AHA, AMA & ANA SEND JOINT LETTER TO CONGRESS ON CORONAVIRUS EMERGENCY FUNDING

March 19, 2020

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy and Leader Schumer:

The past few days have made a dramatic difference in the reality facing our nation due to the novel coronavirus (COVID-­‐19) pandemic outbreak. There are dwindling supplies of N95 respirators, isolation gowns, isolation masks, surgical masks, eye protection equipment, intensive care unit (ICU) equipment and diagnostic testing supplies in areas that had the first community outbreaks. Schools have closed in numerous states, leaving many front line health care personnel with an impossible choice - caring for their children or caring for their patients - a choice that can be alleviated if Congress takes swift and comprehensive action to assist with providing childcare during this unprecedented time.

The ability for front line health care personnel to go to work and provide care to patients will make the difference in whether those who contract COVID-­‐19 and have life threatening or serious complications from the disease recover or not. America's hospitals and health systems, physicians and nurses, are fully engaged in the work to bend the trajectory of this pandemic, and we also must be there to care for those who contract it. America is counting on Congress to provide direct funding to frontline health care personnel and providers, including nurses, physicians, hospitals and health systems, to respond to this pandemic.

It is clear that COVID-­‐19 will test the capacity of America's health care system. The choices that Congress makes about funding will make the difference between the ability of America's health care system to overcome supply shortages, staffing shortages, and financial challenges so that they can continue to serve their communities.

Since our last funding request, there have been critical developments in several states that have revealed the seriousness of the funding need. Due to expenses to treat COVID-­‐19 patients, hospitals are currently losing up to $1 million per day. This loss may increase as the outbreak spreads. There are extraordinary efforts to supply needed equipment. Front line health care personnel are not able to go to work due to lack of childcare and closing of schools, resulting in personnel shortages and significant expenses to backfill staff - when that is even possible. Hospitals need help providing childcare for their staff members so they can come to work.

In order to make sure supplies and inpatient beds are available, surgeries that are not absolutely critical are being postponed in many areas; however, this results in serious financial hardship for many hospitals and physician practices. Some facilities and practices are able to absorb significant losses for a period of time but others, such as rural facilities, are not. Clearly, we need all possible inpatient capacity to respond to the COVID-­‐19 pandemic. Congress needs to assist hospitals, physician practices and other providers on the brink of financial collapse so they are able to make payroll to front line health care personnel and all employees in order to ensure that as many inpatient beds as possible are available during this pandemic.

PRIORITIES FOR CONGRESS INCLUDE:

1. Creating a Stabilization Fund for Emergency Expenses Related to COVID-­‐19
   Critical funding includes covering loss of revenues due to suspension of elective services not related to COVID-­‐19, testing costs, additional training for front line health care providers on pandemic preparedness plans, training on telemedicine and telehealth capacities, and increased costs associated with higher staffing levels and backfilling when necessary; sourcing and purchasing additional and potentially more expensive supplies and equipment, when available; standing up emergency operations centers; providing housing and care for patients who do not require hospitalization but do not have housing in order to prevent spread of COVID-­‐19; construction or retrofitting facilities to provide separate areas to screen for COVID-­‐ 19; and additional security.

1. Providing Critical Childcare Needs For Frontline Health Care Personnel
   Ensuring there is quality childcare for front line health care personnel in need through direct funding to front line health care personnel and facilities, or, like some states have done, partnering with schools and daycare centers to provide funding to ensure there is quality childcare. This will make a critical difference in having more front line health care personnel.
2. Surge Capacity
   Providing the funding for the capacity to care for mildly or moderately sick COVID-­‐ 19 patients in an alternative care site when they cannot appropriately care for themselves at home, such as outpatient facilities or large structures in the community that are in close proximity to a hospital will provide additional capacity for sicker COVID-­‐19 patients that need more intensive care. This is a crucial step in ensuring we have as much inpatient capacity as possible to respond to the sickest COVID-­‐19 patients. Funding also may involve creating temporary structures.

It is clear that the expenses associated with responding to COVID-­‐19 will be extraordinary. It also is clear that in those communities that are experiencing community spread, these expenses are already being incurred, creating a significant cash flow problem. Based on the initial costs in the states with growing COVID-­‐19 community spread, Congress should allocate $100 billion to front line health care personnel and providers, including physicians, nurses, hospitals and health systems, and direct the federal agencies to begin to infuse funds immediately so that they can afford to take the necessary steps to fight the battle against this unseen enemy. It is our mission to care for our communities and without a significant financial commitment from Congress, our front line health care personnel and providers will struggle to respond. We ask that Congress provide resources to ensure America's health care system can respond with the best possible outcome.

Thank you for your ongoing leadership during this difficult time. Sincerely,

Richard J. Pollack James L. Madara Loressa Cole

President and CEO CEO and Executive Vice President Enterprise CEO

AHA AMA ANA

AHA STATEMENT ON SENATE PASSAGE OF THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT

- Rick Pollack, President and CEO, American Hospital Association

March 18 - America's hospitals and health systems are pleased Congress came together to pass today's package, which includes provisions to help workers, families and the uninsured, including boosting Medicaid funding for states and increasing the eligibility for the uninsured to enroll in Medicaid coverage. But more needs to be urgently done. The AHA continues to call on Congress to work on a comprehensive funding strategy to ensure that hospitals, health systems, and our frontline caregivers are directly supported for preparedness and response.

Hospitals and health systems, which are on the frontlines in responding to the COVID-19 pandemic, need significant financial support for numerous time-sensitive and critical tasks. These include obtaining scarce supplies and equipment to protect caregivers and patients, increasing surge capacity, including beds and temporary structures, to diagnose and treat patients and support for obtaining child care for hospital workers. Congress must act now during this critical window of time.

AMA Commends Administration on Executive Order to Bolster COVID-19 Testing and Personal Protective Equipment Supply for Health Care Workforce

Statement Attributable to:
Patrice A. Harris M.D., M.A., President, American Medical Association

March 18 - "With physicians and the entire health care workforce on the front lines of the COVID-19 pandemic facing a dire shortage of the testing supplies and personal protective equipment (PPE) needed to keep them safe and prepared to care for patients, today's Executive Order is a critical and bold step toward ensuring vital needs are met. The AMA has called for a "Manhattan Project" type effort to expand manufacturing capacity and produce supplies needed in this time of national emergency, and this Executive Order will help bolster the supply of PPE, ventilators, and tests to help with diagnosis. We look forward to continuing to work with the Administration as we navigate this unprecedented health threat."

Since the beginning of the COVID-19 pandemic, the AMA has been providing physicians with the latest clinical guidance to help them evaluate, test and care for patients under investigation for COVID-19, as well as guidance to help protect themselves and other health care personnel on the front lines from illness. The AMA developed a COVID-19 online resource center, Physicians Guide to COVID-19, and a COVID-19 FAQ to provide physicians with a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention (CDC), other federal agencies, and the World Health Organization to help prepare their practices, address patient concerns, and provide answers to physicians' most pressing questions.

Additionally, the AMA's JAMA Network has a comprehensive overview of the coronavirus - including epidemiology, infection control and prevention recommendations - available for free on its JN Learning website.

COVID-19: Health Care Leaders Ask VP Pence, Congress for Immediate Action

March 18, 2020

Dear Vice President Pence, Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:

America faces an unprecedented challenge with COVID-19. From expanding public health capacity, and access to and the availability of testing, to taking action to mitigate the economic and societal impact, we know these are serious and significant times. But we also know that immediate, collective action - by the private sector and all levels of government - to address the critical needs of capacity and supply can help resolve this challenge.

We represent the nation's doctors, hospitals, nurses and other health professionals, specialty and post-acute facilities, clinical laboratories, health insurance providers, biopharmaceutical manufacturers, pharmacy benefit managers, and distributors. We test, treat, cover, and serve patients. We develop, deliver, and manage medications. And we provide essential medicines, machines, treatments, and supplies to providers across the country. Today, we stand united.

Given the national and local insights we collectively bring, we offer the most important and immediate actions that must be taken right now in our fight against COVID-19. These solutions represent opportunities to immediately increase medical capacity and testing, enhance our national supply of critical medical equipment required to meet unprecedented demand, protect our front-line care providers and lab technicians, and improve treatment for patients.

The private sector will deploy every necessary resource to match this moment. It is absolutely essential for a coordinated government response to leverage the full force of the President's national emergency declaration. Specifically, we recommend the following mission-critical, time-sensitive actions to ensure that necessary resources are delivered to the communities most in need:

1. We must ensure a stable, continuous supply of needed medical supplies for clinical labs and technicians, health care providers and health care facilities. To meet unprecedented demand, the most critical supplies needed are equipment for testing, personal protection of care providers, and respiratory support for patient care. We recognize that the President has invoked the Defense Production Act and urge the federal government to expeditiously move to spur massive, increased production, distribution, and access to gowns, masks, gloves, testing kits, testing swabs, and respiratory

2. We must strengthen provider capacity and drive patients to appropriate alternative sites of care. This includes modifying existing facilities in and around hospitals, quickly constructing temporary units where needed, making use of surplus government property, and increasing patient beds to prioritize critical patient needs. Changes must go beyond acute care, including maximizing the appropriate role of telehealth, expanding provider capability to work at top of license, expanding provider capacity to practice and for distributors to more easily deliver across state lines, removing regulatory restrictions that limit in-home care, directing patients to appropriate care alternatives when hospitals are not required, and improving patient flow and information sharing between facilities to reduce the burden on acute care

3. We must ensure continued access to medications and avoid supply-chain disruptions. That means assuring that manufacturers can provide a continuous supply of medicines to patients by protecting the free flow of medicines, pharmaceutical ingredients and related goods, while avoiding mandates that could disrupt the supply chain. In addition, it is critical to provide regulatory flexibilities to facilitate safe and expedient patient access through home delivery and early refills where needed, while guarding against unnecessary stockpiling that could lead to drug

We are committed to working with state, federal and local officials in every way possible, from supporting our public health heroes, to offering specific policy and regulatory changes, to assisting governors, legislatures, the Congress and the Administration.

This moment challenges all of us. And we will do everything possible to ensure that the private sector and government collaborate and cooperate on behalf of the American people. We will deliver by working together.

America's Health Insurance Plans American Academy of Family Physicians American Clinical Laboratory Association American Hospital Association

American Medical Association American Nurses Association Association for Accessible Medicines

Association of American Medical Colleges Blue Cross Blue Shield Association

Catholic Health Association of the United States Children's Hospital Association

Federation of American Hospitals Healthcare Distribution Alliance Healthcare Leadership Council HIMSS

Partnership for Quality Home Healthcare Pharmaceutical Care Management Association

AHA URGES CONGRESS TO PROVIDE DIRECT FINANCIAL ASSISTANCE TO HOSPITALS

March 18, 2020

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy and Leader Schumer:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners - including more than 270,000 affiliated physicians, 2 million nurses and other caregivers - and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) urges Congress to quickly pass critically needed direct financial assistance for hospitals and health systems to protect the public health and address the economic turmoil caused by the 2019 novel coronavirus (COVID-19) outbreak. We applaud Congress for the steps taken so far to address the threat to public health and individual financial security, but hospitals and health systems also need additional resources to combat the ongoing public health emergency. Directly supporting hospitals and health systems not only will help us care for our patients but will provide a stimulus to communities in need of financial stability during this turbulent time.

Hospitals and health systems are making significant efforts to reconfigure operations to meet the growing surge of new patients due to COVID-19. The AHA urges Congress to provide financial assistance for hospitals making infrastructure investments, as well as for the purchase of equipment and supplies necessary to combat the COVID-19 pandemic. If tax relief is provided, it is important to provide that assistance through payroll taxes, so as to ensure that all hospitals are able to benefit from that relief. Helping hospitals and health systems fund these investments is necessary to be successful in preparing for, responding to and controlling this infectious disease outbreak.

The AHA also urges Congress to offset the costs of uncompensated care, bad debt and charity care for treating coronavirus patients through a full payroll tax credit or other policy mechanism. Hospitals provide varying levels of financial assistance, which must be budgeted for and financed by the hospital depending on the hospital's mission, financial condition, geographic location and other factors. We know that hospital resources will be stretched beyond capacity as a result of this epidemic. Legislation that recognizes and helps mitigate these additional costs is an essential component to maintaining hospital financial viability.

To expand the availability of financing for needed hospital construction during this crisis, the AHA asks that Congress consider temporary extension and permanent restoration of proven, immediately stimulative financing tools. Bipartisan legislation has been introduced in the House to achieve this goal, and Congress should include the following:

• Restore Advance Refunding of Tax-Exempt Bonds (H.R. 2772): Restoring the ability for governments, hospitals and others to advance refund tax-exempt municipal bonds frees up billions of dollars that governments and hospitals could devote to meeting the urgent needs of this crisis. State and local governments and nonprofits understand that preparing for a pandemic requires strengthening the infrastructure network that underpins their communities and institutions. We are asking you to restore advance refunding thereby providing debt service savings for taxpayers, which can be put to immediate public works purposes. This would be of immense help for planning and budgeting purposes for state and local communities and organizations, such as hospitals that are first line responders during this immediate crisis.

• Increase Access to Capital for Small Borrowers (H.R. 3967): For many thousands of small issuers, and governmental and nonprofit borrowers, increasing the bank-qualified borrowing limit from $10 million to $30 million, and having it apply at the borrower level would provide thousands of small local governments, hospitals and charities access to capital for immediate project needs.

Addressing the significant unanticipated financial burden hospitals face as they serve their communities will help meet the public health challenge we face and provide financial stimulus to communities throughout the country. We greatly appreciate the leadership you have provided on ensuring our nation's ability to respond to COVID-19, and we look forward to continuing to work with you during this critical time to protect the health and economic stability of our nation.

Sincerely,

/s/

Thomas P. Nickels
Executive Vice President