Hospital associations in states with the largest number of confirmed COVID-19 cases said the federal funding in the pipeline so far won't cover their needs, and they are unsure when or how more assistance will arrive.
Hospitals have not yet borne the crush of COVID-19 patients that many experts fear could be coming, and that uptick will require more financial assistance.
Lawmakers appropriated some funds to assist hospitals with surge capacity and medical supplies, but the money is mostly working its way through federal and state bureaucracies. Congress has largely resisted providers' pleas for more direct relief.
The California Hospital Association sent a letter to its congressional delegation last week, which includes House Speaker Nancy Pelosi (D-Calif.) and House Minority Leader Kevin McCarthy (R-Calif.). The CHA made clear that its hospitals will need more aid than Congress has provided so far.
"We appreciate the support of our local, state and federal officials have shown thus far. However, swift action is necessary to combat the spread of the virus and ensure our hospitals have the resources and staff needed to care for their communities," wrote CHA President and CEO Carmela Coyle.
Congress' first supplemental funding package set aside $500 million for HHS to provide drugs, medical supplies and training and additional funding to increase medical surge capacity, but HHS has not yet decided how the money and supplies will be allocated.
"HHS is in the process of developing plans for the supplemental funding based on the evolving situation," an HHS spokesperson said.
Community health centers are supposed to receive $100 million in federal funds, but HRSA has not yet begun distributing funds. The health centers have said they do not have enough personal preparedness equipment to handle a sudden surge of patients. Lawmakers have not yet renewed sustained funding for community health centers, which will expire on May 22.
"HRSA is working quickly to develop a spend plan and will expedite the awarding of funds," the agency said in a statement.
Washington state has seen the most coronavirus-related deaths in the nation, but its hospital association said it is unsure when Congress' first COVID-19 emergency package will be distributed. The Washington State Hospital Association said its rural and financially vulnerable hospitals have voiced concerns that federal funding will not be enough.
"It does not appear the federal appropriation will help to alleviate the stressors of COVID-19 and the impacts to hospital operations," WSHA said in a statement. "We believe further action from Congress will be necessary and hope that dollars will specifically be directed to hospitals to assist in their response."
The Greater New York Hospital Association said the revenue streams from Congress' first COVID-19 package are new, but much of the funds will come through the Hospital Preparedness Program as well as state and local agencies rather than going directly to hospitals.
"Again, all of this is very fluid," GNYHA Senior Vice President of Government Affairs Jon Cooper said.
Similarly, New York's Democratic Gov. Andrew Cuomo criticized Congress for failing to provide enough relief in its original bill.
"I know when someone passes a piece of legislation, they don't want you to criticize the legislation. But the reality of this situation is it's not enough funding for the state of New York," the governor said at an afternoon news conference," Cuomo said on March 6.
Cuomo on Monday asked for the Army Corps of Engineers to build temporary medical facilities to treat COVID-19 patients.
Lawmakers are already working on a second funding package, but it does not include direct aid to hospitals.
"As Congress considers developing an economic stimulus package, we urge you to ensure that it includes a comprehensive funding strategy to ensure that hospitals, health systems, physicians and nurses are viable and directly supported for preparedness and response," the American Hospital Association, American Medical Association and American Nurses Association reiterated to Congress on Monday.
One of CHA's priorities is asking lawmakers to fund the National Disaster Medical System Definitive Care Reimbursement Program, which would allow hospitals to be reimbursed at 110% of Medicare rates to care for disaster evacuees.
"California hospitals continue to care for federally quarantined and isolated patients from the Diamond Princess and Grand Princess cruise ships, many of whom reside in areas and insurance networks far from the hospital where they are receiving treatment," Coyle wrote.
Public health officials in Washington have sounded their own alarms. The federal government has sent Washington state tens of thousands of respirators, gowns, gloves and other protective gear for healthcare providers, from the National Strategic Stockpile, but it's not enough, said Clark Halvorson, Assistant Secretary of Health for Public Health Emergency Preparedness and Response.
Members of the Washington congressional delegation sent a letter to HHS Secretary Alex Azar on Sunday urging him to direct more personal protective equipment to Washington.
"The lack of PPE endangers the health of people on the frontlines, including local health agencies, health workers, and emergency personnel, and limits their ability to respond to those in need and to efficiently curtail the COVID-19 epidemic," lawmakers wrote.
But some of that relief may come from other branches of the government. President Donald Trump declared the COVID-19 pandemic a national emergency on Friday, which unlocks federal funding that could eventually be used in part to reimburse hospitals.
It is unclear how much money would be available for what purposes, but the government has wide discretion in how federal emergency funds are spent, said Georgetown University adjunct law professor and Avalere consultant Nick Diamond.
"The law affords a lot of flexibility for funds to be used in concert with some of the waivers, so there is a possibility for reimbursement for services provided by providers in some of their response efforts," Diamond said.