Several Senate committees — including the Senate Finance Committee, the Senate Health, Education, Labor, and Pensions (HELP) Committee, the Senate Veterans’ Affairs Committee, and the Senate Commerce, Science, and Transportation Committee — each released revised text of the Build Back Better Act on Dec. 11.
Many provisions impacting academic medicine in the House-passed bill remain in the Senate version, including the 4,000 new Medicare graduate medical education (GME) slots and the Pathway to Practice Training Program, both supported by the AAMC [refer to Washington Highlights, Nov. 19].
In addition, the Senate legislation maintains funding for medical school infrastructure, the Teaching Health Centers GME program, Department of Veterans Affairs health residencies, the National Health Service Corps, maternal health, National Science Foundation research and infrastructure, community violence interventions, public health infrastructure, and research infrastructure at historically Black colleges and universities.
The Senate Finance Committee text no longer includes a provision that would reduce the Medicaid disproportionate share hospital allotments for nonexpansion states by 12.5%
However, the legislation maintains a potentially concerning provision that would reduce uncompensated care pools for nonexpansion states for pools authorized under Section 1115 waivers by October 2022.
The legislation may also undergo further revisions as the Senate parliamentarian determines if all provisions are germane for the budget reconciliation process. On Dec. 16, the parliamentarian ruled that the expanded parole provision for immigrants who are living in the United States without authorization must be stripped from the legislation.
Leading Senate Democrats and President Biden announced on Dec. 16 that negotiations and preparation of the Build Back Better Act text will continue in the coming weeks before the bill will be considered on the Senate floor in early January 2022.