April 3,
2020 Christopher Holt
Last
week, President Trump signed the Coronavirus Aid, Relief, and Economic Security
(CARES) Act, aimed at mitigating the economic and public health fallout
of the coronavirus pandemic. Also included were some provisions you might have
missed if you weren’t looking for them. For example, though it hasn’t received
a lot of attention, CARES extends a number of health care programs through
November —provisions collectively called the “health extenders”—that were set
to expire in May. The inclusion of these extenders has some implications for
the two big health-policy items that were on Congress’s agenda prior to the
emergence of the coronavirus pandemic: drug prices and surprise medical bills.
The
health extenders in CARES include funding for diabetes programs, community
health centers, graduate medical education, community mental health services,
and a further delay of scheduled payment reductions to disproportionate share
hospitals, among many other items. It’s a grab bag of important federal health
policies that tend to be paid for through annual extensions rather than
long-term funding. These health extenders are a regular part of the last
minute, must-pass, end of the fiscal year government funding packages that have
come to define the congressional appropriations process.
At the
end of 2019, however, the extenders were carved out; instead of being extended
through fiscal year 2020, Congress decided to have them lapse in May. This was
done primarily at the behest of Speaker Pelosi, and the intent was to create a
piece of must-pass legislation that a legislative deal on drug prices or
surprise medical bills, or even both, could be attached to. While it is not
clear if Congress could have reached deals on these issues by May, including
the extenders in CARES is significant because it removes from the legislative
calendar the most likely opportunity to pass a deal if one came to fruition.
There are
a couple of ways to think about the inclusion of the health extenders in CARES.
Most obviously, congressional leaders simply don’t know when they’ll be back in
DC; both the House and Senate are in recess, and it’s not at all clear when
they’ll be back in session. Congress includes in its membership many who are
among the most vulnerable when it comes to the ongoing pandemic. In fact, the
House went to great lengths to avoid bringing most of its members back to DC to
pass the CARES Act. As a result, leaving the health extenders out of CARES
would have risked forcing Congress back into session when it might not be safe,
or having the programs lapse altogether. By giving up the May date for
extenders and not including anything on drug prices or surprise billing in
CARES, however, Congress does seem to be acknowledging that events have superseded
these important policy matters.
The other
possibility for passing a deal on these issues lies in a further relief
package. Speaker Pelosi is already talking about a phase 4 package, and
certainly one can imagine Democrats seeking to include their preferred
drug-pricing policies in such a bill. Further, some lawmakers have called for
any future coronavirus-response legislation to address surprise medical bills.
But Republicans have been cold to the idea of turning any future relief
packages into a vehicle for unrelated policymaking, and significant policy
differences remain within Congress on both drug prices and surprise medical
bills.
With it
looking increasingly plausible that the pandemic will continue well into the
summer, and perhaps even the fall,
and the must-pass extenders already passed, the two biggest health-policy
issues for Congress and the administration, as of only a month ago, may be on
hold indefinitely.
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