Senate Passes Bipartisan Infrastructure Bill and $3.5 Trillion Budget ‘Blueprint’ with Major Work Still Ahead

Situation Report | August 16, 2021 

The U.S. Senate passed a bipartisan infrastructure bill – one of two “tracks” in the Biden Administration’s overall effort to advance a larger $3.5 trillion budget plan that includes expanded funds for home care and broader human-services infrastructure goals.   

As HCA has extensively reported, the Senate’s bipartisan package, at $1.2 trillion, largely includes projects and initiatives characterized as “traditional infrastructure,” like roads and bridges, but not any investments in home and community-based services. On August 10, the Senate voted 69-to-30 in favor of this measure, with support from 19 Republicans.   

But the Biden Administration has otherwise proposed a larger $3.5 trillion investment plan that includes additional major items that fall under broader “infrastructure” goals. In an effort to overcome Republican resistance, these other proposals are being separately advanced in what’s called a “reconciliation” bill. That package includes green energy and climate proposals, expanded Medicare benefits, housing and education dollars, along with major proposed investments for home care.   

This “reconciliation” measure, as distinct from the bipartisan bill, will use a parliamentary move to avoid a Republican filibuster but would, therefore, require support from all Democrats (including swing-vote moderates) who hold an extremely narrow majority in the Senate.   

In addition to passing the bipartisan package last week, the Senate (by a party-line vote) also passed a blueprint to advance Democrats’ larger $3.5 trillion “reconciliation” plan. While that bill passed with full support from Democrats, some moderates expressed concerns, signaling possible efforts to scale back a final version of the plan as it is fleshed out in the weeks ahead and then negotiated with the U.S. House of Representatives.  

How does home care fit into all of this?   

As part of the Administration’s broader “human infrastructure” goals, the President originally proposed $400 billion in funding for the home care economy, largely aimed at worker wages. While Congress and the Biden Administration have not released a firm number, it is expected that the current proposal for home care in the reconciliation plan is substantially smaller than originally proposed as negotiations continue over the broader $3.5 trillion package.  

There’s a lot more left to come on each of these various moving pieces. Indeed, the Senate still must finalize its “reconciliation” package beyond the baseline blueprint resolution it passed last week; and the House also has to take up both measures (the bipartisan plan and the reconciliation package), with many more weeks of negotiation ahead in this two-track process.   

For its part, House leadership indicated it will reconvene on August 23 to begin considering infrastructure, but the overall process could take months. House Speaker Nancy Pelosi indicated last week that her chamber will not act on either bill until both measures pass in the Senate first.    

HCA will keep members closely apprised of all developments in this complex process.   


In another item of note for members, HCA is confirming what we understand to be a possible extension of Sequestration cuts for Medicare home health and other health care providers in the Senate’s bipartisan infrastructure bill. We have heard varying reports about the timeline of the extension, which appears to extend the cuts into 2031. HCA will confirm this information and report back to the membership.   

Please stay tuned for more updates.