United States Federal Health Policy Response Details

President Donald Trump enacted the Coronavirus Guidelines for America on March 16, 2020, which include avoiding gatherings of more than 10 people, working from home when possible, closing schools, and avoiding unnecessary travel, among other requirements. On March 29, 2020, in light of recommendations from multiple public health advisors, President Trump extended these guidelines from April 12 to April 30. On April 16, 2010, President Trump announced new guidelines for re-opening parts of the country.

Congress began addressing the social and economic impacts caused by COVID-19 and its resulting guidelines with the Families First Coronavirus Response Act, passed March 18. This bill includes the following (read the full text here):

• Expands paid sick leave

• Provides additional funding to WIC and other supplemental nutrition programs

• Mandates that COVID-19 testing be of no cost to patients

• Expands requirements around employers’ infectious disease control plans

Senate Republicans and Democrats also constructed and passed the Coronavirus Aid, Relief, and Economic Security Act (CARES), a $2 trillion stimulus package, which was enacted at the end of March 2020. This package includes (read the most recent text here):

• Direct payments to taxpayers, with the IRS disbursing up to $1,200 per taxpayer based on 2018 and 2019 tax returns, with an additional $500 per child

• Extension of unemployment benefits

• Loans to small businesses

• Bailouts for larger businesses

• Increased funding and Medicare payments to hospitals, including:

  • $100 billion for hospitals and other entities to cover unreimbursed health care related expenses or lost revenues attributable to COVID-19

• Increased Medicare payments by 20% for patients with COVID-19

• $945 million for the National Institutes of Health to support research, including developing an improved understanding of the prevalence of COVID-19

• $200 million for Centers for Medicare and Medicaid to assist nursing homes with infection control

• $425 million for Substance Abuse and Mental Health Services Administration to increase access to mental health services

Another interim coronavirus funding bill worth $484 billion provides more funding for small businesses, hospitals, and testing. A majority of the bill is designated towards replenishing the Paycheck Protection Program (PPP). This bill was signed by the President April 24, 2020.

• The PPP provides government-guaranteed loans to small businesses through the CARES Act. The loan amount is forgiven if “all employees are kept on the payroll for eight weeks and the money is used for payroll, rent, mortgage interest, or utilities.”

On May 15th, the House passed the HEROES Act, a $3 trillion stimulus package. Discussion of a second relief bill will resume in the Senate after the congressional Memorial Day Recess. Notable provisions of the House bill include:

1. Nearly $900 billion for states and local governments

2. A second round of $1,200 stimulus checks, with a new provision granting filers an additional $1200 per dependent (for up to three dependents).

3. Funding to expand testing and tracing programs

4. Extension of unemployment insurance, increased SNAP benefits, COBRA subsidies for health insurance, and support for small business

5. Expansion of vote-by-mail access and early voting

Despite the passage of the HEROES Act in the House, discussion of a second stimulus package remains ongoing at all levels of government. Compared to its predecessor, the HEROES act would expand the number of adults and dependents eligible for a stimulus check, but it remains unclear if this act will pass as written in the Senate. With record unemployment and a worsening economic situation, members of the executive administration have also signaled their interest in a second stimulus package but have not specified their plan for recovery.

As many states struggle to deal with the economic ramifications of the COVID-19 pandemic (discussed below), each state, and, in many areas, each county, is enacting regulations in an attempt to ensure a safe reopening. The CDC has provided recommendations for communities, schools, workplaces, and events as they begin to reopen, and the White House has established broader guidelines for Opening Up America Again. Despite these recommendations, over 30 states were seeing a daily rise in confirmed cases at the end of June, causing 12 states, including California, Texas, and Florida, to pause or move backwards in their reopening plans. To read more about individual state responses, please see our section on State Responses to COVID-19, as well as state policy maps from the Washington Post and CNN.

Thought questions:

• $1,200 is approximately how much an American minimum-wage worker being paid $7.25/hour for 40 hours would make for 4 weeks of work. How does this change your thoughts on the above discussion? Does this change how you think about the American minimum wage?

• What areas of healthcare, if any, are not receiving support from the CARES Act?

• Large companies and institutions have received millions in relief funding through the CARES Act. After facing criticism, Shake Shack returned $10 million in federal loans. Should companies and institutions qualify for the same relief as small businesses?

Federal Response Case Study: Understanding the Medical Supply Shortage

After the 2014-2016 Ebola outbreak, the White House issued a memorandum explaining how “gaps in preparedness and capacity surfaced in every major agency tasked with health and security in the U.S. government.” The report asserted that “the current scale of response activities… is likely not sufficient,” and that future infectious disease threats, “especially those that are airborne and transmissible before symptoms appear” are “ among the most serious threats to our homeland and to international security.” An office was created within the National Security Council to manage potential pandemic responses, and an “H9N2 simulation” of a global influenza pandemic took place in early 2017. Unfortunately, many of the White House staff present for that simulation were no longer in office at the time of the COVID-19 outbreak, and the office dedicated to managing the U.S. response to a global pandemic was dismantled in 2018.

In a later influenza pandemic simulation called Crimson Contagion 2019, it was noted that the “current medical countermeasure supply chain and production capacity [could] not meet the demands” of nations in the scenario, and that officials were unsure of how the Defense Production Act could be implemented. This latter simulation brought to light the inability of the U.S. to manufacture PPE, medication, and ventilators, among other medical supplies in the setting of a global pandemic. Adding to the potential for a medical supply shortage, the national stockpile of face masks was not fully replenished after H1N1 in 2009. On March 4, 2020, the HHS released a statement that the U.S. had 1% of the respirator masks needed in the event of COVID-19 becoming a pandemic, with a Strategic National Stockpile containing only 12 million medical-grade N95 masks and 30 million surgical face masks.

Two weeks later, on March 18, 2020, the White House invoked but did not activate the DPA, which gives the President the authority to order manufacturers to increase their production of needed supplies (such as masks, respirators, and ventilators) in times of emergency. Once the act has been invoked, industries are obligated to fill orders coming from the federal government before any others, and the federal government can distribute medical supplies according to need instead of ability to pay. Without the DPA, state governors were forced to compete with one another and the federal government to purchase medical supplies, leading to increases in medical supply cost and counterfeit sales. President Trump issued an executive order under the DPA on March 23, 2020 “preventing hoarding of health and medical resources necessary to respond to COVID-19” by “business, personal, and home” interests.

The President went further on March 27, 2020, activating the DPA to force ventilator production by General Motors. He took a similar measure on April 2 with two memorandums, the first instructing 3M Company to increase production of N95 masks and a second to facilitate the supply of manufacturing products to General Electric Company, Hill-Rom Holdings Inc., Medtronic Public Limited Company, ResMed Inc., Royal Philips N.V., and Vyaire Medical Inc. to accelerate ventilator production. The U.S. government and 3M reached an agreement four days later, with 3M providing an additional 55.5 million N95 masks each month.

For more information on optimizing PPE use in our current shortage, please see Module 6: Personal Protective Equipment. For more information regarding the ethical considerations surrounding PPE allocation and lifesaving interventions, such as CPR, please see Module 8: Resource Distribution.