September 19, 2021
 BY JOHN BRESNAHAN, ANNA PALMER AND JAKE SHERMAN New: The Senate parliamentarian has ruled against Democrats in their bid to attach immigration provisions to the $3.5 trillion reconciliation package, a huge setback for those seeking a pathway to citizenship for millions of Dreamers, TPS holders, farm workers and undocumented immigrants. Senate Parliamentarian Elizabeth MacDonough has ruled that the Democrats’ proposal isn’t allowed to be included due to the Byrd Rule, which controls what’s in a reconciliation bill. She also found no precedent for including such legislation in the fast-track budget bill. This ruling is a big loss for Democrats. Reconciliation allows the majority to pass legislation on a party-line vote. Immigration reform will continue to need 60 votes to overcome a Republican filibuster. There are a lot of dynamics to dig into here — we will get into all of them in our morning edition — but we wanted to make sure that you had the text of the ruling. See you in a few hours.    |
Presented by AstraZeneca
The 340B program is supposed to help vulnerable patients—but without strong safeguards, it’s siphoning away funds that could be used for free and charitable medicine. The 340B Rebate Model Pilot improves program integrity, preventing duplicate discounts and strengthening accountability. Urge HHS to implement the pilot today. Learn why it matters.
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Presented by AstraZeneca
The 340B program lacks transparency—making it hard to tell if it’s actually helping vulnerable patients. HHS can fix the problem by implementing the 340B Rebate Model Pilot, ensuring the program is transparent, compliant, and accountable. Learn more.