The House is poised to pass a $1.9 trillion COVID-19 relief bill this week with several provisions likely to benefit healthcare providers and insurers.
The package appears to be a major win for the health insurance industry, with billions of dollars in subsidies to help laid-off workers keep their coverage. Meanwhile, hospitals were denied most of the additional relief they requested to deal with the pandemic's financial pressures.
House Majority Whip Steny Hoyer (D-Md.) told reporters Tuesday he expects the lower chamber to vote on the package Wednesday, the last step before making it to the desk of President Joe Biden.
Here's what's in the bill — and what's not.
In: The biggest expansion to the Affordable Care Act in years
The package includes several provisions long supported by Democrats and the healthcare industry that will temporarily expand eligibility criteria for ACA subsidies to include people with incomes above 400% of the federal poverty level. It will also increase the size of subsidies for low-income people.
Democrats have been unable to make major changes to the ACA since it was passed in 2010 due to opposition from congressional Republicans. Now that Democrats control the House and Senate, they have vowed to make good on Biden's promise to build on the ACA and make it more affordable for consumers.
"You really do see in this bill the influence of the Biden administration's emphasis on coverage," said Allison Orris, partner at Manatt Health and former CMS senior policy adviser.
The Congressional Budget Office estimates the ACA changes will extend coverage to 2.5 million uninsured consumers and cost about $34 billion.
Both changes will only be in effect for 2021 and 2022, but Democrats have signaled they would like to find a way to make it permanent.
In: COBRA subsidies
The Senate version of the package will cover 100% of the costs of COBRA premiums for laid-off workers, potentially helping millions of people keep the insurance plans they got through their employers through Sep. 30.
The provision is a win for insurers, who pushed senators to boost the subsidies to cover all premium costs, up from the 85% proposed in the House bill that passed in February. The CBO estimated the later version would cost $8 billion and cover more than 2 million people.
"This strengthened provision will ensure that laid-off workers can remain on their employer plans through the worst of this pandemic, at no cost," Senate Majority Whip Dick Durbin (D-Ill.), who helped push for the change, said in a statement.
In: Medicaid tweaks
The package offers two years of additional federal funding to encourage Medicaid expansion in the 12 states that have not extended coverage to low-income adults.
It's not clear how many states will take the government up on the offer due to the continuing Republican-opposition to the ACA.
"I think there's a strong possibility this provision could be what tips the scales" in some states, Orris said, pointing to Kansas and North Carolina.
Hospitals have become some of the most vocal proponents of Medicaid expansion backing efforts in several states. Research has shown expansion leads to a drop in uncompensated care.
Under the relief package, home-and-community based services will receive increased Medicaid funding under the bill for one year.
It will also allow states to expand Medicaid coverage to new moms for up to 12 months postpartum, an effort to reduce pregnancy-related deaths.
In/out: Some money for rural providers but no large boost to the Provider Relief Fund
The Senate included in its version of the bill $8.5 billion for rural hospitals to dispersed through the Provider Relief Fund, a program Congress established last year to help providers weather the financial pressures of the pandemic.
While Congress has poured $178 billion into the Provider Relief Fund in prior bills, only about $11 billion of that has gone to rural providers as of February, according to the Kaiser Family Foundation.
Hospitals asked for $35 billion in additional Provider Relief Funding to ease pandemic-related financial pressures but were largely denied, with lawmakers directing much of their focus to the public health response to COVID-19.
"This is the first piece of COVID relief legislation that has not had significant provisions for providers," said Carlos Jackson, vice president of legislative affairs for America's Essential Hospitals, an association for safety-net hospitals. "We were hoping for this COVID relief package to be more in line with the past efforts in providing significant help to providers that are on the front lines and hospitals that continue to be financially strained by the pandemic."
But House Energy & Commerce Committee Chairman Frank Pallone (D-N.J.) said in a markup last month that there is still $24 billion in the fund that hasn't been used.
"It's hard to make the case that we should give them more money," he said.
Out: Relief for Medicare loans and a moratorium on Medicare sequester cuts
The legislation doesn't include an extension of the moratorium on Medicare sequester cuts that providers requested. The current moratorium ends April 1, triggering a 2% reimbursement cut.
"This is not the time to reimpose cuts to Medicare payments to providers," Jackson said.
Providers also wanted Congress to relax payment terms for Medicare accelerated and advanced payment loans offered to providers.
"Many of those loans are now becoming due but we're still in the middle of this public health emergency," Jackson said.
Jackson said hospitals will push for those provisions in future relief packages.