What's in the House-passed Build Back Better bill? Paid leave, universal pre-K and more

WASHINGTON — The Democratic-controlled House approved the most sweeping expansion of the social safety-net in decades on Friday, voting 220-213 to send President Joe Biden's Build Back Better plan to the Senate.

The roughly $2 trillion package – passed with only Democratic support – includes an assortment of progressive priorities, such as prekindergarten expansion, subsidized child care, health care subsidies and major climate change initiatives.

It also includes four weeks of national paid family leave – a proposal Biden backs but took out of his earlier framework to appease moderate Democrats in Congress. That provision is not expected to survive in the Senate, where Biden will need the support of all 50 Democratic senators to pass the measure.

Here's a breakdown of what the House approved:

Universal prekindergarten

One of the signature components of the bill is $109 billion to fund free, universal preschool for three- and four-year-olds. The money is projected to benefit as many as 6 million children and will flow to already established programs, such as Head Start.

More: House passes Biden’s Build Back Better bill, sending measure with free preschool, climate initiatives to the Senate

In pushing the program, the White House cited research showing that children who receive early education do better in school over the long-run, are more likely to graduate high-school and college, and earn more as adults than those who don't.

Subsidized child care

The bill includes nearly $276 billion over six years for child care for parents with kids up to five years old. The measure caps child care expenses at 7% of a families' income for low- and moderate-income households.

More: Biden's child, elder care proposals come with a hefty price tag. But can they transform the industry?

To receive the benefits, parents must be working, seeking work, in training or taking care of a serious health issue. The bill also increases pay for child care workers and includes subsidies for child care centers.

Speaker of the House Nancy Pelosi, D-Calif., joined by her leadership team, attends a news conference after the House approved the Democrats' social and environment bill at the Capitol in Washington, Friday, Nov. 19, 2021. (AP Photo/Jacquelyn Martin) ORG XMIT: DCJM108
Speaker of the House Nancy Pelosi, D-Calif., joined by her leadership team, attends a news conference after the House approved the Democrats' social and environment bill at the Capitol in Washington, Friday, Nov. 19, 2021. (AP Photo/Jacquelyn Martin) ORG XMIT: DCJM108

Medicare expansion to cover hearing

Medicare would cover hearing benefits under a $35 billion proposal that was pushed by Sen. Bernie Sanders, I-Vt. Sanders had called for expanded dental and vision benefits as well, but those are not included.

The White House says only 30% of seniors over the age of 70 who could benefit from hearing aids have ever used them, so this extra coverage could help millions of older Americans.

Prescription drug pricing

While the bill did not go as far some progressives wanted on lowering prescription drug prices, the measure allows the government to negotiate prescription drug prices offered through Medicare and sets up safeguards aimed at protecting workers and businesses from price-gouging.

The measure also caps cost-sharing for insulin at $35 per month and requires pharmacies to provide greater transparency regarding drugs costs in private health plans, as well as rebates, fees and other charges.

Health care subsidies for low-income Americans

Some 9 million Americans would see their health care premiums reduced under the Affordable Care Act by an average of $600 per year. The White House says a family of four earning $80,000 per year would save nearly $3,000 per year under this provision. The administration also estimates that the lower costs would persuade more than 3 million uninsured Americans to sign up for health insurance.

The House bill would also extend a provision, first passed in March as part of the coronavirus relief package, that expands premium subsidies to people who buy insurance on their own, instead of getting it through an employer or the government. Subsidies became more generous for those who already qualified for assistance, lowering both premiums and deductibles. They were made newly available to people earning more than four times the federal poverty rate – about $51,000 for a single person.

More: Many programs in Biden's budget have expiration dates. What that means for health insurance, preschool

Private plans would become available without premiums to people living below the poverty line in the 12 states that have not expanded Medicaid through the 2010 Affordable Care Act. Those states are: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Paid family and medical leave

Workers would get up to four weeks of paid family medical leave, a provision that was added in the last minute after Biden’s initial proposal of 12 weeks was scrapped by House leaders.

Under current law, eligible workers can take up to 12 weeks of unpaid leave, but the U.S. remains one of the few industrialized countries without a national paid family and medical leave program.

Climate change initiatives

The bill includes more than $550 billion in clean energy spending for what would be the federal government’s most ambitious effort to tackle climate change.

The bill includes billions to swap out as many as 165,000 gas-guzzling U.S. Postal Service trucks by the end of the decade for electric models, as well as school and transit buses across the country, and funds electrification of American ports. There’s also $6 billion for coastal and Great Lakes restoration and climate resiliency projects, $2.5 billion for restoration of ecosystems on public lands and a ban on off-shore oil drilling that former President Donald Trump had authorized.

More: Biden announces rule to limit methane leaks, targeting oil and gas industry at COP26 climate summit

President Joe Biden on Nov. 6, 2021.
President Joe Biden on Nov. 6, 2021.

As much as $30 billion is set aside for the creation of a Civilian Climate Corps – modeled after the Depression-era Civilian Conservation Corps – to create an army of young activists, earning at least $15 per hour, to combat the effects of a warming planet. The jobs could involve planting trees, helping communities transition to clean energy, and assisting local governments to prepare for and recover from worsening natural disasters.

More: Biden's Build Back Better bill would give young people jobs to fight climate change. What would a new CCC look like?

There’s also an environmental justice initiative under which minority or low-income communities would receive a disproportionately large amount of available resources.

Child tax credit extension

More than 35 million families would receive some benefit from the bill’s expansion of the child tax credit. The measure provides households up to $3,600 in annual tax cuts per child by extending a provision inthe American Rescue Plan, which Congress passed earlier this year.

The families of nearly 90 percent of children in the U.S. are expected to qualify for the benefit, which provides $300 per month per child under six and $250 per month per child ages 6 to 17. The benefit would sunset after 2022.

Home caregiving

The bill includes $150 billion to expand home caregiving services for low-income seniors and disabled Americans through an existing Medicare program. It's half the $300 billion Biden originally proposed.

The goals are twofold: to reduce the backlog of 800,000 eligible seniors and Americans with disabilities unable to get in-home care services and to boost the pay and conditions for home-care workers.

More: Roads, bridges ... and caregivers? Why Biden is pushing a 'radical shift' to redefine infrastructure

Affordable housing

The bill has $150 billion for affordable housing. There's funding for the construction and rehabilitation of more than 1 million affordably priced rental and single-family homes; down payment assistance for first-time homebuyers; new rental assistance; and capital needs improvements for public housing.

The plan also includes financial incentives to encourage states and cities to adopt local zoning changes that support new affordable housing.

More: Where are COVID-19 rescue funds going? The place with pervasive, 'urgent' need: Housing

More: Biden's Build Back Better bill would give young people jobs to fight climate change. What would a new CCC look like?

IRS tax enforcement

In one of the most disputed parts of Biden's plan, the bill includes $80 billion for the Internal Revenue Service in a push to ensure wealthy tax cheats are paying what they owe. The Treasury Department estimates the additional IRS staff and other enhancements will result in $479.6 billion in additional tax revenue, but the Congressional Budget Office gave a more conservative revenue projection of $207 billion.

That's key because the CBO's projects the bill would end up adding about $160 billion to the national debt over the next decade while the Treasury's estimate indicates the measure would pay for itself and lower the deficit.

More: Biden wants to give the IRS more money to chase wealthy tax cheats. Will it work?

Aid for HBCUs

The bill includes $10 billion for historically Black colleges and universities, tribal colleges and universities, and other minority-serving institutions – one of the few funding increases over what was proposed in the president's original $3.5 trillion package.

There's $3 billion for grants to support research and development infrastructure at such institutions; $1 billion for improvements of agricultural facilities at HBCUs, and $6 billion in federal aid including additional tuition assistance for students.

More: School lunches, IRS agents and HBCUs: The under-the-radar proposals in Biden's budget plan

Expansion of free school meals

The bill expands free meals at public schools to serve an additional 8.7 million low-income students during the school year, under the Richard B. Russell National School Lunch Act. It also provide a benefit of $65 per child per month for low-income families to purchase meals during the summer.

The White House estimated the summer benefit would apply to 29 million children.


While the House bill does not include a pathway to citizenship for undocumented immigrants – as many activists wanted – it does include a measure to allow individuals without legal status who have been in the United States since 2011 to apply for work authorization. Roughly seven million of the estimated 11 million undocumented immigrants currently living in the United States would qualify for the benefits of this immigration provision.

Contributing: Rebecca Morin and Maureen Groppe. Reach Joey Garrison on Twitter @joeygarrison.

This article originally appeared on USA TODAY: Build Back Better: What's in the House-passed version of Biden's bill