Apr 6, 2020
Since COVID-19 began ravaging the human race, Congress has passed three bills into law that are meant to respond to both the health care crisis and the financial crisis. In this episode, Jen highlights the first two laws in their entirety and the provisions from the third law that are most likely to help the most Americans - the cash payments and unemployment provisions. She also documents the process used to pass all three bills into law, because this is NOT the way Congress is supposed to function. We have some firing to do.
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CD199: Surprise Medical Bills
HR 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020
There was no rules committee hearing because they passed it bypasses suspending the rules of the house (requires 2/3rds of the house to vote yes to pass)
Trump administration requested $2.5 billion
Title III: $2.2 billion for the CDC that they can use until September 30, 2022
Title III: $836 million for NIH that they can use until September 30, 2024 - which is money that can be used here in the states or abroad
Title III: $3.1 billion for the Public Health and Social Services fund, also available until September 2024. This is the largest batch of money in the bill (although there are permissions to move money around so it could be more or less depending upon the whims of the Trump administration)
Sec. 303: Until September 30, 2024, the law allows contractors to be hired for “the provision of personal services”, but they must be contractors as “such individuals may not be deemed employees of the United States”.
Title IV: Provides $250 million for the State Department’s “Economic Support Fund” and this money will be allowed to be used to “address economic, security, and stabilization requirements” related somehow to coronavirus
Sec. 506: “Coronavirus” means SARS-CoV-2 “or another coronavirus with pandemic potential”
Division B, Sec 102: Allows Medicare to pay for Telehealth services during an emergency
HR 6201: Families First Coronavirus Response Act outline
Document Text: H.R.6201 - Families First Coronavirus Response Act, Congress.gov
H.R.6201 - Families First Coronavirus Response Act, Congress.gov
$500 million for food stamps
$400 million for the commodity assistance program
$250 million for “aging and disability services programs” - more than half is for “home delivered nutrition services”
Sec. 1101: If a school is closed for more than 5 consecutive days under a public health emergency designation, families of children who are eligible for free or discounted school lunches will be able to get benefits valued at least as much as the school meals. The level of benefits will be determined by the Secretary of Agriculture (Sonny Perdue). Benefits might be distributed via the food stamp program - with money on EBT cards. Appropriates unlimited funding and at least $100 million for the territories.
Sec. 6001: Page 5 appropriates $1 billion or “public health and social services emergency fund” to pay the claims of health care providers for "in vitro diagnostic products” (testing) of COVID-19. Health insurance companies “shall provide coverage” and “shall not impose any cost sharing (including deductibles, copayments” and coinsurance” for tests for the detection of COVID-19 or the administration of those tests “furnished during any portion of the emergency period” (which began on March 13th). This includes in person and Telehealth visits, urgent care center visits, and emergency room visits that result in the ordering or administration of a COVID-19 test.
Doesn’t seem to apply to people who got tested before March 13th, because that would be outside the “emergency period”
If a doctor doesn’t order a test because there is no test available, the visit would be eligible for copays, deductibles, etc. It can be billed like any ordinary visit.
There are also sections that prohibit cost-sharing for people on Medicare, Medicare Advantage, Medicaid, people in the military, and veterans.
Sec. 6004: The Federal government will pay 100% of the costs associated with States paying for testing for COVID-19 for uninsured individuals during the emergency period It’s not back dated
Sec. 2301: Beginning in April 2020 and for each month end the month after the emergency declaration is lifted, work requirements for food stamps will not apply. Benefits can not be denied by States for people who had received food stamps for more than 3 months in the last 3 years while not working more than 20 hours per week, as is usually the case.
Sec. 3102: Adds the COVID-19 public health emergency to the list of valid reasons that employees may get 12 workweeks of paid family and medical leave. To be eligible, you have to have been working for the company for at least 30 calendar days. The first 10 days are allowed to be unpaid days but the employee is allowed to use any accrued vacation leave, personal leave, or sick days. After 10 days, the employer “shall” provide paid leave for the following 10 weeks. The employee must be paid at least 2/3 of their regular pay, capped at $200/day and $10,000 total. For hourly workers, they will be paid based on the average numbers of hours worked per day for the 6 months prior. Employers required to provide leave are defined as someone with “fewer than 500 employees” instead of “50 or more employees”. Businesses with under 50 employees are exempt if the requirement could destroy the business. There are about 12 million private sector workers who work for companies with fewer than 50 employees and 59 million who work for companies with more than 500 employees - and 6.5 million of them have no paid sick leave. Not effective until April 2
Sec. 5102: Requires employers to provide paid sick time if the employee is subject to a mandated quarantine, has to self-quarantine for health reasons, is caring for someone sick with COVID-19, or if the employee’s child’s school or daycare is closed. Health care providers are exempt. Full time workers get 80 hours. Part time workers get paid based on the average amount of time they worked per day in the previous six months. The payments must be for the employees regular rate of pay if they are personally sick, no less than minimum wage, and 2/3rds their regular pay if they are caring for someone else. Payments are capped at $511/day and $5,110 total for sick employees and $200/day and $2,000 total for employees caring for children or sick family members. The paid sick time will not carry over to the following year and can’t be paid if an employee quits. Employers may not require employees to get their shift covered in order to receive their paid sick time. This is valid regardless of how long the employee has been with the company. Employer are not allowed to require employees to use their normally accrued sick time first. Employers can not punish employees for using their sick time. Employers who violate this law are subject to up to $10,000 in fines and up to 6 months in prison. Provision expires on December 31 Applies only to government workers and those working in companies with less than 500 employees. Businesses with fewer than 50 employees can apply for exemptions
Sec. 4102: Gives States more money for unemployment insurance payments.
Sec. 6005: Provides liability coverage to the manufacturers and distributors of personal respiratory protective devices subject to emergency use authorizations, including the one issued on March 2, 2020 and used in response to the COVID-19 public health emergency from January 27, 2020 through October 1, 2024.
Sec. 7002 and Sec. 7004: Allows self-employed people to get a tax credit for the days they can’t work. The Secretary of the Treasury will write the regulation, including required documentation to be eligible
H.R. 748: CARES Act
Summary: H.R. 748: CARES Act
Text: H.R. 748: CARES Act
Vote Summary: Senate 96-0 on March 25 at 11:17pm
Subtitle A: Unemployment Insurance Provisions
Sec. 2102: Pandemic Unemployment Assistance
Effective period: Beginning on or after January 27, 2020 and ending on or before December 31, 2020
Limits: No one can get unemployment benefits for more than 39 weeks, but this can be extended by the Secretary of Labor if needed
Amounts: It’s the amount determined by your state’s unemployment law plus $600 per week if the state chooses to enter into an agreement with the Secretary of Labor. The Federal government will pay for 100% of the costs of the extra unemployment payments and the administration costs. It’s an unlimited appropriation and it’s valid until July 31, 2020.
Sec. 2201: Issues a means tested “advanced refund" of $1,200 per adult and $500 per child. You only get the full amount as an adult if you make $75,000 per adult or less. People who make more than $75,000 per adult will have their check amount reduced based on their income up to about $100,000. People who make more than that will get nothing. The payment will be delivered via direct deposit to anyone who has authorized the IRS to do so since January 1, 2018 while everyone else will have to wait for checks. If we accidentally get overpaid, the IRS can’t charge us interest on that payment. The payments will be made for the 2019 tax year if you have already done your taxes for last year. If you haven’t, it’ll be based on 2018. They will send a notification in the mail to us about our payments to our last known address, which will tell us the amount and if it’s going to be delivered via direct deposit or by check.
President Donald Trump: We're a country not based on nationalizing our business. Call a person over in Venezuela ask them how did the nationalization of their businesses work out? Not too well, the concept of nationalizing our businesses is not a good concept, but I'll tell you why...
15:00 Rep. Tom Cole (OK): I understand, as I'm sure all members do, the gravity of the situation and the extraordinary times we're in. But I also must make clear that we learned a couple of days ago, through the press, mind you, that the Speaker's office was beginning to work on a bill. Just a few short hours ago, members of the Majority Party apparently received a closed door briefing on the contents of this package, and already was not given that same consideration. Text wasn't made available until 11pm. And now the Rules Committee is meeting to consider a rule that will provide for consideration on the floor tomorrow.
24:30 Rep. Frank Pallone (NJ): Whether you're in the Medicare program, Medicaid program, whether you're in the Health Service or you're getting your insurance privately or you have no insurance, we're trying to make sure that you can go and have the test done without having any cost. Whether it's deductible, a copay or just outright, not having to pay for it if you have no insurance.
25:30 Rep. Frank Pallone (NJ): But I did want to mention two things and that is for people who don't have insurance. There's flexibility in this. So the states can basically cover them through Medicaid or have them enrolled in Medicaid without having to meet the income requirements that we have now, and they would be tested and that would be paid for under Medicaid solely for the testing for the virus.
25:45 Rep. Frank Pallone (NJ): And then we also have a pot of money that goes to the National Disaster Medical System to pay for the uninsured. And so essentially, if someone goes to a community health center, for example, and they have no insurance, it would be covered with that as an example.
26:00 Rep. Frank Pallone (NJ): For those states right now, as you know, depending on the state and the level of poverty in the state, have to pay at a minimum 50%, or the federal government pays at a minimum 50 percent of Medicaid costs, and that's matched by the states, depending on the state. And so the F map provision increases that federal match by 8%. And this is for Medicaid in general. In other words, anticipating that a lot more people will have to be covered by the - go on to the Medicaid rolls.
27:00 Rep. Frank Pallone (NJ): The masks because they've been a lot of concern about that. And whether or not masks for healthcare providers would be available. As you know, the companies have asked for liability exemption. And that has been the case in the past when we've had other public health emergencies, like I don't know, all or some of the other things that we've had for vaccines and other things. So we do accept and extend that for a limited purpose. So if the mask is is basically approved by the federal government, and during the time of this emergency, as declared by the President under the prep act, there would be the liability exemption for for those masks so that we make sure that they're out there, and they're distributed.
28:00 Rep. Michael Burgess (TX): Like my ranking member on the Rules Committee, I do have some concerns about the process about how this came together. I just saw the text for the very first time when I walked in here I had a chance to read the first four lines on the first page. Look forward to reading more between now and eight o'clock in the morning.
31:00 Rep. Michael Burgess (TX): It's important that the vaccine be established as safe. I am old enough to remember, an episode of the swine flu during the Ford administration, where a vaccine was hastily developed, and its administration was mandated across the country, and some serious complications occurred. And we certainly don't want to repeat that. So once the vaccine has been established to safe Dr. Fauci has assured us that he will proceed with all dispatch to make sure it is effective, and it will be brought online as as quickly as possible. And I think we have provided the funding to allow them to do that.
36:00 Rep. Bobby Scott (VA): Comments have been made about how quickly this has been put together, we have an emergency and I don't think we have much choice. I'd like to spend a lot more time on the legislation but the more time we take putting it together and getting it out there, people will die. And so we've done it as quickly as we possibly can and everybody would like more time.
41:00 Rep. Virginia Foxx (NC): When I heard about this bill today I remembered something that well known democrat said, 'Never let a crisis go to waste.' But then I also remember the phrase 'act in haste and repent at leisure.'
57:00 Rep. Tom Cole (OK): It'd be a shame for us to leave, honestly, without doing something together for the American people. I think they're looking for that almost more than the individual items in the package. They really want to see us, in a time of crisis, put aside differences, find common solutions, common ground that we can agree on, and work together for their interest. And if we managed to do that, I think that'll not only be good in a time of crisis, I think it'll hopefully reinstill some confidence in the process and the institutions that we all are very proud to be part of, and remind Americans that, hey, we're in our very, very best when we're at a time of crisis. We really are.
1:04:00 Rep. Norma Torres (CA): Last week, at a meeting with the Export Import Bank chair Kimberly Reed stated that the US Commerce Department is still promoting the sales of critical supplies that the American people need. What are those critical supplies? masks, masks, hand sanitizer? How can you know what happened to America first? We need those critical supplies here. So part of what we need to do is direct these uninformed officials that the left hand needs to talk to the right hand. That may be the Commerce Department should be consulting with this new Coronavirus Committee that has been set up by the President. Those are the things that we cannot leave undone when we leave here this week.
1:10:00 Rep. Ed Perlmutter (CO): How many hearings have we had on the bill that we've had before us tonight? None. Zero. I mean, that's that is a problem. And I my Republican colleagues have complained about it, but I, as a Democrat want to complain about it too. Because there's no question we have an emergency. Part of our emergency is we want to try to get out of here by tomorrow afternoon, or this afternoon. Okay, I mean, we're setting our own deadline here. Isn't that true? Am I mistaken on that? Rep. Frank Pallone (NJ): Well, look, I'm a big advocate for regular order. We don't always fall well. This is about as far for you're not gonna have you can't have regular order when you have an emergency. I mean, you know, it would for us to go. Rep. Ed Perlmutter (CO): And Mr. Chairman, I appreciate that. But I guess I would say is okay. Why aren't we doing this? You know, Friday. Today's what? Thursday? Now that we're - 12:15 Thursday. Okay, so I just want to get that out of the way.
1:14:00 Rep. Ed Perlmutter (CO): Well, these things are emergencies. Clearly the testing. But I thought part of the testing was what we did last week. Rep. Frank Pallone (NJ): The testing is essentially the authorizing language. In other words, it's not the it's not the spending. What we're saying is that, you know, whether it's federal programs like Medicaid or Indian Health Service, or it's private insurance or for the uninsured, we want to make sure that everybody can have the test and not have to pay for it not have to have any copay, deductible, or out of pocket expenses. That's what we're doing with that. Rep. Bobby Scott (VA): And some of this ought to be done anyway. I mean, if you're taking a vaccine that should be under prevention, and should be on the most plans, no copay and deductible. So it's not it's not a new idea. Rep. Terri Sewell (AL): And what we did last week was to authorize, give the money to states to actually purchase and have these kits on hand. So what we're doing now is for individuals to make sure that the individual who's trying to see testing actually it's free of charge. Whether have private insurance, government insurance or no insurance, that the testing would be free. Rep. Ed Perlmutter (CO): All right, so would have last week's bill would that have covered the protective gear for the health providers and the tents and the ventilators that we try to separate? Rep. Terri Sewell (AL): Yes. Rep. Ed Perlmutter (CO): Okay. Rep. Michael Burgess (TX): About the ventilators. And that's a very good question. We, we can understand that perhaps, on the testing, there were things could have been done better. Can you anticipate what the next part of this crisis will be? If you look at the experience in some of the other countries, the next part of this crisis is going to be an overwhelming load of patients in acute respiratory failure, presenting to hospitals, needing ICU beds needing ventilators. I don't know if we have the capacity. I don't know if anyone has done a survey of unused military facilities that might be available. I don't know if as part of the Ready Reserve, some One has looked into it. Again, that would be one of the questions I would have asked had we had a hearing. But I do think if we want to think over the horizon, we do need to think about the significant number of patients who could be in acute respiratory failure and the stories, and I realize you're reading them online, I'm reading them online. I don't know if they're true. But the crowd out of people with other medical conditions who show up at the hospitals who can't be seen, acute appendicitis now can be a fatal event, because everyone else is tied up taking care of people who are dying of pneumonia. So it is something we need to think about. I don't know if we've addressed it in this bill. I don't think we addressed it in the appropriation last week.
1:30:00 Rep. Michael Burgess (TX): People have spoken about testing at no cost to the patient. I think that's fine. I think it's a great idea. Do remember someone has to administer the test. There has to be overhead paid for the personnel to be in the office to administer the test. Someone has to pay the liability insurance if the test is reported incorrectly, and someone is going to have to report the test to a patient, that tested is positive, someone's got to do the follow through because now a doctor patient relationship has been established. So we do need to think about that. I'm not objecting to what has been described here tonight, but it just it seems to me that it's incomplete.
1:31:00 Rep. Frank Pallone (NJ): And could I say I'm not going to suggest that that everything that the Dr. Burgess mentioned is covered. But it's not just the test. It's also the provider visit, you know the visit of the patient that provided this cover and also without charge, but...I'm not saying that covers everything, but a lot of the things that he mentioned, it's not just the test. It's also the actual visit and the provider.
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