Decisions made this month in the Capitol as part of a new coronavirus aid package will determine the fate of a host of health care and paid leave policy proposals affecting employers. But between the time Congress swiftly passed major relief laws stacked with health policy changes and paid leave allowances in March and today, the consensus about what to do next has eroded even as the political imperative to provide more aid has returned.
By the end of the month, Congress must decide whether to extend a number of key programs propping up the economy, including enhanced unemployment compensation providing an extra $600 a week to those out of work. This issue is fueling a partisan dispute, as are other top-tier issues such as financial aid for state and local governments, liability protections for reopening schools and businesses, and overall spending amounts.
Senate Majority Leader Mitch McConnell, R-KY, said last week that he expected to take up a relief bill when the Senate reconvenes July 20, after a two-week recess. McConnell and Trump administration officials have suggested they are aiming for a measure that costs no more than about $1 trillion. That’s a stark contrast to the nearly $3.5 trillion aid package — the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (HR 6800) — passed by House Democrats in May.
The role of employers and their benefits programs figure prominently in the HEROES Act. It would fully subsidize COBRA coverage from March 2020 to February 2021, provide temporary enhancement for and ease restrictions on cafeteria plans and flexible spending arrangements, offer reinsurance for certain COVID-19-related costs incurred by employer health plans, and impose new group health plan mandates. These include a requirement that employer group health plans cover COVID-19-related treatment, not just testing, without participant cost-sharing during the emergency period.
The HEROES Act would also expand an array of health, paid leave, payroll and employer financial aid programs enacted in March. The emergency sick and family leave programs already on the books, for example, would be extended through 2021 and would be required for all employers, not just those with fewer than 500 employees. Larger employers, however, would not be eligible for payroll tax credits to cover leave costs.
Not in the bill are employer policy priorities like expanding telemedicine, enhancing HSAs, and ending surprise medical bills for services beyond COVID-related services, although proposals are in the mix and could be included in a final package. Medical providers are barred from sending surprise bills to coronavirus patients if they take any money from a $175 billion COVID-19 financial aid fund, and Congress is considering a broader ban on the practice. Employers and other stakeholders recently sent a letter to congressional leaders stressing the importance of protecting all patients from surprise medical bills and holding down health care costs.
Questions around COVID-19 testing in the workplace could also be addressed by lawmakers. Congress required free cost-sharing for COVID-19 tests under a law enacted in March. But last month, regulators released guidance that allows insurers and plans to decline to provide free cost-sharing tests for return-to-workplace programs or for public health surveillance, triggering anger from Hill Democrats, who could move to reverse the guidance. Some Republicans prefer tax incentives as a way to encourage workplace testing, an idea embraced in Senate legislation (S 3966).
McConnell said the emphasis of the coming GOP counterproposal to the HEROES Act would be “kids, jobs and health care,” with details to come. While the contours of potential compromise are highly uncertain at this moment, the next few hectic weeks should produce a much clearer picture – stay tuned.