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The Most Important Health Care Bill You’ve Probably Forgotten

The Medicare and Medicaid Act.  The Affordable Care Act.  These are the landmark laws that have irrevocably shaped America’s health care system.  However, there’s another law that’s made just as much of an impact on health care but hasn’t garnered attention in the last 20 years.  It’s called the Hill-Burton Act, and it’s poised to be potentially revitalized.

House Dems Revive Hill-Burton in Infrastructure Bill

On March 11, all 32 Democrats on the House Energy and Commerce Committee proposed the Leading Infrastructure for Tomorrow’s America Act, or the LIFT America Act.  The proposal calls for investing $312 billion in clean energy, energy efficiency, drinking water, broadband, and infrastructure.  Nestled within the proposal is a provision to reestablish the Hill-Burton Act by providing $10 billion in funding for the construction and modernization of health care facilities.  According to the LIFT America Act, projects that improve public health preparedness or cybersecurity would be prioritized.

What Is the Hill-Burton Act?

President Harry Truman signed the Hill-Burton Act into law on August 13, 1946.   Known formally as the Hospital Survey and Construction Act, it provided construction grants and loans to communities to help build health care facilities.  To receive funding, communities had to demonstrate they had enough population and per capita income to sustain a hospital.  All in all, the Hill-Burton Act’s impact on the nation’s health care infrastructure was nothing short of monumental.  In total, the law financed the construction of nearly 6,800 hospitals, nursing homes, and mental health facilities in over 4,000 communities.  The Hill-Burton Act was also responsible for the construction of one-third of all US hospitals in the three decades following the law’s enactment.

What Happened to the Hill-Burton Act?

Community-based health care construction under the Hill-Burton Act came to a close in 1997, when Congress last included funding for the program in its Fiscal Year 1997 appropriations bills.  Lawmakers’ decision to no longer fund the program is likely related to an overall trend towards cuts in federal spending throughout the 1990s, including passing the landmark Balanced Budget Act of 1997.

It should be noted that the Hill-Burton Act was long in decline before funding finally dried up in 1997.  The federal government had already been drawing down funds for the Hill-Burton Act in accordance with then-President Richard Nixon’s Economic Stabilization Program (ESP).  Established in 1971, the ESP’s calls to cut health care spending catalyzed a trend among politicians from both parties that saw a shift away from funding inpatient care and toward supporting outpatient care.

Reasons for the Hill-Burton Act’s Revival

The House bill, H.R. 1848, calls for funding to “increase capacity and update hospitals and other medical facilities in order to better serve communities in need,’’ with priority given to “projects that will include public health emergency preparedness or cybersecurity.”  Although public health officials have been provided billions of dollars in funding to help fight against COVID-19, there is concern that this money could dry up at the end of the pandemic, leaving the nation unprepared for a future public health emergency.  By prioritizing public health preparedness, the LIFT America Act help provide the infrastructure necessary to address the next public health crisis.

Additionally, the impact of the COVID-19 pandemic on health equity cannot be overlooked.  Research from the Journal of the American Medical Association and Health Affairs has pointed to the pandemic’s impact on health disparities, particularly among communities of color and low-income Americans, and a plan to reinvest in health care infrastructure could be seen as a way to address these disparities.

The pandemic has also exacerbated concerns over cybersecurity.  Recently, the FBI reported nearly 4,000 cyberattack complaints in one day, marking a 400% increase from pre-pandemic levels.  This increase can be attributed to a rise in remote workers and an expansion in telehealth.  Improvements in cybersecurity infrastructure can help mitigate the impact of future cyberattacks and protect patient and provider data.

Is $10 Billion Enough?

The LIFT America Act specifically provides $10 billion for fiscal years 2022-2026 for hospital modernization and improvement.  The nation’s hospitals are certainly in need of modernization – of the 6,210 hospitals in the United States, a 2019 survey by the American Society for Health Care Engineering found 23% percent of operators are planning to renovate or build acute care hospitals.  With the average cost of a hospital modernization project ranging from $250 to $300 per square foot, the funds provided in the LIFT America Act are likely to come up short.  However, future appropriations bills could provide for the opportunity to increase Hill-Burton funding or extend funding beyond 2026, creating the potential for greater funding levels in the future.

Moving Forward

The Congressional debate on infrastructure is just heating up.  Along with the LIFT Act, Senate Republicans proposed $568 billion in infrastructure spending last week, an offer which was roundly criticized by Democrats as being insufficient.  President Biden is set to reveal his second infrastructure plan in recent weeks, dubbed the American Family Plan.  Along with the American Jobs Plan, the Administration and Congress will spend the rest of the spring and summer negotiating a legislative package to address all manner of infrastructure, including perhaps taking old ideas like Hill-Burton, and making them new again.

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The Week in Review: April 19-23

Biden Celebrates 200 Million Vaccinations

On April 21, President Biden announced that the US had administered 200 million COVID-19 vaccine doses, meeting his Administration’s goal of putting 200 million shots into American arms within 100 days.  The President also urged unvaccinated Americans to fulfill their “patriot duty” and get their shots.  To encourage more Americans to get vaccinated, President Biden reaffirmed a commitment to a tax credit for small businesses to incentivize them to provide employees the day off to get vaccinated.

Are COVID-19 vaccinations starting to decline?

According to CDC data, the number of Americans who received COVID-19 vaccinations during the week of April 13 declined 11% from the previous week.  This marks the biggest decline in vaccinations since February, when winter storms delayed shipments and forced vaccinations sites to close.  The drop in vaccinations coincides with the federal government’s pause on the JNJ vaccine, forcing many vaccination sites to cancel appointments or switch to offering Pfizer-BioNTech and Moderna doses.  Public health experts attribute the drop to the interruption of the JNJ vaccines and waning interest in vaccinations among residents of rural areas.

ACIP Could Decide Fate of JNJ Vaccine Today

The CDC Advisory Committee on Immunization Practices (ACIP) meets today at 11:00 AM EDT to discuss whether or not the US should resume usage of the Johnson & Johnson (JNJ) COVID-19 vaccine.  ACIP initially voted to maintain the JNJ pause in its last meeting on April 14 after reports of six severe blood clot cases out of the 7.5 million people who had received the JNJ vaccine.  According to reports, ACIP may recommend resuming the use of the JNJ vaccine, but with new warnings about blood clots.  Alternatively, the advisory panel could impose restrictions on continued use of the JNJ vaccine, such as barring those in certain age groups from receiving JNJ shots, or maintain the pause to allow more data to be gathered.

FDA Finds Overcrowding, Unsanitary Conditions at JNJ Contractor

Following an eight-day inspection, the FDA found multiple flaws at an Emergent BioSolutions facility in Baltimore that had been contracted to produce JNJ COVID-19 vaccines.  The Baltimore facility first hit the news on March 31 after reports that production mishaps required 15 million vaccine doses to be tossed.  Some of the problems FDA inspectors found include unsanitary conditions and insufficient space for materials and equipment.  While FDA and Emergent BioSolutions have committed to addressing the discrepancies, it seems unlikely that JNJ will meet its goal of delivering 100 million vaccine doses to the federal government by June.

Stivers Steps Down from Seat in Solid GOP District

On April 19, Rep. Steve Stivers (R-OH) announced he will leave Congress effective May 16, 2021, to serve as President and CEO of the Ohio Chamber of Commerce.  Stivers, a member of the House Financial Services Committee, has represented communities to the south and west of Columbus in Congress since 2011.   Ohio Governor Mike DeWine, a Republican, has yet to announce a special election to fill Stivers’ seat, which is a solidly red district.  The upcoming vacancy in Stivers’ seat will increase Democrats’ majority in the House from five seats to six.

ICYMI: DC Welcomes New WWI Memorial

The World War I Memorial, DC’s newest national memorial, opened in Pershing Park along Pennsylvania Avenue on April 21.  While the memorial is now open to the public, it’s notably missing its centerpiece – a free-standing bronze relief that won’t be completed for another three years.  However, visitors are still able to view water features, marble walls engraved with quotes and maps, and a statue of General John Pershing leftover from the previous iteration of the park.  The park’s unveiling coincided with a fighter jet flyover that surprised residents across the Washington, DC area.

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What Does the Rise of SPACs Mean for Health Care?

In 2019, special purpose acquisition companies (SPACs) raised $13.6 billion.  In 2020, they raised $83 billion.  The boom in SPACs hasn’t been lost on the health care industry, which saw 50 health care-focused SPACs go public in 2020 alone.  However, the rapid growth of SPACs has caught the attention of regulators and lawmakers, which means the boom may not last forever.

Also known as blank check companies, SPACs are shell companies that raise capital in an initial public offering (IPO) for the purpose of later acquiring a private company.  Typically, SPACs sponsors have 18-24 months to complete an acquisition.  If the acquisition fails, the SPAC is dissolved, and the money is returned to its existing shareholders.  Some investors see SPACs as more attractive than traditional IPOs because of faster access to the market and confidentially negotiated terms.

SPACs are encroaching on the health care industry, albeit at a limited rate.  Of the 120 SPACs that were actively seeking an acquisition target in October 2020, only 15% were considered targets in the health care/life sciences space.  Among the health care companies that went public in the US last year through SPACs are MultiPlan, a health care cost management solutions platform, SOC Telemed, a telemedicine provider, and Cerevel Therapeutics, a biopharmaceutical company.

Take SOC Telemed.  SOC Telemed, a national provider of acute care telemedicine solutions, merged in July 2020 with special purpose acquisition company Healthcare Merger Corporation.  Now listed on Nasdaq (TLMD), SOC Telemed used its strong financial performance during the pandemic and its cash infusion from investors to acquire Access Physicians, a multi-specialty acute care telemedicine provider.  SOC Telemedicine is now the largest pure-play provider of acute care telemedicine, serving over 700 hospitals across 47 states.  All that in ten short months.

While health care SPACs under scrutiny per se, the rapid growth of SPACs is starting to catch the eye of government officials.  On April 8, the Securities and Exchange Commission said it will be heavily looking into SPACs going forward, with a focus on disclosures by sponsors and acquisition targets for any misleading statements or omissions, such as projections or valuations.

SPACs are attracting attention in Congress, too.  In March 2021, House Financial Services Committee members Reps. Brad Sherman (D-CA) and Bill Foster (D-IL) recently expressed concern that companies may be using SPACs to evade disclosures and liabilities, thereby putting unwitting investors at risk.  While these concerns have yet to yield any serious congressional inquiries or legislation, consumer advocates are pushing Congress to take action.  In February 2021, Americans for Financial Reform sent a letter to House Financial Services Committee leaders with several policy recommendations to reign in SPACs, including enhanced disclosure requirements and more study into the risks of SPACs.

Until regulatory and legislative action is taken, however, there seems to be no end in sight to the growth in SPACs.  Therefore, only time will tell the implications of blank check companies for health care providers – and what these implications could mean for patients and consumers.

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The Week in Review: April 12-16

Survey Finds Drop in JNJ Vaccine Confidence

On April 13, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) recommended the US pause usage of the Johnson & Johnson (JNJ) vaccine after six women ages 18-48 developed a severe blood clot out of the 6.8 million doses administered so far. According to a poll conducted by YouGov and The Economist in the wake of the recommendation, the number of people who felt the JNJ vaccine was safe declined from 52% to 37%, while those who felt the vaccine was unsafe jumped from 26% to 39%.  Critics of the government’s recommendation say the pause is directly contributing to an increase in vaccine hesitancy, while federal officials say demonstrating the safety of vaccines is paramount to maintaining public confidence.  Notably, the public’s views on the safety of the Moderna and Pfizer vaccines remain unchanged.

CDC Advisory Panel Punts Decision on JNJ Vaccine Pause

On April 14, the CDC Advisory Committee on Immunization Practices (ACIP) declined to vote on recommendations to continue using the JNJ COVID-19 vaccine, just a day after federal officials announced a pause in JNJ vaccinations over safety concerns.  ACIP opted to maintain the pause to allow more time to gather additional data about the blood clots that occurred in six vaccine recipients.  The Committee will reconvene in 7-10 days to decide whether to continue the pause, allow JNJ vaccinations to continue with certain restrictions, or bar the JNJ vaccine from continued use altogether.  Until the committee votes on recommendations, the pause will likely continue.

Pelosi Has “No Plans” to Bring Bill to Expand SCOTUS to the Floor

Speaker Nancy Pelosi (D-CA) told reporters on April 15 that she has no plans to bring to the House floor a bill from Rep. Jerry Nadler (D-NY) that would add four seats to the Supreme Court, which would effectively tilt the Court in Democrats’ favor.  However, Pelosi said expanding the court is “not out of the question,” and she expressed support for the Biden Administration’s commission to study changes to the Supreme Court, which include adding seats or instituting term limits.

Top W&M Republican Announces Retirement

Rep. Kevin Brady (R-TX), who currently serves as Ranking Member of the House Ways and Means Committee, announced on April 13 that he will not seek reelection to a fourteenth term in Congress.  Brady, who has represented the northern suburbs of Houston since 1997, was term-limited out of being the top Republican on powerful tax-writing committee in the next Congress.  Among the House GOP members eyeing Brady’s seat is Devin Nunes (R-CA), Vern Buchanan (R-FL), Adrian Smith (R-NE), Jason Smith (R-MO), and Mike Kelly (R-PA).

Dem Pollsters Admit to Flaws in Predicting Outcome of 2020 Election

Sure, most polls were correct in saying Joe Biden would win the presidency, but hardly anyone predicted Democrats would lose seats in the House and the Senate would be split 50-50.  Six months later, a group of leading Democratic pollsters reconvened to find out what went wrong.  According to a memo they released on April 13, the pollsters underestimated the amount of Republican turnout on Election Day and the reluctance among Republicans to participate in surveys.  Going forward, the pollsters say they are less likely to use live-interview phone calls and more likely to use innovative methods like text messages to prompt survey participation.

ICYMI: Poll Says DC Is the Worst State

YouGov poll released on April 13 found the District of Columbia – which is not even a state – last in a ranking of US states from best to worst.  The poll, which asked respondents to choose the better of two states in a series of head-to-head matchup, ranked states according to how often they “won” in the matchups.  Fortunately, the District’s neighboring states fared better in the poll – Virginia came in third, while Maryland was ranked 26.

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5 Things to Know about In-Person Advocacy

Will we get back to in-person meetings on Capitol Hill?  When??  How?  COVID-19 is still around, even as the country’s mood is lightening about the overall impact of the virus.  And the safety and security of lawmakers and staff are of top-of-mind after the deadly January 6 riot and April 2 attempt at breaching the Capitol grounds.  Let’s explore  when in-person meetings might return and what those meetings could look like.

It is happening?

By and large, in-person advocacy isn’t happening, at least not on the Hill.  Since March 2020, advocacy has shifted online to videoconferencing like Zoom and telephone calls.  However, that doesn’t mean Members haven’t been yearning for a return to normal.  On March 10, House Republican Leader Kevin McCarthy (R-CA) sent a letter to Speaker Nancy Pelosi (D-CA) requesting a timeline on when certain in-person activities can restart, including allowing visitors in House office buildings.  While Pelosi has not officially responded to the letter, many Democrats say it’s premature to relax restrictions, partially due to the fact that a number of Republican lawmakers have yet to be vaccinated.

Any decision on when to loosen restrictions will ultimately be up to Democratic leadership in the House and Senate, in consultation with the Office of the Attending Physician (OAP).  While the Capitol complex and adjacent congressional office buildings are exempt from public health guidelines from the Government of the District of Columbia, leadership and the OAP are using local COVID-19 health guidances to inform decisions.  These guidelines were last updated February 23 and include masking, de-densifying Hill offices, staggered schedules, and teleworking.

What is open?

Presently, both the House and Senate office buildings are only open to Members, staff, and credentialed press, and while official business visitors are permitted in congressional offices, they must always require staff escorts.  House staff may only escort a maximum of nine visitors at a time, while Senate staff are limited to 15 visitors.  However, this does not mean that advocates have regular, unfettered access to congressional offices.

What about off the Hill?

Over the past few weeks, some lawmakers and staff, mostly Republicans, have resumed some degree of in-person activities, including fundraising dinners, due to relaxations in local restrictions on event sizes as well as new CDC guidelines that allow small groups of vaccinated individuals to gather in-person.  Republicans are also hosting fundraising trips around the country.  Lobbyists and advocates are also interacting in-person with legislators instates and congressional districts where COVID-19 restrictions have been loosened more considerably.

When will things get back to normal?

Anecdotally, some congressional staff and lobbyists are saying in-person meetings may not be permitted on Capitol Hill until 2022.  Whether this happens sooner or later depends on countless factors, including the pace of vaccinations, level of vaccination hesitancy, local restrictions in DC, and to what extent any COVID-19 variants impact the effectiveness of current vaccines.

What will change permanently?

With most details about the future of in-person meetings on the Hill being speculative, one likelihood is the continued use of videoconferencing technology that can complement in-person meetings.  During the pandemic, teleconferencing has been used to great effect to connect advocates who normally wouldn’t be able to make a trip to Washington with lawmakers and staff, which leaves open the possibility for a “hybrid” approach that incorporates building relationships both in-person and virtually.

Furthermore, the aftermath of the January 6 riot on Capitol could serve as the basis for other permanent changes.  Even after the pandemic ends, some congressional staff and lobbyists feel that certain security measures could stick around, meaning limits on in-person meetings could persist.  For instance, limits on group sizes could continue, which would certainly impact large-scale fly-ins.  At the moment, however, both Members of Congress and lobbyists are more focused on removing physical barriers such as fencing and razor wire from the perimeter of the Capitol complex.  On March 15, for example, the National Institute for Lobbying & Ethics sent a letter to the Speaker urging the removal of all physical barriers by July 1.

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