Negotiations between the Trump administration and congressional Democrats on another comprehensive COVID-19 package have devolved into a stalemate, which could jeopardize policies favored by the healthcare industry.
Lawmakers missed a deadline to pass a major bill before enhanced federal unemployment benefits expired, and chances are dimming for a comprehensive package in the near future. Government funding expires at the end of September, which could provide another deadline for a legislative vehicle.
Healthcare industry players were pushing for a bevy of policies that could be delayed or abandoned. James Gelfand, the ERISA Industry Committee's senior vice president on health policy, called a potential failure to reach a deal "the height of dysfunction."
"If Congress gives up on Phase Four, it will be a massive abdication of duty to the American people. Failure to deliver on surprise billing, transparency, telehealth, even COVID testing … issues that supposedly had broad bipartisan support," Gelfand said.
Nine healthcare policies in particular could fizzle without a deal.
1. More Provider Relief Fund money
Both Democrats and Republicans had proposed significant boosts to a fund lawmakers created to help hospitals and other healthcare providers offset coronavirus-related expenses and lost revenue. Lawmakers have set aside $175 billion so far, and HHS has not distributed all of it yet. Hospitals and doctors asked for another $100 billion, which Democrats supported, but Senate Republicans proposed a more modest $25 billion.
FTI Consulting Managing Director Charlene MacDonald said assistance provided in prior relief packages was critical to helping providers survive the first wave of shutdowns, but the virus still is not contained.
"Absent congressional action to provide additional relief, it's not a matter of if but when our country's healthcare infrastructure falters under the weight of sustained economic pressures," MacDonald said.
2. Relaxing Medicare loan terms
Providers in August had to start paying back Medicare loans that were intended for COVID-19 relief, and hospital finance experts have said that hospitals with limited cash on hand could struggle to pay the loans back. CMS will withhold providers' Medicare fee-for-service reimbursement until the loans are repaid. Both parties had suggested tweaks to relax the repayment conditions.
3. Liability protections
Healthcare providers had hoped that a legislative package would include a shield to strengthen protections against medical malpractice liability. Senate Republicans introduced a measure that included many of the features providers wanted, but Democrats objected to the policy.
4. Telehealth policy extension
Senate Republicans' proposal extended several telehealth payment flexibilities from the CARES Act through 2021. Without a COVID-19 relief package, these policies are tied to HHS' public health emergency declaration, which has to be renewed every 90 days.
5. COVID-19 testing funds
Insurers, labs, employer groups and others had asked Congress to create a fund to pay for tests conducted for public health surveillance, back-to-work, back-to-school, and other purposes that insurers aren't legally required to cover. Funding proposed by both sides in the negotiations would have funneled money to the states for testing instead.
6. State and local funding
Healthcare providers asked Congress to provide more financial support to states so their budgets would be insulated. Providers fear that states faced with massive shortfalls could cut Medicaid provider rates to make ends meet. Many healthcare stakeholders were also pushing for increased federal Medicaid matching funds to directly bolster Medicaid programs.
7. Hazard pay
Hospitals and healthcare providers had asked for Congress to fund additional pay, child care and other benefits for healthcare workers. Democrats pushed the policy in their proposal.
8. COBRA subsidies
Some lawmakers had asked for funds to help laid off workers stay on their employers' health plans, but anti-abortion groups objected to the idea. The proposal was also expensive, so its inclusion was unlikely even in better circumstances. Observers say that it's more likely to be abandoned the longer the package is delayed.
"People are losing their health insurance coverage, their jobs, their housing. Widespread issues with testing remain. Our entire healthcare system is under colossal strain and cracks are deepening every day that Congress drags this out," Families USA senior director of federal relations Jen Taylor said.
9. Funds for community health centers
Both parties' proposals also included funding for Federally Qualified Health Centers to support operations as they serve as front-line healthcare providers for vulnerable populations.