Late last Friday night, the House passed the “Infrastructure Investment and Jobs Act,” H.R. 3684 – also known as the Bipartisan Infrastructure Framework (BIF) – by a margin of 228-206. Members also agreed to a rule to advance the Build Back Better (BBB) Act, which is widely viewed as social infrastructure legislation, though when they will do so remains a $1.75 Trillion question. 

The Friday night negotiations provided a nail-biter drama for advocates (and many members) who had been expecting both bills to pass together as complementary infrastructure investments. Despite the ultimate decoupling of the bills and the frustration this has caused for health advocates who had wanted to leverage the bipartisan infrastructure deal to pressure hold-out members to vote simultaneously for the vital provisions in BBB, there are some exciting health-related provisions in BIF that advocates can celebrate and utilize as we pivot to advocacy tactics that don’t rely on simultaneous passage.

We’ve identified the following BIF provisions as those that advocates can highlight in their continued base building and federal advocacy, and applaud their members for passing, specifically because they dovetail with many of our shared social infrastructure priorities.  The next step is to pass BBB so that these provisions can work as intended. 

1.     Clean Drinking Water – $55 billion

The Bipartisan Infrastructure Framework bill is the largest investment in clean drinking water in our history. Currently, up to 10 million American households and 400,000 schools and child care centers lack safe drinking water – see what your state will receive in funding here

BIF devotes $55 billion to water and wastewater infrastructure. Of that, the bill commits $15 billion to replace lead pipes and $10 billion to address water contamination (from polyfluoroalkyl substances, or PFAS, a class of chemicals used in the production of Teflon).

Access to clean water is paramount for communities, especially for the healthy development of young children. The Flint, Michigan crisis demonstrated for the entire country the disproportionate and irreversible harm to children’s developing brains; over 10,000 children between 2015-2019 were exposed to lead in Flint – a majority Black and low-income community. While Flint has become the poster-city for lead contamination, numerous communities continue to be at risk, including Milwaukee, Newark, Chicago and many others. The communities hardest hit are disproportionately Black and brown and advocates will play a key role in ensuring that BIF funds get to the communities that need it most.

BIF is a great step forward, and its provisions will be strengthened when the health coverage provisions in Build Back Better Act are passed and become law as well. These BBB provisions include those that make CHIP permanent and provide continuous eligibility for children enrolled in CHIP and Medicaid,   helping to connect young children with pediatricians and ongoing care, including testing for lead levels to ensure their healthy brain development. It takes both clean water and access to health coverage to ensure that children thrive.

2.     Climate Change – $50 billion

BIF invests $50 billion in “climate resilience” – this means committing funds to protect people from the storms, droughts, floods and other extreme weather events made worse by climate change. The bill includes $216 million to the Bureau of Indian Affairs for climate resilience, recognizing that tribal territories have been disproportionately harmed by climate events. The funding will be distributed under the Federal Emergency Management Agency’s Hazard Mitigation Grant Program, providing resources to states, tribes, and territories to reduce the impacts of climate change. 

There were 22 extreme climate events last year that cost over $1 billion, and this summer was the hottest ever recorded for the nation. As heat waves, droughts and other climate events worsen, so will health outcomes, particularly for people managing chronic conditions and mental health issues. Further, these events place some populations at greater risk, including older adults, isolated individuals and Indigenous, Black and brown people who are more likely to live in areas vulnerable to extreme weather events. The funds will provide needed resources to help respond to these crises, including water and food distribution and home renovation to protect against extreme weather events.

The climate resilience funds can also be used to clean up Superfund sites, brownfields, coal, hard rock mines, and natural gas wells. These resilience funds are important to addressing climate challenges at the community level and also bring funds to these communities, which are all low-income, supporting job creation and better health outcomes. 

Mitigating the effects of extreme climate events is important to advancing health equity and to addressing broader social determinants of health. But people in these communities need immediate health coverage and care to manage the chronic conditions they are already facing as a result of insufficient housing, environmental pollution, unemployment and displacement. We need both the provisions in BIF and BBB to help ensure the health and safety of our communities.

3.     Broadband Access – $65 billion

BIF invests $65 billion in broadband access split across four focus areas: the largest investment provides $42.45 billion in grants directly to states; the second largest investment is $685 million slated for digital equity capacity; the third provision ensures a $625 million investment in a digital equity competitive grant program; and the rest of the funds will focus on consumer affordability, workforce and need assessment.

All of these programs will go through the Department of Commerce, which is tasked with distributing funds to “enable States and Territories to work with local governments, service providers, and anchor institutions to expand affordable broadband access and close the digital divide.” Additionally, there are funds specific to Tribal lands to address remote access.

The broadband investments are historic and necessary. There are longstanding inequities in access to both broadband and smart phone technology. In fact, 13 percent of households in our country currently have no internet subscription and remote, rural regions are not priority areas of investment for broadband service providers, particularly those on Tribal lands. The Joint Center for Political And Economic Studies reports that 34 percent of Black adults do not have home broadband, and 30.6 percent of Black households with one or more children lack high-speed home internet. While this is bad in the best of times, the societal changes wrought by the COVID-19 pandemic have dramatically illustrated that internet access is critical for individuals and families’ economic and health security. From telehealth appointments to online school, broadband is essential to modern life. And so too, is health care. We need both the BIF and BBB investments to ensure our families and communities are thriving both during, and long after, the pandemic is over.

The provisions in the BIF that address the environments in which people work, live and play is critical to advancing equity and bettering people’s health over the long run. It is a crucial first step in ensuring our families and communities have what they need to thrive. The next step is to pass BBB to make sure that these investments don’t go to waste, and that the people working, living and playing in our communities have the coverage and care they need to get and stay healthy. Together, BIF and BBB move the country toward a brighter and more just future.