How the New Infrastructure Law Could Improve American Health

What does infrastructure have to do with health? As some key provisions in the Infrastructure Investment and Jobs Act passed this week demonstrate, quite a bit.

According to the White House, the health-specific elements of this new law, called the Bipartisan Infrastructure Law, are intended to strengthen America's resilience to extreme weather and climate change, clean up and alleviate pollution, and expand access to clean drinking water.

Significantly, the White House said, “these long overdue investments will take much-needed steps to improve public health, reduce pollution, and deliver economic revitalization to communities that have been overburdened, underserved, and left behind.”

Clean Drinking Water

The new law will eliminate the remaining lead water lines in the U.S. and clean up dangerous chemicals that have leached into some water supplies from lead pipes. As Health Affairs senior editors Chris Fleming and Ellen Bayer noted in a podcast this summer, while many people know about the water problems from lead pipes in Flint, Michigan, there are cities all over the country with similar problems. They suggest six million households are affected.

Legacy Pollution Cleanup

The infrastructure law provides funding for the government to reclaim abandoned mine land, cap abandoned oil and gas wells, and clean up left-behind industrial and energy sites that produce pollution and blight.

Many of the sites to be cleaned up are significant sources of methane, a greenhouse gas that is a major cause of climate change.

Public Transit

The government will invest $66 billion in sustainable transportation options. This involves expanding transit and rail networks as well as replacing vehicles—including buses—with zero-emission versions. 

Improved public transit won't just benefit the environment, it will also help reduce disparities. According to the Pew Research Center, people of color are twice as likely to take public transportation than White people. Many of these communities lack sufficient public transit options. In addition, transit workers are disproportionally workers of color. The new law includes investments for a new program that will reconnect neighborhoods cut off from transportation, historically.

At the same time, the law provides for thousands of electric school buses, beginning to offset the diesel air pollution from school buses, which is linked to asthma and other lung issues in students.

Modern and Clean Infrastructure

The government plans to invest $17 billion in port infrastructure and $25 billion in airports in order to:

• Repair vehicles
• Reduce congestion and emissions near ports and airports
• Increase electrification and other low-carbon technologies
• Reduce environmental impacts on neighboring communities

Better Internet Access

Other health provisions include funding to pay the costs of internet access for low-income individuals and families, as well as funds to teach digital literacy skills. Both of these things are critical as telehealth becomes more prominent.

Christine Squires, President and CEO of Americares, a health relief organization that supports over 4,000 health centers in the U.S. and around the world, told Verywell that investing in high-speed broadband internet across the United States will expand access to telehealth for countless low-income patients in underserved communities.

“When the COVID-19 pandemic struck, free and charitable clinics across the country quickly pivoted to telehealth to keep staff, volunteers and patients safe,” Squires said. “A year later, we continue to see the added benefit of giving patients more ways to connect with providers.” 

Funding for the new law’s provisions will be distributed over the next five years. 

Who Pays?

To help pay for the new legislation, the infrastructure law requires that manufacturers of certain single-dose drugs that are covered under Medicare Part B issue refunds to Medicare for any drug left in vials after doses have been drawn. It also adds a three-year delay to a change in drug rebate rules.

Currently, drug manufacturer rebates go to pharmacy managers who use them to reduce the cost of drug insurance premiums for Medicare patients. The delayed rule would potentially give the rebates directly to consumers. 

“Both of these were included more as 'pay-fors' to offset the legislation’s costs than as fundamental changes in policy,” David Farber, a partner in the FDA and Life Sciences practice at the D.C. office of the King & Spalding law firm, told Verywell. “The real policy changes will come in the next legislation (Build Back Better) which has drug pricing provisions and other significant health care initiatives."

As Ryan Urgo, the managing director of health policy at consulting firm Avalere Health, told Verywell, "esoteric" is a good way to describe this payment method.

"The infrastructure bill needed to be paid for and [the government] reached into the healthcare sector to extract some savings," he said.