A bipartisan group of senators is closing in on a $579 billion infrastructure deal after agreeing to pay for it in part by delaying a costly Trump-era Medicare regulation, but they don’t expect to announce details until at least Monday.
Any deal could still face resistance from Democrats on both sides of the Capitol, making the prospects uncertain as a bipartisan group of 22 senators works out the final sticking points.
Senator Tom Carper of Delaware, a typically reliable Democratic vote and ally of President Joe Biden, signaled Thursday that he would object if negotiators didn’t include more funding for water and sanitation. Other Democrats in the 50-50 Senate have raised concerns about funding for their own priorities, like high-speed rail.
The Medicare rule, promulgated under President Donald Trump, eliminates rebates drug companies give benefit managers in Medicare Part D and was aimed at reducing out-of-pocket costs for patients outside Medicare. Delaying the rule reduces expenditures by the Medicare program, producing a budgetary windfall the negotiators want to use to help pay for roads, bridges and other projects.
The Congressional Budget Office estimated that repealing the rule would cut federal Medicare spending by about $177 billion over a decade. Negotiators are delaying it for less than 10 years, but have not revealed how long.
“We had an agreement on 99% when we walked out yesterday afternoon,” Senator Joe Manchin of West Virginia, one of 22 senators negotiating the infrastructure deal, said in an interview. “The pay-fors are pretty much lined up.”
Senate Finance Chairman Ron Wyden, whose committee has jurisdiction over Medicare, said he is still reviewing the proposal. “I share the view that the Trump proposal was flawed and we’re all talking about it,” he said.
Drug companies, which could lose revenue if the rule is set aside, have lobbied against its inclusion in the deal.
“Despite railing against high drug costs on the campaign trail, lawmakers are threatening to gut a rule that would provide patients meaningful relief at the pharmacy,” said Debra DeShong, executive vice president of public affairs at the industry group PhRMA. “If it is included in the infrastructure package, this proposal will provide health insurers and drug middlemen a windfall and turn Medicare into a piggybank to fund projects that have nothing to do with lowering out-of-pocket costs for medicines.”
Negotiators continued their talks Thursday even as some senators were leaving the Capitol for the weekend.
“The negotiations are going very well,” Maine Republican Senator Susan Collins said. But, she said, they would not circulate any legislative text until at least Monday as they await the CBO’s evaluation of the proposal’s costs and revenue.
Senator Mitt Romney, a Utah Republican, said, “I think it’ll be there on Monday,” referring to the text. “If not, not. So it’ll be a day or two after—but I think it’ll be on Monday.”
Across the aisle, Senate Democrats had been banking on the support of all 50 senators in their caucus—making Carper’s last-minute objections notable.
Carper voted to proceed to debate on the bill on Wednesday, but signaled on Thursday that the water and sanitation funding could be a dealbreaker for him. Carper, the chairman of the Environment and Public Works committee, wants the infrastructure plan to fund those programs at the level in a separate bipartisan water infrastructure bill.
“It’s not every day you get 89 senators to vote in favor of water-infrastructure legislation,” Carper told reporters. “That’s a strong statement.”
Carper also expressed concerns about the surface transportation portion of the emerging agreement, which continues to be a sticking point in the talks.