Providers are gearing up for a fight over infrastructure funding, with lobbyists pushing for billions of dollars to modernize and expand facilities, build up the workforce and prepare for the next pandemic.
Congressional Democrats and President Joe Biden are working on a $2 trillion dollar infrastructure bill that touches on nearly every sector of the economy. It could represent the biggest investment in healthcare infrastructure seen in decades, particularly for hospitals serving vulnerable communities.
"Many hospitals that are serving the safety net have not gone through recent upgrades and are really in facilities that were meant for a much smaller patient population," said Carlos Jackson, vice president of legislative affairs for America's Essential Hospitals, which represents safety-net hospitals. "With the impact COVID-19 has had on communities and patients that are typically served by essential hospitals, we certainly want to ensure that our hospitals are able to be able to meet their needs in the next public health crisis, no matter when that comes."
The White House's high-level infrastructure and jobs proposal last week didn't include much funding for hospital improvements. The administration asked Congress to earmark $400 billion for expanding home and community-based care.
Democrats on the House Energy & Commerce Committee, which includes several allies of the hospital industry, included $10 billion in its infrastructure proposal to "reestablish" the historic Hill-Burton program, which funded the construction of hospitals and clinics from 1945 through the 1990s.
Under the House proposal, the $10 billion would be prioritized for projects that modernize facilities for public health preparedness and protecting against cybersecurity threats in the health system.
Jackson said the $10 billion is a "good start," but more funding would be appreciated because "the need is so great." He said he hopes the funds are targeted to hospitals and providers serving communities of color and others who have historically been hit hardest by public health threats.
Meanwhile, the Greater New York Hospital Association, a powerful lobbying presence in Washington, is asking Congress to spend $100 billion to "fully fund" the Hill-Burton program to deal with "rapidly deteriorating hospital infrastructure in rural and urban communities."
"While some segments of the nation's healthcare delivery system are experiencing rapid redesign and innovation, scarce access to capital threatens to leave vulnerable communities behind," GNYHA wrote in its proposal to Congress.
The American Hospital Association is also pushing for additional funding for hospital infrastructure to "ensure the long-term viability of hospitals." AHA argues hospitals have lost billions of dollars because of the pandemic, forcing "delays in necessary capital spending."
AHA also wants Congress to approve more funding for Hospital Preparedness Program (HPP), grants that help hospitals plan for and respond to large-scale emergencies and disasters. Hospitals have argued the HPP has been underfunded for years, and the money doesn't always make its way to providers.
It's not yet clear that those requests will eventually end up in the final infrastructure package, but hospitals have a big influence in Washington. Infrastructure is one of the issues the AHA spent $4.4 million lobbying Congress on in the 4th quarter of last year, according to lobbying disclosures.
The infrastructure discussions are still in the early stages with the House in recess since March 29. But Speaker Nancy Pelosi (D-Calif.) said last week she wants Congress to vote on a package by July 4.
Several groups representing providers including the AHA are lobbying for significant reforms to programs that train new physicians, pointing to a growing shortage of doctors. They're for Medicare to pay hospitals to train more residents through the Graduate Medical Education program.
Congress added 1,000 Medicare GME slots in a COVID-19 relief bill passed in December, but the number of residents Medicare pays for has largely been frozen since 1996. The American Association of Medical Colleges wants Congress to fund another 14,000 slots in the infrastructure bill.
Sen. Robert Menendez (D-N.J.) and Senate Majority Leader Chuck Schumer (D-N.Y.) — both strong allies of the hospital industry — cosponsored a bill to add those 14,000 slots, and it could be included in a larger infrastructure package.
"Physicians are in shortage. That's why this is so key," said Karen Fisher, chief public policy officer for the Association of American Medical Colleges.
However, the program is expensive, costing Medicare about $112,000 to $129,000 per residents. AAMC projects a shortage of between 54,100 and 139,000 physicians by 2033.
The American Academy of Family Physicians is lobbying Congress to include in the infrastructure package a bill that would increase Medicaid reimbursement rates for primary care providers.
Medicaid typically pays less money for services than Medicare and private insurance, disadvantaging small primary care doctors who see a lot Medicaid patients.
"That pay disparity really exacerbates the financial stability of primary care practices," said Stephanie Quinn, AAFP's director of government relations.
GNYHA and other groups also want Congress to make permanent telehealth waivers that were put in place by the federal government because of the pandemic, including allowing providers to provide services across state lines and allowing Medicare to pay for audio-only calls. Congress should also provide funding to providers to build up capacity for telehealth services, GNYHA says.