The 2017 disaster price tag for hospitals is steep. How much those eligible for federal aid will recover, and when, is unclear as the tussle over the end-of-year congressional disaster package continues.
Members of Congress were putting final touches on the numbers for the long-anticipated December appropriation late this week. But on Friday, a spokesperson for the House Appropriations Committee said those numbers wouldn't be released as expected that day.
Appropriations Committee staff and lawmakers are tight-lipped on what the final numbers will be, but House health appropriations subcommittee Chair Tom Cole (R-Okla.) promises the health piece at least will be "substantially" higher than the White House's request. The last Trump administration proposal was $44 billion. Lawmakers were hoping for the appropriation to come in November, but tax reform talks crowded that out of the legislative calendar. Since then, a second massive wildfire has hit California—sharply raising the price tag for the government.
In Texas alone, where Hurricane Harvey wiped out roads and buildings with heavy floods, 92 hospitals reported around $460 million in losses. Most of that estimate—about $380 million—came from facility damage, says Lance Lunsford of the Texas Hospital Association, which surveyed the hospitals. But that number also includes about $40 million in increased uncompensated care costs attributable to the storm and its aftermath and $48 million from business office closures, billing and claims disruption, delayed or unpaid insurance claims and more. While for-profit hospitals don't qualify for federal aid, not-for-profit hospitals can get federal money through the Federal Emergency Management Agency's public assistance program.
Lunsford says the Texas congressional delegation knows these numbers—the THA has made sure of it.
And that is the case for representatives of all states and territories ravaged by hurricanes and fires over the past few months: they know the costs. The damage to critical infrastructure and health systems is so vast that lawmakers of both parties want more than they expect out of this last relief package of the year.
The various delegations have been fighting for their piece of the total pie that's further constrained by the bigger budget fight in Congress over the lifting of spending caps. Lawmakers are nowhere close to a deal on that, a spokesperson for the House Appropriations Committee said.
Appropriators are trying to salve concerned delegations with the promise of more once the costs for all the damage have been assessed. A FEMA spokesperson said the agency is still "in the early stages of assessing damage and eligibility for possible reimbursable damage and expenses."
Lawmakers expect more later, but they also want and need money now.
"This isn't the last tranche," said Sen. Bill Nelson (D-Fla), who said he wants $90 billion for his state before Congress leaves next week.
Congressional delegations shoulder the needs of their battered communities and, as Cole notes, they don't want to go home for Christmas without bringing money with them.
For example, Rep. Carlos Curbelo (R-Fla.) is fighting for Fishermen's Community Hospital in the Florida Keys, which is part of the not-for-profit Baptist Health system in South Florida. Hurricane Irma decimated the hospital, which has been operating out of a mobile tent hospital since late September. This week the local board of county commissioners voted to lease land to Fishermen's at the nearby airport for $1 per year so the hospital could build a temporary facility there.
"While Fishermen's Hospital would prefer to stay on-site, repairs and renovations to the permanent building could require use of its entire site for staging and construction management," the commissioners said in their report.
Curbelo wants to make sure FEMA sustains Fishermen's operations until "the community finds a solution."
Fishermen's is an especially severe example on the mainland U.S.—Puerto Rico's hospitals saw heavy infrastructural damage—but many hospitals in Florida and Texas saw flooding that disrupted their operations and cost them money.
While the full costs of this year's storms and fires aren't totally known, Hurricane Maria's cost to Puerto Rico—the hardest hit of all U.S. states and territories through sweeping devastation of the island's infrastructure—is estimated at $45 billion to $95 billion. Moody's Analytics has projected as much as $190 billion in damage from Irma and Harvey.
Lawmakers are optimistic about passing the disaster package next week, whether it's a stand-alone bill or a rider with the continuing budget resolution to keep the government open after Dec. 22.
It's just a question of how much, and whether everyone is happy.
Texas has one of the Senate's most powerful leaders as a representative: Majority Whip John Cornyn. On Thursday, between bicameral negotiations on the GOP tax bill, he promised the relief package would come.