The House on May 15 passed by a vote of 208-199 an amended version of the Health and Economic Recovery Omnibus Emergency Solutions (Heroes) Act, (H.R. 6800), a $3 trillion supplemental spending package released by Speaker of the House Nancy Pelosi (D-Calif.) and other House Democrats in response to COVID-19. Rep. Peter King (R-N.Y) was the only Republican joining Democrats to advance the bill via an historic remote vote; the Senate is not expected to take up this measure for consideration.
Following introduction of the Heroes Act on May 12, AAMC President and CEO David Skorton, MD, released a May 14 statement expressing appreciation that the legislation addresses “many important issues facing the medical schools, teaching hospitals, researchers, and faculty physicians who are on the front lines of the nation’s response to COVID-19.” The statement continues, “As the package moves forward, we urge all lawmakers to come together to pass legislation with broad support that will help all of those impacted by this national emergency as quickly as possible.”
The legislation would provide an additional $100 billion for the provider relief fund initially established in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) and expanded in the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139) [see Washington Highlights, March 27, April 24]. In addition to increasing the fund’s resources to reimburse for health care related expenses or lost revenue attributable to the coronavirus, the bill codifies the fund with a new algorithm and distribution mechanism. The legislation would also improve the Accelerated and Advanced Payment Program by lowering the interest rate for loans to Medicare providers, reducing the per-claim recoupment percentage, and extending the period before repayment begins.
Other clinical issues addressed in the legislation include:
- Increasing Federal Medical Assistance Percentage payments to state Medicaid programs by a total of 14 percentage points starting July 1, 2020, through June 30, 2021.
- Preventing the Secretary of Health and Human Services (HHS) from finalizing the Medicaid Fiscal Accountability Regulation until the end of the COVID-19 public health emergency.
- Temporarily increasing Medicaid disproportionate share hospital allotments by 2.5%.
- Creating special enrollment periods for Medicare Parts A and B as well as Affordable Care Act plans.
- Providing approximately nine months of full premium subsidies to allow workers to maintain their employer-sponsored coverage if they are eligible for COBRA.
The bill also would provide $75 billion — primarily through state and local health departments — for testing, contact tracing, and other activities necessary to effectively monitor and suppress COVID-19 through a newly established COVID-19 National Testing and Contact Tracing (CONTACT) initiative.
The legislation also would invest $4.7 billion — available through September 2024 — for the National Institutes of Health (NIH) to prevent, prepare for, and respond to the coronavirus, including $3 billion designated “for offsetting the costs related to reductions in lab productivity” as a result of the pandemic. Additionally, the bill would extend the availability of NIH’s unobligated fiscal year (FY) 2020 funds and multiyear awards, currently set to expire in FY 2020, through the end of FY 2021. The AAMC previously urged Congress to provide emergency relief to mitigate disruptions to federally funded research [see Washington Highlights, May 1].
The manager’s amendment added text from the Scientific Integrity Act (H.R. 1709), which would require federal research agencies to establish and/or maintain clear scientific integrity principles and includes a sense of Congress that science and the scientific process should inform public policy. The House Science, Space, and Technology Committee passed H.R. 1709 by a vote of 25-6 in October 2019.
Other supplemental appropriations for critical programs in the legislation include $4.575 billion for the HHS Office of the Assistant Secretary for Preparedness and Response and $7 billion to be used by the Centers for Disease Control and Prevention, as well as state and local health departments, to improve core public health infrastructure.
The Heroes Act would provide $26.7 billion in emergency aid to public higher education institutions and $7 billion in emergency aid to private institutions for “education and general expenditures (including defraying expenses due to lost revenue, reimbursement for expenses already incurred, and payroll) and grants to students for expenses directly related to coronavirus.”
Regarding student loans, the legislation extends the suspension of payments for federal student loans, interest accrual, and interest capitalization through September 30, 2021. The manager’s amendment provides $10,000 of loan forgiveness on all federal and privately held loans for economically distressed borrowers.
The bill also incorporates several technical corrections to the CARES Act that would benefit medical education. These changes include:
- Expanding the definition of “eligible federal student loans” for loan forgiveness, suspension of payments, and suspension of interest capitalization to include all Health Resources and Services Administration Title VII Loans, Perkins Loans, and Federal Family Education Loans.
- Allowing a borrower with a full-time job as a health care practitioner working at a public or nonprofit hospital but prohibited by state law from being employed directly by the hospital to be eligible for Public Service Loan Forgiveness.
- Permitting Deferred Action for Childhood Arrivals (DACA) recipients to receive emergency grant aid from institutions for costs related to the COVID-19 emergency.
- Exempting from taxation all emergency student financial aid grants and any institutionally provided emergency student financial aid grants.
The Heroes Act would amend the Families First Coronavirus Response Act (P.L. 116-127) to make public institutions eligible for the refundable tax credit that helps employers pay for the two forms of mandated paid sick and Family and Medical Leave Act leave. Currently, only private employers are eligible for this tax credit.
The legislation would also allow for automatic extensions of temporary immigration status or work authorizations if they are set to expire during the emergency, including those under DACA. The AAMC led 77 health professions organizations in urging Congress and the administration to take actions to protect DACA recipients during the COVID-19 emergency [see Washington Highlights, May 6].
The path forward for the Heroes Act is uncertain, as significant opposition to many of the proposed initiatives exists in the Senate and administration. The White House on May 14 released a Statement of Administration Policy, expressing opposition to the Heroes Act. In addition, the Heroes Act does not contain any provisions regarding liability protections for businesses or health care providers — a key issue for Senate Majority Leader Mitch McConnell (R-Ky.).