The House of Representatives passed President Biden’s landmark Build Back Better plan this morning — a victory achieved by Democrats to benefit American seniors.  The House-enacted legislation represents the biggest expansion of the social safety net for older Americans and their families in five decades.  It expands Medicare benefits, lowers prescription drug prices, and adds billions of new dollars for seniors to receive care in their homes and communities — improvements supported by majorities of Americans across party lines.

At a press conference shortly after the vote to pass the Build Back Better plan, House Speaker Nancy Pelosi characterized the bill as “historic” and “transformative.” Seniors’ advocates heartily agree.  The National Committee to Preserve Social Security and Medicare lauded the House majority:

During a season focused on gratitude, American seniors should be thankful to House Democrats for passing President Biden’s Build Back Better plan. Not a single Republican voted for this landmark legislation to lift-up American seniors and families. It is now up to Senate Democrats to get this done.” – Max Richtman, President and CEO, National Committee to Preserve Social Security and Medicare 

Here are some of the major benefits in the bill for American seniors:

*Expansion of Medicare coverage to include basic hearing care.

*$150 billion in new funding for Home and Community-based Services (HCBS)

*Medicare drug price negotiation for a select group of medications

*Caps on drug prices linked to inflation

Though seniors’ advocates did not get everything that they wanted in the final House bill, these expansions are historic — and reflect long-held policy goals.  Build Back Better is the first comprehensive federal legislation to address soaring prescription drug prices, and the first expansion of Medicare since the Part D prescription drug benefit was enacted in 2003. Notably, that law prohibited Medicare from negotiating with Big Pharma, allowing the industry to engage in price-gouging that has grown increasingly worse with every passing year. The Build Back Better plan finally begins to correct that ill-advised provision, among other measures to tame drug prices.

During months of sometimes contentious maneuverings, compromises were made to accommodate the objection of Democratic moderates in the House and Senate. Seniors’ allies (including the National Committee) pushed to add dental, vision and hearing coverage to Medicare. But in the end, only hearing coverage survived.  Advocates had hoped that Medicare would be empowered to negotiate many more medications that seniors depend on, but the list was scaled back to ten drugs (escalating to 20 later), thanks largely to an expensive and relentless lobbying and advertising campaign by Big Pharma.  The new funding for HBCS care was cut by more than 60%. These compromises reflect the political realities of passing bold, new legislation within a “big tent” party spanning a range of views — in a closely divided Congress.  Nevertheless, Seniors’ advocates will continue to press for all the improvements that older Americans need until those goals are realized. 

Meanwhile, the Build Back Better Act moves to the Senate, where it still must clear procedural hurtles (to pass via the budget reconciliation process) and overcome any lingering objections from Democratic moderates, most prominently, Senators Joe Manchin (D-AZ) and Kyrsten Sinema (D-AZ).  Moderate Democrats (including Senator Manchin) had demanded an assessment from the Congressional Budget Office (CBO) on the bill’s costs and savings, which was delivered this week. Among other things, the CBO projected that the House’s Build Back Better legislation would produce $296 billion in net savings on prescription drug costs.  Policy analysts say those extra funds potentially could be used to further enhance benefits for seniors in the Senate version of the bill, though there are no guarantees that will happen.

Majority Leader Chuck Schumer (D-NY) wants the Senate to vote on the Build Back Better bill as soon as possible, preferably before Christmas. But the Senate has other priorities, too — including raising the debt limit and passing a continuing resolution to keep the government funded. “Whether they can also pass Build Back Better before the end of the year, we just don’t know,” says one Capitol Hill policy analyst.

Whether the Senate enacts the bill before the holidays or early in 2022, the National Committee has a clear message for Democrats. “They must unite around this historic legislation,” says President and CEO Max Richtman. “Seniors and their families are counting on them.”