President Donald Trump entered an election year as just the third commander-in-chief in US history to be impeached.

Trump was ultimately acquitted in an impeachment trial that would soon become a distant memory amid a pandemic that's killed thousands of Americans and left millions unemployed. 

Though he's been perhaps the most controversial and divisive president in modern US history, Trump has had a remarkably steady approval rating due to his staunchly loyal supporters. 

Even as polling has repeatedly shown that most Americans disapprove of Trump's handling of the COVID-19 pandemic, his overall approval rating has barely fluctuated.

With that said, Trump is trailing former Vice President Joe Biden in the polls, and faces a tough road to Election Day. 

Here are Trump's biggest accomplishments and failures as president so far, measured by their overall impact and taking into account the general response from Congress, the public, and wider world.

SEE ALSO: Angry protesters swarming the US embassy in Baghdad caps off Trump's disastrous year in the Middle East

Accomplishment: Reshaping the federal judiciary

Trump's most lasting impact on the country will be the reshaping of the federal judiciary.

Thus far, Trump has installed two Supreme Court justices and 205  judges overall to the federal bench — all for lifetime appointments. 

By December, Trump nominees made up roughly 25% of all US circuit court judges, according to an analysis by The Washington Post.

He's appointed 53 judges on the 13 US circuit courts, and still has months left in his first term. To put this into perspective, former President Barack Obama appointed 55 circuit judges in his two terms in the White House.

The courts get the final say in US politics, setting precedents that can shape the country for years to come. 

Even if Trump is not reelected in 2020, his presidency will continue to have an impact on the direction of the US due to the sheer number of conservative federal judges he's installed. 

Accomplishment: Space Force

In signing a $738 billion defense spending bill just a few days before Christmas, Trump officially established the sixth branch of the US Armed Forces — the Space Force. 

The Space Force is the first new military service since the US Air Force was created in 1947.

Despite its name, the new branch has not been established to protect the planet from potential extraterrestrial threats, but is tasked with protecting the US military's assets in space. 

"This is not a farce. This is nationally critical," Gen. John Raymond, who Trump tapped to lead the Space Force, told reporters earlier this month. "We are elevating space commensurate with its importance to our national security and the security of our allies and partners."

Many of the details surrounding the Space Force must still be ironed out. In many ways, the new branch is simply a more centralized version of military missions in space that already existed from the Air Force, Army and Navy.

Todd Harrison, who directs the Aerospace Security Project at the Center for Strategic & International Studies, recently told NPR: "It will create a centralized, unified chain of command that is responsible for space, because ultimately when responsibility is fragmented, no one's responsible."

Accomplishment: Tax reform

Three years into his presidency, Trump's signature legislative achievement remains a Republican tax bill that made sweeping changes to the tax code — the Tax Cuts and Jobs Act.

As Business Insider's Joseph Zeballos-Roig recently reported:

• The law was the biggest overhaul to the nation's tax code in three decades, and the president pitched it as "rocket fuel" for the American economy.
• It permanently slashed the corporate tax rate to 21% from 35% while also providing temporary benefits for individuals and their families.
• Critics argued it was a windfall for massive corporations at the expense of the middle class. Meanwhile, supporters of the tax cuts contended it would unleash an economic bonanza. Businesses would invest in their operations, they said, resulting in improved worker productivity and higher wages.
• Treasury Secretary Steve Mnuchin, among others, said the law would juice the nation's gross domestic product to 3% (or more, as Trump said 6%) and soon pay for itself and spread prosperity.
• But the law has achieved none of the ambitious goals that Republicans put forward — and there are scant signs they ever will.

Accomplishment: First Step Act

Trump signed the First Step Act into law in December 2018, marking the first legislative victory in years for advocates seeking to reform the criminal justice system.

The bill passed with overwhelming bipartisan support in Congress. It offers relatively modest changes to the federal prison system, but was praised as an important step forward by groups and activists seeking to end mass incarceration. 

Business Insider's Michelle Mark summarized the key aspects of the legislation after it passed in the Senate last year:

• The passage of the bill...marked the first major legislative win in decades to address mass incarceration at the federal level.
• The bill overhauls certain federal sentencing laws, reducing mandatory minimum sentences for drug felonies and expanding early-release programs.
• The bill also makes retroactive a 2010 federal sentencing law reducing the sentencing disparity between crack and powder cocaine offenses.
• The bill also aims to lower recidivism by offering more rehabilitation and job-training opportunities, and it includes provisions intended to treat prisoners humanely — banning the shackling of pregnant inmates, halting the use of solitary confinement for most juvenile inmates, and mandating that prisoners be placed in facilities within 500 miles from their families.

Accomplishment: Defeating ISIS's caliphate and killing Abu Bakr al-Baghdadi

ISIS shocked the world in 2014 when it took over a large swath of territory across Iraq and Syria and declared a caliphate.

The terrorist group's territorial holdings were the basis for its so-called caliphate, and provided it will a major base of operations to conduct attacks across the world. 

After a five-year effort led by the US, ISIS's caliphate was finally defeated in March 2019.

Trump has at times falsely claimed that ISIS is totally defeated, embellishing the extent of the US military's success against the terrorist organization during his presidency. Though the terrorist group has lost its territory — its so-called caliphate — it's still estimated to have up to 18,000 fighters in Iraq and Syria.

In late October, a US raid led to the death of ISIS leader Abu Bakr al-Baghdadi. 

Baghdadi was the world's most wanted terrorist up to that point and his death represented a major blow to the terrorist group. 

"Last night, the United States brought the world's No. 1 terrorist leader to justice," Trump said at the time. "Abu Bakr al-Baghdadi is dead."

"Capturing or killing him has been the top national security priority of my administration," he added.

Failure: Charlottesville and George Floyd

Trump's response to a deadly neo-Nazi rally in Charlottesville, Virginia, remains one of the most controversial moments in his presidency. 

It was emblematic of Trump's struggle to bring the country together after tragedies, and more generally. His response also typified his controversial record on race relations and white supremacy. 

Trump blamed "many sides" for the violence at the rally, which resulted in the death of a counterprotester, Heather Heyer. He later said there were "very fine people on both sides."

The president was excoriated by Republicans and Democrats alike over his response and his failure to offer a swift and forceful condemnation of white supremacist violence. 

GOP Sen. Lindsey Graham of South Carolina, often one of Trump's fiercest defenders in Congress, at the time said the president's words were "dividing Americans, not healing them."

"President Trump took a step backward by again suggesting there is moral equivalency between the white supremacist, neo-Nazis and KKK members," Graham added. 

In the wake of the brutal death of George Floyd at the hands of Minneapolis police and the nationwide protests that followed, Trump also failed to rise to the occasion. He's done far more to divide the country than bring it together. 

The president had peaceful protesters tear-gassed near the White House so he could pose for a photo with a Bible at a nearby church. He's consistently demonized anti-racism demonstrators, and controversially sent federal agents into US cities to squash unrest and intimidate the local population. Trump has elevated conspiracy theorists and people who've threatened protesters with guns. 

Historians have warned that Trump's tactics mirror those of authoritarian regimes. 

Trump has frequently employed racist rhetoric during his presidency, but especially during times of heightened racial tensions. 

Polling shows that the vast majority of Black Americans believe Trump is a racist, and his approval rating with this demographic stands at 8%, according to Gallup.

Failure: America's global image is in shambles

America's global image has declined significantly under Trump, who has repeatedly insulted key US allies while cozying up to dictators. 

The president's tendency to push important allies away and isolate the US, including by pulling out of landmark international agreements like the Paris climate accord, has had a palpable impact. 

People across the world have expressed negative views on Trump. Pew Research Center in January 2020 released a survey of 32 countries that showed a median of 64% said they do not have confidence in Trump to do the right thing in world affairs, and just 29% expressed confidence in the president.

Trump's handling of the coronavirus pandemic has also left the US embarrassed on the world stage, and created a void in global leadership that China has rushed to fill. 

Failure: Family separations and the deaths of migrant children

Trump in 2016 campaigned on reducing undocumented immigration, pledging to take a hardline approach.

He made good on that promise when coming into office, but has been accused of human rights abuses and violating international law by the UN.

The Trump administration's "zero tolerance" policy on illegal border crossings led to the separations of at least 5,500 families and saw children placed in cages.

The president of the American Academy of Pediatrics at the time described the practice as "nothing less than government-sanctioned child abuse."

After widespread backlash, Trump issued an executive order in June 2018 to halt the family separations, and a federal judge ordered the Trump administration to reunite all those it had separated. But the fallout from the separations is ongoing. 

Trump has falsely blamed his predecessor, former President Barack Obama, for the policy that saw thousands of children separated from their parents. 

Meanwhile, at least six migrant children have died in US custody since September 2018, leading to widespread condemnation of conditions in detention facilities.

The UN human rights chief, Michelle Bachelet, in July said she was "shocked" by the US government's treatment of migrant children and the conditions they faced in detention facilities after crossing the border from Mexico. 

"As a pediatrician, but also as a mother and a former head of state, I am deeply shocked that children are forced to sleep on the floor in overcrowded facilities, without access to adequate health care or food, and with poor sanitation conditions," Bachelet, the former president of Chile, stated.

Failure: Iran, Syria, and Afghanistan

Trump's decision to unilaterally withdraw the US from the 2015 nuclear deal in May 2018 has induced chaos throughout the Middle East. 

It remains one of Trump's most unpopular decisions in the global arena, and has been condemned by top US allies who were also signatories to the deal. 

The president has failed to thwart Iran's aggressive behavior in the region via a maximum pressure campaign, which is meant to squeeze Tehran into negotiating a more stringent version of the pact. 

After a series of incidents in the Persian Gulf region in 2019, tensions between Washington and Tehran reached historic heights and sparked fears of war. This fears were exacerbated after Trump ordered a strike that killed Iran's top general, Qassem Soleimani, in early January. The strike led Iran to retaliate and fire on US troops in the region, and dozens were seriously injured. 

Iran has essentially abandoned the 2015 nuclear deal, which was designed to prevent it from obtaining a nuclear weapon. 

Trump's decision to pull US troops out of northern Syria in October is also among his most disastrous foreign policy moves. In doing so, Trump effectively abandoned US-allied Kurdish forces who bore the brunt of the US-led campaign against ISIS to a Turkish military invasion.

The withdrawal induced a humanitarian crisis and created a security vacuum that Russia, Iran, and Syrian President Bashar al-Assad, an accused war criminal, all benefited from.

Trump has repeatedly pledged to end "endless wars," zeroing in on Afghanistan. He wanted to remove all US troops from Afghanistan by the November election, but that hasn't happened with Election Day less than two months away. The US is engaged in ongoing but tenuous peace talks with the Taliban that have occurred in concert with ongoing violence in the country.

Meanwhile, the New York Times in June reported that US intelligence officials determined Russia has paid bounties to Taliban-linked Afghan militants to kill US troops.

The Trump administration has taken no known responses. Though the White House has claimed Trump was not initially briefed on the matter, reporting from multiple outlets suggests otherwise. Trump in a recent interview said he has not confronted Russian President Vladimir Putin on the matter. 

Failure: Replacing the Affordable Care Act (AKA Obamacare)

The late Sen. John McCain's iconic "thumbs down" vote denied Trump a full congressional repeal (even a "skinny repeal") of former President Barack Obama's signature health care law.

However, Trump has had success in dismantling parts of the law. His tax bill included a roll back of the tax penalty for those who did not enroll in health care, and the Trump administration has had some success in the courts regarding the individual mandate.

Earlier in December, a federal appeals court struck down a core part of the law — the individual mandate. It did not overturn the entire law, sending it back to a lower court, and leaving the fate of Obamacare uncertain as an election year focused on health care intensifies.

What Trump has not done in his first three years is offer a replacement for the Affordable Care Act. As the Associated Press points out, as a candidate Trump promised "insurance for everybody" and a more immediate replacement to the nearly decade-old ACA.

The president said he would introduce a "phenomenal health care plan," during an interview with ABC News in June.

Failure: Impeachment

Trump was impeached in the House of Representatives on December 18. 

The House approved two articles of impeachment against Trump, one for abuse of power over his dealings with Ukraine and one for obstruction of Congress over his efforts to stonewall the impeachment inquiry.

Trump urged Ukraine to launch investigations into his political rivals as he simultaneously withheld about $400 million in congressionally-approved military aid from the country, which is fighting an ongoing war against pro-Russian separatists. 

The president was acquitted Senate trial, but will still go down as just the third president in US history to be impeached. GOP Sen. Mitt Romney of Utah also made history by voting to convict Trump, marking the first time ever that a senator voted to convict a president from their own party. 

Failure: COVID-19 pandemic

Trump's handling of the COVID-19 pandemic will likely go down as one of the biggest disasters in US history. Hundreds of thousands of Americans have died, and millions are unemployed. 

The US has the worst coronavirus outbreak in the world, with over 6.3 million confirmed cases and nearly 200,000 reported fatalities. The US has had more coronavirus cases than the populations of many countries. And more Americans have died from the virus than the number of US soldiers killed in combat in every war since 1945 combined. 

Trump has repeatedly downplayed the threat of the virus and contradicted top public health experts, flouting recommendations from advisers on his own White House coronavirus task force.

In March, Trump privately admitted to veteran reporter Bob Woodward (on tape) that he was deliberately misleading the public on the dangers of the virus in an effort to avoid inducing panic. 

Public health experts have cited Trump's nonchalant approach to the virus and tendency to reject science as one of the primary factors in why the US emerged as the epicenter. 

Trump has refused to accept responsibility for his failed response to the pandemic, blaming China instead. 

There's an obvious playbook waiting for Joe Biden should he win the White House with a mandate to tear down President Donald Trump's legacy. 

It's the same one Trump used four years ago.

Trump's early days in office were largely devoted to obliterating everything President Barack Obama accomplished over two terms. 

Each step of the way, the Republican president relished his moves to pull the US out of Obama-negotiated international agreements, dramatically shift priorities at federal agencies, and issue a spate of executive orders.

"Don't forget, President Obama — they say he was a great president,"Trump said in August. "Well, you can't be a great president when much of what he's done we've undone." 

But a Biden win means there's nothing stopping him from undoing all of Trump's work too. 

"Every administration as they come into office will have identified guidance, rules, regulations, executive orders that they want to change and they'll go in with a plan and make changes as rapidly as the process will allow," said Mike Leavitt, a former Utah GOP governor and George W. Bush administration Cabinet official who led Mitt Romney's  presidential transition planning effort during the 2012 White House campaign.   

"That's part of what you win when you win an election is the ability to do that," Leavitt added. 

You can bank on Biden's team using the exact same tactics to shred Trump's policies, according to former presidential transition team and executive branch officials interviewed by Insider. 

"I certainly expect that a Biden administration would use ...  all the tools that were available," said John Cruden, who was stationed at the Justice Department as an assistant attorney general during the Obama administration. "A lot of things were done by executive orders and policy statements and guidance documents" under Trump, Cruden added. "Those are way easier to undo." 

Indeed, the Democratic presidential nominee is campaigning on big promises that he'll demolish pretty much everything that Trump and his allies have spent the past four years putting in place. Biden's campaign slogan is "Build Back Better," and he's pledging major reversals on Trump policies on healthcare, immigration, environment, LGBTQ rights and education. 

"Joe Biden will consider every tool available, including Congressional and executive actions, to reverse Trump's damaging policies and restore critical environmental and public health protections for the millions of Americans and communities facing the pandemic and economic crisis," said Jamal Brown, national press secretary for the Biden campaign. 

It's the job of Biden's transition team — more than three dozen staffers already are working behind the scenes to prepare for Democrats winning back the White House — to scrutinize everything Trump has done over the past four years. They're mapping out which policies they want to torpedo and how they want to do it. 

Freezing rules

Here's how Biden's administration would get things started rolling back the Trump legacy: On day one, January 20, 2021, the new Democratic president's White House chief of staff issues a memo that halts all federal regulations that are still pending. 

This won't be a surprise to any Washington veterans. Republican and Democratic administrations alike have issued these memos, which make it easier for new political appointees to change or unravel rules they don't like. 

"You can be utterly confident," Cruden said, "that the new administration within a day or two would pull every rule that was not final." 

Trump's first chief of staff, Reince Priebus, issued the most recent regulatory freeze with his memo on the president's first day in office. That stalled last-minute rules issued under the Obama administration like Endangered Species Act protections for bumblebees and energy efficiency standards aimed at combating climate change. Obama's top aide, Rahm Emanuel, did it right after George W. Bush left office; as Andrew Card in the new Bush White House did it to Bill Clinton. 

Such a freeze would give Biden's team time to review policies if Trump loses in November and his team issues any last-minute or "midnight" rules between the election and Inauguration Day. 

Trump world isn't talking about its plans if it gets the boot in November. For now, the president is governing as if he'll win a second term. But GOP veterans anticipate there could indeed be last-minute deregulatory actions.

"I don't know if they're cooking those up, but it's a possibility," said Myron Ebell, who worked on Trump's 2016 transition and is director of the Center for Energy and Environment at the Competitive Enterprise Institute. 

Killing rules on the books 

The Biden team is also eyeing a tool that allows Congress to reject any Trump administration rules that were recently put on the books before Trump leaves office. 

It's allowed through a law called the Congressional Review Act, which was seldom used before Trump entered the White House. By May 2017, the Trump administration — backed by a GOP-led US House and Senate — had used the CRA 14 times to unravel Obama rules. 

Prior to Trump's tenure, it had been used once, when the George W. Bush administration axed a 2001 ergonomics rule issued by the outgoing Clinton administration. 

"That was an unprecedented degree of regulatory rollback," Daniel Esty, a law and environmental professor at Yale University who worked on Obama's 2008 transition team, said of Trump's moves. If Biden wins, he expects "a significant attempt to pull back on a lot of that agenda." 

Using the CRA would depend in large part on the makeup of Congress next year. If Biden is in the White House and Democrats hold the House and Senate, the CRA is far more likely to be effective than if the GOP controls either chamber. 

Democrats are keeping close tabs on which Trump rules could be ensnared by the CRA if Biden wins. A big one for environmental advocates is Trump's policy to speed up federal permitting of infrastructure projects like highways and pipelines. Because it was finalized so late in Trump's term, it could be rescinded by Congress and a Biden White House. 

Writing new rules 

A Biden administration would also be in a position to scrap or rewrite any Trump rules that are already on the books. Those include policies dealing with air and water pollution, healthcare, technology, and every other issue that the alphabet soup of federal government agencies has the power to regulate. 

Every presidential administration issues a steady stream of new regulations, but the pace of rulemaking could be even more frenzied than usual under a Biden administration aiming for swift reversals from the Trump era. 

Still, writing federal rules (or scrapping existing ones) takes time. Agencies under federal law must give public notice, allow anyone to submit comments, and also explain why changes to existing rules are necessary and legal. Mess any of that up and the Biden administration's policies become highly vulnerable to the inevitable challenges that come in court.

The Biden campaign's informal policy groups are already compiling lists of Trump rules that they think should be proposed for reversal come Inauguration Day. 

About-face on international deals

Biden has promised to reenter the US into the Paris climate agreement "on day one" of his administration. Trump has moved to pull America out of that major United Nations-negotiated global warming accord, which the Obama administration signed in 2016.

But Trump's attempt at a unilateral exit won't be formal until the day after the 2020 presidential election. 

Biden has also pledged for the US to rejoin the Iran nuclear deal, another big Obama foreign policy legacy agreement aimed at preventing Tehran from securing a nuclear weapon. Trump revoked the deal in 2018, calling it"a horrible one-sided deal that should have never, ever been made." 

Legal 180s

Another powerful option for the Biden administration: reverse the federal government's position in ongoing lawsuits. 

Like any new administration, Biden's would have the authority to change course in any active litigation over major Trump-era policies. For example, where the Trump Justice Department may have been asking a court to uphold a policy held up by legal maneuvers, a Biden-led DOJ could argue that that same policy is actually illegal. 

Federal judges don't typically take kindly to such reversals. But Trump and other presidents before him have used this approach after a transition in power where the party controlling the White House also changes. 

In a high-profile Supreme Court case early in 2018, Trump's lawyers argued that Ohio could cancel citizens' voting registrations if they hadn't confirmed their eligibility within two years. Obama's lawyers had said the opposite— that Ohio was acting illegally purging eligible voters from the rolls. 

The Justice Department had changed course in at least 10 major federal cases during Trump's first year in office on issues like labor law, voting, immigration, and health care, The Wall Street Journal reported. 

Obama did it, too. In 2009, for example, Obama's lawyers asked a federal appeals court to pause a legal battle over a contentious Bush-era air pollution standard that critics said was too weak. The new Democratic-led administration later told the court it planned to reconsider the regulation itself. A very similar fight with the roles reversed also played out during Bush's term when its EPA shifted away from the Clinton administration's more aggressive approach to curtailing power plant emissions. 

Executive orders

One of the fastest ways for a new administration to enact policies is with the president's pen. Those orders are also by nature extremely easy for the next president to toss out, and Biden could change or revoke any Trump executive orders if he's in charge of the White House. 

In his first few weeks in office, Trump signed piles of executive orders signaling his priorities on everything from directing the construction of a U.S.-Mexico border wall to suspending the entry of immigrants from certain Muslim-majority countries into the United States. 

Some of Obama's first executive orders in 2009 were new ethics guidelines for his administration and an order directing the closure of the Guantánamo military prison within a year (that didn't happen and the prison remains open). 

Obama relied heavily on executive orders for his policies, too, after some of his big-ticket legislative efforts — like climate change and immigration reform — failed to win the necessary support on Capitol Hill. "I've got a pen to take executive actions where Congress won't,"he said after Democrats lost control of the Senate in the 2014 midterms. 

New administrations often roll out rapid-fire executive orders in their early days to show that they're following through on their campaign trail promises. Many of Trump's early orders unraveled Obama policies; early Biden orders could similarly undo Trump's work. 

"You could do 100 executive orders if you wanted on day one," said Chris Lu, a former Obama White House official who was executive director of the Obama-Biden transition team in 2008. 

A new administration will typically roll them out over time, however, as a way to placate its political base and even to galvanize support for more aggressive actions down the line. "A lot of these are messaging opportunities as well, so you want to send a clear signal," Lu said.   

New leaders

Personnel is policy, and a new Biden team would send a clear signal — as Trump did — about his policy plans as he announces new appointments to lead federal agencies. 

A president installs about 4,000 people throughout the federal government — including more than 1,000 with jobs that require Senate confirmation. 

The Trump administration signaled its priorities for environmental agencies by installing leaders who promoted a deregulatory agenda. For example, Energy Secretary Rick Perry had long called for abolishing the Department of Energy before he got the job leading it at the start of Trump's term. 

A Biden team would likely draw upon former Obama administration officials, presidential campaign staff, Biden's former campaign trail rivals, and progressive activists. 

New department leaders offer fresh plans and directions for their own agency staffers and for the public. They can send clear signals about what issues the federal workforce should be prioritizing and can issue guidance documents about how they plan to enforce the law. 

Legislation

Getting a new law passed is the best way a president can ensure that his policies will endure. But congressional gridlock and partisan sparring has made major legislation hard to come by in recent years. 

Of course, Biden would enter the Oval Office with a long legislative wish list packed with items like infrastructure spending, climate change bills, healthcare overhauls, and immigration reform. 

Notably, Biden hopes to convince Congress to spend a whopping $2 trillion to rebuild infrastructure, combat global warming, and kickstart an economy reeling from the coronavirus pandemic. He also pledged to make Roe v. Wade "the law of the land" if he's in the White House. 

The Democrat's chances for success on the legislative front would depend in part on whether his party also holds majorities in both chambers, and also on whether lukewarm Senate Democrats would really go along with a move to ax the filibuster rule that requires 60 votes to advance most controversial bills. 

Biden would also have to prioritize his legislative goals amid the inevitable 2022 midterm political pressures that begin immediately after he takes office, all while grappling with the ongoing coronavirus pandemic and its economic fallout. And like every other White House resident, a president Biden wouldn't get all the big bills on his wish list. 

"Campaigns are almost always based on the assumption that they'll get exactly what they want," Leavitt said. "That isn't always the case." 

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WASHINGTON (AP) — When the Supreme Court weighs the fate of Obamacare on Tuesday, arguments will revolve around arcane points of law like severability — whether the justices can surgically snip out part of the law and leave the rest.

But what's at stake has real-world consequences for just about every American, as well as the health care industry, a major source of jobs and tax revenues. Whether the Affordable Care Act stays, goes, or is significantly changed, will affect the way life is lived in the U.S.

The argument against the law from the Trump administration and conservative states is that the 10-year-old statute was rendered unconstitutional in its entirety when Congress dialed down to zero a penalty on those remaining uninsured. The court has shifted solidly to the political right under President Donald Trump. Here's a look at some of what's at stake if the opponents of the law prevail:

COVID-19 A new pre-existing condition 

Before the ACA, insurers could turn a person down for an individual policy, or charge them more, based on their medical history. The nonpartisan Kaiser Family Foundation estimates that about 54 million working-age adults have health issues that would have made them "uninsurable" before former President Barack Obama's signature law.

Tens of millions more have issues that could have led to higher premiums. Female gender was one, as insurers routinely charged women more.

COVID-19 would become America's newest pre-existing condition, for more than 10 million people who have tested positive so far.

Under the ACA, a coronavirus case cannot be used to deny someone coverage or charge them more. If Obamacare is gone, that becomes a real question.

Trump promised to always protect people with preexisting conditions, but never said how he'd do it.

Coverage for more than 20 million

The ACA's two main programs for covering uninsured people would be wiped out if the law is overturned, leaving more than 20 million people uninsured unless a divided Congress can put a new safety net in place.

About 12 million low-income people are covered through the health law's Medicaid expansion, now available in most states. Most of them are adults working in jobs that don't pay all that much, and don't come with health insurance. Some have lost jobs in businesses like hotels, restaurants, and movie theaters, which continue to struggle because of the pandemic.

Another group, more than 11 million people, has private coverage purchased through taxpayer-subsidized private markets such as HealthCare.gov

That's also in jeopardy.

Prevention

Most American women now pay nothing out of their own pockets for birth control. That's covered as a preventive service, free of charge to the patient, under the ACA.

Many other services, from colonoscopies to flu shots, are also free.

If people again face copays for routine preventive care, that may discourage some to go for tests shown to detect diseases like cancer at early stages when they are easier to treat.

Return of a Medicare gap

"Obamacare" took the first major steps to close Medicare's unpopular "doughnut hole," a coverage gap that used to leave seniors on the hook for hundreds of dollars in prescriptions drug costs. Congress later accelerated the timetable.

Repealing the ACA would mean the return of the coverage gap, sure to infuriate older voters, many of whom say their medications still cost too much.

That's just one of many potential consequences to Medicare. The ACA slowed payments to hospitals and insurers to extend the life of the Medicare trust fund.

Longer runaway shortened

One of the earliest benefits to take effect after the passage of "Obamacare" was a requirement that insurers allow young adults to stay on a parent's plan until they turned 26.

That provided a longer economic runway for millions of young adults, who back then were struggling with the lingering effects of the Great Recession. Nowadays it's the consequences of the coronavirus economy.

Before the ACA's coverage extension, insurers routinely cut off young adults upon graduation.

Tax cut for the wealthy

"Obamacare" raised taxes on upper income individuals to help finance its coverage expansion.

If the entire law is repealed, that would deliver a tax cut to well-to-do people, many of whom have escaped the economic shock of the COVID-19 pandemic because stock market investors have continued to do well.

Political Rubik's cube

Passing the 900-page-plus ACA was a political challenge that took more than a year at a time when Democrats controlled the White House and both chambers in Congress.

Putting together a replacement under a divided government would be the ultimate political puzzle. Neither Democrats nor Republicans agree even within their own ranks what that should look like.

President-elect Joe Biden would build on the ACA by improving it and adding a new public health insurance option. But party liberals want a government-run system for all Americans, including the 160 million covered through employer plans.

Many Republicans, meanwhile, want to scale back the government's support for health care. They would make deep cuts to Medicaid financing, and leave the ACA's insurance markets as a state option. Protections for people with pre-existing conditions could be eroded under new rules.

Trump once famously said, "nobody knew health care could be so complicated." That was in 2017, when he and a Republican-controlled Congress harbored hopes they could "repeal and replace" the ACA.

It didn't happen then because Republicans could never agree on what a replacement would look like.

Fast forward to 2020. Health care has only gotten more complicated.

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The Supreme Court on Tuesday began weighing the latest challenge to the Affordable Care Act, known as the ACA or "Obamacare." It's the first major test for the law since President Donald Trump's nominee, Amy Coney Barrett, was confirmed to replace the late Justice Ruth Bader Ginsburg last month, cementing a 6-3 conservative majority on the high court.

The justices heard two hours of oral arguments in their third review of the case, which would determine whether the Obama administration's landmark healthcare legislation, which provided health insurance to 20 million Americans, will stay intact. In previous rulings in 2012 and 2015, the Supreme Court decided to uphold the act.

And on Tuesday, two conservative justices on the bench, Chief Justice John Roberts and Associate Justice Brett Kavanaugh, the latter of whom is also a Trump appointee, signaled the law may once again survive Republicans' latest effort to strike it down.

Tuesday's case, brought forth by a slew of red states and led by Texas, was backed by the Trump administration. The lawsuit primarily argues that a key provision of Obamacare, known as the individual mandate, is unconstitutional, unjustifiable, and that as a result, the whole law should be thrown out.

But Roberts and Kavanaugh seemed skeptical of the argument and suggested the individual mandate was severable; in other words, they said that specific provision could be struck down while the rest of the law remained intact.

"It's hard for you to argue that Congress intended for the entire act to fall if the mandate were struck down, when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act," Roberts, who cast the deciding vote to uphold the ACA in 2012, told Republican lawyers.

Similarly, Kavanaugh pointed out that "it does seem fairly clear that the proper remedy would be to sever the mandate and leave the rest of the law in place."

"I tend to agree with you that this is a very straightforward case for severability under our precedents, meaning that we would excise the mandate and leave the rest of the act in place," he added.

The chief justice also raised the issue of "standing," which refers to the notion that a party or individual that files a lawsuit must demonstrate that they personally have been wronged by the issue they're litigating.

Roberts said the plaintiffs' argument "really expands standing dramatically ... You're letting someone not injured by the provision he's challenging to sort of roam around through those 1,000 pages and pick out whichever ones he wants to attack."

A final ruling in the case is expected to come by the end of the current term in June 2021, and if Roberts and Kavanaugh were to side with the court's three liberal justices, it would be enough to uphold Obamacare.

The decision would be a major blow to Republicans and the Trump administration, who have repeatedly sought to invalidate the law through Congress and the courts since Trump first took office in 2017 and even before that.

Newsweek documented at least 70 Republican-led efforts to modify, repeal, or drastically downsize the ACA since it was first enacted in March 2010. In July 2017, six months after Trump took office and his administration made a strong push to repeal Obamacare and replace it with the widely panned"Trumpcare," the Republican-controlled Senate again rejected the effort with then Arizona Sen. John McCain's dramatic thumbs-down vote.

The president has since continued to tout healthcare reform as a key pillar of his reelection campaign and said a plan was forthcoming but never released one. As of last week, Insider and every major TV network projected that President-elect Joe Biden defeated Trump in the election.

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Stocks for health insurers Molina and Centene rose on Tuesday after several influential conservative Supreme Court justices sounded skeptical about the latest challenge to kill the Affordable Care Act. 

Industry analysts said investors were reacting to questions from Justice Brett Kavanaugh and Chief Justice John Roberts that appeared wary of the idea of throwing out President Barack Obama's signature legislative accomplishment. 

Molina and Centene are heavily influenced by the strength of the ACA. The companies sell insurance through the ACA-created online marketplaces and partner with states to administer Medicaid, which covers millions of poor people under the law. 

Halfway through the Supreme Court oral arguments, at 11 a.m., Centene's stock price grew by 4% and Molina's rose steadily, reaching an increase of about 7% by Tuesday afternoon. 

"Both of them seemed to get a pretty significant boost, and that makes sense," Spencer Perlman, director of healthcare research at Veda Partners, told Insider. 

Several other healthcare stocks were trending upward by 3 p.m. Tuesday afternoon, including healthcare systems Tenet Healthcare Corp. and Universal Health Services, as well as pharmacy and doctor chain CVS Health, which owns health insurer Aetna. 

Tuesday marked the third time that the ACA's constitutionality has gone before the Supreme Court and the first time it's been argued in front of the new 6-3 conservative majority that includes Justice Amy Coney Barrett as the replacement for the late Ruth Bader Ginsburg. 

The case, California v. Texas, has its roots in President Donald Trump's 2017 tax overhaul, which zeroed out the ACA's financial penalty for going uninsured, known as the individual mandate. 

GOP state officials sued in 2018 to have the ACA thrown out, citing a 2012 Supreme Court decision that said the individual mandate was critical to making the law work. Without it, they said, the rest of the law couldn't exist. The Trump administration sided against the ACA.  

It's hard to predict exactly how the justices will decide, but healthcare market analysts who listened to the two hours of oral arguments conducted over teleconference told Insider that the justices' questioning made them more confident that the ACA would remain law. 

"It can sometimes be foolish to predict what the courts are going to do based on the oral arguments, but I would say in this case it certainly appears the courts are coming toward a resolution that would result in the status quo being maintained," Perlman said. 

The Supreme Court is expected to issue a decision during the first half of 2021, a few months into President-elect Joe Biden's new term. Insider spoke with four analysts about their takeaways from the oral arguments. Here's what stood out to them. 

Most likely outcome: Obamacare will be upheld 

Kavanaugh at least three times during oral arguments appeared to state that he agreed that the individual mandate could be struck down. But the 2018 Trump appointee also said that shouldn't affect the rest of the law. 

"I tend to agree with you that it is a very straightforward case under our precedents, meaning that we would excise the mandate and leave the rest in place," Kavanaugh said.

Kim Monk, who tracks the healthcare debate in Washington for investors at Capital Alpha Partners, said she thought Kavanaugh's comments during Tuesday's proceedings revealed his stance on the case. 

"It's pretty clear he thinks the mandate can be severed," she said. The Supreme Court's three liberal justices, Stephen Breyer, Sonia Sotomayor and Elena Kagan, are widely expected to vote in favor of upholding the healthcare law, which Biden played a critical role in passing and then implementing while serving as Obama's vice president.

Roberts, a George W. Bush appointee who wrote the two previous Supreme Court opinions that upheld the ACA, made comments similar to Kavanaugh. 

Hunter Hammond, an Analyst at Height Capital Markets, said he thought a majority of at least five justices would vote in favor of striking down the individual mandate but still uphold the healthcare law. 

That outcome would benefit healthcare markets. By contrast, throwing out the ACA would have ramifications across the $3.6 trillion US healthcare system. Fewer people with insurance means fewer paying customers for doctors, clinics, and hospitals. Insurance companies would lose millions of customers. 

Dodge the issue by addressing standing 

Another factor in play is whether the Supreme Court will dismiss the latest challenge against the ACA by saying the lawsuit's authors lacked legal standing to even be bringing their case.

"It would not shock me as the court has done before that they not get to the underlying question at hand but dismiss it based on standing," Chris Meekins, director of healthcare policy at Raymond James, told Insider. 

Conservative Justices Clarence Thomas, Samuel Alito, and Barrett all asked questions about whether states or individuals had been harmed as a result of the fine being zeroed out but nonetheless remaining in the statute. 

Perlman said dismissing the case based on standing might be the justices' "get out of jail free card." The ACA has been the subject of political turmoil since its passage in 2009. 

"They might not even have to rule on the merits of the case," Perlman said.  

The ACA's challengers could sue again should the Supreme Court dismiss the case. But in that scenario it would take several more years of litigation before they have another chance to kill the law in front of the nation's highest court. 

What the justices didn't ask

Another subplot in Tuesday's Supreme Court hearing involves questions that the justices didn't ask about. Absent a definitive opinion that likely won't be released for several months, tea leaf readers often are left scrambling to interpret the direction of a case based both on what gets discussed during public arguments and also any topics that are avoided.

Here, the justices didn't bring up one of the central legal issues at play in the Affordable Care Act dealing with whether the law could be cut up into different pieces that allow some parts to stand but not others. 

The ACA leaned on a blend of government health programs and private health insurance to expand coverage to 20 million people. It also reached into other parts of healthcare, including prescription drugs, and created rules saying insurers couldn't turn away sick people or charge them more than healthy people for coverage.  

Monk said throwing out the entire law would "tank" the healthcare markets, and that cutting parts of it — such as its consumer protections — would create an "earthquake to the markets." The online ACA marketplaces that lean on private health insurance would "pretty much completely unravel." 

There's still some uncertainty in the markets until the Supreme Court issues a decision, said Hammond from Height Capital Markets. 

"There is still a possibility that the entire ACA gets taken down," Hammond told Insider. "That possibility — however low — will be there until we have a decision." 

The Supreme Court justices also didn't ask about whether Congress and a Biden administration would rush to rescue the healthcare system if the ACA were to be struck down. The breakdown of the Senate is still in limbo with a runoff in Georgia planned for January 5. 

If Democrats get at least 50 votes in the Senate then they could alter the healthcare law. Meekins from Raymond James said Democrats would have a few options to "complicate any ruling by the Supreme Court," including raising the individual mandate from $0 to a higher amount, whether $1 or higher. 

But Monk said Congress might not be satisfied with incremental measures, and might look at other ways to expand the ACA. 

"If it comes out that the Supreme Court invalidates the ACA," she said, "it will be Donald Trumps' legacy to enable the Democrats to expand the ACA." 

Read more: Joe Biden made his presidential campaign all about healthcare. Just don't expect a public option anytime soon.

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President-elect Joe Biden announced half a dozen picks for top economic jobs in his administration on Monday. Collectively, they signaled a willingness to put a more diverse team in charge of confronting the enormous challenge of rebuilding the economy after the pandemic.

"As we get to work to control the virus, this is the team that will deliver immediate economic relief for the American people during this economic crisis and help us build our economy back better than ever," Biden said in a statement.

Yet one of Biden's choices immediately ignited criticism from some on the left and many Republicans: Neera Tanden as director of the Office of Management and Budget, the agency charged with designing and carrying out the annual spending plan.

The position requires Senate confirmation — and the nomination may set off his first fight in a closely divided chamber that is likely to remain in Republican hands after a pair of Georgia runoffs on January 5.

Josh Holmes, former chief of staff to Senate Majority Leader Mitch McConnell, tweeted on Sunday that Tanden was "a sacrifice to the confirmation gods," a suggestion that Republican fury at Biden's electoral victory could be dampened with the GOP blocking her nomination.

Drew Brandewie, spokesperson for Republican Senator John Cornyn of Texas, also tweeted Tanden "stands zero chance of being confirmed."

Some progressives lambasted the pick. "Everything toxic about the corporate Democratic Party is embodied in Neera Tanden," Briana Joy Gray, former press secretary for the Bernie Sanders campaign, said on Twitter.

Other Democrats, though, praised her. Stacey Abrams, a voting rights advocate in Georgia and influential progressive, said she was "very proud" of her friend on Twitter. That was echoed by Rep. Barbara Lee, another progressive in the House, who said Tanden was "a great choice."

Tanden said she was "beyond honored" to be nominated to lead the OMB on Monday afternoon.

"After my parents were divorced when I was young, my mother relied on public food and housing programs to get by,"she said on Twitter. "Now, I'm being nominated to help ensure those programs are secure, and ensure families like mine can live with dignity."

Should she be confirmed, Tanden would be the first woman of color as well as the first South Asian American to lead the agency. The Biden transition team did not immediately respond to a request for comment. 

In addition to its spending role, the OMB helps set regulatory and fiscal policy for agencies in the executive branch. Its workforce is largely made up of career civil servants that presidents of both parties rely on for their vast knowledge of federal agencies.

Tanden helped muscle through the Affordable Care Act under President Barack Obama, and became president of the Center for American Progress, a left-leaning think tank, in 2011. She has faced some questions over her management of the organization in recent years.

She was later a top lieutenant for Hillary Clinton and advised her 2016 presidential campaign, regularly clashing with Republicans. Since then, Tanden has been a fierce critic of President Donald Trump and maintained a combative presence on Twitter.

Three moderate Republican senators — Mitt Romney of Utah, Lisa Murkowski of Alaska, and Susan Collins of Maine — have all signaled they would back Biden's nominees as long as they are centrist. It's unclear so far how they would vote on Tanden, but the senators could decide whether her confirmation is successful.

Tanden has supported some of Romney's critical statements about Trump's leadership and his handling of the pandemic.

If Democrats win both races in Georgia, the party would hold a threadbare majority with Vice President-elect Kamala Harris casting the tiebreaking vote on much of Biden's economic agenda —  including Tanden's nomination.

Other picks that Biden formally announced for high-profile economic roles are Janet Yellen for Treasury secretary; Cecilia Rouse as chair of the Council of Economic Advisors; and Heather Boushey and Jared Bernstein as CEA members. All are widely considered to be less contentious.

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Seema Verma sparked controversy on her first day in the Trump administration and many times after. But she told Insider in an exclusive interview earlier this week that she has "no regrets" as she packs up just days before her tenure comes to an end.

Shortly after being sworn in back in March 2017, the newly minted Centers for Medicare and Medicaid Services administrator sent letters to governors across the country telling them they could impose work requirements and medical fees on low-income people who use Medicaid. Democrats threw a hissy fit.

Throughout her nearly four-year tenure, she was a frequent critic of the Affordable Care Act, former President Barack Obama's healthcare law that President Donald Trump vowed — and so far failed — to completely undo. 

She pushed for deregulation and other conservative elements at CMS, a $1 trillion agency that provides healthcare coverage to nearly 140 million low-income people, seniors, and people with disabilities. 

Verma, 50, was one of the few women of color Trump appointed and proved to be resilient in an otherwise high-turnover administration. She survived bombshell reports from Politico about personality and policy feuds with her boss, Health and Human Services Secretary Alex Azar, as well as a report about the millions of dollars the agency spent on outside contractors in part to boost her image, triggering a House investigation. 

At the policy level, nearly every change she made to the ACA drew backlash from Democratic politicians who accused her of trying to take away people's healthcare and of sabotaging the law. She slashed millions of dollars in funding for ACA commercials and reduced funding for the "navigator" programs that helped people shop for coverage. 

"I have no regrets about the policy changes that we've made," Verma told Insider Wednesday in an exclusive interview. "I fought a lot of battles internally and externally because I stood up for the people and the things that I believed in, and I think that we've done what's right for people and for patients." 

But some of her work won't survive in the Biden administration. Some are tied up in legal battles. The controversial plan in some states to require low-income people without disabilities to work, volunteer, or enroll in job-training programs as a condition for getting Medicaid is headed to the Supreme Court. 

As her tenure winds down and President-elect Joe Biden prepares to take office on January 20, Verma said she sticks by the decisions she made to shape the US healthcare system. 

Verma had come to the Trump administration by way of Vice President Mike Pence. They became close allies when he was the Republican governor of Indiana and she was a private healthcare consultant in Carmel, Indiana. Verma had made it possible for Indiana to put a conservative spin on Medicaid so that the state could expand it to millions of low-income Hoosiers under the ACA. 

Once at CMS, the White House gave her broad leeway to put her own stamp on healthcare. 

In her interview with Insider, Verma defended her work on the ACA, saying it showed "zero evidence of any sabotage" even as the Trump administration has asked the Supreme Court to kill the healthcare law.

She argued that states should be given flexibility to innovate and pointed to ways the ACA marketplaces stabilized under her leadership. Premiums are down, enrollment has remained steady, and customers have more options when they shop for health insurance plans. 

"That didn't happen just because the ACA magically transformed itself," she said. "That has happened because of the efforts that we have taken to stabilize it."

Biden is likely to reinstate the funding for navigators and ramp up Obamacare commercials after taking office, but Verma maintains she made the right move. She said her agency shifted the money from those programs to reduce fees on insurers, which helped lower premiums and boost enrollment. 

Read more: SCOOP: Trump's promise to send people $200 drug discount cards isn't happening, Medicare chief says

CMS actions during the pandemic 

Despite the scrutiny she faced for her other actions, Verma has drawn plaudits for her quick decisions during the coronavirus pandemic.

Some actions she took to allow patients to visit their doctors over phone and video are set to shape healthcare's future in America. (Verma was named to Business Insider's "Healthcare Transformers" in 2020 for her quick response on telehealth.)

Her agency also sent testing kits to nursing homes and wrote rules so that hospitals would submit data on coronavirus patients to the Centers for Disease Control and Prevention. She changed regulations to ensure people on Medicare and Medicaid would get coronavirus vaccines for free. 

Verma said it'll be important to examine why nursing homes had such overwhelming numbers of coronavirus outbreaks and deaths during the pandemic. If Trump had won reelection giving her four more years on the job, she said, one of the areas she'd want to focus on would be quality and safety in the healthcare system. 

"What's happened in the nursing homes is a canary in the coal mine," she said. "There were long-standing problems in nursing homes, and I think there has to be more effort and focus on creating and ensuring that we have an elder care system that provides choices and can ensure families that their loved ones are going to be safe and have high-quality care." 

Biden hasn't yet nominated a replacement for Verma, even as the agency remains a crucial player in the US pandemic response. Trump in contrast had nominated Verma for the job on November 29, 2016, less than a month after winning the election. 

Verma told Insider she has met with the Biden transition team and plans to stay in her role until the inauguration, she said, "to make sure that we can have an effective and smooth transition and that the next team is prepared to operate the agency." 

Verma anticipates that the Biden administration will continue the work started by the Obama administration and then taken up by the Trump administration toward "value-based care" that changes the way doctors and hospitals are paid. Under this system, healthcare providers get paid to keep patients healthier rather than getting paid for each visit or procedure they perform regardless of whether it helps patients. 

She also said she thinks other areas, like making hospitals and insurers post their prices, as well as giving patients more access to their health information, are bipartisan. She said she thinks these actions, which became a priority under the Trump administration, will continue under Biden.

But one healthcare change Verma does not support, that the Biden administration is almost surely headed toward, would be the expansion of health insurance coverage by funneling billions of dollars to the ACA. Verma criticized it as unsustainable. 

"We've got to be more creative around the solutions and just putting people on a government program isn't solving issues," she said. "We have to get to what we focused on, which is to try to address the underlying problems in the healthcare system and try to identify what is creating problems with affordability."

What's next: 'Trophy wife'

Verma said she's been telling people who ask about her next steps after CMS that she's planning to be a "trophy wife," at least in the short term. Her husband is a doctor and she has two children. In previous interviews, Verma has talked about working long hours and commuting from Washington, DC, to her home in Indiana. 

"I've been so focused on this job 100% that I just haven't had time to think about what comes next," she said. 

Verma sold the healthcare consulting business she owned before joining the administration. Her predecessor under the Obama administration, Andy Slavitt, went on to be a political operative and is now on the Biden coronavirus task force. 

Some news reports have found that Trump administration officials are having trouble landing new jobs after working on controversial policies with the president. Verma said she hasn't faced such impediments.

"I'm a policy wonk at the end of the day," she said. "I'm proud of the accomplishments that we achieved at CMS. I think our results speak for themselves."

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President Joe Biden plans to sign executive orders Thursday seeking to increase access to healthcare during the coronavirus pandemic.

Biden's predecessor, President Donald Trump, balked at encouraging enrollment in the Affordable Care Act, the law better known as Obamacare — leaving the new administration with $1 billion in leftover funds to do just that.

Accordingly, one executive order will reopen enrollment in the Obamacare exchanges from February 15 to May 15.

Typically, the sign-up period is limited to a few weeks at the end of each year, forcing those who have undergone major life events at a later point — the loss of employer-provided insurance, for example — to submit additional documentation to get coverage.

The executive order will also direct federal agencies to reexamine policies that make it more difficult to obtain coverage under the ACA or Medicaid.

Under the Trump administration, states were granted waivers allowing them to impose work requirements on Medicaid recipients; those requirements, implemented in Arkansas and New Hampshire, have been struck down by judges in a case that's headed to the Supreme Court.

The last administration also sought to enable states to divert funding from Medicaid to other priorities.

Biden will also sign an executive order meant to expand access to reproductive healthcare — at home and abroad — with a review of his predecessor's regulations limiting federal funding for Planned Parenthood and a lifting of the ban on international aid organizations that receive US funding from discussing abortion.

Have a news tip? Email this reporter: cdavis@insider.com

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Somebody had to pay for Bruce Springsteen to rock the Lincoln Memorial, Katy Perry to belt "Firework" as actual fireworks exploded over the Washington Monument, and Tom Hanks to narrate President Joe Biden's star-spangled inauguration festivities.

Insider interviews and an analysis of obscure congressional lobbying records revealed that Biden has the numerous corporations to thank — from defense contractors to health insurers to financial firms — that together spend tens of millions of dollars each year lobbying the federal government. 

The interviews and records provide a partial and early picture — a federally mandated accounting isn't due until late April — of how some of the nation's wealthiest and most politically connected entities lavished Biden's inaugural celebration with big money. 

Biden's inaugural committee chose to accept most corporate and union contributions — it excluded fossil fuel companies and executives — of up to $1 million.

Although it vowed to reject contributions from individual, registered federal lobbyists, Biden's inaugural committee accepted money from corporations who in turn hire lobbyists to influence federal policies, rules, and regulations on their behalf.

This stands in stark contrast to President Barack Obama's first inauguration, which banned corporate and union contributions and capped individual contributions at $50,000. Biden's rules are similar to the comparatively permissive contribution policies set forth by Obama's second inauguration committee and President Donald Trump's inauguration committee. Few federal rules govern inauguration money, and the incoming presidents themselves largely determine what kinds of money they accept and how much.

Biden treated top-dollar inauguration donors to a host of perks, including VIP treatment at inaugural events, access to a "virtual event" with Biden, Vice President Kamala Harris, and their spouses, and tickets to a "future in-person event."

In early January, Biden's inaugural committee voluntarily posted on its website the names and states of inauguration contributors and stated it "is committed to transparency." 

But these online disclosures— a White House spokesperson declined to say why — disappeared from Biden's inaugural website after January 27. And Biden's inaugural committee never disclosed the dates and dollar amounts of any donation it received.

Federal law requires Biden's inauguration committee to reveal full information about its financial backers by filing details with the Federal Election Commission within 90 days after the January 20 inauguration. 

Federal law does not, however, require the Biden inauguration committee to reveal any information to the FEC about how it spent its money or who it paid to conduct various events and celebrations surrounding Biden's inauguration. 

Read more: Joe Biden touts transparency, but his presidential inauguration spending remains a money mystery as organizers won't disclose who's cashing in

The Biden inauguration committee has not voluntarily released information about its spending.

"The Inauguration Committee will comply with any financial disclosure requirements," the White House said in a statement to Insider. The White House did not answer several detailed questions from Insider about the inauguration's finances and accounting.

Here is who Insider has identified as a Biden inauguration donor and how much money they contributed. This list, originally published on February 1, is being updated as new information is obtained:

Boeing Co.: $1 million

Aerospace giant Boeing, one of the nation's most prominent defense contractors, confirmed to Insider that it contributed $1 million to Biden's inaugural committee.

The contribution is "consistent with our past contributions over the last several inaugurals for Republicans and Democrats alike," Boeing spokesperson Bryan Watt said in an email. 

In January, Boeing paid $2.5 billion to settle federal charges that it tried to defraud the Federal Aviation Administration during the grounding of its 737 Max airplanes.

During 2020, Boeing spent $12.63 million on federal lobbying efforts, according to congressional lobbying disclosures. Its roster of more than 80 lobbyists includes Brian Ballard, who was a top political fundraiser for former President Donald Trump. 

Since 2008, Boeing has never spent less than $12 million on federal lobbying efforts during a calendar year, according to the nonpartisan Center for Responsive Politics.

AT&T Inc.: $1 million

Telecom giant AT&T contributed $1 million to Biden's inaugural committee on Christmas Eve, according to a congressional disclosure filed Monday.

Few companies in the world spend more money lobbying the federal government.

Each year since 1998, AT&T and its subsidiaries have spent at least $11 million on federal lobbying efforts that cover a vast range of issues, from telecommunications and trademarks, to law enforcement and labor policy, according to federal records compiled by the Center for Responsive Politics.

During 2020 alone, AT&T lobbied on dozens of different bills before Congress.

Its team of nearly 80 individual lobbyists last year included former Rep. Ed Whitfield, a Republican from Kentucky who served in the US House for more than two decades.

"For many years, AT&T has contributed to our nation's presidential inaugural celebrations," AT&T wrote Monday in a statement to Insider. "Our expertise is communications, and we invest in and prepare our network extensively for events like these. All such contributions are made public."

Masimo Corporation: $1 million

Medical technology company Masimo contributed $1 million to Biden's inaugural committee on December 10, according to congressional lobbying records.

Masimo's federal lobbying footprint is relatively small compared to other top Biden inauguration donors.

The company only started lobbying the federal government in 2019. During 2020, it spent $350,000 on federal lobbying efforts and employed just two registered lobbyists, according to federal records compiled by the Center for Responsive Politics.

Representatives from Masimo could not immediately be reached for comment.

Microsoft Corp.: $500,530

Microsoft made a $500,530 contribution to the Biden inauguration, according to a filing with Congress on Monday.

The bulk — a $500,000 contribution on December 4 — is in cash. The other $530 arrived on December 17 in the form of an unspecific ed "in-kind contribution for products," the filing stated.

Microsoft has spent at least $6 million on federal-level lobbying efforts every year for the past 20 years, according to federal records compiled by the Center for Responsive Politics.

Microsoft spent almost $9.5 million on federal lobbying during 2020, federal records indicate.

Among its team of roughly 100 lobbyists in 2020 were 3 former members of Congress: Ben Quayle, a Republican from Arizona; Kevin Yoder, a Republican from Kansas; and Howard Berman, a Democrat from California.

Representatives for Microsoft did not immediately return requests for comment.

Comcast Corp.: $500,000

Comcast Corp. contributed $500,000 to Biden's inaugural committee on December 22, according to a disclosure filed Monday with Congress.

Comcast is one of the most powerful lobbying forces in Washington, DC, spending at least $12 million on federal lobbying efforts each year since 2008, according to federal records compiled by the Center for Responsive Politics.

Five former members of Congress lobbied the federal government on behalf of Comcast during 2020: Blanche Lincoln, a Democrat who served Missouri in the US Senate; Ron Klink, a Democrat from Pennsylvania; Kendrick Meek, a Democrat from Florida; Don Nickles, a Republican from Oklahoma; and Whitfield.

In 2016, the Federal Communications Commission fined Comcast $2.3 million — then the largest fine issued to a cable television operator. Comcast agreed to pay the fine after it stood accused of charging its customers for unwanted services and equipment.

In an email to Insider on Monday, Comcast spokesperson Sena Fitzmaurice said: "We don't have any comment on this contribution. As you've probably seen, we've contributed to inaugurations in the past as well."

Dow Chemical Company: $500,000

Chemical company Dow gave Biden's inauguration committee $250,000, according to congressional lobbying records.

Dow split its contribution into two parts: $100,000 on December 15 and $150,000 on December 21, the congressional records indicate.

Dow merged with chemical company DuPont in 2015, but spun off again in 2019.

In 2020, Dow alone spent about $4.7 million on federal lobbying efforts, with much of its attention focused on energy, power, and environmental issues, per federal disclosures. 

While Dow is not a fossil fuel company, per se, it does maintain oil, gas, and mining operations. 

The Biden inaugural committee banned fossil fuel companies and executives from making donations. The White House did not immediately respond to questions about whether Dow's contribution was made in violation of the Biden inauguration committee's no-fossil-fuel-money policy.

In a statement Tuesday to Insider, Dow said: "We are proud to support the inauguration as the transfer of power from one administration to the next. We look forward to working with President Biden on issues that are critical to US manufacturers, such as addressing climate change, protecting the environment, addressing issues of inequity and strengthening America's relationship with key trading partners around the world."

Centene Corp.: $500,000

Centene Corp., a Fortune 500 health insurance and managed care company, gave Biden's inaugural committee $500,000 on December 15, according to a disclosure filed Friday with Congress.

The Biden campaign listed Michael F. Neidorff, Centene's CEO, as one of its top fundraising "bundlers" during the 2020 campaign.

Centene and its subsidiaries spent $5.46 million on federal lobbying efforts during 2020, according to congressional lobbying disclosures. 

Former Mississippi Gov. Haley Barbour, a Republican, lobbied on behalf of Centene last year.

Among Centene's ties to government: it's a major Obamacare insurer. A Centene subsidiary, Centurion, also provides contract health services to governments in 16 states — primarily for prisons, state hospitals, courts, and juvenile facilities. 

Centene did not immediately return requests for comment.

Anthem Inc.: $125,000

Anthem Inc., another Fortune 500 health insurance and managed care company — and the largest player in the Blue Cross Blue Shield federation — gave Biden's inaugural committee $125,000 on December 11, according to a disclosure filed Friday with Congress.

Anthem spent about $4.2 million on federal-level lobbying efforts in 2020, and has spent anywhere from $4 million to $6.5 million annually on federal lobbying since 2009, according to federal records compiled by the Center for Responsive Politics.

Representatives for Anthem did not immediately return requests for comment.

Coca-Cola Company: $110,000

Coca Cola Co. confirmed to Insider in early January that it contributed $110,000 to the Biden inauguration.

That includes $50,000 in cash and $60,000 worth of commemorative Coca-Cola bottles "donated in recognition of the historic election of Biden and Vice President-elect Kamala Harris," the company said in a statement.

The company did not appear on a voluntary donor disclosure list that the Biden inauguration released in early January.

Coca-Cola has also spent between $6 million and $10 million annually in recent years on federal-level lobbying efforts, ranking it among the more powerful lobbies of any sort in Washington, DC.

Verizon Communications Inc.: $100,000

Telecom giant Verizon contributed $100,000 to Biden's inauguration committee on December 22, congressional lobbying records indicate.

Verizon is another federal lobbying juggernaut, having spent at least $10 million on such lobbying efforts each year since 2005, according to government disclosures compiled by the Center for Responsive Politics.

Its army of more than 100 lobbyists in 2020 included three former members of Congress: Republicans Bob Livingston of Louisiana, Lee Terry of Nebraska, and Jack Fields Jr. of Texas.

Verizon representatives could not immediately be reached for comment.

The Capital Group Companies Inc.: $50,000

The Capital Group Companies Inc.— a major financial services and investment management firm — contributed $50,000 on December 30, it reported to Congress.

In 2020, the Capital Group Companies spent $1.53 million on federal lobbying efforts. It spent between $1.5 million and $2 million each year on federal lobbying since 2015, according to federal data compiled by the Center for Responsive Politics.

Representatives for the Capital Group Companies did not immediately return requests for comment.

Enterprise Holdings: $25,000

The political action committee of Enterprise Holdings — the parent company of Enterprise Rent-A-Car, National Car Rental, and Alamo Rent a Car — gave the Biden inauguration $25,000, per congressional records.

Enterprise Holdings spent $726,000 on federal lobbying efforts in 2020 and has spent at least half-a-million dollars lobbying the federa government each year since 2015, according to federal disclosure data compiled by the Center for Responsive Politics.

Google: $5,279

Google made two "in-kind" contributions to Biden's inauguration committee totaling $5,279.20, according to a disclosure filed with Congress.

The contributions, which were not further detailed, were split into donations on December 3 and December 21.

It's possible that Google, which gave Trump's 2017 inaugural committee $285,000, made a larger cash contribution to Biden's inauguration at some point in January.

If so, Google wouldn't be required to disclose such a payment until later this year, per federal rules.

Google parent company Alphabet Inc. spent $8.85 million on federal-level lobbying efforts during 2020.

While at the upper end of lobbying spending among all corporations, it's less than what Alphabet has spent in recent years, including in 2018, when it spent nearly $22 million, according to federal disclosures compiled by the Center for Responsive Politics.

Representatives for Google did not immediately return a request for comment.

Other corporate and union donors

In early January, the Biden inauguration committee, which is organized as a 501(c)(4) "social welfare" nonprofit, voluntarily disclosed the names of more than two-dozen other corporations and labor unions that contributed money.

Many lobby the federal government or have government contracts. But the Biden inaugural committee did not say how much money these donors gave.

Among the corporations and unions the Biden inaugural committee listed as of January 27: Amalgamated Bank, Amazon, American Federation of Teachers, Area 1, Bravia Capital Partners, Cannae Holdings LLC, Charter Communications, Comcast, Fidelity National Financial Inc., Higherschool Publishing Company, Holland & Knight, and Graff Real Estate Inc.

Also: the International Brotherhood of Electrical Workers, Irwin Hodson Group, MedPoint Management, Microsoft, Qualcomm, Starling Chevy Buick GMC of Florida, The Jernigan Law Firm, United Airlines, United Association of Plumbers & Fitters, United Food and Commercial Workers, UPS, and Yelp Inc. 

One company on that list — Holland & Knight — is a lobbying firm that last year earned nearly $28 million from its working lobbying the federal government on behalf of dozens of clients.

These clients include the American Chemistry Council, Bacardi Ltd., CrossFit Inc., the Financial Services Institute, Spirit Airlines, and Thomson Reuters, as well as the municipal governments of Atlanta, Philadelphia, Phoenix, Seattle, and West Palm Beach, Florida — next door to where former President Donald Trump now lives at his Mar-a-Lago resort.

Bank of America, Ford Motor Co., and Aflac, although not on Biden's disclosure list, previously indicated to Insider that they would make contributions to the president's inauguration.

Corporations that contributed money to Biden's inauguration during January, as opposed to November or December, are not required to disclose those donations to Congress until later this year. Therefore, it's still unknown how much money these companies gave to Biden's inauguration.

During his presidential campaign, Biden took a hard line against lobbyists and offered several detailed proposals to tighten lobbying rules and increase transparency.

"As president, he'll enact legislation to bar lobbyists from making contributions to, and fundraising or bundling for, those who they lobby," Biden's campaign platform stated. "This legislation will be designed to ensure that the public knows as much as possible about the political spending of those who seek to influence officeholders and other government officials.  Any lobbyist contribution must be disclosed within 24-hours, and any lobbyist-hosted fundraising event must be disclosed before it occurs."

It added: "Disclosure requirements are riddled with loopholes, so lobbyists can coordinate a PR campaign without ever disclosing their work."

By law, the Biden inaugural committee must publicly disclose full information about its donors within 90 days after the January 20 inauguration.

Lobbyist donors?

Biden's inaugural committee expressly prohibited contributions from registered federal lobbyists.

But a new filing with the US Senate indicates that several registered lobbyists did make contributions.

Matt Ward of government relations firm Sustainable Strategies DC made a token contribution of $25 on December 1. 

Ward, who declined to comment Thursday, represented 17 federal lobbying clients during 2020, including the municipal governments of Charlestown, West Virginia; Ithaca, New York; Frederick, Maryland; Frankfort, Kentucky; and Dubuque, Iowa, according to federal records compiled by the nonpartisan Center for Responsive Politics. 

General Electric lobbyist Theresa Peterson also reported in a congressional filing that she contributed $217.35 to the Biden inauguration on December 12. In a statement Sunday to Insider, GE said: "We're aware of the donation and have already requested that it be returned."

American Federation of Government Employees lobbyist Ryan Mims, who could not immediately be reached for comment, contributed $25 to the Biden inauguration on December 30, according to a congressional filing.

And Maureen Holohan, who leads lobbying firm Avise Solutions, made two contributions of $27.50 in November, according to congressional disclosures.

Holohan said she had purchased some commemorative inauguration items for her kids — such purchases count as contributions — and wasn't aware that the Inauguration committee had prohibited lobbyists from making donations. She said she plans to contact the Biden inaugural committee to straighten matters out.

"No on want so be out of compliance," she told Insider by phone.

A White House spokesperson told Insider that the inaugural committee would "return any contributions that do not comply with the Committee's rules."

If you recently shopped for health insurance but found it unaffordable, you might want to give it another shot soon. 

The $1.9 trillion coronavirus relief bill that congressional Democrats are writing includes some of the most consequential changes to the Affordable Care Act seen in more than a decade. People who lost their jobs during the pandemic would get help. So would those who've been uninsured for years or have been putting massive chunks of their earnings toward insurance. 

The changes are meant to address long-standing affordability problems with the 2010 healthcare law. Although the Affordable Care Act expanded health insurance to 20 million people and helped keep insurance rates steady during the coronavirus pandemic, 29 million people are still without coverage. The vast majority of those uninsured people blame it on the high cost of insurance, the nonpartisan Kaiser Family Foundation found. 

Now Congress is getting ready to pour billions of dollars into the ACA marketplace, Medicaid, and even health insurance that people gain from their employers.

 "There are a lot of ways people will get coverage during the pandemic," Cheryl Fish-Parcham, director of access initiatives at the consumer health advocacy group Families USA, told Insider.

Lawmakers are still working on the legislation and aim to pass it by March 14 if they can overcome complicated Senate rules. Republicans oppose the ACA and won't help expand it, but Democrats have the backing of powerful business groups and health insurers.

Here's how the stimulus — as well as Biden administration actions — would reduce the cost of health insurance. This story will be updated as the legislation makes its way through Congress.

You can jump to a section through the table of contents below, or you can scroll through.

Help with premiums for more people

The Affordable Care Act allowed roughly 9.6 million people to sign up for private health insurance by helping them pay for their monthly premiums. 

But millions of middle-income people were left out. That's because the healthcare law as written ensures that most people making more than 400% of the poverty level — about $51,000 for one person — don't qualify for any financial help. That makes coverage unaffordable for them. 

Louise Norris, the co-owner of a health insurance brokerage firm in Colorado who also writes for healthinsurance.org and Verywell, said the scenario comes up often. For instance,a 60-year-old in Rifle, Colorado, earning $52,000 this year would have to pay 20% of their income for the cheapest plan available in the marketplace. Another couple from West Virginia faced the prospect of paying more than half its income for the cheapest-available plan. 

Rather than pay such expensive premiums, many people choose plans that offer inadequate coverage or forego insurance. 

The changes in the latest stimulus package would be a game-changer. People would pay no more than 8.5% of their incomes for premiums, and the federal government would pick up the rest of the tab. 

"Eliminating the subsidy cliff would have a huge impact on older enrollees and people who live in areas where coverage is really expensive," Norris said. 

The left-leaning Center on Budget and Policy Priorities estimated that the stimulus would cause premiums to drop from $960 to $425 a month for a mid-level plan for a typical 60-year-old making $60,000 a year.

The bill would also give more financial assistance to people with incomes below $51,000. For instance, a person making $30,000 would pay $85 rather than $195 per month in premiums, according to the CBPP analysis.   

The left-leaning Urban Institute has estimated that 4.4 million people would gain health insurance thanks to these changes.

Some people wouldn't have to pay premiums 

Under the proposal, the federal government would pick up the tab for premiums for anyone making up to 150% of the federal poverty level, or $18,735 a year. For instance, a person making $18,000 would pay $0 rather than $54 a month, the CBPP analysis found. 

The stimulus would also pick up the full premium for people who are on unemployment insurance. 

The changes to health insurance that Congress is working on are temporary. The increase in ACA subsidies would only apply in 2021 and 2022. 

People would still have to watch for out-of-pocket costs 

Just because a health insurance plan has low premiums doesn't mean people won't get hit with a big bill when they seek medical care. The money people are responsible for paying outside of their premiums is called a deductible, and it'll vary by plan. 

A Kaiser Family Foundation analysis for 2020 found they ranged from $209 to $3,268 for the year for a mid-level plan. Insurance plans with the cheapest premiums carried an average of $6,506 deductibles. Preventive care — such as an annual wellness exam — is covered by insurance and won't cost patients extra money.

"The deductible is an important thing for people to keep in mind," Fish-Parcham said. The deductible is a liability the consumer would have before their insurance begins to pay for most services."

Healthcare.gov is reopening

President Joe Biden signed an executive order in January to reopen Healthcare.gov, the health insurance marketplace where people can shop for government-subsidized coverage.  

The enrollment period usually lasts six weeks in the fall. Without the federal government taking action, people otherwise can only sign up for coverage if they can prove they have experienced a  major life change such as a job loss, divorce, or birth of a child. 

Now Healthcare.gov is open for three months — from February 15 to May 15 — and people who already have health plans are allowed to change their policies if they see a better deal. 

"People who found it unaffordable to buy insurance before may be surprised to find they are eligible for free or low-cost coverage," Fish-Parcham told Insider. 

People won't be able to see insurance changes right away because they haven't been signed into law yet. 

One thing to be aware of: The coverage you buy won't start right away. It'll instead kick in the first day of the following month that you sign up. 

New protections from big bills at tax time

The stimulus would protect people from potential health insurance-related penalties when tax season rolls around. When people sign up for coverage on Healthcare.gov they have to try to predict how much they'll make to see what subsidies they can get. 

Under-estimating income can result in people paying back to the IRS thousands of dollars in subsidies during tax season. The stimulus exempts people from these repayments. 

Jodi Ray, executive director of Florida Covering Kids & Families, said projecting income is especially hard during the pandemic with job closures and starting dates getting pushed back. Ray oversees a navigator program that helps people shop for coverage. It's based at the University of South Florida but helps consumers all over the state. 

"When you're projecting your income for 2021 you have no idea what's going to happen," Ray said. "It's like a guessing game." 

An alternative for people who lose their jobs

Laid-off workers would be able to get help paying for the health insurance they got through work should the stimulus package become law. 

Typically laid-off workers who lose their employer-provided insurance have the option of signing up for COBRA, an expensive plan that requires the individual to pay their own premiums with no help. 

Average annual premiums for health insurance people get at their jobs cost $7,500 for an individual and $21,500 for families, according to the Kaiser Family Foundation. 

Under the stimulus, the government would pick up the tab for 85% of people's premiums through September 21. Though people will have the option of signing up for ACA plans, staying on COBRA helps people ensure they can see their same doctors. 

Plus, they may already have started to pay down a deductible. Every time people switch health plans the deductible starts all over again. 

Read more: How a $100 billion plan to buy expensive health insurance for laid-off workers won backing from big companies, hospitals, and unions, and became a bipartisan priority in Washington

More money for Medicaid to help low-income earners

Under the stimulus, the federal government would give states more money to pay for Medicaid over the next two years, opening up the possibility that millions more low-income people could get government insurance.  

All states were supposed to expand Medicaid to cover low-income individuals who make less than $17,774 under the Affordable Care Act. A Supreme Court decision made that provision optional, however, and so now 12 states, including Texas and Florida, still haven't moved to expand the program, leaving people in poverty with no option for health insurance. 

Democrats are hoping to entice the holdout states to expand their coverage by offering them more money if they do. The Kaiser Family Foundation has estimated that 4 million people would enroll if all states were to expand Medicaid. 

Ray said she has in recent months noticed a deeply ironic trend: People who work in the performing arts have been moving from New York and California to the Sunshine State because it has a lower cost of living — but it doesn't offer the same Medicaid coverage they had in those other states. 

"It really puts people in some very challenging situations," Ray said. "I am having to be the person that's going to say, 'I'm sorry this is the cost of plans. I know they're unaffordable but these are your options.'" 

But navigators can still be a help. Some Florida counties have coverage options that are similar to Medicaid, and Ray also tells people where they can access healthcare services for free. 

What the stimulus doesn't do 

The stimulus sidesteps promises that Biden made when he ran for office that would cut into healthcare industry profits. 

The bill doesn't give people the option to sign up for a new government plan similar to Medicare, nor does it lower the age of Medicare eligibility. Biden said when he ran for the White House that people should be allowed to sign up for Medicare at age 60. Right now people are allowed on at age 65. 

Democrats in Congress aren't united behind either of these approaches. They also know the healthcare industry is pushing for the changes they have in the works but would aggressively fight them on expanding government insurance. 

The healthcare industry would also support making the increased Obamacare subsidies permanent. Biden proposed doing so when he was campaigning.  

"I'm hoping that this might be the start of a permanent fix," Norris said. "But even if it isn't, people should still take advantage of it while it lasts, assuming this does come to fruition."

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Hello,

Today in healthcare news: Color's betting big on population health as it goes beyond DNA tests, what changes to Obamacare and Biden's stimulus mean for open enrollment, and the impact of the digital divide on vaccine rollout.

Color got its start during the consumer DNA testing boom. Now, the CEO of the $1.5 billion startup tells us why he thinks genetics are just one aspect of how the upstart will overhaul healthcare.

• Insider sat down with Othman Laraki, CEO of Color, the onetime consumer genetics startup that achieved $1.5 billion "unicorn" status in January.
• Laraki said the pandemic helped Color, which started during the direct-to-consumer DNA test boom, realize its most valuable product: digital health infrastructure.
• Through Color's genetic testing efforts, Laraki realized Color could provide a pathway to basic care access, a significant deviation compared to others in the space like 23andMe.

Read the full story from Patricia Kelly Yeo here>>

Open enrollment just started and changes to Obamacare in Biden's stimulus could mean cheap or free health insurance for millions of people

• Millions of middle-income people have been shut out of Obamacare since they earn more than $51,000.
• The $1.9 trillion stimulus package in Congress would make health insurance premiums cheaper.
• It would also pick up most of the tab for COBRA plans to help laid-off workers.

Read the full story from Kimberly Leonard here>>

Experts warned of the digital divide for years. Now it's 'life or death' as people struggle to sign up for online COVID-19 vaccinations.

• Underserved populations in the US struggle to get COVID-19 vaccines as providers rely on the web.
• About 38 million Americans don't have internet literacy, and 25 million don't have internet access.
• The barrier is another way underserved populations are bearing the brunt of the pandemic. 

Read the full story from Natasha Dailey here>> 

More stories we're reading:

• The world has lost 20.5 million years of life because of premature COVID-19 deaths, a new study found (Insider)
• Here's why we can't make vaccine doses any faster (ProPublica)
• Seniors are recruiting college kids to help them get vaccine appointments (The Wall Street Journal) 
• The first dose of the Pfizer vaccine is 85% effective, Israeli study finds (Insider)

- Lydia

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The latest coronavirus aid package could get a House vote as early as this week, bringing much-needed aid a step closer to struggling people across the country.

The $1.9 trillion package that the House budget panel approved on Monday faces a more complicated path in the Senate with its arcane rules and the Democrats' thin majority.

Fights over provisions like hiking the hourly federal minimum wage to $15, who gets a $1,400 check, or what states and local governments receive could trip up the bill.

Still, Democrats aim to finalize and have the bill signed into law by March 14 when some of the existing aid lapses. 

"We are in a race against time," Rep. John Yarmuth, a Kentucky Democrat who heads the House Budget Committee, said on Monday. "Aggressive, bold action is needed before our nation is more deeply and permanently scarred by the human and economic costs of inaction." 

Here are the biggest provisions in the package that would affect businesses, schools, and personal finance decisions.

You can jump to a section through the table of contents below, or you can scroll through.

$1,400 in direct payments

Biden had promised $2,000 checks in the days leading up to the Georgia Senate runoffs but the plan he unveiled after the inauguration called for $1,400 checks. 

He argued that the total would add up to $2,000 a person after people got $600 checks as part of the $900 billion stimulus Trump signed into law in December. Anyone making $75,000 a year or less would qualify, and people with higher incomes would get smaller checks.

The checks are popular with the public and were first started as part of the $2 trillion CARES Act Trump signed into law in March. In that package, most people received $1,200 in direct payments. 

$400 a week in extra unemployment payments

Democrats want to pass the latest rescue package by March 14 because that's when enhanced payments for unemployment benefits are set to run out in many states. The stimulus would increase the payments to $400 a week from the current $300 weekly payments. Under the new package, the program would run through August 29. 

Still, the unemployment boost would be lower than the $600 a week from the CARES Act. That provision expired in July 2020 and then another $900 billion stimulus from December reauthorized the program at $300 a week. 

$3,600 annual child tax credits 

A new child-tax-credit program would provide families with $300 in cash payments every month per child under age 6 and $250 a month for children between the ages of 6 and 17. The payments would go out over the course of a year starting July 1. 

The child tax credits would start to phase out for people earning more than $75,000 a year or couples earning $150,000 a year, though those details could still change. 

Rep. Katie Porter, a California Democrat, is demanding that lawmakers fix the bill's language so that the income threshold for both single and married parents is $150,000. Otherwise, she says, the bill would unjustly penalize single parents. 

The program is intended to help with the cost of childcare and with lost income as a result of the pandemic. But Democrats also say it's part of an effort to reduce the number of children living in poverty, and they want to extend the program after this year. 

Under current law, families can claim a $2,000 tax credit for children 17 and under, an amount that was doubled under Trump's 2017 tax law. 

Families get the money as a lump sum after they file their taxes, but if their tax bill is lower than $2,000 — which is true for many low-income people — then they only get $1,400. The stimulus would change that, allowing low-income people to receive the full tax credit every month.

Food aid

The bill would provide $3 billion to extend a 15% increase in the food aid program called SNAP through September. Those SNAP benefit increases are set to lapse at the end of June. The plan would also provide $880 million for the WIC program, which provides food aid to low-income pregnant women and mothers, and children up to age 5.

Raising the hourly minimum wage to $15

Biden's proposal to more than double the hourly minimum wage gradually from $7.25 to $15 by 2025 is one of the most controversial parts of the coronavirus rescue package. Even Biden has conceded that provision may not make it into the final bill that eventually lands on his desk for a signature.  

It lacks inadequate support in the Senate — even among Democrats — and the chamber's arcane rules would further complicate its chances. For now, it remains in the House version.

The Democrat-controlled House previously passed a similar bill in 2019, though the party had a larger majority at the time. The GOP-controlled Senate did not take up the measure.

Housing and rental aid

The bill would provide $19.1 billion to help people struggling to pay their rent. States would receive about $10 billion over four years to help people struggling to pay their mortgages or for other housing costs such as utilities or homeowner's insurance.

The bill would also set aside $5 billion in aid to states to assist people experiencing homelessness.

Small business help

The stimulus would add $7.25 billion to the Paycheck Protection Program, a fund initially created under the CARES Act that lets small businesses borrow forgivable loans as long as they continue to pay their workers. Certain nonprofits would newly qualify for the program as would digital-only media companies. 

The addition would increase the PPP to $813.7 billion including the spending under previous stimulus measures. 

The latest package also would set aside a $25 billion fund specifically for restaurants, which have been particularly hard hit after state shut down orders, clearing and capacity restrictions, and customers' avoiding dining out. 

$130 billion for elementary schools

The package would provide funding to help schools reopen safely or operate virtually, in addition to the $82 billion included in the December stimulus.  

The money could be used to pay for protective equipment, plastic barriers, ventilation, additional construction, or internet access, though the nonpartisan Congressional Budget Office showed much of the money wouldn't be spent until after this year. 

The schools would be required to put 20% of the funding toward making up any lost learning for students who missed school. 

Another $39.6 billion would go toward colleges.

Bigger government subsidies for health insurance 

The latest relief package would make some of the most consequential changes to the Affordable Care Act in a decade. It would inject billions of dollars into the health insurance marketplaces so that customers would pay less in premiums when they sign up for health plans.

People who are on unemployment insurance would benefit significantly because the government would pay the full cost of their health insurance premiums. 

The changes would apply to people who buy insurance on their own, and not the majority of people who get health insurance through a government program like Medicare or through their jobs.

The bill includes numerous other provisions for medical coverage. 

Funding for COVID vaccines, testing, and contact-tracing

The bill would allocate $14 billion toward coronavirus vaccine distribution and another $46 billion for testing and contact tracing. The government would also pay $7.6 billion to hire another 100,000 public health workers to help end the pandemic. 

The last COVID stimulus passed in December provided $22 billion to help states test and track down people with the coronavirus and $9 billion to help them distribute the vaccine to their residents.

$350 billion for states and local governments

States and cities would get $350 billion under the stimulus package the House is working on, with 60% of the bill going to states and the rest going to localities. Many states had revenue declines and spent more than in previous years to help control the virus. State and local officials have warned that they'll have to lay off workers if they don't get help from the federal government. 

The final stimulus figure for states may end up being scaled back because some states have done far better financially than they expected. California, for example, is planning to use excess funding to create its own state stimulus program that would supplement the Biden plan.

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Health insurance companies are set for a windfall in the next coronavirus relief package, even though Joe Biden had vowed during his campaign to take on the industry for its high prices.

The stimulus bill making its way through Congress includes a provision that would send insurers almost $48 billion through federal subsidies that would temporarily pay for private plans offered in the Affordable Care Act marketplaces. The money would also pay for subsidies for COBRA, a program that laid-off workers can buy into after losing their employer-provided insurance.

Should those provisions pass as part of the $1.9 trillion package, health insurance companies — the subject of much criticism by Democrats — would check off major items on their wishlist to Congress.

About 29 million people in the US are uninsured and the subsidies would only make a small dent in reducing that number. Instead, they'd shift how people get coverage and lower premiums for people who already have insurance. 

"It's no secret that it's not the approach I would have chosen if I were queen of the world," Democratic Rep. Pramila Jayapal of Washington, who chairs the Congressional Progressive Caucus, told reporters recently. 

The $47.8 billion projections come from the nonpartisan Congressional Budget Office, which is tasked with evaluating how policies will affect businesses, consumers, and federal spending. It found that under the latest relief plan called the American Rescue Plan Act, insurers would get $35.5 billion for ACA subsidies and $7.8 billion for COBRA subsidies. Another $4.5 billion would pay the full cost of ACA premiums for people who are on unemployment insurance.  

The provisions would cut the number of uninsured by less than 2.5 million overall and lower premiums for about 11 million people who already have coverage, according to an Insider tally of numbers from the CBO report. Critics of the plans say there are better alternatives, such as enrolling people in government health insurance. 

"It is saddling taxpayers with unnecessary expense," Wendell Potter, president of the Center for Health and Democracy, which supports expanding government health plans, told Insider. "This is not the right way or the most cost-effective way to try to bring relief to people who are uninsured or under-insured." 

The expected boon for insurers would come after a mostly good year for the industry's bottom lines in a troubled economy. 

Health insurers had record profits during the second and third quarters of 2020 while the coronavirus started spreading in the US. Even in the midst of a pandemic, people used healthcare services less overall by delaying surgeries and doctor checkups. 

That meant insurers didn't have to pay out as much money for medical care. By the fourth quarter of 2020, though, people started getting care again and insurance profits dipped. 

The policies in the stimulus bill indicate Democrats are working with the industry, at least for now, rather than cracking down on prices or cutting into its profits.

A Biden administration official told Insider in an interview Tuesday that right now it was important to focus on how the stimulus plan would quickly make premiums far less expensive for people. The aid package is on track to pass by March 14, which would give Biden a major legislative victory early in his presidency.  

"In addition to bringing new people into coverage, this is a massive premium savings for struggling families as they fight to keep health insurance during the pandemic," the official said. 

'More moderate approach'

The subsidies for ACA plans and COBRA have backing from the powerful health insurance industry as well as many healthcare providers and businesses. The subsidies address the problem of high premiums by having the government pick up a greater share of the costs. 

Democrats say the subsidies in the bill provide the best way to move quickly in the midst of an international emergency and to fulfill their promises to strengthen the Affordable Care Act. 

Millions of people find ACA premiums to be too expensive, and Biden promised if elected that he'd make subsidies for those plans more generous just like he's doing in the stimulus.

But he also promised he'd pair such help with a public option which would increase competition in the ACA marketplaces and lower prices. A public option would allow people to buy into a government plan similar to Medicare or keep their private insurance if they so choose. 

Hospital groups oppose the idea of a public option because they'd get paid less to deliver medical services. And a public option would lure customers away from private insurers.

Despite industry opposition, several Democrats in Congress have said they hope a public option would be next on Congress' agenda, even as soon as this year. 

But the task will be difficult given the entrenched industry opposition and Democrat's slim Senate majority. 

They aren't united on how to create a public option and Republicans oppose expanding government insurance or additional funding to the Affordable Care Act. Some have said they'd be open to COBRA subsidies. 

One healthcare industry consultant and lobbyist predicted Congress wouldn't pass a public option this year. 

"The first step you're seeing played out is: What is the smaller, low-hanging fruit we can do to make healthcare more affordable and more accessible? It's more of a moderate approach," said the lobbyist and consultant, who requested anonymity to speak candidly.

"This bill was about a quick recovery solution," the person added. "No one is ready to talk about a public option right now." 

'Enriching an industry that doesn't need it'

Potter, who was a health insurance executive before becoming a whistleblower, said that Congress should start planning for a public option to reduce healthcare costs in the long-run. Potter said he was particularly worried about the high out-of-pocket costs people will still face under private plans for prescription drugs and doctor and emergency room visits. 

"This is not a good, sound economic policy for the country," he said of the temporary subsidies in the stimulus. "It is enriching an industry that doesn't need it and there are other ways to do this."  

The healthcare industry supported Biden over his predecessor Donald Trump during the 2020 election. Though Trump cut taxes for corporations, he also tried unsuccessfully to kill the Affordable Care Act through Congress and the courts. The industry opposed his actions because they would have caused massive disruption. 

The Biden campaign raised almost $57 million in personal donations from healthcare executives over the course of the 2020 cycle, while Trump's campaign brought in $28 million, according to the Center for Responsive Politics, which runs the money-in-politics website Open Secrets. 

Health insurers such as Centene and Molina stand to profit from the changes in the relief package, analyst Scott Fidel of Stephens predicted in a research note. 

Asked about the legislation, a Centene spokesperson said the company supported "all efforts to facilitate access to comprehensive, high quality, and affordable health insurance for more Americans." 

Insurers support not only more funding for the ACA marketplaces but other plans they administer alongside the government, such as Medicaid. In addition to the subsidies, the coronavirus aid package has a provision to try to entice states to enroll more low-income people in Medicaid. Insurers stand to benefit from that move as well.

Organizations like the Partnership for America's Health Care Future support these kinds of measures, within the existing system, rather than trying to create a new plan. 

"The best way to expand access to quality, affordable health care is to build on the strength of our current system, where private coverage works together with public programs like Medicare and Medicaid to get Americans covered," said Lauren Crawford Shaver, executive director for the organization, which is a coalition of healthcare and business groups. 

Eyes on the next relief package

Potter said the health insurance approaches Congress and the administration were taking was "politically expedient" because they would "satisfy the desires of big campaign contributors and entities with a lot of lobbyists." 

He warned that, in contrast, moving toward a public option would be "a heavy lift because what you're trying to do is really attacking healthcare costs in ways that the Affordable Care Act did not and you've got entrenched opposition to it."

Some Democrats still want to try. Sens. Tim Kaine of Virginia and Michael Bennet of Colorado have a public option plan that they hope can be passed under a reconciliation bill. The process fast-tracks legislation and only requires 51 votes in the Senate, but there are also complicated restrictions tied to it that have to be interpreted by a referee called the parliamentarian. 

Jayapal, too, said she told the Biden administration and House Speaker Nancy Pelosi that she wanted to see a public option in the next legislative package Congress tackles. 

She added that Congress hasn't done enough to make sure uninsured people are covered as part of the stimulus package, but that progressives won't stand in the way of the current plan.

"We are where we are," Jayapal said. "And so the question is: How quickly can we get people covered? A public option would take legislation from Congress and we need to get this rescue package done quickly." 

Progressives want to make sure a public option that Congress creates would be administered by the government rather than a plan like Medicare Advantage that's run by private insurers and is lucrative to the industry. Many centrists support the latter arrangement, while others prefer lowering Medicare's eligibility from 65 to 60. All of this division threatens consensus. 

Jayapal and other progressives would ultimately prefer to go further in the form of the Medicare for All Act. It would virtually eliminate all private health insurance in favor of placing everyone living in the US into a single, government-funded health plan. 

This is the kind of snowball effect the health insurance industry's lobbying arm, America's Health Insurance Plans, warns about, pointing out that 183 million people in the US now have coverage through their employers. 

"The American people want healthcare that works — not a one-size-fits-all health care system. They want to improve what's working and fix what's broken," David Allen, AHIP spokesman, told Insider. He added, "a government-run insurance system will fail, and tens of millions of Americans will pay more to wait longer, for worse care." 

The health insurance industry is almost certain to lobby for the ACA subsidies to become permanent, given that it has pushed for them for years.  

The Biden administration hasn't publicly disclosed a timeline for its other healthcare policies including a public option. 

"We are 32 days in and are working to deliver on as much as we can as quickly as we can," the Biden administration official said. "But there's a lot of legislative work to do over the rest of the administration." 

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Wisteria Davis was a student at Delaware Technical Community College when the coronavirus pandemic hit and upended lives across the country. By November, she and her girlfriend had decided to leave Newark, Delaware, to live in a larger city with more options for their education.

"We made the decision to move pretty quickly," Davis, 24, told Insider. "The pandemic itself really just turned everything on its head. Maybe it was the fact that everything had changed. So we were like, 'All right, I guess we should make a change too.'" 

They moved in with her girlfriend's family in Orlando, Florida. But for Davis, who has a history of several health conditions, the move came with a catch she hadn't expected. 

Soon after she arrived in her new home in the Sunshine State, she was devastated to learn she wouldn't be able to enroll in Medicaid as she had in Delaware, she said. 

Florida, like 11 other states, hasn't expanded Medicaid, a government health-insurance program that pays for healthcare for people with little or no income in most states.

For some people, buying private insurance isn't an option because it's too pricey. And living uninsured can dampen the allure of the low-cost living that many seek in places like Florida and Texas. 

As the COVID-19 pandemic continues, healthcare-enrollment experts are encountering people who were laid off from their entertainment jobs in New York and California looking for a cheaper state to live in. They are then hit with the healthcare sticker shock in their new homes.

The medical costs from one injury or a hospital visit can quickly eat up people's savings, especially for those who have lost their jobs. Going uninsured is an even riskier bet for people with chronic health conditions or those struggling with the long-term effects of COVID-19. 

In some cases, people regret the move enough that they pack up and return to where they came from, healthcare experts who help people sign up for health insurance told Insider.

A 'devastating' conversation to have

Healthcare navigators tasked with helping people enroll for health insurance in states like Florida, Texas, Georgia, and North Carolina have for years had to break the difficult news both to current and new residents. 

"That's one scenario that I just ran into so often: people who came from New York or wherever it is and find out for the first time when they're sitting there with you that there's really not a whole lot of help here for you in the state, even if you're working," Scott Darius, a former navigator who is now the executive director of the advocacy group Florida Voices for Health, told Insider. "And that was a devastating conversation to have. It never got less devastating to have that talk." 

But the problem is taking on a whole new dimension as certain states without Medicaid expansion have become go-to destinations during the pandemic. People are relocating for a host of reasons. Some are moving to be closer to family or to live in cities and towns with larger and cheaper living spaces. Others want to send their children to in-person schools or pay lower taxes.

Stacey Thompson, a navigator-program coordinator from the Houston nonprofit Change Happens, told Insider the organization tried to help a client find health-insurance coverage after she moved to Texas from Michigan during the pandemic. But ultimately, the client ended up returning to Michigan to reenroll in Medicaid, Thompson said. 

Melanie Hall, the executive director of the nonprofit Family Healthcare Foundation in Florida, told Insider she had met people who were laid off from their entertainment jobs and faced that dilemma when they moved to the Sunshine State from New York and California during the pandemic. 

They are going on auditions, and many aren't sure when they'll get their next paycheck, she added. 

"They're looking for a less expensive place to live while they're waiting out this period of time," Hall said. "They're looking for the ability to have a very easy lifestyle, and they just are not expecting when they get here to find out that they're not eligible for any kind of help with their medical coverage." 

Data from the US Census Bureau shows that hundreds of thousands of people have moved during the coronavirus pandemic. Texas added an estimated 374,000 residents during the first half of last year, and Florida gained an estimated 241,256 residents from July 2019 to July 2020. 

"There are so many things about coming to Florida that are very attractive for families and individuals. And we certainly understand that," Hall said, citing examples like low home prices and the lack of a state income tax. 

"But when you move to a place, and suddenly you don't have access to something as basic as health services, it's certainly in the back of your mind as to whether or not it really is going to provide the quality of life that you want," she added.  

Some states have safety-net coverage offered in certain counties. Other people can sign up for private plans offered under the health-insurance marketplaces created through the Affordable Care Act, commonly known as Obamacare. But while these plans are heavily subsidized by the government, they're still more expensive than Medicaid. 

'It was just total hopelessness'

Before the Affordable Care Act, Medicaid worked very differently from state to state. But it generally paid for care for people with disabilities, pregnancies and childbirth, children, and nursing homes. 

It still pays for those services and more under the ACA. In most states, people can sign up for Medicaid if they make less than $17,774 a year. People earning the minimum wage qualify, as do students with little income, people who've given up their jobs to become full-time caregivers, people who choose not to work, or people who have lost medical coverage after losing a job during the pandemic.

But the coverage isn't available in every state because several red states sued against the law in 2010. In response, a 2012 Supreme Court ruling made the decision to expand Medicaid optional in each state.

As a result of that decision, 12 states haven't expanded Medicaid. The Kaiser Family Foundation, which studies healthcare, estimated that this decision had resulted in 2.2 million people in the US falling into the same uninsured gap as Davis does.

When Davis moved to Florida, she had wanted to leave Delaware both for educational opportunities and for her mental health. She said she had lived in Newark for most of her life, where her childhood was punctuated by homelessness, abuse, and poverty. That trauma caused her to develop PTSD, she said, and continuing to live in her hometown triggered panic attacks. 

Now that she's in Orlando, Davis has been studying to return to college and wants to become a veterinarian or go into horticulture. But the move has been tough on her health. In Delaware, Medicaid paid for Davis to have mental-health treatment and gallbladder-removal surgery when the symptoms from both conditions made her unable to work. 

Now she has no health insurance in Florida, and for a time, she ran out of a medication she takes to treat anxiety and depression. That led to a debilitating withdrawal. 

"I didn't really know what to do," Davis said after learning she couldn't get Medicaid in Florida. "It was just total hopelessness on top of being neurodivergent and having these illnesses that I have. It was just a huge blow to everything."

She said that she wanted to get a job to support herself but that without enough medication — and the health insurance to pay for it — she couldn't manage her mental-health conditions. 

"I can't get medicine without Medicaid because I don't have a job, and I can't get a job without having medicine," she said. "So it's kind of like this cycle, and I end up falling through these cracks."  

The plan is to stay in Orlando for now, but once her girlfriend finishes school, they may decide to move to a state that expanded Medicaid, Davis said. 

Help coming in the COVID-19 stimulus

Some people who fall through the cracks will be able to gain new health-insurance options that are set to kick in temporarily as part of the coronavirus rescue package President Joe Biden signed into law on March 11. 

One of those options will benefit people on unemployment insurance starting in July. Under the stimulus law, the federal government will pick up the full cost of premiums for people who sign up for a private insurance plan on the ACA marketplaces.

People will also have the opportunity to stay in the same healthcare plans they had from their employers through a program known as COBRA, or the Consolidated Omnibus Budget Reconciliation Act. Under the stimulus package, the government will pick up the full cost of insurance premiums through September. 

But the main downside of some of those private plans is that depending on how much people make, they can come with high out-of-pocket costs when people go to an emergency room or doctor's office. In contrast, people on Medicaid pay little or no fees to get healthcare in most states. 

Another provision in the stimulus encourages holdout states to expand Medicaid by giving them extra money for the program over the course of two years. Democrats in Congress hoped the funds would head off arguments from Republicans who've said states cannot afford the cost of expanding Medicaid.

Republicans in Alabama and Tennessee have said they're looking at the possibility, and the Wyoming House voted in favor of expansion but the state Senate killed it.

It's not clear how many other states will consider expansion. Florida Republicans, who run the state, say they won't be pursuing the expansion, but there's a push to put the question directly in front of voters in a ballot measure in the 2022 midterm elections.

Going the ballot route has become an increasingly common way to bypass state lawmakers on Medicaid. Six other red states, including Maine and Nebraska, took that route. 

Darius, the executive director of Florida Voices for Health, which is among the advocacy groups pushing for the Medicaid expansion, is reminded of how many Floridians are living paycheck to paycheck every time there's a natural disaster, whether it be a hurricane or the pandemic, he said. 

"It's enough for us to keep pushing," Darius said. "And the fact is, there has just been so many more of those individuals over the last few months that there's no way we can stop at this point." 

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Republicans have roundly rejected President Joe Biden's $2.2 trillion opening bid for an infrastructure, tax, and jobs plan. Now, the White House and Democratic leaders face the arduous task of getting enough lawmakers on board to get a bill to the president's desk for final signature.

They have little room or time for error. 

The outline of the American Jobs Plan Biden unveiled March 31 would stretch over eight years and partially pay for the new spending by raising taxes on corporations. The White House cast the plan as a jump-start badly needed after the economic devastation wreaked by the coronavirus pandemic. 

Congressional Republicans have dismissed Biden's plan because of its tax hikes and because they view the president's definition of what qualifies as infrastructure as too broad. A group of GOP senators are crafting their own $600 billion to $800 billion alternative and say they hope to bring in centrist Democrats, too. 

"Broadband will be part of that, water, sewer, as well as roads, airports and so forth," Sen. Mitt Romney, Republican of Utah, told reporters Wednesday in the US Capitol. 

Even without Republicans, Democrats face a steep climb because they would need to bring their ideologically diverse caucus together. Here are the biggest obstacles they'd have to overcome to pass a massive infrastructure bill.

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A race against time 

House Speaker Nancy Pelosi told lawmakers privately that she wants the House to pass a bill before the Fourth of July, according to several reports. That's a speedy timeline given that the House just returned from a spring recess to Capitol Hill on April 13 and various committees still have to write the legislation.

Even if the bill clears the House by Pelosi's deadline it would still need to pass the Senate where it faces a steeper climb. Plus, senators are likely to make several changes to the House version of the legislation and it would be up to Pelosi and other Democratic leaders to bring the House on board again to support the final version when they're done.  

The longer it takes for an infrastructure bill to get written, the harder it'll be to pass. Presidents historically have a difficult time ushering support for major legislation during an election year, and the 2022 midterms loom for Democrats who will be fighting both to keep and expand their majorities. 

"The White House wants to see an infrastructure bill pass this year, likely knowing it will be the last major piece of legislation the administration signs before the mid-terms, if not for the remainder of Biden's term," Henrietta Treyz, director of economic policy research at the Wall Street analysis firm Veda Partners, said in a note sent April 1.

Agreeing on what counts as infrastructure 

Biden's plan would fund fixes to ailing roads, ports, bridges, and airports, as well as spending on green energy investments. It also includes other provisions not traditionally thought of as infrastructure policy, such as providing billions of dollars for climate research and caregiving.

But many Democrats want the bill to encompass other policy areas. In mid-April the president is expected to introduce a second proposal, which may cost just as much as the first one, to address "social infrastructure."

That piece, the American Families Plan, is expected to include measures that would lower drug prices, expand the Affordable Care Act, and authorize the federal government to pay the full cost of attending community college. 

The White House and Democratic leaders have not said whether they want the two bills to pass separately or to be lumped into one. Either approach risks losing support within Democratic ranks. 

Republicans, in contrast, take issue with the sweeping nature of Biden's plan.  

"This is just an excuse for other spending that's unrelated to roads and bridges," Sen. Bill Cassidy, Republican of Louisiana, told reporters on Wednesday. 

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A small number of Democrats can sink a bill

Sen. Joe Manchin of West Virginia, one of the most critical centrist Democratic swing votes in the Senate, has said he wants any infrastructure package to be bipartisan. But the bill the White House is pushing is unlikely to get Republican support. 

"This bill will not receive 10 Republican votes," Treyz wrote, referring to the number of GOP votes that would be needed to pass a bill if all Democrats in the Senate supported an infrastructure bill. 

Democrats have only a small majority in Congress. If they get no Republicans onboard they can only afford to lose three votes in the House and zero in the Senate.

Progressives demand more

Progressives have been saying that they thought Biden's infrastructure plan was far too small and instead proposed spending upwards of $10 trillion.

One outspoken critic, Rep. Alexandria Ocasio-Cortez, a Democrat of New York, said the president's $2.2 trillion plan was "not nearly enough."  

Rep. Pramila Japal, a Democrat of Washington who chairs the Congressional Progressive Caucus, suggested adding more provisions for childcare, older adults, job training, and education. She also rejected the idea of breaking the bill into pieces. 

"Our preference is for a single, ambitious package that would include both physical infrastructure and care infrastructure," she said. 

The Senate parliamentarian could overrule the process

Because Democrats are expected to pursue the infrastructure bill without Republicans, they'll be using a process called budget reconciliation that allows the Senate to pass certain bills with a 51-vote majority rather than the 60-vote threshold typically needed to break a filibuster. 

Senate Majority Leader Chuck Schumer announced in early April that the nonpartisan Senate Parliamentarian, Elizabeth MacDonough, would allow two more reconciliation bills. The Senate had expected to use the process only one more time this year because they already used reconciliation in March to pass the $1.9 trillion American Rescue Plan Act. 

The details of MacDonough's ruling aren't public yet, and Schumer's office said "some parameters still need to be worked out." But if they get two shots at reconciliation then that would give Democrats an opening to pass both infrastructure bills separately.

Whichever way they go, Democrats risk losing crucial votes among their ranks. Centrists up for re-election in 2022 in vulnerable districts are likely to balk if Democratic leaders lump the two bills into one giant package. On the other hand, progressives will be difficult to bring on board if Democratic leaders choose to only pass the first bill and omit social and healthcare policies.  

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The Senate parliamentarian could rule against parts of the bill 

MacDonough and her assistants would also help guide senators on what policies are allowed or forbidden under reconciliation, as they did with the recently passed COVID relief package.

The procedure helps to fast-track legislation but the trade-off is that the policies allowed must follow strict and complex rules that MacDonough would have to help interpret. She would issue rulings through listening to arguments from both sides, researching precedents, and using long-standing rules.

Some policies Democrats might want to include under their infrastructure plan won't be able to pass because they'll break the rules. One rule says measures passed through reconciliation must pertain directly and significantly to the federal budget.

During the $1.9 trillion American Rescue Plan Act debate MacDonough ruled that the $15 minimum wage was forbidden under reconciliation. 

Repealing a limit on state and local deductions 

House Democrats from high-tax blue states have said they would not vote for the infrastructure bill unless it repeals a rule from the 2017 Republican tax law that limits state and local tax deductions for households to $10,000. This is  known as the "SALT cap."

Pelosi, who represents San Francisco, has said she shares "their exuberance" about getting rid of the SALT cap. "Hopefully we can get it into the bill," she said.

The repeal would largely benefit the rich and cost the federal government $350 billion from 2022 to 2025, according to the Committee for a Responsible Federal Budget, a non-profit public policy think tank. 

If the SALT cap repeal ends up getting included in the infrastructure bill, Republicans would be sure to pummel Democrats over the issue ahead of the 2022 midterms. 

"Don't worry, coastal elites — House Democrats are demanding a special SALT carve-out that would cut taxes for wealthy people in blue states," Senate Minority Leader Mitch McConnell of Kentucky said March 31, offering a glimpse into the GOP's attack plan. 

The White House didn't include the proposal in the plan Biden presented at the end of March, though Biden's chief of staff, Ronald Klain, indicated the money would need to be offset.

"I want to hear from them how they would pay for this tax deduction," Klain said in an April 1 interview with Politico Playbook of Democrats pushing for the SALT cap repeal. 

The battle over tax hikes 

Biden wants to raise the corporate tax rate from 21% to 28% to pay for the first portion of the infrastructure plan. That would generate about $1 trillion in a decade, according to the Wall Street analysis firm Veda Partners. 

The corporate tax rate will still be lower than the 35% level it was before former President Donald Trump's 2017 tax cuts slashed it to its current rate. 

Such a change would force Democrats to face off against powerful business groups that spend a significant amount of money on lobbying and helping elect industry-friendly lawmakers. Business interests, and congressional Republicans, argue that now would be the wrong time to raise taxes as businesses are still recovering from the pandemic's economic devastation. 

The White House proposed the tax increase as a way to pay for a portion of the plan because some Senate Democrats, including Manchin and Sen. Jon Tester of Montana — as well as Sen. Angus King, a Maine Independent who caucuses with Democrats — have said the party shouldn't rely solely on deficit spending for the bill. 

"What we are trying to do is strip away objections to this needed investment," Klain said in the Playbook interview. 

The bill would also get rid of tax loopholes for intellectual property and end deductions when companies send their jobs to other countries. 

Read more: Corporate America and Biden have a budding love affair. But a lot has to happen before Democrats can become the party of Big Business.

A potential unfavorable CBO score

Biden said his tax plan would offset the cost of infrastructure over 15 years, but policymakers won't know whether the math adds up for sure until the nonpartisan Congressional Budget Office scores the bill. 

Past scores have dramatically altered legislation. For instance, Democrats worked hard to keep the Affordable Care Act's score under $1 trillion over a decade. As a result, for years millions of people found health insurance unaffordable. 

If CBO predicts that the tax revenue won't be as high as the White House is envisioning, Democrats could be forced to raise money elsewhere or to find cuts in other programs. 

Treyz said in her note that she didn't think Democrats had enough votes to get the tax rate up to 28%, predicting instead that it would land closer to 23.59%. That would mean far less raised in revenue and could make deficit-wary Democrats skittish. Manchin has already said he favors a 25% corporate tax rate. 

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President Joe Biden is aiming to unleash a flood of new federal spending to cut into inequality and realign the role of the federal government to better assist families.

The second plan is different from the first measure, which was largely focused on physical infrastructure such as roads and bridges, although it also included other provisions like major funding for in-home elder care and broadband expansion.

This plan from the White House includes around $1 trillion in new spending and $800 billion set aside as tax credits. It's likely to undergo some changes, however, as Congress takes it up and writes the legislation in the coming months.

Here are the four key takeaways from the administration's latest plan.

(1) Flooding new money into education and childcare 

The plan would parcel out money for childcare, education, and healthcare initiatives. Experts say many parts of the plan are geared toward assisting middle and low-income families, especially those with kids.

"Almost everything in the plan would directly benefit people, particularly children, particularly lower-income children," Jason Furman, a former top economist to President Barack Obama, wrote on Twitter.  "You can't go very wrong with these policies."

It essentially guarantees an additional four years of education for Americans with a universal pre-K and two years of tuition-free community college. Those two measures come out to around $309 billion, largely contingent on a partnership between the federal government and states.

It also tackles the rising costs of childcare, which is often beyond the reach of many families. Most have to pay the majority of those care expenses on their own. The Biden plan aims to keep a family's childcare spending at no more than 7% of monthly income.

(2) Biden wants the wealthiest Americans to pay up with tax hikes

The package includes tax hikes on the richest Americans. A central element in the administration's revenue plans appears to be $80 billion set aside for the IRS to crack down on tax evasion. The White House projects raising $700 billion from the agency over a decade.

As reported by Insider's Ayelet Sheffey, that would represent a huge jump over current collections, but still leave hundreds of billions on the table very year. It would also only partially reverse a dramatic decline in IRS audits over the past decade.

Biden also wants to raise the top marginal income-tax rate to 39.6% from 37% and hit investors earning above $1 million with a new tax on capital gains, among other things.

(3) Permanently maintaining some emergency stimulus programs

The plan includes a permanent extension of subsidies for people to buy health insurance from exchanges set up under the Affordable Care Act. It would also make permanent the Earned Income Tax Credit, a step to benefit essential workers.

The administration is likely to face pressure from Democrats to keep the boosted child tax credit. It was enlarged to $3,600-per-child under age 6 and $3,000 per kid between 6 and 17. Starting in July, parents will be able to get a monthly payment.

The current plan only extends the elevated levels until 2025, while leaving untouched the monthly payment component. Rep. Rosa DeLauro, a lead architect of the expansion and chair of the House Appropriations Committee, said in a statement to Insider that lawmakers would take up the Biden blueprint and advocate for changes.

"I look forward to turning the framework of the American Families Plan into legislation and working with Chairman Neal to enact our shared desire to include a permanent extension of the expanded Child Tax Credit in the final bill," she said, referring to Rep. Richard Neal, chair of the House Ways and Means panel.

(4) The 'families plan' is unlikely to attract GOP support

Republicans were largely opposed to Biden's first infrastructure plan, arguing it went beyond the scope of physical infrastructure spending that they could back. Some lawmakers, however, favor a slimmed-down spending plan, and negotiations are ongoing.

The GOP appears likely to resist the newest plan on the basis of its tax hikes and spending priorities.

"Even if the spending's popular —a lot of it probably will be — the tax increases I think are going to be a hard sell, not just with people in the country or with Republicans, but I think for some Democrats too," Sen. John Thune told reporters on Wednesday.

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Meeting a self-imposed deadline of passing Biden's infrastructure bill by July 4 means Democrats — including newly minted Senate Majority Leader Chuck Schumer — must hustle to score another legislative win in the narrowly divided Congress.

Emerging Wednesday from a bicameral, bipartisan meeting at the White House attended by the "Big 4" congressional leaders, Speaker Nancy Pelosi said she was "optimistic" that a comprehensive bill would be ready by Independence Day. The pronouncement gives Democratic leaders weeks to hammer out a deal on a White House agenda item that includes tax hikes Republicans have rejected out of hand, and bridge a spending gap that's hundreds of billions of dollars — if not trillions —apart. 

Given that he'd lose control of the chamber if Republicans pick up just a single seat in the 2022 midterm elections, Schumer may need to fall back on the same budgetary maneuvers that allowed him to speed through the latest stimulus package on a party-line vote.

Ask Schumer and, of course, he'll insist the partisan route is not his preferred method. 

"I'm trying to have the Senate be far more bipartisan than it was," the New York Democrat told reporters in late April.

"When the Senate's given the opportunity to work, it can," Schumer added.

But the Brooklyn native is also no dummy. 

He knows he's trapped in a post-Trump Washington where Democrats and Republicans have little incentive to cooperate with each other, and where the wonky ways of process and procedure are shaping up to be the go-to strategy if he's going to succeed in his new role as the most powerful of all 100 US senators.

This is personal for Schumer. What he's able to accomplish over the next 18 months will go a long way toward determining if Democrats can maintain their Senate majority in 2022, when he's expected to make a run at securing a history-making fifth term representing the Empire State.

The way Schumer sees it, fulfilling President Joe Biden's agenda, particularly while the wounds from the recent COVID-19-fueled economic downturn remain so raw, ultimately mandates doing whatever it takes to get results. 

"We're going to work very hard to get it done," Schumer told Insider. "America demands it." 

Chuck is always on

One of Schumer's many regular check-ins on Capitol Hill is with an inner circle of advisors that includes the progressive icon Sen. Bernie Sanders of Vermont and Sen. Joe Manchin of West Virginia, who possesses a coveted swing vote.

"When you start out having Bernie Sanders and Joe Manchin at the same table with Elizabeth Warren, Mark Warner, and Amy Klobuchar, you've got the wide views of the caucus," a senior Democratic aide told Insider, name-checking along the way Democratic senators from Massachusetts, Virginia, and Minnesota, respectively. 

"And if they can agree on stuff then, that's how we build consensus," the aide added.

Schumer's outreach radiates from there. 

Typical daily interactions include touching base via back-to-back calls with newcomer Sen. Raphael Warnock of Georgia via Zoom and discussing infrastructure strategy with Sen. Tom Carper, the chairman of the Senate Environment and Public Works Committee and a well-known Biden sounding board.

Catching up in group settings is tougher during the pandemic quarantine, though the Democrats' weekly caucus lunches did just start back up in the US Capitol on April 13.

Keeping those conversations flowing is one thing. Locking down votes on divisive issues is another. And that's where things start to get wonky.

In pursuit of a major infrastructure bill that Biden has made the lynchpin of his first-term agenda, Schumer is holding firm on his option to revisit a procedural tool known as reconciliation. Essentially, it allows for a simple majority of 51 votes to advance bills and skirt the filibuster morass that would otherwise require 60 votes. This is the trick that Schumer used to help him shepherd Biden's $1.9 trillion COVID-19 relief bill into law in March without any Republican votes. And now it's in play again. 

There's just one challenge. Much of what Schumer wants hinges on whether Senate Parliamentarian Elizabeth MacDonough agrees to let him do it. There are no guarantees, and counting on the Senate parliamentarian to always be in one's corner is folly — particularly one like MacDonough, who prides herself on being politically neutral.

'Nobody asked me about process'

If everything goes according to plan, MacDonough and reconciliation will be mere footnotes rather than the coda to the Senate majority leader's 40-year career on Capitol Hill.

But a lot — as it often does in politics — could easily go awry and ding Schumer's legacy. 

With the midterm elections looming, and the specter of more progressive primary challengers hanging over him, Schumer knows he has a lot of work to do if he wants to maintain control of the Senate.

Age alone is a constant threat to his caucus, given the number of older Democrats who Republican governors would undoubtedly replace with one of their own should any sitting senator die, become incapacitated, or suddenly step down.

Schumer faces mounting pressure to deliver early wins for Biden while he still can.

And with few Republicans eager to play ball, it's meant Democrats must rely on procedural maneuvers like reconciliation.

G. William Hoagland, a former Senate Republican leadership aide turned senior vice president at the Bipartisan Policy Center, categorized Schumer's recent efforts to use reconciliation as a desperation move "to expedite the Biden agenda."

"Getting 60 or more votes to overcome a filibuster is a high hurdle in partisan times, leading majorities to try to stretch reconciliation in new ways to advance their policy priorities," Sarah Binder, a political-science professor at George Washington University, added. 

Binder said reconciliation had shifted from a last resort to the default method because nothing would ever get done in the Senate otherwise.

Outside Washington, no one seems to be bothered much by the parliamentary move, according to Senate Finance Committee Chairman Ron Wyden.

The Oregon Democrat said in an interview that during recent town halls across the state — with stops in districts that President Donald Trump won in 2020, he added — constituents offered to show him crumbling roads in their neighborhoods and that county commissioners peppered him with plans for languishing repairs. 

"Nobody asked me about reconciliation. Nobody asked me about process," Wyden told Insider. 

Democratic Sen. Cory Booker of New Jersey, who rose to fame as the Newark, New Jersey, mayor and personal pothole fixer, said there was no time to waste when it came to rebuilding America.

"There's a lot of broken bridges and roads out there," he told Insider. "And I think it's perfectly just to use reconciliation."

Meanwhile, Sen. Mark Warner, the Democratic budget and tax writer, said producing a mutually agreeable infrastructure deal remained the goal.

"We're all operating on the premise that we can still try to get large swaths of this done in a bipartisan way. And that's what the president's working on too," the Virginia senator told Insider. 

Opening Pandora's box

Richard Arenberg, a former Senate Democratic leadership aide turned interim director of the A. Alfred Taubman Center for American Politics and Policy at Brown University, said getting multiple shots at reconciliation was an intriguing move for Schumer to pursue. 

But he said it could further undermine a process that's evolved "well beyond the expectations of those who adopted it in 1974 imagined."

Tom Kahn, a House Democratic leadership aide turned distinguished fellow at the Center for Congressional and Presidential Studies at American University, isn't ready to hit the panic button. He's electing to reserve judgment until he sees what MacDonough has agreed to.

If she winds up clearing a path to at-will reconciliation bills, then whoever is in charge could "just keep amending it and amending it" to keep the privileged-legislation train rolling, he said. 

"That could open a hell of a Pandora's box," Kahn told Insider.  

Tony Smith, a political-science professor at the University of California, Irvine, is far less concerned about abuse. 

"The rules can be changed by vote after all, so the 'box' can be shut whenever enough senators want it to be," he said.

Rewrites aside, Kahn added that reconciliation wasn't a panacea. Senators still have to slog through hours of debate and battle through the amendment free-for-all known as the vote-a-rama. 

"Democrats shouldn't feel like they've unlocked the genie. All of this takes so much time," he said.  

Why Obamacare and Trump's tax cuts exist

Lawmakers like Schumer have turned to reconciliation with much more gusto than the 20th century pols who signed it into law.  

Some of the monumental bills that have benefited from reconciliation over the past 20 years include: 

• 2021: American Rescue Plan — Biden's opening bid on COVID-19 relief featured direct payments, tax breaks for families, and aid to virus-stung states.
• 2017: Tax Cuts and Jobs Act — Trump's signature tax bill lowered individual and corporate rates. 
• 2010: Affordable Care Act — President Barack Obama's signature healthcare law expanded coverage to about 20 million previously uninsured Americans. 
• 2003: Jobs and Growth Tax Relief Reconciliation Act — President George W. Bush's second tax bill focused on corporations. 
• 2001: Economic Growth and Tax Relief Reconciliation Act — Bush's first tax bill focused on individual income taxes. 

Smith described the American Rescue Plan, Schumer's crowning achievement so far, as a public-policy win that may very well cement his place in the history books.

"Without COVID under control, various economic theories or strategies won't matter," Smith said of the sweeping stimulus bill. 

Arenberg expects even greater things from the infrastructure package. "The 2021 American Jobs Plan, if successfully passed with anything like its intended provisions, would likely supplant it," he said of the package. 

Smith is taking a wait-and-see approach to the infrastructure gamble — "We should know by this time next year" if it pays off, he said — but said he understands why Schumer can't afford to do the same. 

"The Biden administration and the functional Democratic majority in the Senate are 100% dependent on getting COVID under control and the economy humming along," he said. "If those things happen, voters won't care about process. If they don't, voters will punish the Democrats whether they were 'bipartisan' or not."

And that could again make Schumer the Senate minority leader, with far less power in Washington while Republicans resume running the show.

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With negotiations on a major infrastructure package likely to stretch into June, the White House is poised to blow past its self-imposed Memorial Day deadline, which was meant to ensure significant progress on a bipartisan plan.

Senate Republicans led by Sen. Shelley Moore Capito of West Virginia are preparing to make a $1 trillion offer as soon as Thursday. Then a bipartisan group of six senators that includes Joe Manchin, a Democrat from West Virginia, and Susan Collins, a Republican from Maine, are drafting another proposal for President Joe Biden in case those talks break down.

Manchin has insisted on more time to secure a deal, saying on Tuesday that "this is the long game, not a short game." The White House wants to approve a multitrillion-dollar spending package to upgrade roads and bridges and set up universal pre-K, tuition-free community college, and cash payments to families.

But some Democrats doubt that Republicans' interest in giving Biden a bipartisan victory is genuine and are wary of the talks turning into a time-consuming dud. They cite huge differences between the parties over the size, scope, and basic definition of infrastructure. Democrats are anxious to shepherd along new economic programs to cut inequalities using their thin majorities in the House and the evenly divided Senate.

The talks' potential to drag into the summer is prompting comparisons to the negotiations over a decade ago between President Barack Obama and Republicans on overhauling the healthcare system.

"When I read the comments from Sen. Manchin asking for more time, all of a sudden I had bad flashbacks to Obamacare, where there was a push and pull between the desire for more time and the reality that Republicans were never going for it," Jim Manley, a former aide to Senate Majority Leader Harry Reid, told Insider.

Max Baucus, a former Democratic senator and one of the architects of Obamacare, said in an interview that he was getting "somewhat" of a case of déjà vu seeing the infrastructure discussions unfold.

"I'd keep pushing forward as hard as I could, but there's not much time left. I'd give it a month or so and then tell Schumer to push reconciliation," the former Montana lawmaker said, referring to a legislative tactic available to Senate Majority Leader Chuck Schumer to approve some bills with only a simple majority.

'I doubt you're going to see much bipartisanship in the end'

In 2009, the Obama administration chased support from a bloc of moderate GOP senators for the plan that became the Affordable Care Act. As the chair of the Senate Finance Committee, Baucus spent five months trying to draw backing from Sen. Chuck Grassley of Iowa, the ranking Republican on the panel, for a more "durable" health law.

That effort collapsed amid sharp disagreements on tax increases and whether Americans should be obligated to buy health insurance. Republicans stepped up their attacks and cast the healthcare bill as federal overreach, with Grassley misleadingly saying it meant the government would "decide when to pull the plug on grandma."

Anger over how voters perceived Obamacare contributed to major Republican victories in the 2010 midterm elections, losing the House for Democrats and effectively crippling the next six years of Obama's legislative agenda. Now, Baucus sees his experience as a cautionary tale as Democrats attempt to forge ahead with a massive two-part package to reconfigure the economy with new spending on physical infrastructure, healthcare, and education.

"I doubt you're going to see much bipartisanship in the end. Frankly, a lot of Republicans would rather not see a bipartisan bill," Baucus told Insider. "They say they would, but deep down they don't."

Baucus said he believed that next year's midterm elections were factoring into the negotiations, in the sense that a party-line reconciliation bill from Democrats would almost surely include tax hikes on wealthy people and large firms, and a lot of Republicans would "run against those tax increases in 2022."

Democratic Sen. Ron Wyden of Oregon said in an interview that he was "very concerned" about Senate Minority Leader Mitch McConnell's endgame on infrastructure, pointing to McConnell's recent comment about being "100% focused" on thwarting the Biden administration. The GOP leader made similar remarks halfway through Obama's first term.

"I'm always going to try and get a bipartisan approach, but it's certainly a bigger lift after a statement like that," said Wyden, the chair of the Senate Finance Committee.

Other Democrats like Sen. Tim Kaine of Virginia said they weren't troubled by the discussions. "I think we're on the time frame that I always thought we'd be on," he told Insider. "Thus far, it's soliciting their opinions."

Kaine continued: "Even if we go reconciliation, we will put things in that bill that will be extremely attractive to Republican governors, to Republican mayors, to Republican interest groups." He said he thought it was possible for Democrats to "pick up votes we weren't expecting."

The White House used reconciliation to approve a $1.9 trillion coronavirus relief bill in March. Biden met with Senate Republicans once in early February to broker a deal. But he had abandoned those talks by the end of the month after they put only $618 billion on the table. No GOP lawmakers voted for the bill.

There are signs that Democratic leaders are loath to avoid watering down bills for the veneer of bipartisanship. In an interview on MSNBC in late January, Schumer pointed to 2009, "where we spent a year and a half trying to get something good done — ACA, Obamacare — and we didn't do all the other things that had to be done."

"We will not repeat that mistake," he said.

Schumer said on Tuesday that Democrats would move ahead with a "big, bold plan" in July, suggesting reconciliation looms. Capito told reporters that her GOP group would "not walk away" from the negotiating table anytime soon.

"I think you go as far as you can," Baucus said, "but then there comes a time where the other side is just not seemingly negotiating in good faith, so you've got to stop and pass your own bill."

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Rep. Alexandria Ocasio-Cortez of New York ripped into Republicans for the slow pace of infrastructure negotiations, arguing they're sucking up the limited time Democrats have to use their thin majorities. Congress is set to adjourn for a monthlong summer recess within weeks.

"They've been killing time for months and and at this point, I believe it's starting to get to a point where this bipartisan effort is seeming to serve less on investing in our infrastructure and serving more than ends up just delaying action on infrastructure," she told reporters on Tuesday. "It's been enough."

The infrastructure negotiations took a hit over the weekend, when Republicans scrapped a provision to step up IRS funding from the $579 billion bipartisan agreement after fierce criticism from conservatives. Democrats are simultaneously preparing to advance a $3.5 trillion party-line bill in the coming weeks.

Ocasio-Cortez previously warned of this outcome in late June, when she criticized Republicans for wasting time and "negotiating in bad faith." 

Now the bipartisan group — evenly divided between five Republicans and five Democrats — is scrambling to come up with another revenue source to ensure it's fully paid for, a top Senate GOP demand. The blueprint would upgrade roads, highways, bridges, and broadband connections.

Some Democrats are wary about the bipartisan talks, given the proposal will lack tax hikes on the rich as well as the climate and social initiatives they want. Notably, Senate Minority Leader Mitch McConnell hasn't publicly stated whether he supports the plan.

"Of course that's what they're doing, it's a slow-walk,"Sen. Sherrod Brown of Ohio told Insider on Tuesday, citing what he called "feigned outrage" from Republicans on funding the IRS. "They're gonna slow-walk this. Understand McConnell doesn't want a bill, he wants Biden to fail, he wanted Obama to fail."

Many also cite failed efforts to draw Republican support for President Barack Obama's healthcare reform efforts in the summer of 2009. The law, known as the Affordable Care Act, eventually passed without any GOP votes.

Senate Majority Leader Chuck Schumer has set a crucial vote for Wednesday to kick off debate on the infrastructure plan. But Republicans in the bipartisan gang are pushing back against what they view as an arbitrary deadline.

Multiple Republican negotiators of the bipartisan deal are asking for more time.

"It's hard to vote for a bill that's not yet written," Sen. Bill Cassidy of Louisiana, one of the negotiators, told Insider. He said he would probably vote to oppose advancing the blueprint given they are still finalizing details on revenue sources.

"My hope is that Senator Schumer will delay the vote until next week," Sen. Susan Collins of Maine, another Republican negotiator, told reporters on Tuesday.

Schumer appears ready to give the talks more time. "It's only a signal that the Senate is ready to get a process started," he said from the Senate floor.

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Sen. Ron Johnson, a Wisconsin Republican, issued an underwhelming endorsement of his own 11-year run in Congress, telling a conservative podcast host on Wednesday that he didn't think he'd been "particularly successful" in office. 

The second-term senator, who said he was still undecided about running for reelection next year, told the conservative commentator Lisa Boothe that he ran for the Senate in 2010 because he wanted to get rid of Obamacare and lower the national debt. But his party hasn't managed to make progress on either issue, even under President Donald Trump. 

"I feel really bad that I've been here now probably 11 years and we've doubled the debt,"Johnson said. "Obamacare's still in place, and we've doubled the debt. I don't feel like my time here has been particularly successful." 

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Trump, who has publicly urged Johnson to run for reelection, promised to repeal Obamacare, but Republican lawmakers abandoned their campaign to get rid of the popular healthcare law after repeated legislative failures. Trump also promised to pay down the national debt over eight years, but he instead presided over the third-largest increase in the national debt under any administration. 

Johnson said "dysfunction" in Washington made his job frustrating and lamented that the media "rakes me over the coals, relentlessly" because of the "truths that I tell."

The senator, elected as part of the tea party's 2010 surge in Congress, has pushed misinformation about COVID-19 and vaccines and has said he won't get vaccinated. He told Boothe on Wednesday that there were "serious, serious issues" with the COVID-19 vaccines and that there was no reason for Americans who aren't in high-risk categories for COVID-19 to get vaccinated. 

The Wisconsin lawmaker said the federal government was ignoring risks associated with the vaccines and attempting to assert control over the public by pushing Americans to get vaccinated. These assertions aren't backed by science, which shows that vaccines dramatically reduce the chance of serious illness and hospitalization from COVID-19, including sickness from the dominant Delta variant. 

"It creeps me out that the government is wanting to push a vaccine in everybody's arm, even those people that don't need it," Johnson told Boothe. "Sorry Uncle Joe, I'm not signing up for that program. I don't trust them. … It's creeping me out because it's not rational."

He added: "This push to mass-vaccinate everybody — even those who've had COVID or even those that really have very little risk of any kind of serious impact if they get COVID — it just doesn't make sense, particularly with a vaccine that is not fully approved."

The senator has repeatedly and wrongly claimed that natural immunity from a COVID-19 infection is stronger than immunity provided by a vaccine and pointed to misleading data to support his claims about the safety of the vaccines. 

Johnson called this "a perilous moment for our nation" because Democrats who "don't like this country" have "devious plans" to "fundamentally transform" it. The senator said he wanted his Republican colleagues in Congress to focus more on "culture-war issues," including the debate over teaching critical race theory in schools. 

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