WASHINGTON — The U.S. Justice Department announced Thursday it will ask the Supreme Court on an emergency basis to keep access to the abortion medication mifepristone exactly as it is now, amid the appeals process in a much-watched case out of Texas.

Attorney General Merrick Garland said in a statement the department “strongly disagrees” with a decision from the 5th Circuit Court of Appeals in New Orleans that only partly granted the federal government’s request to place on hold the ruling from a district court judge.

The 5th Circuit’s partial stay, issued late Wednesday night, would keep the U.S. Food and Drug Administration’s 2000 approval of mifepristone in place, reversing the district court while the case is on appeal.

The three-judge panel, however, said it would let stand the part of the ruling that reverts prescribing and use of mifepristone to pre-2016 instructions.

“The Justice Department strongly disagrees with the Fifth Circuit’s decision in Alliance for Hippocratic Medicine v. FDA to deny in part our request for a stay pending appeal,” Garland said.

“We will be seeking emergency relief from the Supreme Court to defend the FDA’s scientific judgment and protect Americans’ access to safe and effective reproductive care,” Garland added.

Circuit court ruling

The appeals court in New Orleans partly blocked the judge’s order that would have overturned federal approval of the abortion pill — which means the pill remains available across the nation for now.

But the 5th Circuit also let part of the Texas judge’s order stand. The effect of the appeals court decision appears to be that while the case is on appeal, the abortion medication mifepristone is approved for use in pregnancies up to seven weeks, not 10 weeks, and it can’t be dispensed through the mail.

The Department of Justice appeal to the Supreme Court would seek to continue to allow mail delivery and the 10-week limit for pregnancies while the lawsuit goes on.

U.S. District Court Judge Matthew Kacsmaryk, in the Northern District of Texas, had ruled Friday, April 7, to overturn the U.S. Food and Drug Administration’s 2000 approval of the abortion drug mifepristone.

Kacsmaryk put a seven-day delay in his ruling and the U.S. Justice Department filed an appeal to the 5th Circuit Court of Appeals, asking the court to put the Texas ruling on hold. The manufacturer, Danco Laboratories, also appealed.

In the 42-page ruling in the 5th Circuit, a panel of three judges wrote, “At this preliminary stage, and based on our necessarily abbreviated review, it appears that the statute of limitations bars plaintiffs’ challenges to the Food and Drug Administration’s approval of mifepristone in 2000.” They granted a stay, or pause, of that part of the Texas decision.

But they said the arguments of anti-abortion groups are more likely to succeed in connection with the actions taken by the FDA in 2016 and later to make the abortion pill more widely available, including through the mail, and allow it to be used beyond seven weeks of pregnancy.

The 2016 changes by the FDA increased maximum gestational age to 70 days when the pill could be used; reduced required in-person office visits to one; allowed non-doctors to prescribe and administer mifepristone; and  eliminated reporting of non-fatal adverse events.

In 2021, the FDA announced “enforcement discretion” to allow mifepristone to be dispensed through the mail during the COVID-19 pandemic. Earlier this year the FDA permanently removed the in-person dispensing requirement.

Appeals to continue

The lawsuit was brought by the anti-abortion Alliance for Hippocratic Medicine and others against the FDA.

Kirsten Moore, director of the Expanding Medication Abortion Access Project, or the EMAA Project, said in a statement the appeals court ruling “shows exactly why courts have no place interfering in health care.”

“This middle of the night ruling, while keeping mifepristone on the market, rolls back years of medical progress by reinstating restrictions that were lifted in 2016 and forcing people to go back to picking up their medications in person, essentially eliminating teleheath access and forcing people to travel, in some cases hundreds of miles, just to receive care,” Moore said.

The three-judge appeals court panel that issued Wednesday night’s order was made up of Judge Catharina Haynes, appointed by former President George W. Bush; Judge Kurt D. Engelhardt, appointed by former President Donald Trump; and Judge Andrew W. Oldham, also appointed by Trump.

Haynes said in a footnote that she concurred in part, including on the grant of an expedited appeal and the denial of the motion to dismiss the case. She said she would have granted a stay of the Texas order “for a brief period of time” and defer the question until oral arguments.

It was not immediately clear how the 5th Circuit ruling would affect — or not affect — a separate ruling from U.S. District Court for the Eastern District of Washington Judge Thomas Rice.

Rice on Friday, just minutes after the Texas order, barred the FDA from changing “the status quo and rights as it relates to the availability of Mifepristone” in the 17 states and District of Columbia that filed a lawsuit about the pharmaceutical in his court.

The U.S. Justice Department has asked Rice to clarify his ruling, saying it “appears to be in significant tension” with the Texas opinion.

Doctors ‘face a harm,’ appeals court says

The 5th Circuit rejected arguments from the federal government that the anti-abortion medical organizations that brought the lawsuit didn’t have standing to sue, writing that “not only have these doctors suffered injuries in the past, but it’s also inevitable that at least one doctor in one of these associations will face a harm in the future.”

The four medical organizations and four doctors argued they were negatively impacted by having to treat patients in emergency departments or elsewhere experiencing complications from medication abortion, given the doctors’ opposition to elective pregnancy termination.

The appeals panel, however, emphasized the “narrowness” of that decision.

“We do not hold that doctors necessarily have standing to raise their patients’ claims,” they wrote. “We do not hold that doctors have constitutional standing whenever they’re called upon to do their jobs. And we do not hold that doctors have standing to challenge FDA’s actions whenever the doctor sees a patient experiencing complications from an FDA-approved drug.”

Lawmakers, attorneys general and pharmaceutical companies have raised concerns the Texas judge’s ruling could set a problematic precedent where any federal judge might be able to overturn the FDA’s approval of a medication.

The panel did seem to question the prescribing and use of mifepristone, writing it “is an exceedingly unusual regime.”

“In fact, as far as the record before us reveals, FDA has not structured the distribution of any comparable drug in this way,” they wrote.

On timing of the lawsuit, the appeals panel mostly rejected Kacsmaryk’s ruling that the FDA changing prescribing and administration of mifepristone in 2016 and 2021 reopened the 2000 approval to legal challenges.

Everyone in the case, they wrote, acknowledged the “six-year limitations period applies to all of this case’s challenged actions.”

“Although a close call, we are unsure at this preliminary juncture and after truncated review that FDA reopened the 2000 Approval in its 2016 Major REMS Changes and its 2021 Petition Denial,” they wrote.

The FDA applies Risk Evaluation and Mitigation Strategies, or REMS, to 61 pharmaceuticals that have “serious safety concerns to help ensure the benefits of the medication outweigh its risks.”

The judges later added the changes didn’t appear to rise to the level of FDA substantively reconsidering the original approval, but then said that the anti-abortion groups “might very well prevail on that claim later in this litigation.”

FDA and data

The appeals court wrote the federal government at this stage failed “to show that FDA’s actions were not arbitrary and capricious.”

The judges wrote the FDA failed to “examine the relevant data” when it changed how mifepristone is prescribed and used in 2016.

“That’s because FDA eliminated REMS safeguards based on studies that included those very safeguards,” they wrote.

“True, FDA studied the safety consequences of eliminating one or two of the 2000 Approval’s REMS in isolation,” they wrote. “But it relied on zero studies that evaluated the safety-and-effectiveness consequences of the 2016 Major REMS Changes as a whole.”

The appeals court noted that in 2016 the FDA eliminated a requirement that non-fatal adverse events must be reported to the agency and then in 2021 the FDA “declared the absence of non-fatal adverse-event reports means mifepristone is ‘safe.’”

The judges added the “ostrich’s-head-in-the-sand approach is deeply troubling” and suggested the “FDA’s actions are well ‘outside the zone of reasonableness.’”

Question of ‘irreparable harm’

In deciding to put part of the Texas district court’s ruling on hold while leaving the other part to take effect, the appeals court wrote neither the federal government nor the manufacturer of mifepristone met a standard called irreparable harm for the entire ruling.

“FDA’s assertion that the district court’s injunction will harm pregnant women or other members of the public does not speak to the irreparable injury factor (although it may speak to other factors), because those persons are not stay applicants in this case,” they wrote.

“Since FDA does not articulate any irreparable harm that FDA will suffer absent a stay, it makes no showing on this ‘critical’ prong,” they added.

Danco, which solely manufactures mifepristone, did note that it would have to shut down if the 2000 approval was overturned. But the appeals court wrote, “irreparable injury alone does not entitle Danco to a stay.”

“And even if it did, neither FDA nor Danco articulates why this, or any other, injury would require a stay of all of the district court’s order, rather than only part,” they wrote.

Reactions pour in

Anti-abortion organizations and abortion rights supporters quickly reacted to the 5th Circuit’s decision to keep the 2000 approval of mifepristone in place, while pushing use of the medication back to pre-2016 prescribing and administration guidelines.

Alliance Defending Freedom CEO and President Kristen Waggoner wrote Thursday morning on Twitter the 5th Circuit’s “decision is a step forward for the rule of law.” The legal organization argued the case on behalf of the anti-abortion groups.

“Critical safeguards removed by the @US_FDA will be restored and abortion by mail will end,” she wrote.

“The FDA put politics over science when it unlawfully approved dangerous chemical abortion drugs. It has evaded legal responsibility for years and has jeopardized the health of women and girls,” Waggoner added. “While there is still work to do to hold the FDA accountable for its lawlessness, girls and women are safer today.”

Morgan Hopkins, president of All Above All, an abortion rights organization, said in a statement the 5th Circuit’s “decision to roll back recent measures that have ensured greater access to medication abortion care undermines the FDA’s authority and science, all while real people pay the price.”

“It proves just how entrenched anti-abortion extremism is in our judicial system and shows just how far they will go to take away our rights and freedom,” Hopkins added.

Democratic Rep. Hillary Scholten of Michigan tweeted that “women shouldn’t have to live in a world where we have rights one day and not the next.”

“We must create a stable healthcare system where women have consistent and equal access to the healthcare they need,” Scholten added.

New Hampshire Democratic Sen. Jeanne Shaheen tweeted that mifepristone is safe and effective, though she didn’t specifically mention the appeals court decision.

“The safety of women is on the line as GOP lawmakers & unelected jurists enact & uphold anti-woman laws rooted in political rhetoric, not science,” Shaheen wrote. “Mifepristone has been safely prescribed by health care providers for decades.”

WASHINGTON — A major spending bill from U.S. Senate Democrats would allow Medicare for the first time in its history to begin negotiating the prices of certain high-priced prescription drugs — a proposal that’s been around for years but has never come so close to the finish line.

Under the legislation, Medicare would start negotiating the prices of some drugs in Part D, the program’s prescription drug plan, beginning four years from now. 

What’s more, seniors’ out-of-pocket drug costs would be capped at $2,000 a year, beginning in 2025, which would help with paying for expensive drugs like those used to treat cancer. And beneficiaries would get all their covered vaccines for free, including those for shingles.

“We will finally empower Medicare to negotiate the price of prescription drug costs,” Senate Majority Leader Chuck Schumer, a New York Democrat, said on Saturday. “After years of trying, we will finally cap out-of-pocket expenses and make vaccines free for our seniors. After years of trying.” 

Drug inflation

One disappointment for Democrats, though, came on Saturday when the chamber’s parliamentarian ruled against a section of the measure aimed at drug inflation — it would have forced drugmakers to pay rebates if the prices of prescription drugs in private insurance plans rose faster than inflation.

The inflation curb still would apply to drugs in Medicare, and that’s significant. A Kaiser Family Foundation study said that price increases ran ahead of inflation for half of all Medicare-covered drugs in 2020.

The Medicare prescription drug reforms are included in a piece of budget legislation known as reconciliation, whose main attractive feature for Democrats is that the final product can’t be filibustered by Republicans under U.S. Senate rules. 

Initially, the prescription drug provisions overall were scored by the non-partisan Congressional Budget Office as reducing the deficit by $288 billion over 10 years, though a new score reflecting last-minute changes to the bill was expected.

The Senate was heading toward beginning debate on the measure on Saturday, with a final vote sometime over the weekend or Monday following a series of votes on amendments. Schumer has said he believes the legislation will be backed by all 50 Democrats, following a deal on taxes struck with Arizona Sen. Kyrsten Sinema, and it is scheduled to be taken up by the House on Friday.

Medicare is the federal health insurance program for Americans 65 and older, as well as some younger people with disabilities. About 64 million people were enrolled in Medicare as of the most recent coverage year, and close to 49 million in a prescription drug plan of some kind.

Public support

While pharmaceutical companies have argued against Medicare price negotiation, saying it would harm research and development of new drugs and innovation, polling has found strong public support. 

The non-partisan Kaiser Family Foundation conducts regular tracking polls on health issues and found in October that 83 percent of those surveyed backed negotiation, even after they were told about the arguments on both sides. 

The same poll found that 27 percent of those over 65 taking four or more medications said they had problems affording their medications.

Here’s what the Democrats’ proposal would do for Medicare prescription drug costs, based on an analysis by the Kaiser Family Foundation, Senate Democrats’ summary and the legislative text:

• Beginning in 2026, the prices of 10 high-priced prescription drugs in Medicare Part D would be directly negotiated by the federal government. The number of negotiated drugs would climb to 15 in 2027. Then in 2028 it would cover 15 drugs in both Part D and Part B  — typically those drugs in Part B are given by doctors or in hospital outpatient treatment. In 2029 and later, it would include 20 Part D and Part B drugs.
• Drugs that would qualify would include those that don’t have generic or what is called biosimilar equivalents — copies of more complex drugs. Depending on their type, it would have to be nine or more years since their approval by the Food and Drug Administration, which means newer drugs would not be included.
• Pharmaceutical companies that don’t comply with negotiation would face steep excise taxes and potential civil financial penalties.
• Any secretary of Health and Human Services would have to negotiate for the maximum number of drugs allowed in a given year, which Democrats say would keep a future Republican presidential administration from balking at negotiation. 
• Drug manufacturers would have to pay rebates to the Medicare trust fund under some circumstances, beginning in 2023. They would have to pay if their drug prices increase faster than the rate of inflation, except for drugs with an average annual cost under $100. Penalties would be levied on those who don’t pay out the rebates. The inflation curb would apply only to Medicare and not private drug plans.
• Out-of-pocket spending on drugs would be capped at $2,000 a year, beginning in 2025, and seniors could spread out their drug costs throughout the year. In 2024, a 5% coinsurance requirement above the Medicare Part D “catastrophic” threshold, which was $7,050 in out-of-pocket spending in 2022, would be eliminated.
• A Low Income Subsidy Program that gives extra help with paying Medicare costs to very poor Medicare recipients would be expanded, beginning in 2024. Seniors qualify now for full benefits in the program if they have incomes of up to 135 percent of the federal poverty level, and resources of about $9,900 for an individual and $15,600 for a couple. The Senate plan would extend full benefits to people up to 150 percent of the federal poverty level and resources up to $15,510 for an individual and $30,950 for a couple.
• There would be no charge for vaccines covered under the Part D program, beginning in 2023. This would include vaccines recommended by the Advisory Committee on Immunization Practices.
• Growth in Part D premiums would be capped at 6 percent annually from 2024 to 2029.
• A Trump administration drug rebate rule that was supposed to go into effect in 2027 would be repealed.

An earlier version of this report misstated requirements for the Low Income Subsidy Program. 

WASHINGTON — President Joe Biden on Tuesday urged that COVID-19 vaccine doubters stop “peddling lies” on TV and online, as the nation grapples with a rising number of cases due to the highly transmissible omicron variant.

Biden also announced new federal help for testing and treatment in the states, including 500 million at-home rapid test kits that will be distributed for free by the federal government beginning in January.

“Look, the unvaccinated are responsible for their own choices,” the president said in an afternoon address from the White House. “But those choices have been fueled by dangerous misinformation on cable TV and social media.

“You know, these companies and personalities are making money by peddling lies and allowing misinformation that can kill their own customers and their own supporters,” he said. “It’s wrong. It’s immoral. I call on the purveyors of these lies and misinformation to stop it. Stop it now.”

Biden stressed that Americans must get their vaccinations and booster shots as the best protection against contracting COVID-19. “Those who are not vaccinated are causing hospitals to be overrun again,” he said. “Omicron is serious, potentially deadly business for unvaccinated people.”

The new surge is causing many Americans to wonder if they can safely celebrate the holidays with family and friends, he acknowledged. “The answer’s yes, you can, if you and those who celebrate with you are vaccinated, particularly if you’ve gotten your booster shot,” he said. 

He said more than 60 million Americans, including 62 percent of eligible seniors, have received boosters — including former President Donald Trump. “Maybe one of the few things he and I agree on,” said Biden.

The new surge “absolutely” will not resemble the initial wave of COVID-19 that hit the U.S. in March 2020, Biden insisted. More than 200 million Americans now are fully vaccinated, and the nation is more prepared, he said.

The White House announced multiple steps that the U.S. will take this winter as omicron emerges as the dominant variant, responsible for more than 73 percent of new COVID-19 cases, according to the Centers for Disease Control and Prevention. 

It’s been difficult in many regions to obtain appointments or kits for COVID-19 tests, and administration officials said that Americans soon will be able to order free at-home kits from a website to be set up by the federal government. 

The kits, which officials said will be delivered by mail, will be in addition to 50 million test kits already bought by the federal government for free distribution at community health and rural health centers, officials said.

White House press secretary Jen Psaki said details are still being worked out, such as the number of kits each individual can order and whether certain groups will be prioritized.

“Five hundred million tests in January is the largest order we’ve ever made to date, and we’re going to do it as quickly as we can,” she said.

Psaki earlier this year had rejected a suggestion by a reporter that tests be sent to every home free of charge, questioning the cost. At retail, the kits generally cost at least $25 for a pack of two tests and often more. 

She said with Tuesday’s move, “We are providing an opportunity, another opportunity or ability for people to…go on a website and request a test if their preference is to get their test to their home. Not everybody will want to do that.”

New federal free testing sites will be set up, the first in hard-hit New York City, in addition to thousands of sites that already are up and running, Psaki said. She said states are coordinating with the federal government as to where new sites should be located.

Biden said he will also direct the secretary of defense to mobilize an additional 1,000 troops such as medical doctors and nurses to work at hospitals through January and February as needed.

Six emergency response teams made up of federal clinical staff and paramedics will deploy to Michigan, Indiana, Wisconsin, Arizona, New Hampshire and Vermont, the White House said.

To assist hospitals with the expected surge in cases, Biden directed the Federal Emergency Management Agency to mobilize planning teams to work with every state to assess hospital needs and begin expanding bed capacity, “with the federal government paying for all of it,” according to a White House fact sheet. Millions of gowns, gloves, hospital gowns, masks and ventilators are stockpiled, too, Biden said.

FEMA also is ready to send out ambulances and emergency teams to transfer patients from overburdened medical facilities, the administration said. “Just this week, 30 paramedics are heading to New Hampshire, 30 to Vermont, and 20 to Arizona, and 30 ambulances are headed to New York and 8 to Maine,” according to the fact sheet.

On the vaccination front, the White House said that FEMA will establish new pop-up vaccination clinics across the country, including four new mobile units across New Mexico expected to open Thursday. More sites are expected in the coming weeks. 

Biden in his remarks sought to calm anxiety provoked by the new round of business, school, college and entertainment closures.

“I know you’re tired…and I know you’re frustrated,” Biden said. “We all want this to be over. But we’re still in it. This is a critical moment. But we also have more tools than we’ve ever had before. We’re ready. We’ll get through this.”

WASHINGTON—A federal judge in Louisiana on Tuesday issued a ruling blocking nationwide the Biden administration mandate requiring millions of health care workers be vaccinated against COVID-19.

A suit challenging the mandate was led on behalf of multiple states by Louisiana Attorney General Jeff Landry, a Republican, and U.S. Judge Terry Doughty granted the states’ request for a preliminary injunction. 

Doughty said in his opinion that he extended the injunction beyond those states and to the entire U.S. because “there are unvaccinated healthcare workers in other states who also need protection.” 

States joining Louisiana in its suit, filed Nov. 15, included Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Ohio, Oklahoma, South Carolina, Utah and West Virginia.

Doughty, an appointee of former President Donald Trump, said that “this Court believes the balance of equities and the public interest favors the issuance of a preliminary injunction.”

“The public interest is served by maintaining the constitutional structure and maintaining the liberty of individuals who do not want to take the COVID-19 vaccine,” he wrote. “This interest outweighs Government Defendants’ interests. “

At issue is President Joe Biden’s campaign to ensure that workers throughout the country are vaccinated against COVID-19.

Under Biden’s order, many private-sector employees were required to get vaccinated or undergo weekly tests, while some 17 million health care providers at facilities participating in the federal Medicare and Medicaid health insurance programs must be vaccinated — with no option to choose weekly testing instead.

Under the requirement, health care workers were to be fully vaccinated by Jan. 4, 2022.

Becker’s Hospital Review reported earlier this month that a federal study found 30 percent of health care workers in 2,000 hospitals across the U.S. remained  unvaccinated as of Sept. 15.

“I applaud Judge Doughty for recognizing that Louisiana is likely to succeed on the merits and for delivering yet another victory for the medical freedom of Americans,” Landry said in a statement. “While Joe Biden villainizes our healthcare heroes with his ‘jab or job’ edicts, I will continue to stand up to the President’s bully tactics and fight for liberty.”

The Louisiana ruling followed another on Monday by a federal judge in Missouri that blocked enforcement of the Biden administration’s vaccine mandate for millions  in 10 states.

That ruling by U.S. District Judge Matthew Schelp, another Trump appointee, affected the states involved in that lawsuit: Missouri, Iowa, Kansas, New Hampshire, North Dakota, South Dakota, Nebraska, Arkansas, Wyoming and Alaska.

White House press secretary Jen Psaki told reporters Monday that the administration is “obviously going to abide by the law and fight any efforts in courts or otherwise” to prevent health care facilities from protecting their work forces.

WASHINGTON—The U.S. Senate this week passed a massive bipartisan infrastructure bill and an even larger budget blueprint that would pave the way for historic changes in U.S. health, education, climate and tax policies.

The two measures are roped to each other, reflecting Democrats’ strategy to pass what could be bipartisan with Republicans—and to go it alone on the rest. 

The Senate votes represented important steps for that approach—and the Biden administration’s priorities. But getting the packages to President Joe Biden’s desk will still require delicately balancing competing factions among congressional Democrats, who hold slim majorities in both chambers and are unlikely to get further GOP help. 

Plus, the strategy is complicated.

Below are questions and answers about what happened this week, what the bills would do if they become law, and what we know about what will happen next. 

What does the Senate infrastructure bill do?

The Senate passed a $1.2 trillion bipartisan infrastructure bill to upgrade the nation’s roads, bridges, transit, passenger rail, electric grid, water systems, broadband and more. 

It includes record spending for items that have been underfunded for years, but doesn’t dramatically alter a transportation system that’s a major contributor to climate change. 

Nineteen Republicans voted for it—including Minority Leader Mitch McConnell.

What else did the Senate do before it left for recess?

The Senate approved a budget resolution for fiscal 2022, the federal budget year that begins on Oct. 1. That document serves as a blueprint for how much revenue the federal government expects to take in and how much it expects to spend. 

It also opens the door to an ambitious $3.5 trillion package of health, education, climate and social services items much desired by progressives and President Joe Biden, and on a scale not seen since the New Deal.

The budget resolution is not a law—it is not signed by Biden—and instead guides Congress in a spending plan. It was adopted by the Senate, which is split 50-50 between Democrats and Republicans, on a 50-49 party-line vote.

What happens next with the budget?

House Majority Leader Steny Hoyer of Maryland says the House will return from its recess on Aug. 23 and pass the resolution.

What else does the budget resolution include?

The resolution that the Senate adopted includes instructions for what is known as reconciliation. That is a process that operates separately, in a second stage and will be used to pass the social programs Biden wants. 

It’s not employed every year but it is useful when Congress wants to move relatively quickly on budget matters. Congress used reconciliation earlier this year to enact the American Rescue Plan.

Those reconciliation instructions make recommendations to 11 Senate committees on legislation that would change laws in their jurisdictions dealing with spending, revenue, deficits or the debt limit. 

Why is reconciliation politically important for Democrats?

In the Senate, a reconciliation bill is not subject to the 60-vote filibuster, and that means it requires only a majority vote to pass. Routine legislation usually needs 60 votes to advance.

Why is reconciliation even more important right now?

It’s pretty much the only way Democrats can pass into law the sweeping package Biden has proposed.

The specifics in that $3.5 trillion package will be spelled out by the 11 committees in detail when they write up their reconciliation legislation.

What are some policies likely to be included?

Universal pre-K for 3-and-4-year olds; paid family and medical leave; drought, forestry and conservation programs to help prevent wildfires; expanding Medicare to include dental, vision and hearing benefits; extending the child tax credit; tuition-free community college; tax cuts for Americans making less than $400,000 a year; reductions in prescription drug costs; and much more.

“Every part of Biden’s proposal will be there in a big, robust way. We’re going to all come together to meet that goal,” Senate Majority Leader Chuck Schumer says.

When will the Senate committees start that work?

Schumer says committee chairs will meet weekly with their members through the rest of the month and into September. There is a Sept. 15 deadline, though it’s not ironclad.

But what happens now with the bipartisan infrastructure bill?

House Speaker Nancy Pelosi has said she won’t take up the roads-and-bridges infrastructure bill until the Senate also passes the reconciliation, or “human infrastructure” bill, which now won’t happen until September at the earliest. This has become known as the “two track” approach.

What happens with the reconciliation bill in the meantime?

The Senate Budget Committee, if it follows usual procedures, would wrap together all the policies adopted by the 11 committees into one giant omnibus bill that will be considered by the full Senate. There are limits on debate time and the kinds of amendments senators can try to attach to change it.

Why are there two tracks? 

Moderate Democrats in the Senate were adamant that they could work with Republicans on physical infrastructure, long a priority for both parties. 

Additionally, Senate rules limit what can be included in a reconciliation bill, requiring some provisions to go through the normal legislative process.

The bipartisan nature of the infrastructure bill resulted in a product that some progressives found inadequate because it left out the “human infrastructure” pieces. The second track, the Democrats-only reconciliation bill, provides a path to their more ambitious goals.

Will all Senate Democrats support the reconciliation bill?

All 50 Senate Democrats voted for the budget resolution that would unlock the reconciliation process, a good sign for Schumer, who predicted all his members would be on board for the final bill.

Keeping them all satisfied will be a challenge, though. Senate Democrats across the political spectrum disagree about the level of spending. 

West Virginia’s Joe Manchin said Wednesday he had “serious concerns” about the $3.5 trillion figure, which is down from Vermont independent Bernie Sanders’ initial $6 trillion plan.

“There are some in my caucus who may believe it’s too much,” Schumer said. “There are some in my caucus who believe it’s too little. …We are going to all come together to get something done.”

Could there be last-minute changes in the Senate?

The reconciliation bill will be subject to a grueling Senate procedure known as “vote-a-rama,” a series of back-to-back votes on amendments proposed by senators, often by members of the minority party trying to score points. This can go on for hours and the votes can be very rapid. 

What does the House do with reconciliation?

Like the Senate, the committees in the House will be assigned to make decisions about the policies affecting spending or revenue that should be in the reconciliation bill. 

What do House Democrats think about the reconciliation plan?

As in the Senate, members on the moderate end of the House Democratic caucus have voiced concerns about the $3.5 trillion price tag for the partisan reconciliation bill. Nine members have asked Pelosi to take up the bipartisan infrastructure bill first. 

That’s unacceptable to about 50 or more House progressives, who are withholding support for the infrastructure bill until the larger spending plan is approved. 

What about the debt limit?

Congress must raise or suspend the debt limit, the total amount the federal government is permitted to borrow, before spending reaches that limit or the government will be unable to pay for what it has already committed to. 

Democrats are not including debt limit changes in the reconciliation process, even though 47 Senate Republicans have pledged not to support any changes to the debt limit. One of those things will have to change for the U.S. to avoid default.