It started out as a $4 trillion infrastructure package; but nearly a year and a half later, Biden’s Build Back Better initiative is now a $40 billion healthcare bill.

The whittling down of the package was mostly the work of one senator, Democrat Joe Manchin of West Virginia. Manchin has successfully hacked away at the package for 16 months now, and two weeks ago, Manchin made clear that he would not support the clean energy and tax provisions of the package, because he thought they would add to inflation. Manchin did say he would tentatively support the provisions intended to lower prescription drug prices and extend the Affordable Care Act (ACA) exchange subsidies.

President Biden has signaled to Senate Democrats that they should take Manchin’s deal. As for the climate and clean energy provisions of the original Build Back Better, Biden said that he would work through executive action and federal agencies and see what he could do.

So now the package that the Senate hopes to bring to the floor before September will allow Medicare to negotiate lower drug prices, which would be a big win, and will extend the ACA exchange subsidies (expected to expire at the end of this year) for two more years.  

The Congressional Budget Office, or CBO, estimates that if the ACA exchange subsidies are not extended, 2.2 million individuals a year would go without health insurance. On the flip side, the CBO calculated that if the subsidies are extended, the cost to the government would be an increase in the deficit of nearly $250 billion over the course of 10 years.

Talking about the ACA exchange, premiums for the ACA exchanges are expected to go up an average of 10percent in 2023, according to a recent Kaiser Family Foundation survey of insurer filings. Insurers attributed the rise in premiums to increasing medical costs, caused by the growth in the prices themselves, inflation and an expected post-pandemic bump in utilization. A few insurers indicated that if the ACA subsidies are not extended, that too would add to the premium increase.

In other news, the administration has extended the COVID-19 public health emergency (PHE) through Oct. 13. This is the 10th time the PHE has been extended. As we’ve discussed on this show many times, the PHE includes flexibilities on Medicaid eligibility, telehealth and reporting deadlines.

Just so we’re keeping track, the PHE telehealth waivers actually get an additional 151 days—or about five months—after the end of the PHE before they expire. This further extension was meant to give Congress some time to think about whether to keep the waivers.

In an uncharacteristic move, however, Congress looks like it’s not going to wait until the night before to do its homework, and will start working on telehealth early. The House plans to vote on a telehealth bill this week that would extend some of those waivers. We’ll be following that story over the next few weeks.

One last story: If it feels like there’s a lot of healthcare regulations coming down the pike, you’ll be happy to know that the statistics back that feeling up. On the website of the U.S. Office of Management and Budget (OMB), there’s a graph that breaks down all the regulations that are in their final stage of review before being published.

According to the graph, there are currently 32 regulations coming out of the Department of Health and Human Services, HHS. That’s more than the Department of Labor, Justice, Education, Commerce, the Department of Defense, the Department of Energy, and Homeland Security combined.

So, it’s not you, readers. It’s them.

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