On March 11, President Joe Biden signed a $1.9 trillion coronavirus (COVID-19) relief and stimulus bill, the American Rescue Plan (ARP) Act of 2021, H.R. 1319, into law after the U.S. House of Representatives and Senate finalized the legislation.
The ARP moved through Congress via the budget reconciliation process, which allows a bill to be fast-tracked and enacted with simple majorities in both the House and Senate, bypassing the 60-vote threshold usually required for passage in the Senate. H.R. 1319 includes individual measures developed by relevant committees, which were then bundled into one package based on the Biden Administration’s priority issues. The House passed the bill first and sent it to the Senate, where it was heavily amended based on the “Byrd Rule.” Because the bill was changed, it went back to the House for consideration and final passage before being signed into law.
Budget reconciliation process
The reconciliation process is limited to measures that affect the budget and allows legislation to be passed with a simple majority, thus avoiding the 60 votes necessary to succeed through regular order in the Senate and a possible filibuster. To achieve passage in the Senate, all 50 Senate Democrats would have to approve a plan put forth under the budget reconciliation process, with the Vice President required to pass the tie-breaking vote if necessary.
The Senate Parliamentarian is responsible for determining whether legislation complies with the rules of reconciliation, including the Senate’s Byrd Rule on germaneness. The Byrd Rule prohibits the Senate from considering extraneous matter as part of the reconciliation process. If a point of order is raised against an item within a reconciliation package and it is determined to violate the Byrd rule, then it is stripped from the legislation.
Health care provisions
The ARP contains several public health provisions aimed at supporting COVID-19 vaccine distribution and strengthening the health care workforce, as well as provisions to expand certain aspects of Medicare and Medicaid coverage.
To support the U.S. COVID-19 response, the ARP contained the following:
- $7.5 billion for the Centers for Disease Control and Prevention (CDC) to prepare, promote, administer, monitor, and track COVID-19 vaccines
- $1 billion for the CDC to strengthen vaccine confidence, further information and education with respect to authorized or licensed vaccines, and improve vaccination rates
- $6.05 billion to the U.S. Department of Health and Human Services (HHS) to support advanced research, development, manufacturing, production, and purchase of vaccines, therapeutics, and ancillary medical products used to treat and prevent COVID-19
- $500 million to the Food and Drug Administration to support the review, facilitate the development and post-marketing surveillance of COVID-19 vaccines and therapeutics, and address drug shortages
- $47.8 billion to HHS to detect, diagnose, trace, and monitor COVID-19 infections
- $1.75 billion to CDC to conduct, expand, and improve activities to sequence genomes, identify mutations, and survey the circulation and transmission of viruses
- $500 million to CDC to establish, expand, and maintain data surveillance and analytics infrastructure to modernize the U.S. disease warning system to forecast and track hotspots for COVID-19
- $750 million to CDC to combat COVID-19 globally
- $7.66 billion to HHS for efforts related to establishing, expanding, and sustaining a public health workforce, and to make awards to state, local, and territorial public health departments
Other health care provisions include the following:
- Amends the Social Security Act to provide $8.5 billion for a program to rural providers enrolled in Medicare, Medicaid, and the State Children’s Health Insurance Program to compensate for COVID-related expenses and losses
- $100 million to the Medical Reserve Corps
- Requires Medicaid coverage of COVID-19 vaccines and treatment
- Provides an enhanced federal medical assistance percentage to incentivize state Medicaid programs to cover mobile crisis intervention services for individuals experiencing a mental health or substance use disorder crisis
- Provides an incentive for states to expand Medicaid
- $7.6 billion to community health centers
- $800 million for the National Health Service Corps
- $330 million to expand the number of teaching health centers graduate medical education sites
- $20 million for educational campaign for health care professionals related to mental health and substance abuse services
- $40 million for health care providers to promote mental health
Changes to the Paycheck Protection Program (PPP) include the following:
- Provides an additional $7.25 billion for PPP and increases the PPP funding level from $806.4 billion to $813.7 billion
- Expands eligibility of not-for-profits to include a new category termed “additional covered nonprofit entity”
- Makes larger not-for-profits eligible for PPP by striking the application of the Small Business Administration’s affiliation rules to not-for-profits in the Coronavirus Aid, Relief, and Economic Security Act and looks at the employee headcount at the “per physical location” level of the organization
- Makes eligible additional covered not-for-profit entities for second-draw PPP loans, provided that they have suffered at least a 25 percent revenue loss and employ 300 or fewer employees
For more information, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org
