President Trump signed a $2 trillion economic stimulus bill on March 27, the Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748) in response to the coronavirus disease 2019 (COVID-19) outbreak – the largest such package in U.S. history. The Senate passed the measure in a late night 96-0 vote on March 25, and the House followed on March 27 in a voice vote.
Prior to Senate passage, the AAMC issued a statement thanking congressional and administration leaders for their work on the legislation and urging expeditious enactment and implementation. The statement describes how “major teaching hospitals and their medical school faculty physicians have mobilized on all fronts to develop and perform diagnostic tests, advance research on vaccines and other potential countermeasures, and provide front line patient care during an unprecedented emergency,” and notes that the supplemental package will “provide an important level of relief for these heroic efforts.”
The legislation is the third in a series that is intended to provide aid as the nation responds to the COVID-19 outbreak [see Washington Highlights, March 13, March 20]. Among other measures addressing unemployment, nutrition, and grants to businesses impacted by the outbreak, H.R. 748 contains several critical health care provisions.
The legislation will provide $100 billion for hospitals and health care providers to be reimbursed for health care or lost revenues attributable to COVID-19. The legislation directs the Department of Health and Human Services (HHS) to make funds available to support building or construction of temporary structures, leasing of properties, medical supplies and equipment including personal protective equipment and testing supplies, increased workforce and trainings, emergency operation centers, retrofitting facilities, and surge capacity. Funds would be granted through an application process to be established by the HHS secretary.
Other provider relief provisions include a temporary lift of the 2% Medicare sequester until Dec. 31, a 20% Medicare payment increase for patients admitted with COVID-19, an expansion of Medicare accelerated payments for providers to assist with cash flow throughout the emergency period, and an expanded Small Business Administration loan program for providers.
To provide relief for federal student loan borrowers, the legislation requires the secretary of education to defer student loan payments, principal, and interest through Sept. 30 on all federal direct student loans without penalty to the borrower. The bill also clarifies that any payments made during this time are eligible for loan forgiveness.
The legislation also includes significant supplemental appropriations for critical programs, including:
- $27 billion for the Assistant Secretary for Preparedness and Response, of which up to $16 billion can be used for the Strategic National Stockpile.
- $4.3 billion for the Centers for Disease Control and Prevention (CDC), including $1.5 billion for state and local preparedness grants.
- $945.4 million for the National Institutes of Health to support COVID-19-related research.
- $3.5 billion for the Child Care and Development Block Grant to support state grants for child care for families, including health care workers, first responders, and others playing critical roles during the COVID-19 crisis without regard to typical income eligibility requirements.
- $1 billion for Defense Production Act purchases.
- $150 billion in a Coronavirus Relief Fund for state and local governments.
The legislation extends the Medicaid Disproportionate Share Hospital (DSH) payment reduction, the National Health Service Corps program, Teaching Health Center Graduate Medical Education (GME), and community health centers until Nov. 30, 2020.
The bill also reauthorizes the Health Resources and Services Administration Title VII health professions and Title VIII nursing diversity and workforce development programs through 2025 [see Washington Highlights, Dec. 12, 2019].
The AAMC joined more than 90 organizations on March 20 in urging House and Senate lawmakers to provide $4.5 billion in additional annual funding for CDC, state, local, tribal, and territorial core public health infrastructure.
Congress has indicated that this third supplemental package is likely not the last, with the possibility of a fourth, or even fifth, package as the COVID-19 response continues.