Several retiring senators were eager to use the bill to pass preferential measures and cement their legacies. Among the departing senior Republicans were Richard Burr of North Carolina, who was a member of the Senate Health, Education, Labor and Pensions Committee; Roy Blunt of Missouri, a Republican who was a member of the Senate Health Subcommittee; and Richard Shelby of Alabama, vice chairman of the Senate Appropriations Committee. The references were also meaningful to outgoing Democrat Patrick Leahy, who was Appropriations Chairman, as well as Nancy Pelosi, who was giving up her position as the House’s top Democrat.
Mr. Burr worked all year with his Democratic counterpart to develop a pandemic preparedness package known as the Pandemic Prevention Act. This bill was passed as part of the spending bill.
Senate Minority Leader Mitch McConnell indicated earlier in the year that he hoped for relatively modest spending. But he didn’t stand in the way of the giant banknote in the end.
“A lot of it was probably driven by, ‘Let’s deal with this and accept the reality of a lot of stagnation that we’re going to see in the next Congress,'” said Drew Keyes, a senior policy analyst at the Paragon Health Institute and a former staffer. at the Republican Study Committee. He was critical the size and scope of the bill, especially given the limited discussion of many of its provisions. But he said he understood why it came together: “We saw a lot of pieces that felt it was the last chance.”
Some convoluted budget math allowed lawmakers to pass Medicaid expansion without appearing to cost much money, an opportunity that is likely to disappear over time. By scheduling an end date for the costly pandemic policy, Congress could then use the projected savings to pay for expanded Medicaid benefits for children, postpartum mothers and residents of U.S. territories.
The bill requires states to keep children enrolled for at least one year and expands funding for the Children’s Health Insurance Program. It also lays out a series of policies to discourage states from automatically kicking out large numbers of adult enrollees after the end of emergency policies that protected enrollment during the pandemic. The provisions reflected Ms. Pelosi’s longtime interest in expanding health care through the Affordable Care Act and other means.
In addition to expiring funding sources, there was a “time-limited coalition” behind some of these policies, said Matthew Fiedler, a senior fellow at the Brookings Institution who has tracked the Medicaid provision.