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Negotiations Stall on Next COVID-19 Package

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Tannaz Rasouli, Sr. Director, Public Policy & Strategic Outreach
Len Marquez, Senior Director, Government Relations
Matthew Shick, Sr. Director, Gov't Relations & Regulatory Affairs

Congressional and White House leaders are continuing negotiations on the next COVID-19 emergency supplemental package following the release of a series of COVID-19 emergency relief bills by Senate Republicans on July 27, together considered the Health Education and Liability Protection and Schools (HEALS) Act. The package includes about $1 trillion in spending to support recovery from the COVID-19 pandemic.

The path forward on another COVID-19 relief package remains unclear as lawmakers debate how to address expiring unemployment benefits, and the Senate took procedural steps on July 30 to allow for a Monday vote on an as-of-yet unspecified legislation. Republicans have proposed advancing stand-alone legislation to extend unemployment benefits, while Democrats continue to urge a comprehensive package. An agreement on the approach will allow negotiations on the content of a potential package to begin in earnest.

Democratic leaders in the House and Senate have criticized the HEALS Act. House Speaker Nancy Pelosi (D-Calif.), who led the House-passed Heroes Act in May to provide $3 trillion in relief [see Washington Highlights, May 15] said, “Ten weeks after House Democrats passed The Heroes Act to defeat the coronavirus and safely reopen the economy, Senate Republicans’ ongoing delay continues to wreak its deadly toll on the lives and livelihoods of the American people.”

Senate Minority Leader Chuck Schumer (D-N.Y.)  echoed Speaker Pelosi’s comments.

“The House passed a comprehensive relief package over two months ago, and I have been ready and willing since then to negotiate a package that provides real help for struggling Americans. Enough dithering and delay, let’s get to work for the American people in need – renters, the unemployed, the sick and our students and parents,” said Sen. Schumer.

The Senate HEALS Act addressed several aspects of coronavirus impacts related to academic medicine:

Research and Public Health

The appropriations provisions of the HEALS Act would provide $15.5 billion in emergency supplemental funds for the National Institutes of Health (NIH) available through Sept. 30, 2024, including $10.1 billion to reopen laboratories and support pre-pandemic research, and additional funding to conduct COVID-19 research, including how the disease impacts those with underlying conditions, minorities, pregnant women, and children. The bill would also extend the obligation period for fiscal year (FY) 2015 NIH grants through FY 2021.

Following introduction of the package, the Ad Hoc Group for Medical Research, convened by the AAMC, issued a July 28 press statement noting strong support for the Senate’s proposed investment for NIH and urging Congress to “work expeditiously to enact critical relief of no less than $15.5 billion” for the agency.

Related to foreign government influence in research, the bill would include text of the Safeguarding American Innovation Act (S. 3997). The AAMC previously joined other members of the higher education community in acknowledging the importance of addressing research security but highlighting several concerns with the bill as written [see Washington Highlights, July 24].

The bill would also provide $3.4 billion for the Centers for Disease Control and Prevention (CDC), including grants to states/localities and other entities, funding for seasonal influenza vaccine activities, funding for public health data surveillance and analytics modernization, and other activities. The bill would also allocate $16 billion for testing, contact tracing, and other activities, including no less than $15 billion for states, localities, and other entities, allocated through the CDC Public Health Emergency Preparedness formula.

The bill would also provide $6 billion for COVID-19 vaccine preparations and distribution, including plans to focus efforts on high-risk, underserved, and minority populations. The HEALS Act would also invest $20 billion in the Biomedical Advanced Research and Development Authority and no more than $2 billion for the Strategic National Stockpile.

Clinical Care

In addition to including another $25 billion for the Provider Relief Fund, the legislation would revise the Medicare Accelerated and Advance Payment Programs by delaying the repayment date until Jan. 1, 2021, aligning repayment timelines between Part A and Part B programs, and providing additional repayment time (18 months for Part A and 14 months for Part B) before paying interest. The proposal also includes the Time to Rescue United States’ Trusts (TRUST) Act (S. 2733/ H.R. 4907), which would establish a “Rescue Committee” for each of several federal trust funds, including Medicare Part A and Social Security, that is tasked with avoiding depletion of the fund, providing for solvency, simplifying the program, and otherwise improving the program. Members of the committee would develop legislation that corresponds with the mission, and the legislation developed would receive expedited consideration in both chambers.

The package allows the Department of Health and Human Services (HHS) to extend the temporary Medicare telehealth waivers until the end of the public health emergency or Dec. 31, 2021 (whichever comes later). It also requires the Medicare Payment Advisory Commission to report on the impact of the telehealth waiver and HHS to post data on the use of telehealth throughout the pandemic and provide legislative recommendations to Congress.

The Senate proposal does not include any Medicaid provisions related to enhancing the Federal Medicaid Assistance Percentages or the proposed Medicaid Fiscal Accountability Regulation.

Education

The HEALS Act would provide an additional $29 billion for the Higher Education Relief Fund to support institutional and student aid. However, institutions that paid the “endowment tax” in 2019 would receive decreased allocations and could only use the funding for student aid. The measure would require states to maintain their funding for education at least at the same proportional levels as in 2019 as a condition for receiving Education Stabilization Fund grants. The bill clarifies that any funds received by a student or family during the national emergency under the CARES Act should not be counted toward taxed or untaxed income.

The HEALS package also includes the Student Loan and FAFSA Simplification Act (S. 4247) [see Washington Highlights, July 24], which amends the Higher Education Act to establish just two repayment plans: a 10-year standard and an income-driven repayment plan with a floating scale for monthly payment amounts based on the borrower income. The bill would also adjust “cost of attendance” to include a student’s technology expenses.

Liability Protections 

The HEALS package includes temporary liability protections for hospitals, medical schools, health professionals, and administrators, among others, under the SAFE TO WORK Act (S. 4317). The AAMC joined 78 state and national education organizations in a July 29 letter to House and Senate leadership supporting these provisions.

 “Academic medical centers are at the intersection of education, research, and patient care, and now are on the front lines of fighting COVID-19. In the midst of an unprecedented health care crisis that is straining our health care system, we must support our health care facilities and professionals as they meet the demands of their patients and communities, including protecting those serving from unwarranted legal action related to COVID-19,” the letter stated.

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