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House Democrats have made another effort to enact a meaningful coronavirus relief package to address the severe economic and health care challenges posed by the pandemic. To appease Senate Republicans’ concerns over the cost of their original coronavirus relief package passed in May – the HEROES Act – House Democrats reduced their package by $1.2 trillion. The $1.2 trillion-worth of cuts in the new proposal – being called HEROES 2.0 – primarily stem from reductions in both duration and potential benefits, emphasizing the fact that this is a short-term relief package. While these cuts are not optimal, House Democrats have prioritized provisions that families need most right now and that we can build upon.
The proposed legislation incorporates many of the elements in the May version of the bill including stimulus checks and federal unemployment benefits, as well as new provisions that include federal aid for education, airlines and restaurants. Furthermore, it tackles the spectrum of policy needed during this crisis, from assistance to struggling households to state and local fiscal relief– including additional Medicaid funding to avert budget cuts. This is a stark contrast to the “skinny bill” that Senate Republicans released last month that failed to address any actual concerns the American people have during this pandemic. We remain cautiously optimistic as Speaker Pelosi and Treasury Secretary Steven Mnuchin engage in ongoing negotiations.
What could this mean for health care during the COVID-19 pandemic?
This package makes one thing very clear regarding House Democrats’ priorities: they recognize the need to make health care more affordable. Here are the ways in which they have demonstrated that:
- Made the highest subsidies available on the ACA exchanges for unemployed Americans (this would apply to individuals receiving unemployment compensation in 2020 and 2021 and ends 60 days after the public health emergency period). For 49 percent of Americans, health insurance is inextricably tied to employment, making the current health and economic crises more complicated. While the unemployment rate has improved since April and May, it still remains high at 8.4 percent, more than double the average unemployment rate in 2019. For those who have become unemployed and live in a non-expansion state, this provision may be especially beneficial. Newly unemployed individuals may not necessarily be eligible for Medicaid if they do not fit into one of the traditional Medicaid eligibility categories – primarily affecting low-income childless adults. The new package is mindful of this coverage gap and attempts to make health care more affordable for people who may fall into it by making the highest premium subsidy automatically available to people receiving unemployment compensation, limiting the individual financial contribution. This also benefits newly unemployed individuals whose household incomes may be above the Medicaid income threshold or whose household incomes may normally be above the income threshold for the highest premium subsidy on the ACA exchanges.
- Increases the federal match rate for Medicaid by 14 percent for one year. Enhancing the Federal Medicaid Assistance Percentage (FMAP) would benefit consumers and states alike. Without enhanced FMAP, states may turn to cuts to Medicaid eligibility and benefits as a way to avoid financial strain. This would ultimately harm consumers who need access to critical health care during this pandemic. A 14 percent FMAP increase is an equitable approach for this relief package since both COVID-19 and unemployment have disproportionately affected communities of color and frontline industry workers. Furthermore, the 14 percentage-point FMAP increase will lead to a 9.8 percentage-point increase in the federal share of Children’s Health Insurance Program (CHIP), which benefits children and their access to needed health care as well.
The package also includes aid to specific health care areas during this pandemic:
- Increase federal payments for Medicaid home- and community-based services (HCBS) by 10 percent. HCBS spending comprises 57 percent of total Medicaid long-term services and supports (LTSS) as of 2016. This presents potential challenges for states experiencing budget crises. The additional federal aid for HCBS alleviates the burden for states to allocate normal levels of funding to such services and enables them to focus on other parts of their budget.
- Provide Medicaid coverage of COVID-19 treatment and vaccines without cost-sharing, thereby making COVID-related treatment more accessible and contributing to an expedited end to the pandemic (hopefully in the near future).
- Clarification for COVID-related coverage of immigrants who are ineligible for full-scope Medicaid due to immigration status, but who meet other Medicaid eligibility requirements. These individuals would receive coverage for COVID-19 testing, treatment and future vaccines through Emergency Medicaid.
- Funding for substance use disorders and mental health treatment and services. House Democrats have allocated $8.5 billion for Substance Abuse and Mental Health Services Administration (SAMHSA), increased from $3 billion. Notably, this SAMHSA funding includes $3.5 billion for the Substance Abuse and Prevention Treatment Block Grant (increased from the previous $1.5 billion), as well as funding for the Mental Health Services Block Grant, Certified Community Behavioral Health Clinics, suicide prevention programs, Project AWARE to support school-based mental health for children, and emergency grants to states.
- Commitment to making health care more accessible to incarcerated individuals upon release. House Democrats kept the Medicaid Reentry Act in the new version of the HEROES Act, which provides Medicaid coverage for incarcerated individuals starting 30 days pre-release. This promotes uninterrupted, continuous health coverage for services they need to stay healthy and is especially important for incarcerated individuals with substance use disorders, who are at increased risk offatal overdose upon release.
Senate Republicans must work with House Democrats to get this bill passed
Our health should not be politicized. Americans have been urgently awaiting this type of assistance that House Democrats have laid out in HEROES 2.0. House Democrats have shown a willingness to negotiate, as demonstrated by the lowered price tag of this new COVID relief package and a return to negotiations with the Trump administration. As many of the helpful provisions from the CARES Act, the first COVID relief package passed by Congress in March, are set to expire soon, Senate Republicans must act now for the American people.