Congress returns this week to a full plate of contentious issues – coronavirus relief and fiscal year (FY) 2021 spending – as the December 11 deadline for extending government funding approaches. An impasse remains on the overall price tag of a relief bill as House Speaker Nancy Pelosi (D-CA) continues to push for a $2.2 trillion package and Senate Majority Leader Mitch McConnell (R-KY) is sticking to $500 billion.
Sen. Rob Portman (R-OH) is spearheading a bipartisan “targeted” relief package that would provide federal funding for coronavirus vaccine development and distribution, another round of Paycheck Protection Program loans for small businesses, and enhanced unemployment benefits. Alternatively, some relief measures could be tacked on to the FY 2021 spending package if negotiations on a standalone stimulus package fail.
Additional funding for vaccine distribution is particularly critical as states prepare to allocate a limited supply of vaccine doses. Of note, the Centers for Disease Control and Prevention (CDC) has scheduled an emergency meeting for tomorrow (December 1) to vote on their recommendation of who should receive the coronavirus vaccine first once one is authorized by the Food and Drug Administration (FDA). The meeting precedes the meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee on December 10 to discuss emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine for individuals 16 years of age and older. Prior to the Thanksgiving holiday, Pfizer announced that their coronavirus vaccine is 95 percent effective.
Lawmakers appear on track to reach a deal on an omnibus spending package and avert a government shutdown. A renewed effort to include surprise billing measures in the spending package is building as retiring Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Sen. Bill Cassidy (R-LA) have reached a bipartisan solution “that is supported by large bipartisan majorities” in the Senate HELP Committee, the House Energy and Commerce Committee, and the House Education and Labor Committee.
Alexander and Cassidy have not yet released legislative text, but their proposal combines elements of previously debated solutions. Of note, a health care provider would be provided with an “interim payment” that is “based on where the patient lives and where they receive care” – which sounds to be the median contracted rate. “Independent Dispute Resolution” (i.e., baseball-style arbitration) could be used “if a health care provider determines the interim payment is unfair.” It is unclear what would be considered “unfair” and if the arbitration option would become available if a certain payment threshold is reached – for example, $750, which was the amount previously agreed to by Alexander and E&C leaders. The House Ways and Means Committee has not yet expressed support for this dual approach of benchmark payments and limited arbitration.
In addition, a conference committee is reconciling differences between the Senate and House versions of the National Defense Authorization Act (NDAA) (S. 4049 and H.R. 6395). A vote on final passage is anticipated in early December, and President Trump is expected to sign the bill into law shortly thereafter. Both bills include varying levels of support for the federal government’s COVID-19 response. The Senate version would authorize $44 million for vaccine and biotechnology research supported by the Department of Defense. The House version would provide more generous funding through a $1 billion Pandemic Preparedness and Resilience National Security Fund, which would include $200 million to purchase goods or services from small businesses in response to the COVID-19 pandemic; $50 million to produce medical countermeasures against novel threats; and $750 million to support research and development efforts related to biopreparedness and pandemic preparedness and resilience.
The Medicare Payment Advisory Commission (MedPAC) is scheduled to convene later this week (December 3 and 4). While the agenda has not yet been published, commissioners may continue their discussions on telehealth, access to care in rural areas, among other topics.