The House of Representatives voted to promote President Joe Biden’s $ 1.75 trillion domestic policy program on Friday, including a historic expansion of the Affordable Care Act, investment in health workforce, and funding for pandemic preparedness.
Now the package goes to the Senate, where 51 votes are required to pass it, which leaves the Democrats no margin for error, given their small majority. Biden said he believed he could go to the upper house after speaking with key senators.
The passage of the House of Representatives in a 220-213 vote marks a victory for the president, who for several months sought to win over more moderate party members who wanted to cut spending. The House of Representatives’ version of the Improved Condition Recovery Act passed today has been significantly cut from $ 3.5 trillion by cutting several health priorities that have been lobbied by providers and advocates.
However, if passed by the Senate, this package will expand ACA subsidies to millions of people through 2025. This includes 2.2 million people in the coverage gap because they live in 12 states that have not expanded Medicaid under the ACA, and those with incomes four times the federal poverty line. The legislation will also make subsidies more generous for low- and middle-income people, and those in deficit will be eligible for zero premium policies with minimal cost sharing from health insurance exchanges.
“We will act as quickly as possible to get this bill to President Biden’s desk and help middle-class families,” Senate Majority Leader Chuck Schumer (DN.Y.) said Friday.
Biden campaigned to expand access to healthcare and ACA development, extending coverage to those blocked since the law went into effect in 2010, and making exchange plans more affordable through increased subsidies.
The expansion of ACA subsidies is a win for healthcare providers, especially in rural areas where hospitals face higher levels of uncompensated care. However, as a compromise to expand coverage for people in the coverage gap, the package will also cut benefits that will help hospitals pay for uncompensated care.
Hospitals have called on Congress to remove formulations from the package that would cut a disproportionate share of hospital payments by 12.5% and cut funding for uncompensated health care pools in states that have not expanded Medicaid. These cuts will save the government $ 35 billion over 10 years, according to the Congressional Budget Office.
“While we value the goal of increasing coverage in states that have not expanded their Medicaid programs, it should not come at the expense of vital funding for hospitals and health systems in parts of the country that serve large numbers of children. , the poor, the disabled and the elderly, “American Hospital Association President and CEO Rick Pollack said Friday.” These cuts are unacceptable, especially as long as hospitals remain at the forefront of the fight against COVID-19 and the deadly Delta option. “
Experts argue that with the expansion of coverage in the bill, providers in states that are not expanding will see a net benefit despite the cuts. But providers note that extended ACA subsidies are temporary, while changes in DSH and uncompensated care pools are permanent.
These cuts may not survive the Senate, whose members, including Democratic Georgia Senator Rafael Warnock and John Ossoff, oppose them.
Pollack also expressed disappointment that $ 10 billion was allocated from the final version of the House bill to improve hospital infrastructure.
The package includes other significant hospital benefits, including 4,000 new Medicare-funded medical school accommodations, the largest increase since the 1990s.
“We strongly support and appreciate the historic increase in funding for physician training that will benefit patients across the country, especially in the areas most affected by the shortage of physicians,” said David Scorton, President and CEO of the Association of American Medical Colleges and Director of Public Policy, Karen … Fischer said in a statement.
Other important provisions of the bill include:
- $ 3.4 billion for the Health Education Center’s postgraduate medical education and $ 200 million for GME programs in children’s hospitals
- $ 2 billion for the National Health Corps and $ 500 million for the Nursing Corps, which provides scholarships and loan payments to healthcare providers and nurses in underserved areas.
- $ 500 million each for nurses and medical schools in underserved areas
- Medicare hearing aid coverage starting in 2023
- The package will direct the Department of Health and Human Services to negotiate prices with pharmaceutical companies for a small amount of high-priced drugs without generic or biosimilar competitors. Drug manufacturers will be required to pay rebates to the federal government if their price increases exceed inflation. Sharing costs for insulin products will be limited to a maximum of $ 35 for Medicare and private health plans.
- Medicaid programs will be required to expand postpartum coverage within one year to reduce maternal mortality. Currently, states are required to provide coverage for mothers only for 60 days after childbirth. The package also contains nearly $ 1 billion in grants to organizations addressing maternal mortality and health inequities.
- $ 150 Billion to Expand Medicaid Home and Community Services
- The bill continually expands the Children’s Health Insurance Program, which currently requires periodic approval by Congress.
- $ 2 billion in capital projects in local health centers, but no funding to improve infrastructure in hospitals
- $ 7 Billion to the Centers for Disease Control and Prevention to Strengthen Public Health Infrastructure