A bipartisan COVID-19 stimulus deal reached Wednesday includes billions for hospitals and critical medical supplies as well as short-term funding for community health centers.
The $2 trillion package has broad bipartisan support for relief directed to employers and workers suffering from a shuttered economy, but some provisions could dismay key House members.
The legislation includes controversial language on substance use records that has been a hard sell for some influential Democrats including Senate Health, Education, Labor and Pensions Committee ranking Democrat Patty Murray of Washington and House Energy and Commerce Chairman Frank Pallone Jr., D-N.J. Neither lawmaker responded to questions about the inclusion of the language in the deal.
That language would align substance use records with the privacy law called HIPAA, which some Democrats and privacy advocates worried could lead to discrimination.
The bill includes a so-called “Marshall Plan” for hospitals that Minority Leader Charles E. Schumer, D-N.Y., demanded. The legislation would send $100 billion to hospitals in need of cash for supplies and staffing, while another $11 billion would go toward a potential vaccine and therapeutics.
The American Hospital Association had asked Congress for $100 billion to aid facilities hamstrung by a loss of revenue from elective procedures.
Hospitals would also receive a 20 percent payment boost for Medicare patients admitted for COVID-19, in addition to relief from the 2 percent sequester reduction through the end of the year. A Senate GOP aide estimated the sequester suspension would amount to around $10 billion in extra revenue for health systems. Certain hospitals could also elect to receive advance Medicare payments to help with cash flow.
Rodney Whitlock, a health care executive with McDermott+Consulting and former Senate GOP aide, said the bill language is vague and could be confusing for the health care industry.
Lobbyists will watch the Trump administration's policies implementing the legislation closely.
“Health care stakeholders are going to be fighting to figure out what the rules are and who is writing the checks. Who exactly is eligible for the money? It is fairly clear that Congress did not want to take on the responsibility of making those specific decisions, but that means they've given [them] over to someone else. This could end up being incredibly chaotic,” Whitlock said.
Another $3.5 billion in state grants would help keep child care providers afloat and provide child care support for health care workers and first responders.
The bill also would build on previously expanded telehealth capabilities in an earlier package affecting a broader range of medical providers.
Impact on veterans
The Department of Veterans Affairs, meanwhile, would receive $19.6 billion — including $3.1 billion to bolster IT operations and telehealth — along with additional authorities tied to expanded veteran assistance and worker pay.
The VA serves as the back-up medical system for the nation’s hospitals and is already aiding facilities in the New York City area. The VA has confirmed 365 veteran cases as of Wednesday, with four deaths.
The department is separately proposing to suspend routine referrals to private doctors as laid out under a 2018 law, according to a memo sent to Hill staff Tuesday. VA spokeswoman Christina Mandreucci said the policy aligns with the Centers for Disease Control and Prevention's guidelines to defer elective procedures.
“Similarly, many community health care systems are taking the same approach, and we anticipate less capacity in the community for routine care in an effort to limit foot traffic in their facilities and help stop the spread of COVID-19,” she said.
But the move is prompting concern from advocates and lawmakers. Senate Veterans Affairs’ Chairman Jerry Moran, R-Kan., voiced “serious concerns” about the proposal.
“As the VA’s role in the COVID-19 response grows and Community-Based Outpatient Clinics are closing to reduce exposure, now more than ever is the time for community care,” he said in a statement.
The legislation also would provide billions more in spending on personal protective equipment like respirators and masks amid a severe shortage that has led hospitals to ration them and nurses to make homemade substitutes.
The bill includes $16 billion for the Strategic National Stockpile, the biggest infusion of funding for the reserve since the swine flu epidemic depleted much of its medical supplies. That’s on top of $1 billion in the first COVID-19 stimulus law Congress passed earlier this month.
Another $1.5 billion would go to the CDC for state and local governments to buy equipment and other measures to mitigate the virus’ spread.
Without a boost in the supply chain, the spike in spending on equipment could be slow to translate into masks, gloves and gowns in the hands of health care providers and other frontline workers. State governments and the Strategic National Stockpile are already competing for scarce supplies, according to some governors of hard-hit states. Industry experts say some manufacturers are still facing a shortage of Chinese-made materials.
The Department of Homeland Security, which oversees Transportation Security Administration agents, would receive another $278 million for equipment. DHS also includes Immigration and Customs Enforcement, which began requiring attorneys to wear respirators Sunday, a move opposed by attorneys and judges amid concerns it could direct supply away from hospitals.
The supply chain could be further strained by a $627.8 million allocation to the Department of Defense for “non-medical” protective equipment for biohazard mitigation, and another multi-million dollar allocation for personal protective equipment for the Drug Enforcement Administration.
Manufacturers are facing enormous demand for supplies and it's unclear if they should prioritize an order from the Strategic National Stockpile, Defense Department, TSA, DEA, or private companies.
Under the Defense Production Act, the government could compel manufacturers to prioritize government contracts and manage their distribution, but so far, the White House has been reluctant to exercise that authority. Federal Emergency Management Agency Administrator William Brockmann Long initially announced Tuesday that FEMA would use the authority to produce diagnostic test kits, only for the president to pull back hours later. FEMA said in a statement that “at the last minute” the test kits were “acquired from the private market.”
The bill also allocates $1 billion under the Defense Production Act to manufacture more supplies, which could be used to require safety equipment manufacturers to boost their capacity or force other sectors, like the garment industry, to transform their production to respond to the pandemic.
The Office of the Vice President did not immediately respond to a request for comment.
The National Institutes of Health would also receive $946 million for vaccine development and other research on COVID-19, on top of about $1 billion allocated in the first COVID-19 spending law.
The bill also calls for more domestic production of medicines amid reports that global supply chain disruptions caused by COVID-19 reduced supply of some essential drugs, and would provide about $80 million to the Food and Drug Administration for that.
The language also would require that in a public health emergency, drugmakers and medical device manufacturers must provide information about shortages to federal officials. FDA Commissioner Stephen Hahn has raised concerns in testimony to Congress that the agency’s inability to compel drugmakers to share “proprietary information” impedes its ability to respond.
The bill also includes a provision to make it easier for the Biomedical Advanced Research and Development Authority to enter into agreements with drug companies in a way that bypasses a law that allows federal agencies such as the NIH to "march in" and take away a company's patent exclusivity rights, allowing other applicants to make a drug.
Consumer advocates say the language undercuts federal officials' ability to step in should a vaccine be priced too high. BARDA gave Sanofi $226 million to produce a COVID-19 vaccine.
No surprise billing, drug provisions
The bill also would extend funding for community health centers and other programs from May 22 until Nov. 30. Congressional leaders were hoping to use community health center funding as a vehicle for legislation on surprise medical billing and drug prices, but the coronavirus pandemic changed their plans.
Michael Zona, spokesman for Senate Finance Chairman Charles E. Grassley, R-Iowa, said Congress and President Donald Trump would prioritize both drug prices and surprise medical bills later.
"Congress can pass a bill anytime it wants. Having available vehicles makes it easier, but doesn’t prevent anything from happening," he said in a statement.
The stimulus bill's extensions include temporary funding to help individuals move out of assisted living back into their communities through a program known as Money Follows the Person; funds for spousal impoverishment that allow an individual whose spouse is in long-term care to retain some of their income; and sexual education programs. The bill would also delay cuts to disproportionate share, or DSH, hospitals and extend Temporary Assistance for Needy Families cash assistance and related programs until Nov. 30.
The bill also would change the regulatory process for over-the-counter medications, allowing FDA to approve these drugs administratively instead of through a longer rulemaking process. The language would eliminate a full notice-and-comment rulemaking period.
The Indian Health Service would receive roughly $1 billion, a little less than the $1.2 billion American Indian and Alaska Native organizations requested last week. Of that, $125 million could be transferred to Indian health facilities for emergency use. The overall funding would cover increased capacity for telehealth, public health support, and other services.
The bill also includes $250 million in additional funding for Certified Community Behavioral Health Clinics to provide mental health care.
A provision that did not make it in was language supported by nurses unions' that would require the Occupational Safety and Health Administration to develop safety standards to protect health care workers.