The Build Back Better Act (BBBA) was adopted by the House of Representatives in November of 2021. The total package includes $1.7 trillion in spending for everything from healthcare to climate change.

There are 11 major healthcare provisions in BBBA, which may be modified as it moves through the Senate. Chiefly, the bill seeks to lower prescription drug costs and extend Affordable Care Act tax credits. Also included in the bill:

• The expansion of Medicare benefits
• Medicare Part D redesign
• Medicaid coverage gap
• Maternity and postpartum care and coverage

How Payors and Organizations Feel about the BBBA

The Blue Cross Blue Shield Association was pleased at the BBBA passage in the House, saying that the extension of the Affordable Care Act’s tax credits will save families thousands on health care premiums.

The American Health Insurance Plans stated it supported legislations that expand more affordable health care coverage, but raised concerns about any proposal that would increase premiums or reduce benefits.

The American Benefits Council expressed support for prescription drug pricing reform, but expressed concern about proposals that shift the cost of these drugs to employers. The Council also expressed issues with the BBBA’s provision that penalizes employers for not complying with mental health parity laws.

The American Hospital Association expressed its support for expanding coverage to Americans who need it, but asserted it should not come at the expense of funding to hospitals. The BBBA would cut federal funding to some hospitals that treat many uninsured or low-income patients.

On Nov. 3, several members of Congress wrote a letter to House Speaker Nancy Pelosi and Senate Majority Leader Charles Schumer asking that the provision reducing the Medicaid Disproportionate Share Hospital (DSH) allotment by 12.5% be removed from the BBBA.

“Reducing federal funds to hospitals and providers can be detrimental to their survival, and in the midst of a global pandemic, we should not be imposing additional financial constraints. It is critical that we do everything we can to support our providers and ensure they are able to provide the best care to patients across this country. A reduction in DSH could jeopardize their ability to provide such care,” they wrote.

The Senate on December 13th removed the updated text of the bill to remove the $8 billion in cuts to facilities in states that don’t expand Medicaid. The text could undergo more changes before the upcoming floor vote. With West Virginia Senator Joe Manchin’s recent spike of the bill, Democrats are still trying to reach a compromise on this piece of legislation.