HEALS Act and Rural Hospital Closure Relief Act — Congressional Record, Senate, July 28, 2020
Summary
Page S4534 of the Senate section of the Congressional Record for July 28, 2020. Under the heading HEALS Act, Cornyn says COVID–19 cases have surged in the Rio Grande Valley and South Texas, and that Texas reported more than 10,000 new cases in a single day, 5 days in a row. The remarks say the first coronavirus package made testing free and that Congress has already provided $175 billion for a healthcare provider relief fund. A Rural Hospital Closure Relief Act is described as updating Medicare's critical access hospital designation to provide flexibility around the 35-mile distance requirement.
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“HEALS Act and Rural Hospital Closure Relief Act — Congressional Record, Senate, July 28, 2020.”
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S4534 CONGRESSIONAL RECORD — SENATE July 28, 2020
HEALS ACT it be in multigenerational households who have been on the frontlines. In my
Mr. CORNYN. Mr. President, as I or with the people who are most vul- State, I know the Governor has asked a
said, the number of COVID–19 cases has nerable to this virus—mainly, the el- number of hospitals in the hardest hit
surged in recent weeks in the Rio derly and the people with underlying areas to defer elective surgeries. As I
Grande Valley, South Texas, and health problems—is that they cannot have come to learn and as the Pre-
throughout the State as well. Just a be properly isolated unless we can iden- siding Officer, no doubt, knows, that is
couple of weeks ago, Texas reported tify the people who are carrying the how hospitals pay the bills. Many of
more than 10,000 new cases in a single virus even though they themselves the people who show up either get
day, and that happened 5 days in a row. may not be suffering any symptoms. charity care or the payment through
It certainly was a wake-up call for The first coronavirus package we Medicaid or Medicare is less than that
many who had not had taken the most passed made testing free. It removed from private health insurance, so hos-
effective precautions seriously—things the cost barrier that could prevent pitals need a mix of elective surgeries
like social distancing, good personal those who needed a test from receiving and other treatments so they will have
hygiene, the wearing of masks if you one. At the time, if you were asymp- full insurance coverage in order to bal-
can’t socially distance, and staying tomatic, the CDC—Centers for Disease ance their books overall.
Control and Prevention—didn’t rec- Congress has already provided $175
home if you are sick. It is amazing
ommend your getting a test. Some of billion for a healthcare provider relief
what we can do as individuals to stop
that was because of the constraints on fund, which has given hospitals, clin-
the spread of this virus by doing those
the numbers of tests that were avail- ics, and physicians the resources they
simple things. Unfortunately, some need to continue treating COVID–19 pa-
people let their guard down and didn’t able. The fact is, if you are not suf-
fering from any symptoms, you are tients and stay afloat financially. So
follow those protocols, so we saw a far, more than 20,000 hospitals and
huge uptick in the number of cases. probably not highly motivated to go
get a test because you may not even healthcare providers in my State alone
Thankfully, though, I think the mes- have benefited from that funding, with
sage has been received and understood, know you have the virus, and you may
over $4.1 billion coming to Texas.
and we have recently seen a gradual not know you need one.
The HEALS Act will supplement that
and encouraging decline in cases. We are testing a lot more now than
fund with an additional $25 billion to
Yet, as the war against COVID–19 we were back then. Congress has pro-
help these providers navigate the surge
wages on, we can’t afford to lose any vided another $26 billion to scale up
in cases and maintain critical supplies
additional ground whether from a pub- testing, and we have gone from con-
like masks, gloves, and ventilators. If
lic health perspective or from an eco- ducting an average of 145,000 tests a
our hospitals don’t have the personal
nomic recovery perspective. So I be- day nationwide in early April to more
protective equipment to protect the
lieve it is time for Congress to pass ad- than 780,000 per day in mid-July. So
frontline staff, the resources to treat
ditional legislation to strengthen our that has been a dramatic improvement.
patients, or the funding to keep their
fight. That is why my colleagues and I What we know is there is more we need doors open, we will be in bad, bad
introduced the HEALS Act yesterday. to do. shape. This legislation will go a long
This legislation builds on the signifi- The HEALS Act, which we intro-
way to making sure we don’t ever
cant progress we have made already in duced yesterday, will provide an addi-
reach that point.
four bipartisan bills that have already tional $16 billion to support testing ef- In addition to supplementing the
passed the Congress and have been forts. When combined with the approxi- healthcare provider relief fund, this
signed into law by President Trump mately $9 billion that still exists from legislation will also support some of
that will sustain our effort to defeat the previous bills, it will make another our most critical health resources. We
this virus and recover economically. $25 billion available to strengthen our know our community health centers
This legislation will ensure that testing nationwide. This will help to are an important part of the safety net
workers who had the rug pulled out improve our testing strategy and ca- when it comes to accessing healthcare.
from under them earlier this year will pacity and reduce the backlog that has This bill will provide $7.6 billion to our
continue to receive enhanced unem- left some Texans waiting more than 2 community health centers, which usu-
ployment benefits. weeks for test results. These tests are ally serve people on a sliding scale
It will provide funding to help K–12 not very useful if it takes 2 weeks to based on their ability to pay. Some
schools, colleges, and universities safe- get the results. people have full insurance coverage;
ly and effectively educate their stu- Because we ramped up the number of others are covered by Medicare or Med-
dents this fall whether that means people who were tested, the lab compa- icaid; and some simply don’t have the
there being a combination of online or nies that were analyzing the tests means to pay at all, but all are wel-
in-person instruction. ended up getting backlogged. Now we come and are treated at our commu-
It will send additional and needed as- have taken corrective measures in cit- nity health centers.
sistance to our farmers, ranchers, and ies like Dallas to make other testing We also send $4.5 billion to mental
producers who are keeping our families available and bring that number down, health, suicide prevention, and sub-
fed in the midst of the pandemic, and it but this has been a constant challenge. stance use disorder services. We all
will give States and local governments It needs to be as quick and easy as pos- know that the mitigation efforts we
the flexibility they have requested and sible for folks not only to get tests but have all been engaged in by staying in
that they need to use CARES Act fund- to get the results, and this funding our homes and not leaving for a period
ing where it is needed the most. helps to make sure there will be seri- of time, as instructed by public health
In the coming days, I will talk more ous strides in support of that goal. and other government officials, has ex-
about how this legislation supports the I know there are testing protocols acted a very difficult toll on families,
workers and institutions that have that are being analyzed right now that particularly on people who have had
been hit the hardest by this virus, but, may make this easier and may even nowhere to go to escape somebody who
today, I would like to focus on the make the results quicker. I know, for has been abusing them in domestic vio-
ways it bolsters our fight against the example, in the Texas A&M University lence scenarios or on people who are
virus itself. System, Chancellor Sharp said he has simply feeling a sense of isolation and
One of the most important ways we contracted for 15,000 tests a month for a challenge to their mental health as
can do that is through testing. The students who will return on campus. they wonder how they are going to pay
ability to identify positive cases as Now, in his view, he said those students the bills and take care of their fami-
early as possible is the key to stopping will probably be safer on campus than lies. Maybe they have loved ones who
Dlhill on DSK120RN23PROD with SENATE
the spread of the virus. Yet, as we have they will be back home, especially if are in nursing homes—the elderly are
learned, there are massive numbers of they end up going to bars or other so- particularly vulnerable—whom they
people who have the virus who don’t cial venues and do not properly social haven’t been able to see because of the
even know it and don’t experience any distance or wear masks. isolation efforts.
symptoms. In short, they don’t even Beyond testing, we need additional And then we know people will self-
feel sick. What we have seen, whether support for the healthcare providers medicate with alcohol or drugs. So this
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July 28, 2020 CONGRESSIONAL RECORD — SENATE S4535
$4.5 billion is important to help provide only had 12 tests available. Because of The legislative clerk proceeded to
the mental health, suicide prevention, limited resources, a physician made call the roll.
and substance use disorder services the difficult decision not to test an ER Mr. LANKFORD. Madam President, I
that are going to be needed not only patient for COVID–19 because the pa- ask unanimous consent that the order
right now but in the indefinite future. tient didn’t meet the criteria set out for the quorum call be rescinded.
We also provide an additional $15 bil- by the Centers for Disease Control. The The PRESIDING OFFICER (Ms.
lion to the National Institutes of following day, that same patient went MCSALLY). Without objection, it is so
Health for research and an additional to Wichita Falls and received a test, ordered.
$26 billion for vaccine research. and several days later found out that Mr. LANKFORD. Madam President,
We know our frontline healthcare they tested positive. Senator DURBIN and I have worked for
providers have gotten much, much bet- Now, imagine you are that physician. months on an issue on rural
ter and saved many more lives by com- You followed the CDC guidelines for healthcare. Whether it is in rural Illi-
ing up with treatments that actually testing; you tried to conserve the lim- nois or it is in rural Oklahoma, there is
have been effective. Some of these are ited resources available in your com- a challenge dealing with rural hos-
common prescription drugs that are munity; but there is nothing stopping pitals and sustaining their viability.
used for other purposes that have been the patient from heading to the nearest So Senator DURBIN and I partnered
repurposed for treatment of COVID–19 lawyer’s office and filing a lawsuit together to determine what is the best
symptoms. against you for somehow refusing them way to get a solution that is a long-
We know that convalescent plasma, a test. term solution to what they are cur-
taken from people who have had the All of a sudden, you are scrambling rently facing with COVID–19.
virus, who have developed immunities, to defend yourself in a lawsuit that, While COVID–19 has impacted all
when they donate blood, that plasma quite frankly, should not have been types of businesses, rural hospitals
can actually be used to help treat pa- filed in the first place. have uniquely dealt with some very dif-
tients with serious COVID–19 symp- But I have spent enough time in ficult challenges. Getting PPE early on
toms. courtrooms to know that many times in the process was much more chal-
And we know that there are other lawsuits are not filed with the goal of lenging for rural hospitals than it was
treatments in progress, along with the actually prevailing on the merits; they for urban—keeping doctors, managing
race to get a vaccine. Ultimately, we are filed in order to gain a settlement separation, getting airflow areas in
know that the vaccine is going to be because the cost of defending yourself hospitals to manage the flow of the
important to our ability to defeat and can be large, indeed. And, in fact, if virus through areas, and also managing
live with this virus. you are a business that has been hang- just patient count, where, for many
But in the meantime, we know we ing on by a thread, just the threat of rural hospitals, they just shut down be-
need to learn to live with this virus in that kind of litigation and the expense cause all elective surgery was stopped
a way that protects our public health and energy it takes to defend that case, and such, and so they lost all of that
and allows us to safely reopen our even though it lacks merit, could well income, though they still had all the
economy. cause you to throw in the towel or put employees. It was an exceptionally
So the last thing I want to mention you out of business. challenging thing, but it is challenging
is liability protection. Why is this so So we have introduced, as part of this on top of the challenge that they have
important? HEALS Act, legislation that will pro- already faced for decades in just sur-
Well, as many nonprofits or busi- vide that safe harbor. It will not pro- viving in rural America.
nesses think about reopening, thinking vide blanket immunity; it will not pro- So what Senator DURBIN and I have
about kids going back to school safe- tect against intentional or reckless brought is a reasonable, nonpartisan
ly—whether online and then misconduct; but it would establish solution to how we can deal with not
transitioning to in person, or colleges clear guardrails like those in a number only COVID–19 but to help rural hos-
and universities—we know that there of States. As a matter of fact, 30 dif- pitals long term.
are going to be a lot of lawsuits filed, ferent States have passed similar pro- Decades ago, Congress established
second guessing why people didn’t do tections for their healthcare workers. something called the critical access
something different, when, in fact, this Other States have done it in other cat- hospital and made sure that those hos-
pandemic has surprised all of us in so egories, but it is important, I believe, pitals that were designated ‘‘critical
many ways. for us to provide clear authority so access hospitals’’ would receive proper
And what this does is provide a safe people know what they are dealing reimbursement from the Federal Gov-
harbor from legal liability for those in- with. ernment for healthcare services.
dividuals who followed government I would note, for example, that some Many individuals in rural areas—in
guidance in good faith. It can’t be the of these same guardrails are very simi- fact, the dominant proportion in many
fact that you would subject a frontline lar to those enacted by Executive order rural areas receiving healthcare are re-
healthcare worker who had no choice in the minority leader’s home State of ceiving it through Medicaid or Medi-
but to put on personal protective New York. I know the legislature has care. We want to make sure that those
equipment and go to work to treat pa- now sent Governor Cuomo another bill, providers providing those high-need
tients—it would be a cruel joke to say: basically, with the same framework, areas are reimbursed appropriately.
Now we are going to come back and file and he has not yet made a decision to But, in 2006, Congress shifted the des-
lawsuits against you and sue you for sign that. ignation for critical access hospitals
money damages because you didn’t But overall the HEALS Act will help and took away something called the
somehow know exactly what you were provide the resources Texas hospitals, necessary provider, giving the flexi-
dealing with. clinics, and healthcare providers need bility to the States.
We know that frontline healthcare to sustain and win this fight, while As a result of that action in 2006, we
workers are performing a physically protecting our heroic healthcare work- have seen the closure of 118 rural hos-
and mentally taxing job, made only ers from a second epidemic in the pitals nationwide since that time pe-
more difficult by the fact we didn’t un- courtroom. riod. The ‘‘critical access hospital’’
derstand exactly what we were dealing So I hope both sides of the aisle will designation was created because of a
with, with this novel virus, and we are work together, as we have in the past string of hospital closures in the 1980s
still learning more. on COVID–19 response legislation, and and early 1990s. Yet we have not re-
Well, I learned, for example, about a make sure we can get a bill to the sponded in the way that we should
rural hospital where test kits are in President’s desk on a timely basis that from the change in statute in 2006.
Dlhill on DSK120RN23PROD with SENATE
short supply. In fact, it was especially delivers these and other necessary Simply what we are trying to do is to
true in the early days as testing infra- changes at a critical time for our coun- give that flexibility back to States
structure was being stood up, and I try. again. If they have a hospital in a rural
mentioned that a moment ago. I suggest the absence of a quorum. area that is the only provider in that
I learned about a hospital in a rural The PRESIDING OFFICER. The community that is a Medicare-depend-
community outside Wichita Falls that clerk will call the roll. ent hospital or is a very small hospital
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S4536 CONGRESSIONAL RECORD — SENATE July 28, 2020
with fewer than 50 beds, that area has munities. Auxiliaries, volunteers, and We project that six hospitals in Iowa
to be an area that is designated as a so many people make these hospitals and scores more in Illinois, New York,
rural area. It can’t just be any subur- the focal point when you visit these and Kentucky would qualify for this fi-
ban area or any other type of hospital. communities. They are so proud of nancial lifeline, securing their sta-
It has to be a rural hospital in par- them. bility. We do it in a restrained, cost-ef-
ticular. It has to have a high percent- Of course, we are worried about what fective manner by focusing on the hos-
age relative to the national average of this current pandemic is going to do. I pitals that have faced financial losses
individuals with income below the pov- have had conference calls with leaders and are located in areas with a short-
erty line. Those hospitals in those loca- from almost 120 hospitals across Illi- age of healthcare providers. It is com-
tions could be designated by their nois. I invited Members of Congress in, mon sense.
States as a necessary provider and be so we had bipartisan exchanges about This bipartisan bill is a priority for
treated as if they are a critical access the current state of affairs. One hos- us. We want to make it a priority for
hospital. What would that do? That pital CEO from Crawford County, the Senate, and we hope to do so. We
would be a lifeline for reimbursement downstate along the Indiana border, know that we have come to this discus-
because now we have some rural hos- told me that he used to pay 22 cents for sion with a good, encouraging con-
pitals designated as critical access and a surgical gown, and now he pays be- versation with Senator GRASSLEY
some hospitals that meet all the other tween $11 and $20 for each one. Hos- today in support of the Iowa Rural
criteria, but they may be 34 miles away pitals are facing limited access to re- Health Association. The CEO and lead-
from another hospital, so that hospital agents, swabs, and supplies that they er of the Kentucky Rural Health Asso-
in that county dies while the other need. The Heroes Act would direct the ciation projects that more than 18
hospital survives. In my State, we have administration to utilize the Defense rural hospitals in that State are at
a critical access hospital 34 miles away Production Act to help solve that prob- high risk of closure. We hope to make
from a hospital across the border in lem, and I commend Senators MURPHY that point very clear to the majority
and BALDWIN for their legislation, leader. Several of them would be
Texas, so the hospital in Oklahoma
which I am joining, to do the same. helped by our legislation.
can’t get the critical access designa-
One of the most profound con- With a spike in COVID–19 cases
tion and can’t survive because 34 miles sequences of the pandemic is the im- across rural America, we have seen
away there is a hospital in another pact on the solvency of these hospitals. hospitals reaching capacity, and we
State that has the critical access. Across Illinois, rural hospitals are the
We need the flexibility in our States need to make sure that our hospitals—
heart and soul of the community; oth- the ones we are talking about in rural
to be able to do this kind of designa-
erwise, people drive literally for hours areas—survive. The health and eco-
tion. Senator DURBIN and I have run
to get medical care, sometimes in nomic toll of this crises demands it. I
this through a lot of places and a lot of
emergency situations. They are impor- hope that Democrats and Republicans
people, and we have gotten a lot of tant parts of the local economy. We in the Senate include this in any bipar-
technical input in it to make sure this think downstate hospitals generate $5 tisan package. The cost of inaction will
actually works for our rural hospitals billion into our State economy each be disastrous.
and provides not just a short-term sur- year, and I don’t doubt that. Senator LANKFORD and I were pre-
vival through COVID–19 but also pro- This pandemic has pushed them to pared to seek passage of this bill by
vides long-term stability for them. the brink. Even prior to this crisis, unanimous consent today, but we have
This is the kind of work we should do they were facing financial uncertainty. been encouraged to continue negoti-
together to make sure we stabilize Half of rural hospitals were operating ating with our colleagues to see if we
those rural hospitals. They are a life- in the red. One in four were at risk of can make it part of the package—a
line to people in rural America. They closure. As the Senator from Oklahoma timely part of the package—in the near
are a lifeline of employment, and they mentioned, 120 have closed across the future. I hope that is the case, and we
are a stable feature in every commu- Nation in the past decade. will hold off from any unanimous con-
nity. Without them, those commu- We have fared a little better in Illi- sent request because of that hope.
nities dry up because people need ac- nois, but we are worried about the fu- f
cess to healthcare, and this is the way ture. When a rural hospital closes, not
that they can get it. only do doctors disappear, but jobs dis- UNANIMOUS CONSENT REQUEST—
I am glad to partner with Senator appear, and businesses struggle to stay. H.R. 6
DURBIN on this issue, and it is our hope The coronavirus pandemic has accel- Mr. DURBIN. Madam President, last
to get this into the next bill dealing erated and compounded the strains we month, in a landmark decision, the Su-
with COVID–19 in the days ahead. Quite face. We believe our Illinois hospitals preme Court rejected President
frankly, it was our hope to get it into are losing $1.4 billion each month. Trump’s effort to repeal deportation
the last one—we didn’t get it—and into Many, like those near nursing homes protections for Dreamers. Those are
the one before that. Surprisingly and meat processing plants, have had the young immigrants who came to the
enough, everyone seems to be nodding to expand surge staffing to deal with United States as children.
their heads on both sides of the aisle COVID patients. All have been forced In an opinion by Chief Justice John
saying: That is a good idea. That will to cancel outpatient and elective serv- Roberts, the Court held that President
be effective. We want to move it from ices. In Illinois, 70 percent of rural hos- Trump’s attempt to rescind DACA, De-
‘‘that is a good idea’’ to ‘‘done’’ for the pital revenues are from outpatient ferred Action for Childhood Arrivals,
sake of rural hospitals across the Na- services. The same is true in neigh- was ‘‘arbitrary and capricious.’’
tion. boring States like Kentucky. Those were the words of the Court.
With that, I yield the floor. Nationwide, rural hospitals have on More than a month later, the Trump
The PRESIDING OFFICER. The Sen- average only 33 days of cash on hand. administration has refused to restore
ator from Illinois. There is an immediate need to sta- the DACA Program despite the deci-
Mr. DURBIN. I thank my colleague bilize, and that is why we have come up sion written by the Chief Justice. The
from Oklahoma. I could not have said with this bipartisan plan. Senator administration is now in open defiance
it any better or more effectively than JAMES LANKFORD and I have introduced of the Supreme Court when it comes to
he just did. a bill called the Rural Hospital Closure the DACA Program. The stakes are too
Like Oklahoma, downstate Illinois Relief Act. It is supported by the high, both for the rule of law and the
has an area of smaller cities and rural American Hospital Association and the lives of these young Dreamers, for us
towns and smalltown communities. National Rural Health Association. It to ignore it. Republicans and Demo-
Dlhill on DSK120RN23PROD with SENATE
Many of them are lucky enough to would update Medicare’s ‘‘critical ac- crats in Congress need to come to-
have great hospitals, and they love cess hospital’’ designation to provide gether to compel the President to im-
their hospitals. They are not only im- flexibility around the 35-mile distance mediately comply with the Supreme
portant sources of medical care; they requirement, so more rural hospitals Court mandate.
are a major part of the local economy would qualify for additional payments On June 4, 2019, the House of Rep-
and really are a rallying point for com- from the Federal Government. resentatives passed H.R. 6. In 2019, they
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