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1 Estimated Budgetary Effects of Title II, Committee on Health, Education, Labor, and Pensions, for the Senate Amendment to H.R. 5376, the Build Back Better Act, as Posted on the Website of the Senate Democratic Leadership on December 11, 2021 1 (December 20, 2021)

handle is hein.congrec/cboesbetiic0001 and id is 1 raw text is: Congressional Budget Offica Cost Estimate December 20, 2021 By Fiscal Year, Millions of Dollars 2022 2023 2024 2025 2026 2027 2028 2029 2030 Increases or Decreases (-) in Direct Spending Budget Authority 291,502 -4,646 -2,695 58,337 Estimated Outlays 10,448 30,253 62,765 78,823 Increases Estimated Revenues 37 621 3,813 3,702 On-Budget Revenues 37 439 3,631 3,555 Off-Budget Revenues 0 182 182 147 Net Increase From Changes Estimated Effect on the Deficit 10,411 29,632 58,952 75,121 On-Budget Deficit 10,411 29,814 59,134 75,268 Off-Budget Deficit 0 -182 -182 -147 69,916 74,328 191 189 97,679 89,766 76,698 34,947 142 3,237 6 1,41 or Decreases (-) in Revenues 3,332 3,350 -18 167 39 254 136 -87 -97 -69 -109 -158 40 12 -23 -109 -121 -135 s or Decreases (-) in the Deficit in Direct Spending and Revenues 94,347 94,329 18 89,599 89,512 87 76,659 76,562 97 35,016 34,907 109 3,346 3,225 121 1,575 1,440 135 See https://wv.democratssenate ov/iro/media/docTitiel20I°2OCommitt°2onl20Hea~thl20Educatianl2OLabor%20and%2OPensions of Sources: Congressional Budget Office; staff of the Joint Committee on Taxation. Budget authority reflects appropriations specifically provided in title II or amounts estimated by CBO. The costs of title II fall within budget functions 500 (education, training, employment, and social services), 550 (health), 600 (income security), and 750 (administration of justice). Title II would increase on-budget deficits after 2031. Title II would impose intergovernmental and private-sector mandates as defined in the Unfunded Mandates Reform Act. It would require health care providers to accept payment for certain items and services at amounts established by the negotiation processes under existing surprise-billing law. The title would impose additional private-sector mandates. It would require some health insurance plans to provide retroactive coverage of claims. It would cap the amount that certain group and individual health insurance plans could require enrollees to pay out of pocket for insulin products. Finally, it would require pharmacy benefit managers to report detailed information about beneficiaries and about drug costs, fees, and rebates. Page 1 of 1

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