Rural hospitals seek help in covid-19 response legislation, which is blocked by Democrats, who say it’s too friendly to corporations

The Kentucky Rural Health Association is urging its members to ask Senate Majority Leader Mitch McConnell, their senior U.S. senator, to include help for rural hospitals in the third coronavirus package being written in the Senate.

“Prior to covid-19, one in four hospitals were at risk of closure – but this has dramatically accelerated with growing workforce, equipment, bed capacity strains. Rural hospitals are telling us they have only weeks left of cash flow,” KRHA Executive Director Tina McCormick said in an email.

She said the rural hospitals’ proposal “would allow the most financially vulnerable rural hospitals . . .to convert to a status known as Critical Access Hospital and would allow them to receive a slightly enhanced Medicare reimbursement rate. Please contact Sen. McConnell to request support of this.”

Many interests are trying to get help in the legislative package. They include advocates of long-debated legislation to control surprise medical billing and control drug prices, Inside Health Policy reports. For surprise billing, the package “is viewed as the last vehicle for the legislation for some time,” Ariel Cohen writes. “There’s no telling when lawmakers will return to the Capitol, due to the global pandemic.”

The billing legislation would use a plan “favored by insurers because it relies on a benchmark payment rate before moving to arbitration for out-of-network charges,” Cohen reports. “Hospitals and providers prefer surprise-billing fixes that rely more heavily on arbitration. . . . Lawmakers are presenting the measure as part of the bailout to hospitals,” which “are going to have to make a choice,” an unnamed insurance lobbyist told Cohen. “Do they defeat surprise billing or say we’re getting a lot here, let’s not rock the boat too hard’?”

About one in six emergency visits and inpatient hospital stays in 2017 involved at least one out-of-network medical bill, according to the Kaiser Family Foundation.The surprise-billing measure “includes a benchmark payment rate to resolve air ambulance payment disputes,” Cohen notes. “Air ambulance providers have lobbied against the policy because they say it could lead to air bases closing in rural areas.”McConnell has said he wants to move at “warp speed,” and “GOP senators are hoping to vote as soon as this weekend but at least by next week, underscoring the pressure they are under to move quickly to reassure both constituents and the market, Jordain Carney reports for The Hill.

UPDATES, March 21-22: “The effort fell flat,” Cohen reports. The bill “includes several Medicare and Medicaid extenders, which jeopardizes the surprise-billing and drug-pricing policies that were excluded. Congress is already talking about writing another stimulus bill.”

In a press release Saturday afternoon, McConnell said bipartisan agreement is still needed to produce a bill, and suggested that long-debated proposals that haven’t moved before may not make it: “Two days ago, the press reported that a senior member of House Democratic leadership told his colleagues, ‘This is a tremendous opportunity to restructure things to fit our vision.’ Well, let me suggest that is exactly the wrong approach right now. That is exactly the kind of thinking that could bog down these urgent discussions. . . . This is not a political opportunity. This is a national emergency.”

Saturday night, McConnell issued a release saying the negotiations were nearly done. “I have asked committee chairmen to draft final legislative text that reflects their compromise products and deliver that text later this evening. “This would allow all senators to review the complete bipartisan text in advance of our first procedural vote at 3 p.m. tomorrow.”

Sunday afternoon, The Washington Post reports, “Negotiations sputtered in the Senate on Sunday over an enormous stimulus bill to keep the economy afloat during the coronavirus crisis, threatening at times to devolve into all-out partisan warfare even as a desperate nation sought relief. But the sheer magnitude of the potential calamity kept lawmakers at the bargaining table as negotiators on both sides said they must deliver to slow the financial landslide that is disrupting millions of businesses and households by the day.” McConnell delayed an initial procedural vote “as it became clear it would fail due to Democratic opposition, moving the vote from mid-afternoon to evening to allow more time for talks.” Democrats said the Republican bill “is tilted too far in favor of corporations and doesn’t include much oversight for $500 billion in loans and guarantees that could go to firms selected by the Treasury Department.”

Later, McConnell held the procedural vote, and it failed because Democrats did not vote to proceed with his bill. Afterward, he was “angrier than we’ve ever really seen him,” MSNBC‘s Josh Letterman said. McConnell said on the Senate floor, “We had a high level of bipartisanship in five different working groups . . . members who were participating were reaching agreement, and then all of a sudden the Democratic leader and the speaker of the House show up and we’re back to square one.” But Sen. Jeff Merkley, D-Oregon, told MSNBC that McConnell had lost Democratic support by removing some provisions from the final bill draft. Just before 9:30 p.m., Democratic Leader Chuck Schumer told CNN that he was negotiating with Treasury secretary Steven Mnuchin and making progress. Much of the Democratic unhappiness was about limited oversight of a $500 billion loan fund that Mnuchin would control.

Sen. Joe Manchin, D-W.Va., told Charleston’s WOWK-TV, “Mitch McConnell’s proposal fails miserably at protecting the people most impacted by covid-19. It fails our first responders, nurses, private physicians and all health-care professionals in both hospitals and rural clinics across the board.”

UPDATES, March 23: McConnell tried to schedule another procedural vote for 9:45 a.m. Monday, 15 minutes after the opening of trading on the New York Stock Exchange, but Schumer blocked that, and the vote was scheduled for noon. As it again fell short, “Near-pandemonium erupted on the Senate floor with lawmakers venting fury,” The Washington Post reports. McConnell issued a long press release with his floor speech, in which he said:

“. . . When the Democratic House passed their ‘phase two’ bill, even though Senate Republicans would have written it very differently, we sped it through the Senate and passed it quickly without even amending it.

“I literally told my own Republicans colleagues to ‘gag and vote for it,’ for the sake of building bipartisan momentum. Because Republicans understand that a national crisis calls for urgency and bipartisanship.

“It is time for that good faith to be reciprocated. It is time for Democrats to stop playing politics and step up to the plate. . . . “