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Monday, June 29, 2020

Editor’s Note: This blog has been updated on June 29, 2020​

If you are a person impacted by the novel coronavirus (COVID-19), are living with cancer, or are immunocompromised, one important way to maintain some sense of control in what might be an anxiety-provoking time is to understand what is being done from a policy perspective to help respond to the pandemic, and how these changes have the potential to actually impact you and your community.

Background

On March 13, 2020, President Trump declared a state of emergency which will allow for faster responses and relief efforts across the United States, as well as provide additional resources for testing and treatment. Congress has undertaken legislative action to respond to the crisis with emergency coronavirus stimulus packages. These bills are aimed at funding research, treatment, and vaccine development, increasing access to certain health care provisions, and lessening the economic suffering for individuals and business, as a result of the coronavirus pandemic.

First Stimulus Package (March 6)

First Stimulus Package

Bill: The Coronavirus Preparedness and Response Supplemental Appropriations Act
Passed: March 6, 2020
Focus: Research and Vaccine Development, Small Business Relief, and Telehealth Flexibility
Funding: $8.3 Billion

COVID-19 Testing

The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 was signed into law to help fund research and vaccine development. This $8.3 billion aid package provided emergency funding for federal agencies to respond to the coronavirus outbreak, including $4 billion to make more coronavirus tests available.

Loans to Small Businesses 

The bill also includes $1 billion in loan subsidies to be made available to help small businesses who have been impacted by financial losses as a result of the COVID-19 crisis. This funding could enable the Small Business Administration (SBA) to provide an estimated $7 billion in loans to small businesses. Learn more at SBA’s Small Business Guidance & Loan Resources webpage.

Telehealth Flexibility

Additionally, the bill includes a waiver removing restrictions on Medicare providers to allow them to offer telehealth services to Medicare beneficiaries regardless of whether they are in a rural community or not. The provision allows beneficiaries who are covered by Medicare to receive telehealth services from home, reducing the potential risk of COVID-19 exposure associated with visits to medical facilities.

Second Stimulus Package (March 18)

Bill: Families First Coronavirus Response Act
Passed: March 18, 2020
Focus: COVID-19 Testing Access, Emergency Sick and Family Leave, Unemployment Insurance, and Nutrition Assistance
Funding: $104 Billion, according to Joint Committee on Taxation estimates

The Families First Coronavirus Response Act was signed into law to provide rapid assistance on many fronts including:

Free COVID-19 Testing

The bill allows for free COVID-19 testing, including emergency room visits and doctor’s fees, for all patients, regardless of insurance type or status. Contact your health care insurer directly with any questions regarding this provision. The bill also provides $1 billion to the National Disaster Medical System to reimburse providers for the costs of COVID-19 testing for uninsured individuals.

Emergency Paid Family and Medical Leave

The bill provides funding for paid time off to allow some symptomatic or exposed workers, or parents of children with school closures, to stay home through Family and Medical Leave Act (FMLA) leave. Under this provision, employers with fewer than 500 employees and government employers will have to provide eligible full-time employees up to 10 days/80 hours of paid sick leave, while part time employees are eligible for leave based on the number of hours typically worked in a two-week period. Employees who are unable to work (or telework) are eligible for this paid sick leave if they meet any one of the following six eligibility categories:

  1. Are subject to a Federal, State, or local quarantine or isolation order related to COVID-19,
  2. Have been advised by a health care provider to self-quarantine due to concerns related to COVID-19,
  3. Are experiencing symptoms of COVID-19 and seeking a medical diagnosis,
  4. Are caring for an individual who is subject to an isolation order or is a quarantined employee,
  5. Are caring for a child if the school or childcare provider has been closed, due to COVID-19 precautions, or
  6. Are experiencing any other substantially similar condition as specified by the Secretary of Health and Human Services.

Paid sick leave is calculated based on an employee’s regular compensation, up to $511 per day (up to a total of $5,100) for employees who fall into the first three eligibility categories (1-3) listed above. For employees who fall into categories 4-6, paid leave is no less than two-thirds of their regular compensation, up to $200 per day (up to a total of $2,000). Employers are reimbursed through a payroll tax credit, which applies to both for-profit and non-profit employers.

Additionally, employees unable to work because they are caring for a child due to COVID-19 related school or childcare closures, can receive family leave pay for a month (up to three months) at a rate not less than two-thirds of their usual pay, capped at $200 per day (up to a total of $10,000). This emergency leave will take effect after 10 days of unpaid leave; however, an employee can utilize vacation, sick, or personal leave during these 10 days. An employee must have worked for at least 30 calendar days for the employer to be eligible for benefits under this provision.

Health care providers or emergency responders can elect out of providing paid sick leave to these employees. The Department of Labor can also issue exemptions for employers of fewer than 50 employees. For more information about whether this provision applies to you, please visit the Department of Labor.

The bill directs that the provisions of the emergency paid sick leave and emergency paid family leave take effect no later April 2 through December 31, 2020.

Expanded Unemployment Insurance

The bill directs $2 billion to state unemployment insurance programs that see spikes in unemployment enrollment due to COVID-19. Certain eligibility requirements are waived under this provision for those who have lost their jobs due to the spread of the virus, including work search requirements and the waiting week. View your state unemployment insurance program to learn more.

Food Assistance

The bill provides emergency funding to ensure the nutrition assistance programs have adequate resources to help those impacted by the COVID-19 public health emergency, including the Supplemental Nutrition Program for Women Infants and Children (WIC), senior nutrition programs, and food banks. The bill also suspends the work and work training requirements for SNAP (formerly known as the food stamp program) during this crisis. For more information about these nutrition assistance programs, please visit the U.S. Department of Agriculture website.

Third Stimulus Package- CARES Act (March 27)

Bill: The Coronavirus Aid, Relief, and Economic Security Act (CARES Act)
Passed: March 27
Focus: Broad Economic Stimulus
Funding: $2 Trillion

A third stimulus package focused on broad economic stabilization, The Coronavirus Aid, Relief, and Economic Security Act, was signed into law on March 27. This bill will provide assistance to individuals, businesses, and infrastructure, including:

Direct Payments (Economic Impact Payment​)
The bill provides a one-time, direct deposit payment to individuals and families, who are not a dependent of another taxpayer and have a valid social security number, based on the income levels below:

  • $1,200 for individuals ($75,000 income cap)
  • $2,400 for couples ($150,000 joint income cap)
  • $500 for each qualifying child 16 years old or younger

For individuals and couples whose income is more than the caps noted above, payments are adjusted by 5% of income, phasing out at $99,000 for individuals and $198,000 for couples (without children). The payment will be based on an individual's 2019 tax return, if they already filed it, or their 2018 return.

Individuals don't have to pay income taxes on the payment and it doesn't affect eligibility for Marketplace financial assistance, Medicaid eligibility, and Medicare Savings Programs. The payment also is not counted as income for SSI, SNAP, TANF, or federal hosing purposes.

The IRS announced of March 30 that distribution of payments will begin in the next three weeks and will be distributed automatically via direct deposit, with no action required for most people. For those who filed a 2019 or 2018 tax return but did not receive a refund by direct deposit, payment will be mailed to the address the IRS has on file. People who receive Social Security retirement and disability payments each month, and don’t usually file taxes, will also get their payment through their regular direct deposit account.

Other people who typically do not file returns will need to submit a simple tax return by Wednesday, April 22 to receive the stimulus payment. Individuals should use this application if they did not file a 2018 or 2019 federal income tax return because their gross income was under $12,200 ($24,400 for married couples), or they weren’t required to file a 2018 or 2019 federal income tax return for other reasons. Additionally, people with a filing requirement and have not filed a tax return for 2018 or 2019 must file a 2019 tax return to receive the payment.

You can check on the status of your Economic Impact Payment on the IRS website.

Learn more and view frequently asked questions related to these payments on the IRS' Economic Impact Payment Information Center webpage.

Expanded Unemployment Insurance
The CARES Act creates a temporary Pandemic Unemployment Assistance program to provide payment to those not traditionally eligible for unemployment benefits (self-employed, independent contractors, and gig economy workers).

The bill further expands unemployment insurance to recipients of unemployment insurance and individuals in the Pandemic Unemployment Assistance program by:

  • Waives the 7-day waiting period for benefits.
  • Raises the maximum benefit by $600 per week, for up to four months.
  • Provides an additional 13 weeks of unemployment benefits of federally funded unemployment insurance benefits.

For more information about filing for unemployment insurance, visit the Department of Labor website to learn more.

Payroll Taxes
The bill includes a provision that enables individuals to defer payment of 2020 taxes until 2021 or 2022.

Student Loans
The bill requires the Department of Education to suspend monthly payments on all federally held student loans, without interest, through September 30, 2020. Borrowers with those loans would not have their credit dinged for the suspended payments and the postponement would not interrupt their progress toward any federal loan forgiveness programs. The suspension of payments does not apply to private loans, federally guaranteed loans held by private lenders, or federal Perkins loans.

The bill also creates a provision that enables employers to provide a student loan repayment benefit to employees on a tax-free basis. Under the provision, an employer may contribute up to $5,250 annually toward an employee’s student loans, and other educational assistance (e.g., tuition, fees, books), and such payment would be excluded from the employee’s income.

Emergency Relief
The bill includes over $330 billion in emergency relief funding, including $100 billion for hospital, public and not-for-profit entities, and Medicare and Medicaid providers to cover costs related to crisis.

The bill also provides emergency assistance to:

  • $25 billion for the Emergency Food Assistance Program, which includes:
    • Supplemental Nutrition Assistance Program (SNAP) – The bill includes $15.5 billion in additional funding for SNAP to ensure all Americans, including seniors and children receive the food they need.
    • Child Nutrition Programs – The bill includes $8.8 billion in additional funding for Child Nutrition Programs in order to ensure children receive meals while school is not in session.
    • $450 million for food banks, the Emergency Food Assistance Program (TEFAP).
  • $30 billion for the Disaster Relief Fund to provide financial assistance to state, local, tribal, and territorial governments, as well as private nonprofits providing critical and essential services. 
  • $7 billion for affordable housing and homelessness relief
  • $200 million for Centers for Medicare & Medicaid Services (CMS) to assist nursing homes
  • $425 million to increase access to mental health services in communities
  • $1 billion for the Defense Production Act to bolster domestic supply chains, enabling industry to quickly ramp up production of personal protective equipment, ventilators, and other urgently needed medical supplies.
  • $16 billion to replenish the Strategic National Stockpile supplies of pharmaceuticals, personal protective equipment, and other medical supplies, which are distributed to state and local health agencies, hospitals and other healthcare entities facing shortages during emergencies.
  • $4.3 billion to support federal, state, and local public health agencies to prevent, prepare for, and respond to the coronavirus, including for the purchase of personal protective equipment.
  • $45 billion for FEMA’s Disaster Relief Fund
  • $30.75 billion for local school systems and higher education institutions
  • $25 billion for transit systems
  • $10 billion for airports

While the CARES Act didn't include COBRA subsidies to help employees continue their job-based coverage after being laid off due to COVID-19, under current law individuals who lose their jobs are able to sign up for a health plan on the state marketplaces or could qualify for Medicaid. Learn more on Healthcare.gov.

Fourth Stimulus Package (April 24)

Bill: Paycheck Protection Program and Health Care Enhancement Act
Passed: April 24
Focus: Small businesses, hospitals, and testing
Funding: $484 Billion

A fourth stimulus package, the Paycheck Protection Program and Health Care Enhancement Act (PPP & HCE Act), was signed into law on April 24 to deliver more pandemic aid to small businesses and hospitals, in addition to coronavirus testing.

Loans to Small Businesses 

The bill provides $380 billion for small businesses, including and additional $321 billion for the Paycheck Protection Program. The package also appropriates an additional $50 billion for the Disaster Loans Program Account and $10 billion for Emergency Economic Injury Disaster grants, which are both housed by the Small Business Administration.

    COVID-19 Testing​

    An additional $25 billion is provided for necessary expenses to research, develop, validate, manufacture, and expand capacity for COVID-19 tests, including:

    • $11 billion for states, localities, territories, and tribes to develop, purchase, administer, process, and analyze COVID-19 tests, scale-up laboratory capacity, trace contacts, and support employer testing. 
    • $1 billion provided to Centers for Disease Control and Prevention for surveillance, epidemiology, laboratory capacity expansion, contact tracing, public health data surveillance and analytics infrastructure modernization.
    • $1.8 billion provided to the National Institutes of Health to develop, validate, improve, and implement testing and associated technologies; to accelerate research, development, and implementation of point-of-care and other rapid testing; and for partnerships with governmental and non-governmental entities to research, develop, and implement the activities.
    • $1 billion for the Biomedical Advanced Research and Development Authority for advanced research, development, manufacturing, production, and purchase of diagnostic, serologic, or other COVID-19 tests or related supplies.
    • $22 million for the Food and Drug Administration to support activities associated with diagnostic, serological, antigen, and other tests, and related administrative activities;
    • $825 million for Community Health Centers and rural health clinics;
    • Up to $1 billion may be used to cover costs of testing for the uninsured.

    Hospital Aid

    The bill provides $75 billion for hospitals to support the need for COVID-19 related expenses and lost revenue.

    Other Advocacy Actions

    The Cancer Support Community is Advocating for the Following Issues:

    Access to Care and Patient Protections

    Group Letter Urging Congress to Advance Permanent Telehealth Reform (June 2020)

    Group Letter Urging Congress to Strengthen the Medicaid Program in Future COVID-19 Legislation (May 2020)

    Group Letter to the Office of Civil Rights at HHS Asking for More Guidance on State Emergency Triage Plans (May 2020)

    Group Letter to CMS Regarding Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule (May 2020)

    Group Letter to Congress in Support of Guardrails on Step Therapy Protocols in Next Relief Bill (April 2020)

    Cancer Community Anti-Discrimination Letter to Governors (April 2020)

    Group Letter to HHS Regarding COVID-19 and Complying with Federal Nondiscrimination Laws (April 2020)

    Cancer Community Letter to Congress Urging Action to Help Patients Access Health Coverage During COVID Pandemic (April 2020)

    Group Letter to HHS Secretary Azar on Health Care Enrollment (April 2020)

    Group Statement of Support for the Worker Health Coverage Protection Act (April 2020)

    Coalition Statement Urging the Trump Administration to Implement a Special Enrollment Period for Healthcare.gov (March 2020)

    Group Letter to Congress Regarding Access to Medications in Third COVID-19 Stimulus Package (March 2020)

    Policy Priorities

    CIACC Coalition Letter to Congress in Response to the Preparing for the Next Pandemic White Paper (June 2020)

    PQLC Coalition Letter to Chairman Alexander in Response to his Preparing for the Next Pandemic White Paper (June 2020)

    Coalition Letter to Chairman Alexander in Response to his Preparing for the Next Pandemic White Paper (June 2020)

    CSC Guidelines on Home Infusion (June 2020)

    Cancer Community Letter to HHS Secretary Azar Regarding Important Policy Changes for Cancer Patients During COVID Pandemic (April 2020)

    Coalition Letter to Congress Regarding Legislative Priorities for Fourth COVID-19 Package (April 2020)

    Cost of Care

    Coalition Letter to HHS Regarding Reconsidering Cost Sharing Provision in 2021 NBPP Under COVID-19 Circumstances (May 2020)

    Coalition Letter Urging Congress to Include the Cancer Drug Parity Act in Fourth COVID-19 Legislative Package (April 2020)

    Group Letter Urging Congress to Enact Legislation to Permanently End Surprise Medical Billing (April 2020)

    Daily Living

    CSC Letter to Chairman Alexander Urging the Expansion of the Paid the Family and Medical Leave Program (June 2020)

    Group Letter to Congress in Support of Expanding the Paid Family and Medical Leave Program Created in the Families First Coronavirus Response Act (April 2020)

    Non-Profit Relief

    Group Letter to Congress Encouraging Non-Profit Research Relief in Response to the COVID-19 Public Health Emergency (May 2020)

    Group Letter on Potential Aid for Patient and Community-Based Organizations Impacted by Coronavirus (March 2020)

    What Happens Next?

    In an effort to build upon the aid provided in the previous stimulus packages, the U.S. House of Representatives passed another multi-trillion dollar relief package on May 15, titled the HEROES Act, to provide more economic relief for individuals, hospitals, and state and local governments. While this bill is not yet law, it gives us insight into what Congress is considering for additional relief. We will continue to keep you updated on what this means for you

    CSC will continue to update this information and reach out to you with breaking news. In the meantime, please visit our website, cancersupportcommunity.org/coronavirus, on what people impacted by cancer need to know about COVID-19. Sign up for our Grassroots Network to ensure that you receive all policy updates on issues that will impact people with cancer.

    Please note that Coronavirus policy updates are quickly evolving. We are providing this content for informational purposes only and updating it as quickly as possible. If you have questions or concerns, please contact action@cancersupportcommunity.org.

    Category: Cancer Advocacy

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