PPC CAPITOL CONNECTION
June 10, 2021
What Matters Now in Washington:
- Negotiations on a bipartisan infrastructure package are continuing, but skepticism remains about whether a deal can be reached. More…
- Vaccine inequity persists as the U.S. begins sharing COVID-19 doses with other countries. More…
- President Biden outlined an ambitious federal spending proposal that envisions the highest sustained federal spending levels since World War II. More…
- Pediatricians speak out as some states advance legislation targeting transgender youth. More…
- PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…
President Biden Presses on with Bipartisan Infrastructure Negotiations as Initial Deadlines Pass. The White House is aiming to follow up its blockbuster $1.9 trillion American Rescue Plan with trillions more in spending on physical and human infrastructure in the coming months, but now comes the hard part: moving the Biden administration’s ambitious plans through a narrowly divided Congress.
In tightly choreographed succession, President Biden rolled out the American Jobs Plan and the American Families Plan to great fanfare from progressives within weeks of signing the emergency relief package into law. The proposals are intended to make good on Biden’s campaign promise to reinvest in Americans and include huge sums to support children and families, like an extension of enhanced Child Tax Credit benefits, paid family and medical leave, and universal child care. The American Jobs Plan would also include billions of dollars in research, with a focus on eliminating racial inequities in research. After pushing through the rescue plan on a party-line vote, though, President Biden has made reaching across the aisle a focus of his early outreach to Congress on the proposals, preferring to sign a bipartisan infrastructure bill if possible.
To that end, the White House has been engaged in direct negotiations with congressional Republicans on compromise infrastructure legislation, but numerous challenges stand in the way. Democrats and Republicans disagree on a number of substantive points, including what constitutes infrastructure. While Democrats are defining infrastructure broadly to include a wide array of investments in American competitiveness, Republicans insist on limiting the scope of the package to so-called hard infrastructure like roads, bridges, and airports. The two sides also remain hundreds of billions of dollars apart in the amount they would like to spend on the deal overall and disagree about whether the deal must be comprised entirely of new federal money or if unspent money from COVID-19 relief packages can be repurposed to pay for infrastructure. Taxes remain a hurdle as well: while President Biden campaigned on making large corporations pay their fair share through increased taxes, Republicans refuse to touch the corporate tax rate they slashed dramatically in 2017 during a round of tax cuts.
Despite these obstacles, good-faith negotiations are ongoing, though challenges abound. President Biden ended negotiations with a group of Senate Republicans led by Sen. Shelley Moore Capito of West Virginia on Tuesday. During that process, both the White House and Senate Republicans made some concessions. For instance, President Biden indicated he could accept a bipartisan deal costing as little as a trillion dollars, and he also backed off his demand to include an increase in the top corporate tax rate. Senate Republicans also increased their offer to just under a trillion dollars, though nearly three-quarters of that money would have been repurposed from past legislation rather than the new federal spending Biden is seeking. Biden has indicated he will now turn his negotiations to a bipartisan group of senators that has been developing a separate infrastructure proposal in the hopes of striking a deal. The President has made clear that his appetite for extending negotiations is not unlimited.
To date, Democrats in Congress have given Biden space to work on a bipartisan deal, though there are signs that their patience is running thin. While most congressional Democrats do not object to a bipartisan infrastructure bill in principle, there is significant skepticism that Republicans will ever agree to a proposal that Democrats feel comes close to the amount needed to meet the moment. Democrats remain wary after Republican intransigence during the Obama years; when negotiations over health care reform and other priorities dragged on for months only to later be opposed by Republicans, the delay sapped momentum from the former president’s legislative agenda. Even if a deal is struck, there are concerns that a more limited infrastructure bill will end up being the only major legislation passed, leaving behind major pieces of the Biden agenda.
Congressional Democrats and outside groups are beginning to signal that the time is nearing for Biden to abandon the talks and move forward with a more expansive Democrat-only proposal that could be passed through the budget reconciliation process, which only requires a simple majority vote. This path too faces challenges—moderates like Sen. Joe Manchin (D-W.Va.) are highly invested in preserving bipartisanship and may be less willing to push through such massive proposals on a party-line vote. As a result, no matter the outcome of the bipartisan negotiations, it seems likely that President Biden will have to compromise with someone to get a bill to his desk.
U.S. Expands Global COVID-19 Vaccine Dose Sharing, Other Public Health Assistance, but Much of the World Lacks access. President Biden announced plans to buy 500 million doses of Pfizer-BioNTech’s COVID-19 vaccine for global distribution ahead of a G-7 meeting in the United Kingdom Wednesday. The announcement comes on top of a separate announcement late last week that the U.S. would begin immediately sharing 25 million unused COVID-19 vaccine doses with countries around the world as vaccine shortages have left the pandemic raging in many low- and middle-income countries. Three-quarters of the immediate dose distribution will be shared through COVAX, the international effort to equitably distribute COVID-19 vaccinations globally, while the remainder will be sent to allies and partners like Canada, Mexico, South Korea, and India. In total, the Biden administration plans to share 80 million unused doses by the end of the month.
Even with the new commitment to helping vaccinate the world, reports continue to indicate that wealthy nations are locking down an ever-greater share of COVID-19 vaccines, with the European Union, Canada, and others inking deals directly with manufacturers for doses well into 2023. The scramble by rich countries to fully vaccinate their populations has led to a troubling split screen in which some countries have more vaccine than they can feasibly use while most countries struggle to vaccinate their frontline workers and vulnerable populations. Indeed, the dose sharing comes as U.S. states turn to incentives like cash giveaways to coax their residents into getting the shot on the path to meeting Biden’s goal of vaccinating 70 percent of adults by the July 4th holiday. The federal government is also grappling with the impending expiration of vaccinations states haven’t used.
In addition to vaccine dose sharing, the Centers for Disease Control and Prevention (CDC) and other federal agencies have been providing public health assistance to countries globally. The CDC recently announced that it has provided emergency assistance to India, including oxygen cylinder procurement and support for India’s core public health functions.
Biden Releases Ambitious Federal Spending Blueprint. In late May, President Biden unveiled a $6 trillion budget request that includes robust funding for federal health and education programs. While the proposal does not become law, it outlines the administration’s spending priorities and marks the first step in a long process to determine Fiscal Year (FY) 2022 funding levels. The full federal budget request comes after a high-level sketch was released earlier in the month outlining several key highlights.
As previewed in the budget sketch, the National Institutes of Health (NIH) would see a $9 billion increase over its current funding level, including $6.5 billion for a new Advanced Research Projects Agency for Health (ARPA-H) and an increase of over $100 million for the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The budget also proposes a $52 million increase for the Agency for Healthcare Research and Quality, a $5.8 million increase for the Emergency Medical Services for Children program, and level funding for the Children’s Hospital Graduate Medical Education program. The President has also requested a doubling of gun violence prevention research at the NIH and the Centers for Disease Control and Prevention (CDC) to $50 million in aggregate.
Congressional appropriators have now begun the work of developing FY 2022 spending bills, though it remains to be seen the extent to which President Biden’s request will ultimately factor into final spending levels.
State Lawmakers Target Transgender Children in Latest Round of Culture Wars. Florida Governor Ron DeSantis signed a bill on the first day of Pride Month banning transgender young people from participating in youth sports teams that align with their gender identity, the latest in a spate of policies spreading around the country that threaten the health and well-being of transgender individuals. The move made Florida the 8th state this year to enact such a ban. Several states have also advanced bills to ban gender-affirming care for transgender minors, a harmful move that threatens to cut off access to lifesaving treatment for young people and makes dangerous incursions into the provider-patient relationship. In April, Arkansas became the first state to enact such a ban after the state legislature overrode a veto from the state’s Republican governor. The ACLU has already filed suit challenging that law.
Pediatricians have been speaking out in opposition to these harmful bills nationwide, urging state legislators to reject pending sports and gender-affirming care bans. In May, AAP President Lee Savio Beers joined 60 Minutes’ Lesley Stahl to explain the harms these bills pose to transgender young people. Work will continue at the state and federal level to stop these efforts.
PPC POLICY COMMENTARIES. Members of the PPC have authored commentaries detailing the policy implications of research published in Pediatric Research. You can read these PPC-authored commentaries online: