The Senate took action to finalize a handful of must-pass items before adjourning in December and ending the first session of the 117th Congress. Most notably, lawmakers raised the debt-ceiling, passed the annual National Defense Authorization Act, and delayed a pending 2% Medicare sequester cut. With moderate and progressive Democrats unable to reach an agreement on the Build Back Better Act (BBB) human infrastructure package, negotiations will carry over to the new year. Congress also passed a Continuing Resolution (CR) keeping federal agencies operating with level-funded until February 18th, 2022, to buy additional time to finalize the FY 2022 appropriations bills.
The House proposed a notable investment in medical research for FY 2022 with a $3.5 billion increase for the discretionary budget for the National Institutes of Health (NIH) and $3 billion to establish the new Advanced Research Projects Agency for Health (ARPA-H). The Senate also proposed substantial FY 2022 investment in NIH and other medical research and public health programs, though not quite at the levels recommended by the House. If lawmakers are unable to reach consensus on the FY 2022 spending bills, Congress may pass a year-long CR that would forgo any funding increases and disrupt ARPA-H implementation and the Department of Defense Congressionally Directed Medical Research Program. At this time, the key negotiating items are balancing non-defense spending with defense spending and addressing policy riders.
The fate of the BBB remains unclear with moderate Democrats, most vocally Joe Manchin (D-WV) and Kirsten Sinema (D-AZ) continuing to voice concerns over social policy, inflation, and the overall price tag of the package. Currently though, the package includes provisions to enhance physician training and the health workforce, cap patient out-of-pocket costs in Medicare Part D, and bolster research, public health, and patient care programs in general. It is unclear which provisions and investments might be on the chopping block when negotiations resume (or if a compromise can be reached).