The coronavirus funding bill signed into law by the president Friday puts much more money toward treating and preventing the spread of COVID-19 than his administration requested from Congress last week.
The Trump administration's initial request — in the form of a two-page letter to Congress on Feb. 24 — was for $1.25 billion in new funds, with additional money moved from other parts of the federal budget to get to a total of $2.5 billion. The amount authorized Friday is more than three times that.
"It's a significant amount of money," says Jen Kates of the Kaiser Family Foundation. In comparison, Congress put $5.4 billion toward the Ebola response in 2014 and nearly $7 billion for H1N1 in 2009 — though, of course, each epidemic is different and requires a different response.
"It appears to me to be an appropriate number to definitely begin the fight — and likely handle the fight, assuming nothing goes sideways," says Chris Meekins, a health care policy analyst at Raymond James who, until January 2019, worked on preparedness and response at the Department of Health and Human Services.
So what do taxpayers get for that $8.3 billion? Here are some highlights:
$3.1 billion for the health secretary's dispersal
The biggest pot of money goes to the Office of the Secretary of HHS, and that funding is available until 2024.
"I thought the flexibility they gave within the Office of the Secretary's public health emergency account was good," Meekins says. "It allows us to not just put money toward therapeutic development — also vaccine development — but also purchase additional supplies that are needed, like masks and personal protective equipment, which for years had been underfunded by Congress and administrations."
Of that money, $100 million is directed to community health centers for underserved groups. "I think that a focus on underserved populations is going to continue to be very important as we see more cases in more states," says Beth Cameron who works on global biological policy for the Nuclear Threat Initiative. During the Obama administration, she served as senior director for global health, security and biodefense on the White House's National Security Council, a position that was eliminated by the Trump administration in 2018.
$950 million for state and local health departments
Of all of the $950 million for state and local public health response that's to be dispersed via the Centers for Disease Control and Prevention, half must be allocated within 30 days.
"That's great because that will hopefully get around some of the bureaucratic delays we've seen in previous responses," says Dara Lieberman of Trust for America's Health, a nonpartisan public health policy research and advocacy organization.
Lieberman says health departments across the U.S. are now in the beginning of the "mitigation phase" of responding to the virus. "They're doing the outbreak investigations, they're trying to implement isolation orders, they're trying to disrupt chains of transmission," she says. "As the outbreak evolves, you'll see different needs and different responses."
What will state and local health departments be using this money for? Lieberman says one need may be staffing. "Health departments may have to do some quick hiring or contracting of people," she says. "Laboratories may have to buy equipment and pay people overtime because people may be working 12-hour shifts, six or seven days a week as testing ramps up."
Data analytics, she says, is another area where health departments may need to quickly invest, so they can conduct surveillance of how coronavirus infections are spreading. "We've long neglected data modernization among health departments — because we underfund public health so much — so they may have to be investing in those kinds of basic capabilities."
$300 million to buy vaccines and treatments
Will whatever treatments or vaccines that are eventually developed for coronavirus be affordable?
That was a question put to the head of the federal coronavirus task force and HHS Secretary Alex Azar by Rep. Jan Schakowsky, D-Ill., at a hearing last week. Azar responded that he couldn't guarantee affordability: "We would want to ensure we work to make [a vaccine] affordable, but we can't control that price because we need the private sector to invest." His comment triggered accusations that Azar, a former executive at drugmaker Eli Lilly, had more loyalty to the private sector than to the American public.
In Friday's funding package, there's a provision that the vaccines and treatments purchased by the government are to be priced fairly and reasonably.
Congresswoman Rosa DeLauro, who chairs the House Appropriations health subcommittee, pointed out in a statement that the bill gives "authority for the Secretary of Health and Human Services to make the vaccines, therapeutics, and diagnostics developed from funding in this bill to be affordable in the commercial market." She urged Azar to make use of that provision.
$1.25 billion for international activities
The Trump administration's original request to Congress was focused purely on responding to coronavirus on the domestic front. As Azar explained in another congressional hearing last week: "Our activities are really containment and mitigation preparation in the homeland, because we're not going to help the Chinese stop this in China — China will do that or not be able to do that."
In the end, the bill the president signed into law does include funding for responding to the spread of coronavirus response internationally.
Cameron says that global investment is essential and that she was glad to see it ultimately included. The international funding isn't as much as she was hoping for, she says, but it's a "good start."
"It's superimportant to make sure that we are focused not just within the United States," Cameron says. "We don't know which countries are going to be most affected," she explains, and so supporting low- and middle-income countries that might not have the resources to contain outbreaks on their own is a "fantastic investment."
What may be missing from the funding package
Nothing in this law spells out how much, if any, money will go to reimburse hospitals or patients for medical care associated with COVID-19 treatment. Some announcements came through this week that the diagnostic test will be covered by many private insurers and Medicare and Medicaid, but there will be lots of other expenses associated with COVID-19 care.
For instance, if someone is compelled to stay isolated in a hospital for 14 days, who is to pay for that? That question is especially pressing for the more than 70 million Americans who don't have health insurance or are underinsured.
"That's the next frontier that's going to have to be grappled with," Kates of KFF says. "If [coronavirus] gets much more widespread, all the challenges of the existing way in which health care is financed and provided in this country are going to be in stark relief. And they're not addressed in this bill."
AUDIE CORNISH, HOST:
Eight-point-three billion dollars - that's the total amount of emergency coronavirus funding that President Trump signed into law today. But will - what will that money be getting us? NPR's Selena Simmons-Duffin is here to give us the highlights.
Welcome back to the studio.
SELENA SIMMONS-DUFFIN, BYLINE: Hi.
CORNISH: Eight-point-three billion sounds like a lot. How is it helpful here?
SIMMONS-DUFFIN: It really is actually a lot. There are some figures for comparison here - 5.4 billion for the Ebola response in 2014, nearly 7 billion for H1N1 in 2009 - so this is many millions of dollars more than Congress put towards those efforts. One important point - this is quite a turnaround for the Trump administration. Just last week, they requested only 1.25 billion in new funding. They wanted to move money around to get to 2.5 billion, and they defended that figure as members of Congress from both sides of the aisle said, this really seems like a lowball. The president did say last week he was open to more, and that is what he got - 8.3 billion; more than three times that initial ask. Experts I talked to today say it's really remarkable in this political moment that Congress was able to act so quickly to come up with this comprehensive package. No one can really say whether it's enough, but everyone I talked to said it's a really encouraging start.
CORNISH: How is the money supposed to be spent?
SIMMONS-DUFFIN: The biggest pot of money goes to the office of the Secretary of Health and Human Services. That is $3.1 billion, and the money is very flexible. It can be spent on developing treatments and vaccines, buying personal protective equipment like face masks for the Strategic National Stockpile, on community health centers which serve underserved populations. There's 300 million to purchase vaccines and therapeutics when we get them and a provision that those should be fairly priced.
CORNISH: And this is all supposed to move quickly, right?
SIMMONS-DUFFIN: Yeah, so another big pot of money in here - 950 million - will go to the state and local public health response through CDC. And, as you say, half of that has to go - or be allocated in 30 days. That's really, really fast. And what the money will be used for, at this point in the epidemic, is things like health departments staffing up to work 24/7, laboratories buying equipment and paying staff overtime and investments in data to be able to properly do surveillance.
CORNISH: And to be clear, is this all domestic spending? Or is there any money being offered to other countries that are dealing with the outbreak?
SIMMONS-DUFFIN: Yeah, so this is interesting. The Trump White House did not request any funding for an international response. The head of the coronavirus task force and Health and Human Services Secretary Alex Azar actually told Congress they were focusing on the homeland. But Congress, in this law, did include over a billion dollars for the international response. And that could be used, for instance, to help low- and middle-income countries shore up their resources to be able to contain or mitigate outbreaks. Experts I talked to were really pleased and quite, actually, relieved to see this funding in there.
CORNISH: Any other notable areas that are missing?
SIMMONS-DUFFIN: So one thing that we're starting to hear about are the people who don't have health insurance or are underinsured. That's about 70 million Americans, and nothing in this bill spells out whether any of this money will go to reimburse hospitals or patients for care. So we've seen some announcements this week that tests will be covered by private insurers and Medicaid and Medicare, but there are going to be lots of other expenses. If you're compelled to stay isolated in a hospital for 14 days, for instance, who's going to pay for that? That is not clear. And experts I talked to today said that the way in which this public health crisis collides with our fractured health insurance system is really the next frontier here.
CORNISH: That's NPR's Selena Simmons-Duffin.
Thank you for the update.
SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.