House Democrats are devising a $3.5 trillion domestic policy package that includes billions of dollars in hospital infrastructure, health manpower, nursing shortages and increased insurance coverage.
The House Energy and Commerce Committees, and Method and Means Committees that share jurisdiction over health spending and programs, passed their bill provisions this week in line with party politics, with the House hoping to pass the full Efficiency Improvement Act recovery “by the end of the month.
“The Committee on Energy and Trade today passed a Transformation Act that invests in the American people, responds to the challenges of our times, and builds a better future for future generations,” said Chairman of the Energy and Trade Council Frank Pallone (DN.J.) in a statement …
Republicans argue it’s too expensive and are frustrated by Democrats who use a process that denies the need for bipartisan support.
In the Senate, Democratic leaders are still working on a package that could win the support of all 50 party members. Senator Joe Manchin, a moderate West Virginia Democrat, is a key voice and has said he will not support the $3.5 trillion bill, which means anything that happens in the House of Representatives could be cut back.
Here are some key messages from the House of Representatives proposals that could impact the healthcare industry:
Infrastructure
In particular, leaders of social welfare hospitals say their facilities are in desperate need of modernization, as they were originally built for small populations.
The Greater New York Hospital Association has demanded at least $100 billion, but only $10 billion was included in a bill passed this week by the Energy and Trade Committee. This funding will be a priority for projects that increase capacity, renovate communities in need, prepare for public health emergencies or natural disasters, and protect against cybersecurity threats.
The bill also includes:
- * $10 billion in grant funding for federally certified health centers to renovate, renovate, expand, or build facilities.
- * $500 million to improve, upgrade or modernize the infrastructure of mental health centers and health education centers.
Health workforce
The pandemic highlighted the limited health workforce, especially in rural and underserved parts of the country. There is a shortage of healthcare workers across the country, especially nurses, and the problem is expected to worsen in the coming years as the US population ages.
Bills passed by committees of the House of Representatives include:
- * A new program that will fund 1,000 scholarships per year for medical students from rural and underserved communities if they agree to practice in these communities after graduation.
- * 1,000 new residency places per year starting in 2026 for medical schools committed to providing cultural skills training, community learning, and increased mentoring for students.
- * $1 billion in grants for underserved areas medical schools that can be used to recruit and retain students, including racial and ethnic, underrepresented medical students, rural people, and low-income people. Funding can also be used to develop a curriculum that focuses on caring for rural and underserved populations, building medical schools in areas where they do not exist, hiring teachers, or modernizing or expanding facilities.
- * $1 billion to increase the number of teachers and students in medical schools with a priority for people from rural areas or underrepresented racial or ethnic groups. Schools providing care in underserved areas will have priority.
- * $6 billion in training at medical centers to create new postgraduate medical education programs or to maintain or expand existing programs.
- * $300 million to help pay off loans for Registered Nurses and Advanced Registered Nurses who agree to work in a nursing shortage or teach in a nursing school.
Pandemic preparedness
Public health departments say they have been underfunded by states and the federal government for decades, making it difficult for them to respond to COVID-19. While President Joe Biden has called for at least $30 billion in public health funding, Democrats in Congress, faced with competing priorities, have included about half of that amount.
- * $16 billion in funding to strengthen the country’s response to the pandemic, including $5 billion to renovate, expand, and modernize state and local public health and CDC laboratories, and $8 billion to replenish strategic national stockpiles and strengthen supply chains …
- * Of this amount, $1.25 billion will be used to improve and strengthen public health surveillance in hospitals and other healthcare facilities.
Health insurance
After passing the Affordable Care Act in 2010, Democrats lost control of Congress and lost the ability to make any changes to the law. When Democrats regained their Senate and White House majority this year, they pledged to “lean” on the ACA. Bills passed this week:
- * Continuously expand the Affordable Care Act subsidies for people with incomes of 400% of the federal poverty level or higher, and make subsidies more generous for people on low incomes. In the COVID-19 relief package passed by Congress earlier this year, these changes were only made for two years.
- * Provide coverage for over 2 million low-income adults in 12 states who have not accepted the Medicaid ACA extension. Initially, these people will be eligible for ACA grants. Beginning in 2025, they will be eligible for a new federal Medicaid-like program that will be run by managed care organizations in non-expanding states.
- * $10 billion a year in government reinsurance programs to reduce premiums, deductibles, and other personal expenses.
- * Require states to provide health insurance to prisoners 30 days before they are released.
Maternal and Child Health
According to the Centers for Disease Control and Prevention, black women are three times more likely to die from pregnancy-related causes than white women. Several provisions in bills passed this week address maternal health with a greater focus on inequities in health, including several proposals from Rep. Lauren Underwood, Illinois. The bills will be:
- * Requires states to give postpartum women 12 months of full Medicaid and Child Health Insurance benefits. Requires states to grant 12 months of continuous entitlement to children enrolled in CHIP, rather than excluding them due to income changes.
- * Include $1 billion in support of maternal mortality, including grant programs to improve the social determinants of health, diversify the health workforce, tackle mental health and substance use disorders, and reduce discrimination and bias in health care.
- * Continuously fund the Children’s Health Insurance Program, which currently requires congressional reapproval every few years, sometimes resulting in state funding delays.
- * Get Medicare coverage for vision, dentistry, and hearing benefits.
Medicines prices
The House Methods and Remedies Committee this week passed a regulation that would allow Medicare to negotiate lower prices for prescription drugs with pharmaceutical companies. The same provision did not pass after three moderate Democrats raised concerns about the potential impact on new drug development. The House of Representatives will need to resolve these differences before voting on the full package of proposals. The nonpartisan Congressional Budget Office estimates that this version of the policy will save the federal government about $450 billion over ten years. Since the House bill is counting on those savings to pay for part of the package, it could ultimately be cut if Democrats don’t come to an agreement on drug prices.
“While I am disappointed that we were unable to move the price negotiations outside of the committee today, lowering the cost of prescription drugs remains a top priority for Democrats,” Pallone said. “The most effective way to curb the skyrocketing drug prices is to finally allow Medicare to negotiate lower prices, and I am confident that this will be part of the final drug improvement bill.”