HealthCare Roundtable e-News – March 9, 2021

Senate Passes $1.9 Trillion COVID-19 Relief Bill

On Saturday, the Senate passed President Joe Biden’s $1.9 trillion COVID-19 relief package by a 50-49 vote—all Democrats voting in support of the bill and all Republicans opposed— following a lengthy voting period of amendments and aid disputes. The American Rescue Plan, as the bill is known, will provide millions of Americans with additional $1,400 stimulus checks and commit billions in funds for vaccine distribution, economic assistance, and reopening schools across the country. The legislation now goes the U.S. House where it is expected to pass and be sent to the President for his signature.

Notably missing from the final package is the controversial $15 minimum wage, supported by most progressive House legislators, and a $400 weekly unemployment benefit. The deals on unemployment aid ensured that moderate Democrats were on board, but many Republicans have decried the bill as “bloated legislation that disproportionately benefits blue states and large cities with assistance that has nothing to do with the pandemic.” Other key components of the bill include an expansion of the child tax credit up to $3,600, $50 billion for small-business assistance, $130 billion to help fully reopen schools, and $30 billion to help renters and landlords suffering from the economic fallout from the pandemic that began last year.

Senate Majority Leaders Chuck Schumer (N.Y.) praised the passing of the bill, stating, “It’s been a long day, a long night, a long year, but a new day has come,” while Minority Leader Mitch McConnell (R-Ky.) criticized the bill, claiming that the Senate “has never spent $2 trillion in a more haphazard way or through a less rigorous process.” The package has been a key initiative for Biden, who told reporters the package was “one more giant step forward” on delivering on his pledge to deliver aid to millions of Americans suffering from the effects of the COVID-19 pandemic.

COVID-19 Relief Bill Undergoes Changes Before Senate Vote

Ahead of the Senate voting to approve the president’s COVID-19 relief bill on Saturday, congressional leaders spent hours voting on several key amendments before sending the package back to the house. The Senate bill maintains a few key provisions, including a temporary increase in existing Affordable Care Act tax credits and giving maximum subsidies to anyone receiving unemployment in 2021, but includes several updates to funding for local governments and coverage and COBRA premiums.

The updated version of the American Rescue Plan would reduce overall funding for local governments by $10 billion to pay for increased broadband access and would set aside $10 billion of the coronavirus relief for state and local governments to invest in capital projects related to enabling remote work, education and health monitoring in response to COVID-19. Despite the funding cuts, the National Association of Counties announced their support of the plan because it gives counties and cities direct relief instead of receiving it through the state. NACo Executive Director Matthew Chase said in a statement that direct aid enables localities to “strengthen [their] communities”. (InsideHealthPolicy)

Additionally, the rescue plan will cover 100% of COBRA premiums, up from the approved 85% in the House bill, which the Roundtable advocated for in a letter to Senate leadership on February 25. Majority Whip Dick Durbin (D-Ill.), Sen. Catherine Cortez Mastro (D-Nev.), and others announced they had secured the full subsidies, which were strongly pushed by employers and unions. (InsideHealthPolicy)

The Senate voted 50-49 to approve the plan this past Saturday (March 6), following a marathon debate of more than 24 hours. The House is preparing to vote on the rescue plan on Tuesday, March 9th.

CMS Announces Initiative to Align Quality Across Federal Health Programs

At CMS’ Quality Conference last week, Michelle Block Schreiber, Director of CMS’ Quality Measurement & Value-Based Incentives Group announced that the agency will be assembling an action plan to better align quality measures. The changes come in response to an external evaluation last year of the agency’s quality measurement framework, which identified too many measures, a lack of alignment of measures, and not enough focus on social determinants of health.

The pandemic also showed that the agency needed to address quality across sites of care. According to Schreiber, the pandemic brought to the surface a “vital need for quality and performance data that crosses sites of care,” in real-time. The agency is moving in a digital direction to meet these needs, with 80% of measures being considered for programs this year being focused on digital channels.

Also addressed at the conference is how the health care system can look to further embrace patient engagement and equity in addition to digital platforms and other technology. According to Kedar Mate, President and CEO of the non-profit Institute for Healthcare Improvement, it’s essential for the agency to explore digital therapeutics, diagnostics, and monitoring systems in addition to telehealth and hospital-at-home care. Mate also emphasized that equity must be a central tenant of an improved health system, saying that targeted universalism could help advance the needs of the systemically disadvantaged. (InsideHealthPolicy)

Senior Hill Aide and Obama Administration Alum Elizabeth Fowler Leads CMMI

Elizabeth Fowler officially took over as Director for Center for Medicare and Medicaid Innovation last Tuesday (March 2) after the U.S. Department of Health and Human Services announced additional Biden Administration appointments. In her new role, the Obama administration alum will be tasked with directing and running payment models and managing more than 50 demonstrations or projects under the center’s purview. She takes over for Brad Smith, who headed CMMI for nearly a year within the Trump administration.

Fowler took on the role a day after the center put a hold on former President Trump’s Geographic Direct Contracting model for agency review. Fowler had previously described the demo as one of the biggest changes to Medicare since managed care and raised questions about its impact on Medicare spending, including whether the model would achieve the savings CMS expects. (InsideHealthPolicy)

It’s also expected that under Fowler’s purview, CMMI will focus its work on furthering value-based care, which centers reimbursement on outcomes rather than volume. It’s possible that CMMI may look to do this by expanding existing models to more providers and having hospitals and doctors take on more financial risk for their patients, according to Healthcare Finance News.

Fowler had previously served in the Obama administration as a special assistant on healthcare and economic policy at the National Economic Council. She also served as deputy director for policy at the CMS Consumer Information and Insurance Oversight office and is one of the architects of the Affordable Care Act.