What’s still in the Dem megabill? Cheat sheet on 12 big topics
Tax hikes
— What they wanted: Democrats planned to raise almost $600 billion to help pay for their social spending plan by hiking taxes on corporations and the nation’s highest-earning individuals. Even Manchin, who has snubbed so much of his party’s proposal, is on board with increasing the corporate and highest individual tax rates.
— Where they’re headed: Sinema opposes those hikes, spelling doom for rate increases, but she’s open to raising tax revenue in other ways. So Democrats are trying to build support for more complicated and potentially controversial tax changes, like a yearly tax on the unrealized gains of the wealthy, a corporate minimum tax, and a proposal to crack down on tax cheats by forcing banks and credit unions to give more account information to the IRS.
Wyden, the Senate’s top tax writer, plans to unveil a plan this week that would require people who have more than $1 billion in wealth or earn more than $100 million for three consecutive years to pay taxes on assets they hold, even if they don’t sell them.
Lowering prescription costs
— What they wanted: The bill House Democrats crafted would empower Medicare to bargain down the cost of hundreds of drugs and make those lower prices available to people on private insurance. It included hefty penalties to compel pharmaceutical companies to comply and pegged prices to those paid by other developed nations that have long bargained the cost of medicines.
Democrats said the policy would fulfill their campaign-trail promises to tackle health costs and raise upwards of $700 billion.
— Where they’re headed: Democrats have been at an impasse for weeks as a small handful of House and Senate centrists continue to push back on the planned sweeping system for negotiating drug prices. Now lawmakers acknowledge they will end up with a far narrower drug pricing bill, if they can secure one at all.
Fallback plans include negotiating a smaller set of drugs under Medicare Part B, which covers drugs people usually wouldn’t self-administer, like vaccines and IV fluids. Lawmakers are considering leaving out drugs covered under Medicare Part D, which covers other prescriptions. They are also mulling negotiation only for the cost of drugs with expired patents and setting prices based on a U.S. standard, rather than an international baseline.
Other options for scaling back the plan include applying the lower prices in Medicare and not private insurance plans, or phasing in the changes more slowly to give corporations time to adjust.
Child care
— What they wanted: Democrats laid out $450 billion for universal Pre-K and a separate, multibillion-dollar program to bolster the child care industry and make it more affordable for parents.
Party leaders dreamed of giving states money over three years to expand child care options and subsidize care for families. In the fourth year, the plan would help build out an entitlement program to cover child care costs, with states shouldering 10 percent and the federal government paying 90 percent.
The proposal is among the most popular in the bill. Nearly 8 in 10 voters said in a September poll that they support it.
— Where they’re headed: Lawmakers were already considering changes in hopes of bringing down the program’s multibillion-dollar price tag. Then business lobby opposition rose this week, spurred by an unlikely critic: a left-leaning think tank.
An analysis by the People’s Policy Project predicted that the plan could jack up child care prices by more than $13,000 a year for families making more than their state’s median income, which ranges from about $45,000 in some states to $85,000 in others.
Democrats are still considering an expiration date for the program. Child care advocates warn, however, that an end date might discourage states from participating and stop short of the investment needed to remedy the nation’s child care shortage.
Clean energy
— What they wanted: Biden campaigned on a plan to transition the United States to clean power production, while creating “good-paying” jobs and weaning the nation off fossil fuels. He called for a long-term extension of key tax credits that boost clean energy, plus a clean electricity standard to cut down on emissions from the power sector.
— Where they’re headed: Manchin’s opposition has all but killed the clean electricity program Democrats envisioned to penalize utilities that don’t increase their use of renewables and pay those that do.
Lawmakers are now looking at a host of other options to cut emissions, including grants to encourage states to ratchet up clean energy resources, as well as expanded tax credits for clean energy.
Health insurance credits
— What they wanted: Democrats originally aimed to pack nearly all of their health care agenda into the bill, aware that they may not have another chance to enact such sweeping changes for years, if not decades. Party leaders made plans for a permanent extension of beefed-up Obamacare subsidies that are set to expire in 2022, keeping tax credits flowing to help people cover the cost of their health insurance premiums.
— Where they’re headed: Pressure to cut the overall package’s cost split Democrats into two opposing camps, with Pelosi and moderates insisting they choose among their health care priorities and do fewer programs permanently, while progressives and the White House pushed for short-term continuation of all the programs. So far the White House has won, and Democrats are now weighing just three or four years of Obamacare subsidies.
Medicaid in red states
— What they wanted: Top Democrats hoped to permanently provide Medicaid to roughly 2 million people stuck in the safety net’s “gap” in a dozen Republican-run states that have refused to expand coverage to low-income residents under Obamacare. Proposals in both the House and Senate would have created a new federal program for people in those holdout states, and provided free Obamacare plans to that population in the years it would take to set up the program.
Sen. Raphael Warnock (D-Ga.) and other vulnerable red-state Democrats have championed those plans and are expected to campaign on the issue next year.
— Where they’re headed: Instead of closing the Medicaid gap for good, the majority party is now eyeing a three-year expansion to cover people left out in those red states.
Short-term extensions of all of the health care benefits are giving Democrats agita, particularly the prospect that Republicans will win the House in 2022 and refuse to act when the help expires.
“We’ve all seen the ongoing attacks from Republicans on the Affordable Care Act and the uncertainty that has caused,” said Rep. Suzan DelBene (D-Wash.), who leads the moderate New Democrats caucus. “So to the people who say things will automatically get renewed: That’s not a safe assumption.”
Housing aid
— What they wanted: House Democrats signed off last month on more than $300 billion in housing aid. That included $80 billion for public housing repairs and $75 billion for housing vouchers that help low-income families, older Americans and people with disabilities pay rent for housing on the private market, rather than in public housing units.
— Where they’re headed: Democrats are considering cutting housing funding to $175 billion. They’re driving down the initial figure by trimming investments in programs like grants for community development projects and helping states provide affordable housing to low-income residents.
In-home care
— What they wanted: Biden called for a $400 billion boost to home care services for older people and those with disabilities. That money would shrink the more than 800,000-person list of those waiting for home-care support and raise wages for the industry’s workers, who are overwhelmingly women of color.
— Where they’re headed: House Democrats have approved less than half of the funding Biden wanted for at-home care, and that number could go even lower.
Sen. Bob Casey (D-Pa.), who is leading the effort in the Senate, has said Democrats are also still negotiating how long the expansion would last.
Bernie Becker, Michael Stratford, Eleanor Mueller, Kelsey Tamborrino and Katy O’Donnell contributed to this report.
