Five House committees with jurisdiction over health, research, and education agencies marked up and advanced portions of The American Rescue Plan (S. Res. Con. 5), a $1.9 trillion COVID-19 relief plan proposed by President Joe Biden [see Washington Highlights . Jan. 15].
The House Committees on Ways and Means, Energy and Commerce, Education and Labor, Veterans Affairs, and Oversight and Government Reform, which met the week of Feb. 7, each marked up pieces of the package within their jurisdiction following congressional approval of a fiscal year (FY) 2021 budget resolution [see Washington Highlights, Feb. 5].
Bills from the 12 committees that received reconciliation instructions to draft legislation will be consolidated and sent to the House Rules Committee by Feb. 16, where additional amendments may be considered. This will be followed by consideration on the House floor, expected the week of Feb. 22.
The bills that were marked up this week contain the following provisions that would impact the academic medicine community and its patients and communities.
Access to Affordable Health Care Coverage
To encourage states that have not yet adopted Medicaid expansion under the Affordable Care Act (ACA), the Energy and Commerce bill provides a 5-percentage point increase in the federal medical assistance percentage (FMAP) for new states that decide to expand coverage. The FMAP increase applies to all Medicaid eligibility groups in states that adopt the ACA adult expansion – not just the new Medicaid expansion eligibility group. It also gives all states the option to provide 12 months of postpartum coverage to women in Medicaid or the Children’s Health Insurance Program.
The Ways and Means bill includes several provisions that would help people purchase coverage through the ACA Marketplace. It would provide financial assistance for people currently eligible for advance premium tax credits and extend assistance to those who earn above 400% of the federal poverty level (FPL). The tax credits are calculated to ensure that enrollees do not contribute more than a capped percentage of their income toward premiums. Anyone who earns up to 150% FPL or who received an unemployment insurance payment in 2021 would have no cost-sharing requirement. Those who earn between 150% - 400% FPL would contribute between 2 - 8.5% of their income. The bill limits anyone earning above 400% FPL from contributing more than 8.5% of their income towards premiums, regardless of their income. The enhanced subsidies would be available through 2022.
The Education and Labor and Ways and Means bills provide premium assistance of 85% for COBRA continuation coverage for eligible individuals and families through Sept. 31, 2021. The AAMC joined a Feb. 10 letter urging congressional leadership to include additional COBRA funding in this package [see related story].
Public Health Measures and State and Local Funding
The Energy and Commerce Committee bill includes funds for a variety of public health activities related to COVID-19 mitigation efforts. For the Centers for Disease Control and Prevention (CDC), the bill includes $7.5 billion for COVID-19 vaccine activities including promotion and distribution, and $500 million for activities through the U.S. Food and Drug Administration (FDA). The bill would also provide $1 billion to the CDC for public campaigns on vaccine confidence.
The bill would provide $46 billion for COVID-19 testing and contact tracing, and an additional $1.8 billion for efforts in congregate settings. For research, development, manufacturing, and production, as well as the purchase of vaccines and therapeutics to mitigate COVID-19 and future diseases with pandemic potential, the bill includes $5.2 billion.
The bill also includes $1.75 billion for SARS-CoV-2 genomic sequencing and surveillance through the CDC to more quickly respond to new coronavirus variant outbreaks [see related story]. The bill would also provide the CDC with $500 million for data modernization, data surveillance, and data analytics infrastructure.
Separately, the Oversight and Government Reform bill includes $350 billion in state, local, territorial, and Tribal funding through a proposed State and Local Coronavirus Relief Funds program to support local economies.
Workforce and Physician Well-being
The Energy and Commerce legislation includes $800 million in supplemental funding for the National Health Service Corps (NHSC) scholarship and loan repayment programs, which incentivize physicians to serve in health professions shortage areas. The AAMC previously endorsed NHSC supplemental funding [see Washington Highlights , Jan. 28 ].
Additionally, the Energy and Commerce marked up legislation would provide $330 million for Teaching Health Centers Graduate Medical Education through fiscal year (FY) 2023.
The legislation also provides $7.7 billion in awards under the Department of Health and Human Services to state, local, and territorial health departments to establish, expand, and sustain the public health workforce.
The bill would provide $80 million in Health Resources and Services Administration grants to institutions, academic health centers, state and local governments, and other non-profit entities for training health professions students, residents, or professionals in strategies to reduce and prevent suicide, burnout, mental health conditions, and substance use disorders. Furthermore, the bill would also dedicate an additional $20 million to establish a national evidence-based education and awareness campaign through the CDC that encourages health care professionals to seek support and treatment for mental and behavioral health concerns.
The $100 million set aside for the physician well-being programs was part of the previously introduced “Dr. Lorna Breen Health Care Provider Protection Act,” which the AAMC endorsed [see Washington Highlights , Aug. 14, 2020 ].
Higher Education
The Education and Labor Committee bill includes an additional $36.2 billion allocated for the Higher Education Emergency Relief Fund (HEERF). An institution’s HEERF allocation will be determined by a formula in which 75% of the allocation is based on the number of Pell Grant students, 23% is based on the number of non-Pell students, and 2% is based on the number of exclusively online Pell students.
The HEERF formula accounts for both full-time equivalent enrollment and headcount enrollment. Of an institution’s allocation, 50% must be used in emergency grants to students, and the other 50% can be used for institutional costs.
Prior to the committee’s mark-up, AAMC Chief Public Policy Officer Karen Fisher, JD, sent a letter to Chairman Bobby Scott (D-Va.) and Ranking Member Virginia Foxx (R-N.C.) highlighting how “the HEERF allocation formula weighs heavily the number of Pell Grant recipients at an institution…Since graduate students are not eligible for Pell Grants, independent medical schools inherently receive less funding for our learners, including former Pell Grant recipients and other economically disadvantaged students.”
Health Care for Veterans
The House Veterans Affairs (VA) Committee bill includes $13.5 billion for the Veterans Health Administration for veterans’ medical care and health needs, including approval for allocation of funds to the VA Medical and Prosthetic Research program. The approval of funds to go to VA research would be provided by VA leadership.
Absent from the all of the bills considered were supplemental funds for federal research agencies to mitigate the pandemic’s impacts on the nation’s research enterprise. During the Energy and Commerce Committee markup, Rep. Fred Upton (R-Mich.) introduced an amendment to add a $10 billion investment for the National Institutes of Health (NIH) to support non-COVID-19 research and additional COVID-19 research projects.
The amendment did not gather sufficient support to be included in the package, with Committee Chair Frank Pallone (D-N.J.) noting, “The budget reconciliation gives us instructions and a certain amount of money, so if we put in money for CDC research and then add NIH as you’re proposing without cutting something else, which I don’t want to do, then we go above the amount that they’ve instructed us or given us."