Lawmakers late Tuesday were polishing up a roughly $8 billion emergency aid package to respond to the COVID-19 illness, with signs pointing to talks going on into the wee hours.
By most accounts, there was bipartisan agreement on the broad contours of the measure. But a Democrat briefed on the negotiations said Tuesday night that outstanding issues included price limitations for drug treatments and eventually vaccines; reimbursements to hospitals for uncompensated care; and a Medicare waiver to allow payments to certain health care providers for telehealth services, such as in-home video visits.
This person, who spoke on condition of anonymity in order to discuss ongoing negotiations, said Republicans were pushing to offset the $500 million cost of the telehealth waiver.
Top Democrats earlier said they expected appropriators will reach agreement as early as Tuesday on an emergency supplemental to provide resources to contain and treat the COVID-19 illness, which has so far killed nine individuals in the U.S.
The drug and vaccine pricing issue centered around federal procurement regulations stipulating that the contracting officers negotiate "fair and reasonable" prices. Democrats charged Republicans were seeking to undermine the existing rules to let drugmakers negotiate above-market rates, while Republicans said Democrats wanted additional restrictions that could hinder investment in new treatments and vaccine development.
"That's one of the disputes that is holding up the bill right now. Our Republican friends don't want to see the kind of limitations that we want to see," Senate Minority Leader Charles E. Schumer, D-N.Y., said Tuesday. He allowed that a bill could still be sent to President Donald Trump's desk as early as this week, however.
House Majority Leader Steny H. Hoyer, D-Md., told CQ Roll Call earlier Tuesday he hopes to hold a floor vote on the unreleased COVID-19 aid bill Wednesday. A schedule update released Tuesday evening said consideration was still “possible.” Hoyer said that if negotiators can't quickly reach consensus on drug and vaccine affordability provisions, they should put that issue aside for now.
Potential treatments won't be ready for a few months at minimum anyway, pharmaceutical executives told Trump on Monday. And government health officials reminded Trump that approval on a vaccine was at least a year away.
"We need to get resources quickly and if that cannot be worked out, my thought … would be that we would make resources available and then continue to work on that issue because it's a longer term issue," Hoyer said. "I think they are proceeding and hopefully we will have a bill on the floor tomorrow. What I've told the caucus is I don't expect us to leave here this week without passing a supplemental through the House."
One senior Democratic lawmaker earlier Tuesday said it was possible a bill won't be introduced until Wednesday, though the House and Senate could still act on it this week. Some aides later in the day said it remained possible text could be introduced late Tuesday, but other sources said Wednesday was more likely.
Rosa DeLauro of Connecticut, who leads the Labor-HHS-Education Appropriations Subcommittee, said Tuesday evening negotiators were “going back and forth.”
“So there are no firm answers at the moment, but we’re moving toward getting this done and getting it done this week because the need is so critical,'' DeLauro said.
Appropriations Chairwoman Nita M. Lowey said Tuesday afternoon that negotiators were "very close" to agreement. "Nothing's finished until it's finished," the New York Democrat added, noting that vaccine affordability was "the one issue that's out there."
Three more deaths in Washington state were reported Tuesday, including a 54-year-old man who died Feb. 26 before authorities knew the cause was COVID-19.
Other affordability issues were also cropping up, such as how to prevent surprise medical bills for patients kept in isolation or tested for the illness and other out-of-pocket expenses. Health and Human Services Secretary Alex Azar, speaking at a briefing with Trump, said the supplemental funding package could help with hospitals' costs of caring for uninsured individuals being tested or treated for the disease.
Schumer has repeatedly urged a waiver of Medicare copays for any vaccine expenses, while House Democrats expressed concern Tuesday about individuals stuck in quarantine or being tested for the coronavirus and then getting hit with surprise bills.
"We're already seeing surprise billing popping up for families around the country who had the test done, were required to have tests done and now are facing medical bills of thousands of dollars," said Katherine M. Clark of Massachusetts.
"These are issues that absolutely have to be addressed," added Jan Schakowsky of Illinois. Describing an instance of an individual receiving a hospital bill after being quarantined, she added: "This was not a personal choice, but the insurance company said it was not medically necessary."
Lawmakers are discussing broader surprise medical billing legislation, just as they are talking about a comprehensive drug pricing bill. GOP Rep. Liz Cheney of Wyoming accused Democrats of trying to capitalize on a public health crisis to ram through their policy priorities.
"This is not a time for partisanship. This is not a time to try to seek additional pieces of legislation in the appropriations supplemental," she said.
But Democrats have taken pains to say they won't let their longer-term health care policy efforts slow down the immediate need to get resources into the hands of public health officials to try to stamp out a COVID-19 outbreak.
The emergency supplemental will include funds to reimburse state and local officials, lawmakers have said. And concerns about ensuring little to no financial burden on affected individuals were bipartisan: Sen. Rick Scott, R-Fla., for example, called for lawmakers to provide enough funding so that anyone with symptoms of the disease could get tested for free.
The talks were ongoing as policymakers were weighing possible responses to a global economic slowdown caused by the COVID-19 illness, which has killed more than 3,000 worldwide.
The Federal Reserve announced an emergency cut in its benchmark interest rate on overnight bank loans, but leaders of the major advanced economies comprising the G-7 couldn't agree on a specific coordinated response. U.S. stock markets were down nearly 3 percent Tuesday after a massive upswing on Monday recouped some of last week's big losses.
Trump late Monday floated the idea of another payroll tax cut, akin to the 2 percentage point cut in the Social Security tax that was in place in 2011 and 2012. But Trump has been talking about a new "middle class" tax cut for months prior to the novel coronavirus' emergence, and top Democrats were cool to the idea.
"I don't think tax cuts are the answer to every problem," Hoyer said. "I think that was more politics than it was health."
Hoyer and other Democrats also said an extension of Foreign Intelligence Surveillance Act authorities, expiring March 15, likely wouldn't be added to the COVID-19 supplemental. Lawmakers are working on a separate FISA reauthorization.
Andrew Siddons, Griffin Connolly, Lindsey McPherson contributed to this report.