Inside DC: Update on what to expect from the infrastructure plan

August 17, 2021

Congress has recessed for the summer and isn’t scheduled to return to Washington until September 20. During this period, we’re asking WSHA members to meet with members of the delegation. In preparation for your encounters with them, here’s an update on recent developments in Washington.

Infrastructure. Infrastructure summer in Washington wrapped up on August 10 with Senate approval of a $1.2 trillion bipartisan bill. The package, approved by a 69 to 30 margin, would fund roads, bridges, ports, pipes and broadband expansion – so-called “hard” infrastructure projects.

The bad news is that other than $65 billion for broadband expansion, the bipartisan bill does not include any capital financing or other provisions that would directly benefit hospitals. The good news is that at hospitals’ urging, lawmakers rejected an effort to divert money from the Provider Relief Fund to help offset the cost of the package.

With approval of the bipartisan package, Senate Democrats have turned their attention to a $3.5 trillion “human” infrastructure package that aims to address health care, education, and tax policies, among other issues. They hope to pass this measure using an arcane process called “budget reconciliation” that will allow them to approve the bill with just Democratic votes. It is likely to be the main vehicle for health care legislation in the months ahead.

Several health care provisions are being discussed as part of the human infrastructure package, including:

  • An extension of the premium subsidy increases for persons purchasing health insurance through the Affordable Care Act’s (ACA) insurance exchanges. These increases were approved in the March economic recovery package but will expire next year. WSHA strongly supports this extension.
  • An expansion of Medicare benefits to include dental, vision and hearing services.
  • Policies aimed at reducing prescription drug prices. Savings from these would help offset the cost of expanding health benefits.

In addition to extending the ACA’s premium subsidies, WSHA and AHA are likely to push for several other health care initiatives in this second package, including:

  • An extension of the Medicare telehealth flexibilities adopted during the pandemic,
  • An extension of the deadline for hospitals to spend Provider Relief Payments,
  • An extension of the Medicare sequester moratorium, and
  • Workforce development initiatives.

Two oft-discussed proposals – reducing the Medicare eligibility age and creating a public option for the ACA’s insurance exchanges – are expected to be left out.

The Senate took the first step toward crafting this second package on August 11 when it approved a budget blueprint or budget resolution that sets spending and tax parameters for the reconciliation package. Senate committees will develop specific legislative proposals beginning in September. Sens. Murray and Cantwell, and Reps. DelBene, Schrier and Kilmer are likely to be players in this process. It is unclear how long this will take, but likely through the fall.

Meanwhile, the House of Representatives, which recessed on July 30, is scheduled to return August 23 to vote on the Senate’s budget resolution. It also must act on the bipartisan package, but how soon that will happen is unclear.

COVID-19. Hospitals all over the state have been grappling with the fifth surge  Unlike earlier surges, hospitals are grappling with a nationwide shortage of critical health care workers and a workforce that is exhausted and burned out after 18 months of caring for COVID-19 patients.

It is important that we tell this story to members of the congressional delegation.

It is also important to underscore the importance of the Provider Relief Fund (PRF) payments, which have been critical to our ability to withstand the loss of revenue that resulted from stopping non-essential procedures and dealing with the added costs of preparing for COVID patients. At this point, there is $43.7 billion in unspent funds in the PRF plus an additional $8.5 billion for rural hospitals approved in December. We may need to request additional appropriations in the weeks ahead.

The CARES Act required hospitals to use PRF payments received before June 30, 2020, by June 30, 2021. This has been a hardship for many facilities. We support legislation introduced just before the recess that would extend that deadline through December 31, 2020, or the end of the COVID-19 public health emergency – whichever is later.

That legislation is S. 2493/H.R. 4735 – the Provider Relief Fund Deadline Extension. Please urge members of the delegation to cosponsor this bill. Also urge the delegation to oppose any effort to use PRF money to help pay for non-health care infrastructure projects. Dollars set aside for health care should be used for health care – and not diverted.

Workforce. The workforce shortages suffered during the pandemic underscore the need for long-term investments in workforce development. Several bills are pending in Congress that could help address this crisis. We are pushing to include them in the “human” infrastructure package that will be considered in the fall.

WSHA strongly supports a major increase in residency programs for physicians, especially those geared to getting physicians to rural areas. Specifically, we support The Resident Physician Shortage Reduction Act (S. 834), which would boost the number of residency slots by 2,000 per year between 2023 and 2029.

Also, reauthorization of the Conrad 30 J-1 Visa program, which expires at the end of September, would enable foreign doctors trained in the U.S. to work in underserved communities. And the Rural Physician Workforce Production Act (S 1893) would stimulate additional residents in rural areas.

In addition, nurse training and support for nursing faculty are critical to meeting the demand for these caregivers.

Telehealth. Telehealth has flourished during the pandemic. The CARES Act and several executive decisions have greatly enhanced the use of this technology and improved access to services all over our state.

However, the flexibilities in rules governing telehealth will expire at the end of the public health emergency. WSHA has endorsed extending these flexibilities; however, several of these will require congressional action. Specifically, there are several changes in law that we support:

  • Removal of the restrictions on the location of the patient and provider. Currently coverage for telehealth is restricted to rural and underserved urban areas. We support striking this limitation and allowing beneficiaries across the state to receive virtual care in their homes or the location of their choosing.
  • We especially want to preserve access to telehealth services in critical access hospitals and rural health clinics and to ensure adequate reimbursement.
  • We also urge Congress to reject restrictions that would require an in-person visit prior to access to mental and behavioral health services via telehealth.

There are a number of bills that would preserve the telehealth flexibilities granted during the pandemic and would help us achieve our broader policy goals. Again, this will be a priority for the “human” infrastructure bill that will be considered in the fall.

HHS Appropriations. Before leaving Washington, the House approved a bill funding the Department of Health and Human Services in FY 2022, which begins October 1. Their version includes funding increases for a variety of workforce development programs including the National Health Service Corps and training for nurses and other health care providers.

Overall, funding for rural programs would be set at $400 million, up nearly $70 million from the current spending level. The Rural Hospital Flexibility Grant program would receive $79 million, a $21.5 million increase over current levels. Telehealth programs and the Rural Health Residency also would receive significant funding increases.

Finally, funding would be increased for several key health research programs. Rep. Jaime Herrera Beutler serves on the House subcommittee that approved the funding. Sen. Murray chairs the Senate subcommittee that funds HHS.

If you need any assistance scheduling time with your member of congress, please reach out to Jacqueline Barton True (


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