HEALTH CARE BRIEFING: Biden Budget to Sidestep Build Back Better

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President Joe Biden will broadly endorse the climate, social safety net and tax-code changes the White House has pursued as part of his “Build Back Better” agenda in his budget proposal Monday, but he won’t specify the costs or revenues in a bid to avoid disrupting congressional negotiations.

Instead, the fiscal 2023 budget document will include a placeholder known as a “deficit-neutral reserve fund,” signaling Biden’s commitment to sweeping policy changes without spelling out the costs and benefits.

As a result, Biden’s budget tables won’t include the prices of proposals such as universal free pre-school, an expanded Child Tax Credit, and funding to combat climate change, and also won’t assume deficit reductions from policies such as prescription-drug reforms or tax increases on corporations and wealthy Americans. The document will simply treat the agenda — which Biden has pledged would be fully paid for — as being deficit-neutral.

  • The proposal will be vetted for how it incorporates the biggest consumer-price surge in four decades, and what Biden proposes spending on his so-called “Unity Agenda.” That package, unveiled in the State of the Union address and designed to garner support from both sides of the aisle, would see billions of dollars for veterans, mental health, cancer research and fighting the opioid epidemic. Read more from Justin Sink, Laura Davison and Erik Wasson.

In leaving out the details of “Build Back Better,” Biden’s goal is to avoid upsetting delicate congressional negotiations, according to three people familiar with the strategy who asked not to be identified discussing the budget ahead of its release. The White House believes the approach will preserve maximum flexibility and avoid the budget release spoiling talks during a critical legislative window.

Senator Joe Manchin (D-W.Va.) sunk Build Back Better by declaring in December that he wouldn’t vote for the plan as it stood. Had the White House fully integrated “Build Back Better” into its budget, it would risk alienating Manchin. Read more from Justin Sink.

  • Manchin has told climate activists and clean-energy executives that he is interested in restarting negotiations on a slimmed-down version of the Build Back Better Act that would focus on climate change, prescription-drug prices, and deficit reduction, according to a person familiar with the matter. Legislation along the lines that Manchin has outlined could have some room for Affordable Care Act subsidies or other heath measures, depending on the size of the tax increases and deficit cuts. Read more from Ari Natter and Erik Wasson.

Biden’s HHS Budget: Cabinet and agency chiefs are scheduled to begin testifying on Biden’s fiscal 2023 budget request this week, including Health and Human Services Secretary Xavier Becerra to the House Appropriations Labor-HHS-Education Subcommittee Thursday.

  • Biden’s Fiscal Year 2023 Budget Proposal — BGOV Webinar: In a March 30 webinar, Bloomberg Government’s expert analysts lead a deep dive review of and provide insights on Biden’s budget proposal for fiscal year 2023, and answer your questions on the administration’s top priorities. Topics include topline agency funding levels, new spending initiatives and revenue proposals, and next steps in the budget process. Register here.

Happening on the Hill

House to Consider Marijuana Bill, Looks Ahead to Covid Funding: The House Rules Committee is scheduled to meet Wednesday on a bill (H.R. 3617) to decriminalize cannabis, impose a tax on cannabis products, and provide assistance to cannabis businesses. That will set up a floor vote on the legislation sometime this week. Read more in the BGOV Bill Summary: H.R. 3617, Decriminalize & Tax Marijuana.

Majority Leader Steny Hoyer (D-Md.), in a letter outlining plans for the work period through April 8, said he’s looking to act the week of April 4 on a supplemental spending measure for Covid-19 needs “as soon as the Senate sends us a bill.” Hoyer said the chamber also will take up H.R. 1916, which would require insurers to cover corrective vision and dental treatments to individuals born with congenital abnormalities or birth defects.

More legislation scheduled for House consideration this week:

Fourth Covid Shot Projected to Cost Up to $9.4 Billion for Biden: The Biden administration would need to secure as much as $9.4 billion more in funding to offer enough second round Covid-19 boosters to all eligible Americans, if those shots are deemed necessary, according to new estimates published Friday. The Kaiser Family Foundation’s analysis quantifies what the U.S. government would have to spend should top health officials determine that fourth shots are needed for even a segment of the U.S. population. Biden has ramped up warnings of limited funding for future vaccine doses, pushing Democrats on Capitol Hill to negotiate with Republicans on a potential new Covid-19 relief bill. Read more from Celine Castronuovo.

  • The FDA is poised to clear a fourth dose of the mRNA coronavirus vaccine for adults age 50 and older, looking to shore up protections for more vulnerable groups, a person familiar with the matter said. The authorization could come as early as the week ahead and, for most Americans, it would mean a second booster shot of either the Pfizer-BioNTech or Moderna vaccines. Currently, only immunocompromised people are eligible in the U.S. for the additional dose. Read more from Josh Wingrove and Ella Ceron.

Democrats Urge Biden on ACA Family Provision: Thirty-nine House Democrats, led by Reps. Susan Wild (D-Pa.) and Abigail Spanberger (D-Va.), sent a letter to Biden asking him to tweak Obamacare’s family provision by regulation. The often called “family glitch” is a long-time policy issue that makes whole families ineligible for premium assistance on the Affordable Care Act’s marketplaces if one member is eligible for a certain types of employer-sponsored coverage for themselves alone. This issue means millions of people on the ACA marketplace face higher costs. Wild introduced legislation in the 116th Congress to address the issue, but it was never enacted. Full text of the letter can be found here.

Universal Health Coverage: The House Oversight and Reform Committee meets for a hearing Tuesday on ways to implement universal health coverage.

The Coronavirus Pandemic

Supreme Court Says Navy Can Curb Deployment for Unvaccinated: A divided U.S. Supreme Court said the Navy can limit deployment and training for 35 Seals and other special operations forces who are refusing on religious grounds to get vaccinated against Covid-19. Granting a Biden administration request over three dissents, the justices partly blocked a federal judge’s order that required the Navy to assign and deploy the sailors without regard to their unvaccinated status. The order will apply while litigation over the Navy’s vaccine mandate goes forward. In a concurring opinion that accompanied the one-paragraph order, Justice Brett Kavanaugh pointed to the “bedrock constitutional principle” that the president is commander in chief of the military. Read more from Greg Stohr.

What Else to Know

South Dakota Abortion Consulting Rule is Coercive, Doctors Say: A South Dakota law requiring people seeking abortions to consult crisis pregnancy centers before undergoing a procedure is unlawful, multiple national doctors’ groups told the Eighth Circuit. The American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Medical Association joined other professional associations in calling on the U.S. Court of Appeals for the Eighth Circuit to uphold a lower court’s order blocking South Dakota’s “Pregnancy Help Center Mandate.” Read more from Mary Anne Pazanowski.

Hospitals’ Challenge to Medicare Payment Formula Tossed by Court: A challenge by two hospitals over how Medicare calculates reimbursements was properly dismissed by an administrative appeal board, a federal district court ruled. The lawsuit, filed by two Indiana hospitals, concerned the way the Centers for Medicare & Medicaid Services adjusted reimbursements to provide additional support to hospitals that treat a large number of patients who are uninsured or on Medicaid. Read more from Christopher Brown.

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With assistance from Alex Ruoff

To contact the reporter on this story: Michaela Ross in Washington at

To contact the editor responsible for this story: Giuseppe Macri at

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