That provision is bad enough. But there’s another one hidden in the massive stimulus bill, which was drafted by Senate Republicans, that Democrats also see as a major sticking point.
And the battle that’s brewing over this particular provision says a great deal about the stark divide between the parties’ priorities over how to help the country through this crisis.
The provision in question is a limitation on funding that the GOP stimulus bill has built into the measure that sets aside $350 billion to provide loans for small businesses. That money would be available to small businesses that don’t lay off workers.
According to language in the bill forwarded to me by a senior Senate Democratic aide, this provision excludes “nonprofits receiving Medicaid expenditures,” which would not be eligible for those loans.
This language has been interpreted in some quarters as an effort to deny funding to Planned Parenthood, a longtime GOP target. But Democratic aides think the language means a lot more than this.
Specifically, Democratic aides believe this language would exclude from eligibility for this financial assistance a big range of other nonprofits that get Medicaid funding, such as home and community-based disability providers; community-based nursing homes, mental health providers and health centers; group homes for the disabled; and even rape crisis centers.
“The Republican Senate bill would prevent many small Medicaid-funded providers from accessing small business loans,” Mara Youdelman, the managing attorney of the National Health Law Program’s D.C. office, told me.
Youdelman added that tens of millions of people across the country are reliant on such programs, and agreed that the GOP bill, as drafted, would exclude them from accessing the stimulus package’s assistance for small businesses. She noted that providers in rural areas could also get targeted.
The rub here is that in an economic downturn, such nonprofit providers are subject to similar stresses as for-profit small businesses. While they get funding through patients who are on Medicaid and use it to pay for their services, Medicaid historically underpays for those services. With a surge in demand for such services amid the crisis, these providers will need more assistance — and if they’re denied it, some could go out of business at the worst possible time, Youdelman noted.
“We should be doing everything possible to keep them in businesses, both to help manage the pandemic and to keep people needing routine care healthy and out of overwhelmed hospitals,” Youdelman told me.
“It’s a huge problem,” said Nicole Jorwic, senior director of public policy at The Arc, a national advocacy organization for the disabled. “Our chapters who provide services would all be impacted,” Jorwic continued, making it harder to “provide home and community-based services all over the country.”
A fluid situation
This new sticking point comes at a moment when the situation is extraordinarily fluid. The massive stimulus bill has prompted other objections from Democrats, who say it doesn’t include strict enough conditions on bailed-out corporations and lacks funding for states and safety-net programs.
Senate Republicans forced a vote on Sunday to move to debate on the bill, but it fell far short of the 60 votes needed for passage, with 47 Republicans voting for it (five GOP Senators have quarantined themselves) and 47 Democrats voting against it.
Senate Majority Leader Mitch McConnell (R-Ky.) had threatened another vote on Monday morning, hoping to jam Democrats. But McConnell’s leverage appears to be dissipating as his numbers dwindle, and under pressure from Senate Minority Leader Charles E. Schumer (D-N.Y.), he postponed that vote and agreed to reenter negotiations.
In that combustible atmosphere, various advocacy groups are set to weigh in on this provision. This could scramble the politics of this unfolding battle in unpredictable ways.
For instance, it might be hard for several vulnerable GOP Senators — such as Susan Collins of Maine and Joni Ernst of Iowa — to embrace a bill that includes such a measure. Collins, for her part, has called on Congress to put aside “partisan bickering” and deliver help to the American people.
But that posture of nonpartisan constructive problem-solving could prove tough to strike when GOP senators are using this bill to jam through a provision that could exclude so many nonprofit providers.
“The last thing anyone should do in the middle of a public health crisis is restricting access to health care providers that women, people with disabilities, people with substance abuse disorders and more rely on,” Sen. Patty Murray (D-Wash.) said in a statement sent my way.
A stark divide
Democrats will try to get this provision removed as the negotiations continue, and if they hold a hard line, one hopes it will be tough for Republicans to allow it to remain.
“Congress needs to make sure people with disabilities and mental health challenges and victims of domestic violence do not lose access to care at an especially vulnerable time,” Andy Slavitt, a senior health care official under President Barack Obama, told me.
This standoff gets at another massive divide between the parties. From the Democratic perspective, the coronavirus and the coming economic downturn will badly strain existing services and exacerbate a range of social problems — which tend to get worse in recessions — that make those services even more crucial.
So Democrats and liberals see the need to fortify the safety net as particularly acute right now — and see this as a crucial element in getting this country through the crisis. This battle’s outcome will help determine how successfully we end up doing that, so a great deal is at stake.
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