Build Back Better Act–an update

What’s in the Build Back Better Act as passed by the House:

Families and children:

  • $382 billion for childcare and universal preschool. The plan is designed to save most American families more than half of their spending on childcare by providing two years of free preschool for every 3- and 4-year-old in America and additional funding for childcare.
  • $205 billion family and medical leave. Permanently authorizes the first-ever national paid family and medical leave guarantee for U.S. workers, providing up to four weeks of paid leave.
  • $198 billion for Child Tax Credit and Earned Income Credit. The proposal extends the expanded Child Tax Credit for one year and provides additional funds to extend the expanded Earned Income Tax Credit.
  • $3 billion to support child nutrition. This investment will help expand eligibility and eliminate paperwork so more children can receive free school meals.

Home care for people with disabilities and the elderly

  • $150 billion for home care. This funding expands home care for older people and those with disabilities.

Affordable housing

  • $166 billion for housing. The plan invests in affordable housing, including construction and rehabilitation of homes, as well as investments in rental assistance and housing vouchers.

Post high school education

  • $56 billion higher ed and workforce development. The legislation will increase Pell Grants and provide post-high school education opportunities including apprenticeship programs for underserved communities.


  • $130 billion in ACA credits. This money will be used to expand affordable healthcare coverage, reduce premiums for more than 9 million Americans, and deliver healthcare to uninsured people in states that are not enrolled in expanded Medicaid coverage.
  • $35 billion Medicare hearing coverage. While dental and vision coverage did not make the cut, Medicare recipients will have coverage for hearing aids and hearing tests. The funding will also cover nursing home transparency and staffing standards, and bolster funding for the Elder Justice Act program.


  • $559+ billion for clean energy and climate. The plan proposes cutting greenhouse gas pollution by over a gigaton in 2030, reducing consumer energy costs, helping to create more clean air and water, and creating hundreds of thousands of jobs.


  • $110 billion for immigration. This is part of the framework, but also separate since it requires a ruling by the Senate parliamentarian. This would constitute an investment to reform the immigration system, reduce backlogs, expand legal representation, and make border processing more efficient and humane.


  • $17 billion for the Small Business Committee. This provides for small business access to credit, investment, and markets.
  • $40 billion for equity and other investments. Spending in this area will be designed to achieve equity through investments in maternal health, community-violence interventions, and nutrition according to the White House.
  • $5 billion in supply chain investments. These investments will be designed to safeguard our economy and support domestic job growth.
  • $275 billion in State and Local Tax (SALT) deduction relief. Accomplished by increasing and applying the cap over the long-term, allowing states and counties to raise more revenue to deliver essential public services.

Above is from Investopedia

Drug Pricing (Kaiser Family Foundation)

The key prescription drug proposals included in the BBBA would:

The above changes in drug pricing will be delayed by at least a year:

  • Penalties on drugmakers that hike prices faster than inflation and a new $35-per-month cap on insulin won’t begin until 2023.
  • A $2,000 cap for all out-of-pocket drug spending for seniors won’t be implemented until 2024, and
  • The lower prices Medicare will negotiate with pharmaceutical companies for some of the most expensive drugs won’t be available until 2025 — with a full phase-in coming in 2028.
  • Coverage of hearing aides under Medicare, another one of the provisions most popular with voters, will similarly not begin until 2024. (Associated Press)

What may change in the Senate (Causes)

  • Paid leave may be removed due to objections from Senator Manchin and other moderate Democrats in the Senate who have signaled that they would prefer to develop a federal paid leave program on a bipartisan basis with Republicans.
  • Immigration reform may be removed by the Parliamentarian because everything in a bill that is passed through reconciliation must be related to budget. The House version creates temporary work permits so millions of immigrants could remain in the U.S. up to a decade.
  • Raising the cap on the state and local tax (SALT) deduction from $10,000 to $72,500 for individual taxpayers, a tax cut that would benefit wealthy taxpayers in states with higher income, property, and sales tax rates, which made the change popular with Democrats from states like California, New Jersey, and New York.
  • Steven Waldman of Report for America says the Build Back Better Act would provide payroll tax credits for local newsrooms to support struggling papers. “On the ground, people know this is a very non-partisan issue,” he says. The decline of local news “affects every community in America.” (CNN)
  • Your mail trucks are about to look different: Biden’s Build Back Better bill would speed up conversion to electric mail trucks at struggling USPS (USA Today)

CBO True Cost Estimate

The non-partisan Congressional Budget Office (CBO) estimate pegged the deficit created by Build Back Better at $367 billion, but trimmed that to $160 billion after subtracting the additional $207 billion brought in by increased enforcement of IRS collections.5

The Treasury Department estimates greater savings than those suggested by the CBO resulting in the Build Back Better Act being completely or almost completely paid for. The legislation would generate more than $2 trillion in savings. These savings come from ensuring large multinational corporations and wealthy Americans pay their fair share and reducing the cost of prescription drugs. These provisions will not raise taxes on any taxpayer making less than $400,000. (U.S. Dept. of the Treasury)

For now, the CBO estimate will be the basis on which the Senate debates, amends, and eventually either passes or rejects the Build Back Better Act.