The Build Back Better Act, a scaled-back version of which passed the U.S House of Representatives on November 20, contains many provisions of importance to Well Spouses. This call to action focuses on just three of them: (1) a big increase in funding for Medicaid home care, (2) a brand-new paid sick and family leave program, and (3) enabling Medicare to negotiate drug prices.

Build Back Better now faces an uncertain fate in the Senate. Please call, write and/or e-mail your Senators today and urge them to vote for the House-passed Build Back Better bill without delay and with no further weakening or watering down. Here are three reasons why:

Medicaid Funding for Home and Community Based Care: President Biden’s original proposal for a $400 billion investment over the next ten years in home- and community-based services, sufficient to end waiting lists for home care, was reduced to $150 billion—not enough, but a substantial and welcome improvement in home care funding nevertheless. The new funds will shorten waiting lists and improve access to home care all over the country for those who meet Medicaid’s stringent eligibility requirements. Fewer people will be forced into nursing homes when they would prefer to receive care at home.

Paid Family Leave: the original proposal to provide 12 weeks of paid leave for workers has been reduced to four weeks in the House-passed version of Build Back Better. This is disappointing, but an important long-overdue precedent will be set if paid family leave becomes law.

For Well Spouses who are still in the paid workforce, struggling to balance the demands of their jobs with caregiving, the benefits are clear. Build Back Better would establish a permanent, comprehensive national paid leave program that provides employed workers—including the self-employed—with four weeks of paid family and medical leave, which can be used for caregiving or personal illness. If this provision is adopted by the Senate and signed into law by the President, starting in 2024 workers requesting paid leave will receive a percentage of their pay starting at about 90% and scaling down for higher earners.

Giving Medicare the Power to Negotiate Lower Drug Prices: for nearly 20 years, Medicare has been banned from negotiating the price of prescription drugs. Repealing this ban is widely popular with the American public and would trigger huge cost savings for patients and the Federal government, but Build Back Better’s initial attempt at repeal ran into a predictable buzz saw of Big Pharma opposition.  All is not lost, however: under the House-passed bill, Medicare would at long last be empowered to negotiate prices for certain select drugs. Beginning in 2025, 10 drugs, in addition to insulin, will be negotiated with that number increasing to 15 drugs in 2026, and 20 drugs in 2028. By 2030, more than 100 drugs will be eligible for Medicare price negotiation. As with Paid Family Leave, this is an important foot in the door.

Take Action: Don’t wait, please call, write and/or e-mail your Senators today. Urge them to vote for the House-passed Build Back Better bill without delay and with no further weakening or watering down. If you already contacted your Senators about the bill, reach out to them again. Point to provisions of Build Back Better that will be of particular importance to Well Spouses, including but not limited to increased funding for Medicaid home care, establishing paid sick leave and empowering Medicare to negotiate drug prices. If we don’t take action to protect and advance our interests as spousal caregivers, who will?


Find your Senators’ contact information here -