill probably is in the hands of a handful of moderate Democratic senators, including Sens. Joe Manchin (W.Va.), Kyrsten Sinema (Ariz.), Maggie Hassan (N.H.) and Jon Tester (Mont.).

Possible scenarios

With the passage of the physical infrastructure bill, there are various scenarios with respect to the legislative outcomes for the human infrastructure bill, with significantly different implications for bipartisanship on Capitol Hill.

If the human infrastructure bill passes along party lines, the level of partisan acrimony in Congress would likely rise, poisoning the well of bipartisanship at least for the remainder of this year.

However, if the human infrastructure spending plan is significantly amended or blocked because of moderate Democrats’ concerns, such scenarios could signal to Republicans — especially moderates such as Collins, Murkowski and Romney — that the Democrats recognize they need to be willing to compromise, at least within their caucus and potentially across the aisle. 

Relevance to healthcare

In addition to sucking up all the oxygen in Washington for several months, the fate of the two bills will impact the prospects of much less costly, but still important, common-sense bipartisan healthcare initiatives.

For example, the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759/S. 1362), introduced in the House on April 22 and in the Senate on April 26 with bipartisan sponsorship, would add pharmacists to the list of providers whose patient care services, when delivered in medically underserved areas (MUAs), are covered by Medicare Part B. This change would help to ameliorate the nation’s current shortage of 15,000 primary care physicians and improve access to care for the
44 million Americans living in MUAs.

A potentially big role for moderates

Given the current composition of the Senate, which is split equally between Democrats and Republicans, it is clear that bipartisanship will be required to pass significant legislation, as seen with the physical infrastructure bill. Without some measure of bipartisanship, common-sense bills could stall for the remainder of 2021, resulting in legislative gridlock that will not sit well with most voters. Amid a climate of voter dissatisfaction, moderates from both political parties could succeed in passing less-ambitious bipartisan bills, since most members of Congress want to be able to cite some legislative accomplishments before the 2022 midterm elections. 

Footnote

a. Caitlin, E., et al., “Climate, immigration, Medicare lead progressive highlights in Dems’ $3.5T budget plan,” POLITICO, July 14, 2021.