Here are the policies and reforms that could reshape health care in the $ 2T bill just passed by the House

The House has passed a massive approximately $ 2 trillion infrastructure package that will give Medicare the power to closely negotiate the prices of certain prescription drugs and close the Medicaid coverage gap.

The package, called the Build Back Better Act, rolled out of the House Thursday night with a vote of 220 to 213. It is now heading to the Senate, where it could face further changes.

Here are the biggest health items included in the package:

  • Closing the Medicaid Coverage Gap. The legislation would provide enhanced grants so that eligible residents in states that have not extended Medicaid under the Affordable Care Act can purchase coverage on the exchanges. The enhanced grants, which would apply to residents of the 12 non-expanding states, would only apply until 2025, but would apply to more than 2 million people, according to data from the Kaiser Family Foundation.
  • Propose several drug price reforms. A controversial part of the negotiations around the Build Back Better Act was how to reduce drug prices. After objections from centrists in the House and Senate, the final package would select a small amount of drugs in Medicare Parts B and D, which would allow Medicare to negotiate lower prices. The legislation would also create an annual cap of $ 2,000 on out-of-pocket expenses for the elderly in Part D and prevent drug companies from raising prices above the cost of inflation. It would also cap insulin costs at $ 25.
  • Extension of Medicare benefits to cover hearing aids. Democrats initially hoped to expand traditional Medicare benefits to cover dental, vision and hearing benefits. However, the cost of the package was originally offered at $ 3.5 trillion and reduced to $ 1.75 trillion after centrist concerns. From now on, the flat rate would cover hearing services.
  • Expand Medicare-Supported Graduate Physician (GME) Medical Education Opportunities. The legislation gives a major boost to Medicare-backed GME, increasing the number of slots for physician training by 4,000. The boost comes on top of an increase of 1,000 locations in a spending bill passed late last year. Advocates say the boost can help avert a looming shortage of doctors. The legislation would also require some of the slots to be reserved for doctors who can treat rural or underserved areas.

The passage of the legislation was welcomed by some provider groups, but others were concerned about the inclusion of reductions in Disproportionate Hospital Payments (DSH) that help facilities cover unpaid care.

The reductions only apply to hospitals in states that have not extended Medicaid. The idea behind the reductions is that higher DSH payments will not be required due to the extension of coverage.

Hospital groups, however, have criticized the cuts as shortsighted.

“These cuts are unacceptable, especially since hospitals remain on the front lines in the fight against COVID-19 and the deadly Delta variant,” said Rick Pollack, president and CEO of the American Hospital Association, in a statement. communicated.


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