This week, the House Energy and Commerce Committee approved sweeping health care legislation as part of the Democratic Congress’ plan to enact a $3.5 trillion legislative package through budget reconciliation. The committee considered six subtitles that contained health-related legislation: Drug Pricing, Affordable Care Act, Medicaid, CHIP, Medicare and Public Health . Notably, the committee did not approve the proposed drug pricing plan, which would allow for negotiation of drug prices in Medicare Part D, with three Democrats voting in opposition. This puts a signature piece of the Democrats’ proposal, which would save close to $500 billion to pay for other priorities, in peril.

The Energy and Commerce Committee legislation proposes to spend $190 billion for Home- and Community-Based Services (HCBS), closing the Medicaid gap (no known score, estimated to be ~$300 billion), and $300 billion to expand Medicare benefits to include vision, dental and hearing. In order to offset this spending, they propose fully repealing the rebate rule, which will raise about $170 billion as well as prescription drug reforms that would save approximately $500 billion. While the Energy & Commerce Committee voted the drug provisions down, the House Ways and Means Committee adopted legislative recommendations containing identical language for drug pricing. This gives the drug provisions a path forward in the process, though it may not have enough support to ultimately pass the House. None of the costs or savings of the programs are official yet; the Congressional Budget Office will publish their estimates in upcoming weeks.