White House ‘Build Back Better’ Framework to Include $100 Million to Build Out Hospice, Palliative Care

After a series of negotiations with lawmakers the White House has announced a “framework” for drafting of the Build Back Better Act. The massive $1.7 trillion package would include $150 billion to expand home- and community-based services for seniors as well as $100 million to grow the hospice and palliative care nursing workforce and educate the public about those services.

Provisions of the forthcoming legislation include $30 million for hospice and palliative care education, $20 million for physician training in that specialty, and $10 million for dissemination of palliative care information. The framework would also allocate $20 million for hospice and palliative care academic career awards.

Enhanced services for seniors is one of the cornerstones of the proposal.

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“We’re going to expand services for seniors so families can get help from well-trained, well-paid professionals to help them take care of their parents at home — to cook a meal for them, to get their groceries for them, to help them get around, to help them live in their own home with the dignity they deserve to be afforded,” President Joe Biden said in public remarks.

The framework pares down some of items on Biden’s initial $3.5 trillion wishlist for the legislation, including Medicare expansion, provisions for free community college, paid family and medical leave and measures to reduce prescription drug prices. The cuts were made to sway holdouts in the Democratic Party who objected to the bill’s hefty price tag, most notably Joe Manchin (D-W.V.) and Kyrsten Sinema (D-Ariz.).

Congressional Democrats are working to pass the bill through a process called reconciliation in the Senate. Through this process, budgetary legislation can be approved with a simple majority after limited debate and cannot be filibustered. Democrats see this as the most likely path to passing the bill in the face of 100% Republican opposition.

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The framework contains funds to support affordable housing for seniors, the inclusion of hearing benefits within Medicare, and tax credits for uninsured persons in states that have not expanded their Medicaid programs under the Affordable Care Act.

It also allocates $1 billion in grants to bolster the direct care workforce and $40 million in aid for unpaid caregivers for seniors who have behavioral health needs.

“This is an historic step to address the critical needs of older Americans and their families,” said Katie Smith Sloan, president and CEO of the senior advocacy group LeadingAge. “We can’t let up now. The number of Americans 65 and older will more than double over the next 40 years, and half of us will need long-term services and supports as we age. Without further investments in our aging services infrastructure, too many older adults will not have their basic needs met.”

The cost of the bill would be offset by an estimated $2 trillion in additional taxes on corporate profits for large companies, surcharges on corporate stock buybacks and new or increased taxes on those whose income exceeds $10 million.

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