On Monday, the Republican Study Committee (RSC) Health Care Task Force, chaired by Rep. Roger Marshall (R-KS), offered 10 policy options for lawmakers to combat the economic and public health impacts of the COVID-19 (coronavirus) pandemic. Congressional leaders should include several of these policies in a future COVID-19 relief package, or simply pass them in standalone legislation as both chambers reconvene in the coming weeks and months.
The RSC recommendations tackle challenging questions about health coverage, drug approval, hospital bed supply, and other pressing issues NTU and others have written about at length over the course of the pandemic.
We urge taxpayers to review all 10 recommendations here, but we highlight a few ideas we strongly support below.
De-linking HSAs from HDHPs
The Task Force’s first recommendation is to “[s]uspend the requirement that [health savings accounts] HSAs be tied to a high-deductible health plan (HDHP).” Sen. Ted Cruz (R-TX) and Rep. Ted Budd (R-NC) recently introduced bills (S. 3546 and H.R. 6338) that would do just that, and NTU signed a coalition letter in support of the effort. We have long argued that individuals should be able to open an HSA whether or not they have an HDHP. Given that COVID-19 presents both an economic and health threat to American workers and families, people should be able to direct funds to an HSA regardless of their insurance status. This would leave them in a better position to pay for unexpected medical expenses in the midst of a pandemic.
Lawmakers should also consider allowing current and future HSA holders to use account funds for insurance premiums, which may help people experiencing a loss in income or a sudden loss of insurance due to the crisis. NTU has a proposal specifically to help people who are losing health coverage as they lose their job, called Pandemic Health Accounts (PHAs), that mirror HSAs and would help displaced workers bridge the gap between their loss of insurance and their next job with health coverage.
Establishing a fast-track FDA process for COVID-19 treatments
Another Task Force recommendation is support of the RESULTS for Coronavirus Patients Act (S. 3545 and H.R. 6260), which would establish a 30-day, fast-track Food and Drug Administration (FDA) approval process for COVID-19 treatments that are approved in a limited set of other countries. NTU included passage of the RESULTS for Coronavirus Patients Act in our Health Policy Menu for Phase 4. We continue to believe that FDA should have a process in place to prioritize the most promising COVID-19 therapies and cures that are given the green light in the European Union (EU), Australia, Canada, Israel, Japan, New Zealand, Switzerland, or South Africa. Unlike harmful importation proposals, this legislation would have the U.S. importing more efficient regulatory processes (where applicable) rather than price controls.
Allowing full and immediate expensing for businesses
The Task Force correctly rejects counterproductive efforts like a “Buy American” mandate or an overly aggressive use of the Defense Production Act. Instead, to help facilitate economic recovery, policymakers should follow the Task Force’s fourth recommendation: allow businesses to fully and immediately expense their investments in research, development, and physical capital.
NTU has long been a proponent of full and immediate expensing, going back to the Congressional debate over the Tax Cuts and Jobs Act (TCJA). Full and immediate expensing would allow businesses to reduce their tax liability by the full price of an investment in the same year the investment is made, rather than having to reduce their tax liability over years and a complicated depreciation schedule. This year we endorsed the Accelerate Long-Term Investment Growth Now (ALIGN) Act (S. 3296) from Sen. Pat Toomey (R-PA), which would permanently extend the TCJA’s 100-percent first-year expensing allowance for qualified assets like machinery and software (this provision is scheduled to start phasing out in 2023).
We also asked Congressional leaders to include in any Phase 3 relief package a provision allowing for full and immediate expensing of capital investments in residential and nonresidential property - a measure that was left out of TCJA. It is vital that Congress supports robust investment in American businesses as the economy recovers from an unprecedented challenge, and full and immediate expensing is the most effective way to do so. Leaders would be wise to follow the RSC Health Care Task Force’s recommendation and include full and immediate expensing in an upcoming economic stimulus bill.
Suspending the ban on physician-owned hospitals
The Task Force recommends suspending the ban on new physician-owned hospitals (POHs), a critical provision that could help states and municipalities with hospital bed supply. The Affordable Care Act (ACA) put an effective cap on the growth of physician-owned hospitals (POHs), which the Physician Hospitals of America has estimated led to “37 planned hospitals [that] have not been constructed, and over 30,000 planned healthcare jobs [that] have gone uncreated.” While the U.S. could use those hospitals now, policymakers can improve the hospital bed supply situation by temporarily lifting the ACA provisions that stopped the growth of POHs. Sen. Cruz’s Creating Capacity for Communities in Need Act (S. 3547) would make this happen, and we included passage of the bill in our Health Policy Menu for Phase 4.
Encouraging states to suspend certificate of need laws
The Task Force is right to point out the “devastating effects” of state certificate of need (CON) laws during the pandemic, and luckily there is legislation that would make it easier for states to temporarily suspend harmful CON programs that limit the growth of hospital and nursing home beds. The Increasing Hospital Capacity to Fight the Coronavirus Act (H.R. 6336) from Rep. Dan Bishop (R-NC) would remove Medicare and Medicaid payment reductions levied against hospitals that expand capacity in violation of a state’s certificate of need (CON) program. It would also express the sense of Congress that CON laws should be waived during the COVID-19 emergency, sending a strong message to the 35 states that have these policies on the books. NTU included passage of this bill in our Health Policy Menu for Phase 4.
Expanding licensing reciprocity for telemedicine
States across the country, along with the Centers for Medicare and Medicaid Services (CMS) at the federal level, have made it easier than ever for doctors, nurses, and physicians assistants to deliver care via telemedicine, which has the potential to slow and prevent the spread of COVID-19 to both frontline workers and vulnerable populations. The Task Force is right to recommend that lawmakers “further expand the availability of telemedicine services and encourage licensing reciprocity to allow for telemedicine delivery across state lines.”
One way policymakers could do so is by encouraging or nudging CMS to issue more blanket Section 1135 waivers of Medicare and Medicaid requirements. While CMS has issued blanket waivers for policies such as prior hospitalization and length of stay requirements, states have had to seek approval for licensing reciprocity waivers on a case-by-case basis. In our Health Policy Menu for Phase 4, we encouraged more blanket CMS Section 1135 waivers that apply to all 50 states and don’t require a state’s application for approval. NTU has also encouraged states to suspend continuing education (CE) requirements and scope of practice laws and regulations for the millions of health care providers who are not physicians or surgeons. This includes nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs). Federal policymakers in Congress and at CMS should ensure that states are including these critical health care workers in their licensing reciprocity and telemedicine efforts.
The path forward
We applaud the RSC Health Care Task Force for putting forward a strong list of recommendations for Congress to consider. One question that lawmakers on both sides of the aisle have left unanswered is how to best assist the millions of people who have lost access to their employer-provided health insurance in the last few weeks alone.
NTU has an answer: Pandemic Health Accounts (PHAs). This one-time benefit to displaced workers, of $2,000 for individual PHAs and $6,000 for family PHAs, would enable individuals to maintain their link to private health insurance for the next several months. PHAs would also cost less than a 100 percent COBRA subsidy (proposed by many Democrats) and more effectively target displaced workers than permanent expansion of Medicaid or the ACA’s premium tax credits. While multiple aspects of the health care sector are stressed like never before by this pandemic, we believe the next big question lawmakers must tackle is how to best help millions of people who are newly uninsured.
That said, we applaud the work of the RSC Health Care Task Force, and extend our thanks to the following Task Force members: RSC Chairman Mike Johnson (R-LA), RSC Health Care Task Force Chairman Roger Marshall (R-KS), RSC Task Force Vice Chairman Phil Roe (R-TN), Rep. Debbie Lesko (R-AZ), Rep. Larry Bucshon (R-IN), Rep. Mike Kelly (R-PA), Rep. Mark Green (R-TN), Rep. John Joyce (R-PA), Rep. David Rouzer (R-NC), and Rep. Chip Roy (R-TX).