Medicare fixes, Amtrak boost in draft Senate aid package

Senate prepares to remove $15 minimum wage from bill

Sen. Bill Cassidy, R-La., disinfects the gavel before the Senate Energy and Natural Resources Committee confirmation hearing on May 20. (CQ Roll Call)
Sen. Bill Cassidy, R-La., disinfects the gavel before the Senate Energy and Natural Resources Committee confirmation hearing on May 20. (CQ Roll Call)
Posted February 28, 2021 at 9:30pm

Senate Democrats were honing a substitute amendment to the House-passed $1.9 trillion coronavirus aid package that chamber plans to take up this week, with one early version circulating that would add money for Amtrak, cybersecurity and Medicare payments for ambulance services and certain hospitals, among other changes.

The draft substitute obtained by CQ Roll Call was still being tweaked and will likely change before it reaches the floor. It was also possible Democratic senators could make changes they've been discussing in recent days with an amendment during the "vote-a-rama" session that will begin after up to 20 hours of debate have elapsed.

The 615-page Senate amendment leaves out the House-passed minimum wage increase to $15 an hour in order to comply with the "Byrd rule," which prohibits items that aren't purely budgetary.

It also doesn't reflect an alternative that Senate Finance Chairman Ron Wyden, D-Ore., previewed on Friday that would impose a 5 percent tax on employers' payroll if they don't meet wage standards while giving tax credits worth up to $10,000 annually to the smallest businesses if they boost wages.

Sen. Chris Coons, D-Del., said Sunday he hadn't seen Wyden's proposal, which Budget Chairman Bernie Sanders, I-Vt., had also been working on. Coons also suggested the minimum wage issue could wait for subsequent legislation, given the difficulty of filtering it through the Byrd rule's constraints.

"This isn't the last bill we will adopt this year. There may be several other chances to move a minimum wage bill," Coons said on CNN.

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White House Press Secretary Jen Psaki also suggested there would be other opportunities to pass minimum wage legislation, while not ruling out some kind of budget compromise this week.

President Joe Biden is "absolutely committed to raising the minimum to $15 an hour. We're going to spend the next few days and weeks looking for the best path forward, working with Democrats and Republicans hopefully to do exactly that," Psaki told CNN on Sunday.

Near party-line vote

The House passed its version of the $1.9 trillion relief bill at about 2 a.m. Saturday morning, after 195 pages worth of changes were added by a manager's amendment. The vote was 219-212, with no Republican support and two moderate Democrats, Kurt Schrader of Oregon and Jared Golden of Maine, voting "no."

Removing the minimum wage proposal frees up about $67 billion in the bill, which as passed by the House had been over the $1.89 trillion ceiling set by the fiscal 2021 budget resolution. The early Senate substitute would add to the House package in a variety of places while taking from others.

For example, the measure would add $2 billion for varied federal government information technology upgrades, including $650 million for cybersecurity. Biden asked for $9 billion for such purposes, but the House left out that part of Biden's request.

The Senate substitute also appears to cut $428 million from the House's $7.6 billion allocation for broadband connectivity and distance learning.

The Senate would tack on an extra $200 million to the House's $1.5 billion for Amtrak, with $150 million going specifically to the Northeast Corridor routes running from Boston to Washington.

It also has $400 million for the Federal Emergency Management Agency's emergency food and shelter program; $175 million for the Corporation for Public Broadcasting, including to help maintain service for small and rural stations suffering revenue losses; and $30.4 million for the Federal Trade Commission for consumer education and to help monitor and address "unfair or deceptive acts or practices" related to COVID-19.

The measure would address one complaint from House Republicans during floor debate, by directing $80 million to pediatric mental health services. There's also $420 million for community behavioral health clinics. Both pots of money appear to be offset by cutting $500 million from the House bill's overall allocation for mental health services and substance abuse prevention and treatment.

Another addition in the still-evolving Senate substitute would exempt unemployment benefits in 2021 from the calculation of income to qualify for cost-sharing subsidies on the 2010 health care law's exchanges.

Hospital, ambulance payments

Medicare changes in the bill include a provision based on bipartisan legislation from Sens. Catherine Cortez Masto, D-Nev., and Bill Cassidy, R-La., that would reimburse ambulance service providers for care delivered at a patient's home or on-site at other locations. Both are members of the Finance Committee, which has jurisdiction over about $1.3 trillion out of the $1.9 trillion aid package.

When they introduced their bill in late January, Cortez Masto and Cassidy said current law penalized ambulance providers who were trying to keep lower-risk patients out of hospitals since Medicare only reimburses them when a patient is moved.

Cassidy on Sunday said Democrats haven't let Republicans in on what would be included in their aid bill, however. "I have no clue how it will come out of the Senate. Republicans have not been involved," he told CNN. "They made a conscious decision not to include us."

Another Medicare provision in the evolving Senate substitute appears to set higher reimbursement rates for hospitals in states considered to be "all urban" under current law. The three states in that category are Biden's home state of Delaware, plus New Jersey and Rhode Island.

A Trump administration policy shift led to lower payment rates for hospitals in those three states, and their delegation members introduced legislation last year to reverse the change and permanently extend the prior policy. Cosponsors of that bill included Finance Committee Democrats Bob Menendez of New Jersey, Thomas R. Carper of Delaware and Sheldon Whitehouse of Rhode Island.

The measure introduced last year appears close to the language in the Senate's draft virus aid package, except the latter would apply prospectively starting on Oct. 1, 2021.

Peter Cohn and David Lerman contributed to this report.