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What America’s Richest Ski Town’s Handling of COVID-19 Says About the Country

Posted on by • Posted in Asymptomatic Transmission, Community Spread, Coronavirus, Coronavirus Mutation, Economic Crisis, Economic Recovery, Economic Stimulus, Essential Workers, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Security, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Sign of the Times, Social Determinants of Health, Social Distancing, Vulnerable Populations • Leave a comment
A view of the JHMR slopes and the village at the base of the mountain in Jackson, Wyoming.

Tucked in the shadow of the Tetons, the town of Jackson, Wy., and surrounding Teton County is home to less than 25,000 fulltime residents, but annually hosts over 2.5 million visitors. The valley’s natural beauty attracts an influx of tourists, who in turn are responsible for roughly 30% of the region’s jobs and over $1 billion in annual revenue, but this year, visitors came with an unwelcome price tag for locals: “Every time in this pandemic that we’ve had an influx of visitation, whether that’s second homeowners, or people just coming for a weekend, it follows with an uptick in cases and hospitalizations” says Dr. Jeff Greenbaum, medical director at the Emergency Department for St. John’s hospital and the Jackson Hole Mountain Ski Resort (JHMR) ski patrol.

With just one major hospital and eight emergency room physicians serving Teton County, any increase in COVID-19 cases is cause for concern. And in January, following the Christmas and New Year’s tourism rush, COVID-19 cases in Teton County skyrocketed to some of their highest levels since the pandemic began. Despite these developments, the ski resort, hotels, bars and restaurants remain open in the town. And Greenbaum remains optimistic that with the right strategies and precautions, the small hospital will not be overwhelmed by cases and skiing can stay open during the season for both visitors and locals. “The nightmare scenario is if the patients are stacking up in the emergency room and we don’t have enough personnel to treat them,” says Greenbaum. “But we’ll see that coming in advance, and we are not there yet.” The local hospital still has over 50% of its ICU beds unoccupied and has no COVID-19 patient on a ventilator. JHMR is similarly optimistic that it can stay open the entire season, trusting in the protocols it has put in place to protect both guests and staff.

Teton is the wealthiest county in the U.S., with a per capita income of over $250,000. At the start of the pandemic, a flurry of private jets landed at the Jackson Hole Airport, sometimes with a private ventilator in tow, as second homeowners and new buyers escaped to this rural paradise. Greenbaum posits that part of the reason why St. John’s hasn’t been overrun by cases is that many of the tourists that get COVID-19 in Teton County might not stay to get treatment in Teton County. At a time when millions of Americans are out of work, when daily infection rates are at an all-time high, and when thousands across the country are dying daily from the virus, should the wealthy indulge in an après ski, looking out onto the beautiful Teton mountains, all while potentially shuttling COVID-19 into and out of Jackson?

“This place is pretty much a gigantic country club, relying on second homeowners and tourism for its revenue,” says Jesse Bryant, a doctoral candidate in American Sociology at Yale University and creator of Yonder Lies, a podcast exploring the history of Jackson Hole. “But Jackson has to balance the ultra-wealthy with the real reality of people eking out a living here.” Teton County has the largest income gap of any county in the U.S., with the top 1% making almost 150 times more than the other 99%. From mountain guides to house cleaners to bartenders, much of the employment in Jackson cannot easily be transitioned to remote work, meaning that Jackson’s working class are among the most susceptible to unemployment from the pandemic. All across America the costs of the pandemic are being born by the poorest members of society; a Pew Research Center survey from September found that about 50% of low-income Americans say they or someone in their household has lost employment or had take a pay cut due to the pandemic, and similarly about 50% of low-income Americans reported having trouble paying their bills since the pandemic started.

During the spring and summer, the Coronavirus Aid, Relief, and Economic Security Act passed by the federal government at the start of the pandemic had provided $600 in additional unemployment payment per week, assuring many local and seasonal workers that their livelihoods were safe even if their jobs weren’t. But almost a year into the pandemic, Jackson’s working class are left with far fewer options: federal unemployment relief dropped to $300 and state unemployment benefits in Wyoming, although extended by 13 weeks, dry up after 39 weeks. “Many of the workers here don’t have a six-month buffer saved up,” said one restaurant worker who wished to remain anonymous for risk of losing their job, “so, while tourism presents a risk, we’re willing to take it to keep our paychecks coming in.”

This is the predicament that America has put herself in: a country with a limited safety net during the pandemic forces her workers to choose between the risk of getting sick, or losing their livelihoods. The mountain and the town are left trying to find a balance between keeping the economy open for tourists, and keeping COVID-19 out. As the second largest employer in Teton County, JHMR takes center stage in this unfolding drama. The resort is responsible for the livelihood of around 2,000 seasonal and local workers, and if the mountain were to shut down, many of the ancillary services in the town, like hotels, restaurants, rental shops, clothing stores and other retailers, would likely shutter their doors as well. In 2017, when the resort had to close for five days because of a power outage, the net economic impact to the local economy topped $5.5 million. “What’s happening in Jackson isn’t just a story of wealthy people coming into the rural west and getting the locals sick,” says Bryant. “This place has become more like a symbiotic relationship.”

One particularly vulnerable population is the Latino community, a significant number of which is undocumented, that lives in Jackson, and in the neighboring towns of Victor and Driggs. While it’s difficult to get exact numbers of their contribution to the economy, these workers keep Jackson running by filling jobs in all sectors, from house cleaners and construction workers to cooks and waiters.

“I’ve lived in Jackson for 25 years and used to go back to Mexico every winter because it was just too cold,” says Jorge, an undocumented construction worker in the town. “But then I got used to the cold and began skiing every single day.” Asked whether opening up the resort is worth the risk of bringing more COVID-19 into Jackson, Jorge says that by and large the Latino community welcomes the tourism with open arms, because it means job security. This lines up with findings from a survey undertaken by the Yale School of Environment this past summer, showing that Latino residents in the rural West had some of the highest rates of COVID-related unemployment in the country. “My wife and I work hard, her as a house cleaner, me in construction,” said Jorge. “The resort opening up and tourists coming to town is how many of us make our living.”

For its part, JHMR has been doing nearly everything within its power to keep COVID-19 from spreading on its slopes, iterating as the situation evolves to try to keep the 2021 season operating. In March of 2020, as the first wave of the pandemic was sweeping across the globe, the Wyoming State Health Officer shut down JHMR for the remainder of the season. The resort reopened in May, first for hikers and then mountain bikers—the summer tourists that in total are only about 10% the size of the winter tourist population. Before reopening for the summer crowd, it tested every single one of its staff members for COVID-19, and the resort’s human resources department transitioned into a contact-tracing team, coordinating with town officials whenever a case arose. While Wyoming didn’t issue a statewide mask mandate until Dec. 7, the resort instituted a mandatory mask policy during the summer. JHMR also learned to be more flexible in its operations: staff are now trained to perform a number of different functions, so they can sub in if there’s a shortage in a department, and shifts function as separate pods, meaning that if a person in one group has been exposed to COVID-19, another totally isolated pod can come in to take its place.

Over the summer and fall, tourists came in droves to Jackson, with as many as 40,000 total visitors in a day. According to the Jackson Hole Chamber of Commerce, both Yellowstone and Grand Teton National Parks—both within a quick drive from of Jackson—had about 50% more visitors in October of 2020 than they did for the same month in 2019. While many of the outdoor activities that bring people to Teton County during the summer—hiking, biking, climbing—have been deemed relatively safe during the pandemic, tourists also flocked indoors to the bars, restaurants and stores that remained open throughout most of the summer and fall. As a result, Teton County experienced large COVID-19 spikes in July and again at the end of October and into November.

Unsurprisingly, workers got sick. In response, Teton County’s Health Officer, Travis Riddell, sent out a series of recommendations pressing citizens to not gather with groups outside of their immediate family, avoid crowded indoor spaces and not congregate at trail heads, parks or other outside spaces. Still, most businesses stayed open as patrons kept coming. Riddell noted that the town had little choice: “Economic disasters are public health disasters,” Riddell said in an interview in July 2020 to National Geographic. “We know that when there are economic downturns, where there is an increase in poverty, an increase in uninsured numbers—that has direct health effects.”

Once JHMR opened for skiing the weekend after Thanksgiving, it was clear that demand for outdoor recreation would carry into winter; even with almost no international travel, JHMR expects demand during the 2021 winter months to be comparable to past years, at least. “If we just opened up [completely], the mountain would be packed, because demand itself is through the roof,” says LaMotte, “but we’ve imposed a maximum daily capacity for the mountain, to keep guests and staff safe.”

On a bluebird day near Christmas, the resort was sold out. It had snowed almost 15 inches the day before, and cars inched into the packed parking lot. Skiers and snowboarders waited in line for the lot shuttle bus, which, despite operating at 25% capacity, still felt uncomfortably full. The restaurants and bars looking out onto the sunny mountain were similarly capped at 25% capacity, and while masks and social distancing were required, patrons waiting for tables escaped the cold by standing shoulder to shoulder in the foyer.

At the resort, the socially distanced lines for the gondola were dangerously compressing. A resort worker cheerfully reminded guests from every corner of the U.S. to keep their distance and their masks above their noses. “We’re going to make it all the way through the season, without closing” yelled the worker, to cheers from the crowds. The lines moved slow—normally eight people fit onto the gondola, but under the new policies there was no mixing between groups, so often times the gondola ascends with just one or two passengers. At the top of the mountain, with views of the valley floor against the backdrop of the jagged Tetons, everyone breathed a bit easier.

Rob Kingwill and Emilé Zynobia, professional snowboarders based out of Jackson, stepped off the gondola into the cold Wyoming air, about 4,000 feet above the valley floor. Both sported COVID-19 masks made by Kingwill’s apparel company, Avalon 7. “I feel like this is almost an essential service, to give people the opportunity to be outside, said Kingwill. “We need this for our mental health.” When JHMR shut down in March of 2020, Kingwill strapped his snowboard to his backpack and hiked up Teton Pass’s infamous 1,300-foot Glory Boot Pack—every day for 77 days until all the snow had melted. But, he points out, most recreational skiers don’t have the knowledge and skills to navigate such technical terrain—and without the money those tourists bring in, Jackson’s working class would suffer. “It seems like the benefits outweigh the costs of keeping the resort open,” agreed Zynobia, as she and Kingwill strapped onto their boards. “Even though this is an activity skewed towards to wealthier people, it is helping a remote economy, and it is getting people outside at a time when we feel caged in.”

By the middle of January, Teton County’s COVID-19 cases were skyrocketing. Teton County currently has the highest caseload per capita of any county in the state of Wyoming and the highly contagious U.K. variant of COVID-19 was found to be circulating in the area. While the state of Wyoming had loosened COVID-19 gathering restrictions, the county reissued a series of guidelines on Jan. 25 that kept indoor gatherings capped at 25% and limited outdoor gatherings to 250 guests. At the resort, group ski lessons have been replaced by private lessons (at no extra cost), and the gondolas and lifts are ascending the mountain with minimal group mixing. Still JHMR can only control what happens on the mountain; “My main concern is not skiing itself,” says Greenbaum. “But rather I’m concerned about peripheral activity to skiing that lead people indoors, whether it’s a bar, a restaurant, a hotel lobby, a rental shop, a bus.”

Across the nation cases are surging, and other Colorado mountain towns like Telluride and Crested Butte have had similar spikes, likely due to an influx of winter tourism. The infection rate in Pitkin County, Colo., home to the Aspen and Snowmass ski resorts, was skyrocketing in the middle of January, with an incidence rate of about 3,500 per 100,000 people. In response, the county’s health department shut down all indoor dinning operations, but left the ski resorts open. The results were promising: in the past two weeks the COVID-19 rates for Pitkin County dropped by over 50%. “We’re on pace to be below 700 [cases per 100,000 people] in early February and I don’t think any of us thought that would happen so quickly,” said Josh Vance, the county’s epidemiologist, in an interview with the Aspen Times. “I’ll be honest—I think not having indoor dining plays a role.”

In Teton County, restaurants and bars remain open for indoor operations long as they follow social distancing guidelines. The reliance on the ultra-rich creates an undeniable risk to the livelihood of Jackson residents and workers. In the early days of the pandemic, ski resorts across Europe became super spreaders, with visitors transporting the virus like carry-on luggage, threatening other tourists and locals alike. As a result, resorts have been closed this winter across much of Europe, including in France, Germany and Italy. These precautions protect remote mountain towns from an influx of the virus, but there are other, massive costs associated with closing down. Without government support, there is little option for communities like Jackson but to stay open, follow existing public health guidelines and hope for the best. “When the pandemic first started coming to work felt like entering the lion’s den,” said the restaurant worker from Jackson who wished to remain anonymous. “But by now we’re all used to the risk, and really what choice do we have?”

Health systems in a state of suspended animation

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https://mailchi.mp/2c6956b2ac0d/the-weekly-gist-january-29-2021?e=d1e747d2d8

Researchers have placed humans in suspended animation - YouTube

Hardly a week goes by without a health system leader telling us about an initiative that’s been “put on hold because of COVID”.

The range of things delayed by the pandemic is wide, from major facility expansions to incremental changes in organizational structure and operational processes. But in general, there’s a growing list of action items—many of them critical—that health systems have been putting off. Across last year we heard that many had plans to return to those items in early 2021, once the COVID situation eased. But of course, the past two months have been the busiest of the pandemic so far, and now the challenge of vaccine rollout has been layered on top of the day-to-day task of maintaining care delivery amid persistently high levels of COVID hospitalizations.

With a protracted, uneven immunization campaign, and worrisome variants on the rise, there may yet be another surge of cases and hospitalizations in the spring, which will cause systems to further delay important projects. That’s not all bad news—surely some will realize that what seemed urgent pre-COVID is no longer necessary.

We’ve already had a few leaders tell us that COVID has forced a rethink of capital plans, with facility expansions likely scaled back in favor of faster investment in digital care delivery. But it’s worth remembering that COVID didn’t just cause hospital systems to delay or cancel non-emergent surgeries and procedures (to the tune of $20B last year). It’s forced these large, complex businesses into a state of suspended animation, and likely set back a significant number of needed operational improvements. It’ll take some time to catch up when this is all over.

Washington health system rebuked for offering COVID-19 vaccines to ‘major donors’

Posted on by • Posted in Commitment, Communication, Conflicts of Interest, Core Values, Coronavirus, Coronavirus Mutation, Health System, Hospital, Hospital Industry, Intent, Leadership Commitment, Leadership Intent, Leadership Messaging, Messaging, Mission, Mistake, Vaccine, Vaccine Distribution • Leave a comment
https://www.beckershospitalreview.com/strategy/washington-health-system-rebuked-for-offering-covid-19-vaccines-to-major-donors.html?origin=CEOE&utm_source=CEOE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Overlake Hospital Medical Center (Bellevue, Wash.) | 100 hospitals and health systems with great orthopedic programs 2017

Overlake Medical Center & Clinics invited about 110 donors who gave more than $10,000 to the Bellevue, Wash.-based health system to receive COVID-19 vaccines, drawing criticism from the state’s governor, according to The Seattle Times. 

Molly Stearns, the chief development officer at Overlake, emailed the “major donors,” as they were addressed in correspondence, about 500 open appointments in its COVID-19 clinic that were set to open Jan. 23. According to The Seattle Times, donors who received the email got an access code to register for appointments. 

The vaccination appointments weren’t exclusive to donors, but were open to some 4,000 people who were board members, some patients, volunteers, employees and retired health providers, Overlake told the newspaper. All registrants were supposed to meet state-specific eligibility requirements for the vaccine, according to The Seattle Times.

Tom DeBord, Overlake’s COO, told the newspaper that the invitation was sent after the hospital’s scheduling system stopped working properly. To speed up distribution, the system began contacting people whose emails they had access to, which included donors, retirees, some patients and board members.

“We’re under pressure to vaccinate people who are eligible and increase capacity. In hindsight, we could certainly look back and say this wasn’t the best way to do it,” Mr. DeBord told The Seattle Times.

Once Gov. Jay Inslee’s office found out about the “invite-only” appointments, the office asked Overlake to shut down the sign-ups, which the system did.

In a Jan. 27 statement posted to the health system’s website, Overlake said all communications with people invited to sign up for the vaccine “made clear that people must show proof of eligibility under current Washington State requirements to ultimately be vaccinated, no matter who they are or how they are affiliated with us. We recognize we made a mistake by including a subset of our donors and by not adopting a broader outreach strategy to fill these appointments, and we apologize. Our intent and commitment has always been to administer every vaccine made available to us safely, appropriately, and efficiently.”

Read the full report here.

Citrus Health denies it’s violating compensation law; state says probe continues

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https://www.miamiherald.com/news/politics-government/state-politics/article248806165.html

Mario Jardon, president and CEO of the Hialeah-based Citrus Health Network, made $574,660, which the state says includes $360,840 in excess compensation. The state says the agency also paid excessive compensation to two other executives at the community-based mental health center, for a total of $403,000 in excessive compensation. The company denies it.

The child welfare agency that serves Miami-Dade and Monroe counties pushed back Wednesday against allegations made by the governor’s chief inspector general, denying claims that it used taxpayer funds to pad excessively high salaries of top executives.

In a statement, Citrus Health Network President and CEO Mario Jardon and Citrus Health Network Board of Directors Chair Patricia Croysdale said that the state did not check with them before issuing the preliminary report and Jardon’s salary, and that of chief operating officer Maria Alonso, “do not come from state funds allocated to Citrus as the lead agency, and are provided at no cost to the state.”

Citrus Health Network, a mental health nonprofit, won a half-billion dollar contract in 2019 from the state Department of Children & Families to oversee child welfare cases in Miami-Dade and Monroe. The arrangement is part of the state program that has privatized state services to a patchwork of “lead agencies.”

According to the preliminary findings by the governor’s Chief Inspector General Melinda Miguel, Citrus Health was one of nine agencies that appear to be paying their executives more than the amount allowed by state law.

Florida law prohibits a community-based care lead agency that receives state and federal funding to provide welfare services from paying its executives more than 150% of what the Department of Children and Families secretary makes — a threshold estimated at $213,820.

In response to the Citrus Health comments, Meredith Beatrice, spokesperson for Gov. Ron DeSantis, said that the intent of the report was to highlight agencies that “were either in non-compliance or appeared to have excessive compensation” and will be investigated further.

“Nothing within the document is conclusory or final,’’ she said.

PRELIMINARY FINDINGS

The report says Jardon made $574,660, which the state says includes $360,840 in excess compensation. The state also said Alonso, Jardon’s partner, made $42,379 over the maximum, and the company’s chief information officer, Renan Llanes, made $172 over the limit.

“The Governor’s Office of Inspector General chose to release a preliminary report incorrectly alleging inappropriate use of state funds and excessive executive compensation without first confirming the information in the report directly with Citrus, and without utilizing other publicly available fiscal documents related to our company,’’ the company’s statement said.

The Citrus Health contract began in July 2019, but the state report appears to have used compensation data from tax documents ending in June 2019.

Citrus also pointed to its web site, which has posted a document that shows a 2020-21 budget that includes compensation of $207,711 with “other compensation” of $20,498 for its director. The company said that refers to Esther Jacobo, the director of the Citrus Health Family Care Network, who formerly was the interim secretary at DCF.

A footnote then adds that “CEO and COO are provided at no cost to [Citrus Family Care Network] and DCF.”

“At the beginning of operations as the lead agency, Citrus’ Board of Directors resolved not to burden the budget of the lead agency with the salaries of the CEO and COO of Citrus Health Network,” said Citrus Health Network spokesperson Leslie M. Viega in a statement. “Our CEO and COO’s salaries do not come from any funds allocated to Citrus as the lead agency, regardless of the source, including state-appropriated funds, state-appropriated federal funds, or private funds.”

The company says the salaries are paid through another division, its federally qualified health center which provides behavioral health, primary care, housing for the homeless, and other social services. The Herald/Times asked Citrus Health for a copy of the financial documents that demonstrate this claim but the organization has not provided them.

A NEW CONTRACT

In 2019, Citrus Health won the child welfare contract from a rival non-profit, Our Kids, after a bruising yearlong fight plagued by allegations that the selection process was marred by the appearance of conflicts of interest. The contract gave the company, which had never handled child welfare before, the job of overseeing about 3,000 vulnerable children in the state’s most populous region.

The inspector general’s investigation is the result of an executive order by DeSantis in February 2020 after the Miami Herald reported and a House of Representatives investigation found that the Florida Coalition Against Domestic Violence paid its chief executive officer, Tiffany Carr, more than $7.5 million over three years.

Carr, who is now a party to two lawsuits, including an attempt by the state to claw back the compensation she was awarded, is currently engaged in negotiations with the attorney general’s office over a mediated settlement.

But it was Carr’s ability to use her network of influential legislators and lobbyists, coupled with the lack of oversight by the Department of Children and Families, that provoked legislators and the governor’s investigators to look into how other non-profits are compensating their executives.

Carr persuaded her board of directors, a close-knit group whom she hand-selected, to approve her compensation package that included thousands of hours of paid leave which she converted to cash.. She justified her salary and bonuses by using comparable salaries of similar organizations but she is alleged to have misrepresented the size of her organization to make the comparisons work to her advantage.

Investigators also suspect Carr avoided declaring millions of dollars in deferred compensation on her tax forms by using a loophole in the tax code.

The inspector general’s report does not name executives but a spreadsheet provided to the Herald/Times from the governor’s office indicates the amounts of compensation by title. The Herald/Times used publicly available tax data to identify the individuals under investigation.

The governor’s office said the next phase of the investigation will be to meet with the nine community-based care organizations early next week “to explain the process” before the final report is completed by June 30.

“It is important to note that the entities impacted from this review will have an opportunity in late May to offer a written response to the draft of the final report,’’ Beatrice said. “Their responses will be included as an attachment to the final report presented to the governor.”

Baylor Scott & White to cut, outsource 1,700 jobs

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https://www.beckershospitalreview.com/finance/baylor-scott-white-to-cut-outsource-1-700-jobs.html?origin=CEOE&utm_source=CEOE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Baylor Scott & White Health To Outsource, Eliminate 1,700 Positions – CBS Dallas / Fort Worth

Dallas-based Baylor Scott & White Health will outsource, lay off or retrain 1,700 employees who work in information technology, billing, revenue cycle management and other support services, according to The Dallas Morning News. 

The health system said outsourcing the finance and IT jobs and other support services will help it improve efficiencies and focus on reducing costs in noncore business areas.

About two-thirds of the 1,700 employees will be joining third-party RCM, IT, billing or support staff vendors. About 600 to 650 positions will be eliminated. 

Baylor Scott & White said that employees whose positions are being eliminated will be invited to participate in retraining programs. 

The retraining program would allow the employees to remain employed at the health system and receive the same pay or higher, depending on their role, according to the report. Some of the retraining programs that will be available are learning to become a certified medical assistant or learning a job in patient support services.

“In no case — in no case — is anyone going to miss a paycheck,” Baylor Scott & White CEO Jim Hinton, told The Dallas Morning News. “We can afford to make these commitments, and we want to do the right thing for the great employees of Baylor, Scott & White. They’ve really done everything we’ve asked and more during this last year.”

This is the third time Baylor Scott & White has announced cost-cutting initiatives related to its workforce since the pandemic began. Last May, 930 Baylor Scott & White employees were laid off, and in December the health system said it would lay off employees and outsource 102 corporate finance jobs. 

Mr. Hinton said that Baylor Scott & White has 2,000 clinical positions open, and it is investing in a new regional medical school campus and a joint venture to improve care for the underinsured. 

“This is a transition to a new business model, a transition to a new way of working,” Mr. Hinton told The Dallas Morning News. 

Teachers want the vaccine, but they’ll have to wait

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https://www.axios.com/teachers-want-to-get-vaccinated-covid-51b9016e-1f2d-4e67-adc1-4928b1fc06bc.html

Some teachers don’t want to return to the classroom until they’ve been vaccinated — setting up potential clashes with state and local governments pushing to reopen schools.

Why it matters: Extended virtual learning is taking a toll on kids, and the Biden administration is pushing to get them back in the classroom quickly. But that will only be feasible if teachers are on board.

Where it stands: Although the rise of new, more contagious variants has scrambled the calculus on school reopening, for now the expert consensus is that vaccinations aren’t essential to safely reopening schools.

  • A pair of studies from the CDC this week reiterated the agency’s stance that schools can operate safely with the proper precautions, along with other mitigation measures in the broader community.
  • Most states haven’t put teachers at the front of the line for vaccines. Only 18 have included teachers in the early priority groups that can get vaccinated now, and in all but four of those states, teachers are competing for shots with other higher-risk populations, including the elderly.

Yes, but: Teachers in some large school districts don’t want to return to the classroom without being vaccinated — which could mean several more months of virtual classes.

  • The Chicago teachers union has asked to delay reopening until teachers receive at least the first dose of the vaccine, but the city’s public health commissioner has said it could take months for teachers to be vaccinated, the Chicago Tribune reports.
  • “If you are required to work with students in person — which thousands of educators have been doing for months now — you should be vaccinated as soon as possible,” Jessica Tang, president of the Boston Teachers Union, said in statement after teachers were bumped behind the elderly in the state’s priority line, per Boston.com.

What they’re saying: “The issue is that we should be aligning vaccination with school opening. That doesn’t mean every single teacher has to be vaccinated before you open one school, it means there has to be that alignment,” Randi Weingarten, the president of the American Federation of Teachers, told ABC News.

  • Teachers should be eligible for vaccination by “late January,” she wrote in a USA Today op-ed over the weekend.

The other side: Ohio Gov. Mike DeWine has said school staff will be prioritized for vaccination, with the goal of having students return to classrooms by March 1.

  • But prioritizing teachers can be controversial. Oregon Gov. Kate Brown has been criticized for the decision to vaccinate teachers ahead of the elderly, high-risk essential workers and other vulnerable communities.
  • In a rural county in Georgia and at a private school in Philadelphia, teacher vaccine clinics were shut down by their state health departments, which said that educators were not yet eligible.

The bottom line: “It’s challenging to make those decisions about how to prioritize different populations, all of whom are at significant risk,” the Kaiser Family Foundation’s Jennifer Tolbert said.

Go deeper: Schools face an uphill battle to reopen during the pandemic

Taking executive action to bolster the Affordable Care Act

Posted on by • Posted in Abortion, ACA, Essential Health Benefits, Executive Orders, Family Planning, Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Expansion, Medicaid Work Requirements, Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans • Leave a comment

https://mailchi.mp/2c6956b2ac0d/the-weekly-gist-january-29-2021?e=d1e747d2d8

Thursday was healthcare day at the Biden White House, the latest in a series of themed days during which the President has issued executive orders on topics ranging from COVID response to climate change to racial equity.

Facing a closely divided Congress, the new administration has focused so far on actions it can take unilaterally to advance its agenda, and as President Biden described it at a signing ceremony yesterday, his healthcare agenda is centered on “restoring the Affordable Care Act and restoring Medicaid to the way it was” prior to the Trump administration.

The new executive order reopens the HealthCare.gov insurance marketplace for a “special enrollment period”, lasting from mid-February to mid-May, allowing approximately 15M uninsured Americans in 36 states (including 3M who lost employer-based insurance due to COVID) to sign up for coverage, many subsidized by the federal government.

The order also instructs agencies to review many of the regulatory changes made by the Trump administration, including loosening restrictions on short-term insurance plans, and allowing states to use waivers to implement Medicaid work requirements. (Also included in Thursday’s action was a measure to immediately rescind the ban on taxpayer funding for abortion-related counseling by international nonprofits, the so-called “Mexico City rule”.)

Actually unwinding those Trump-era changes will take months (or possibly years) of regulatory work to accomplish, but Biden’s executive order puts that work in motion. Attention now turns to Congress, which the Biden team hopes will provide funding for increased subsidies for coverage on the Obamacare exchanges, along with allocating money for the administration’s aggressive COVID response plan. 

Yesterday’s executive order is best understood as the starting gun for the lengthy legislative and regulatory process that lies ahead, as the Biden administration tries to bolster the 2010 health reform law, and stamp its mark on American healthcare.

Payers double down on lucrative MA market

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https://mailchi.mp/2c6956b2ac0d/the-weekly-gist-january-29-2021?e=d1e747d2d8

As the oft-cited 10,000 Baby Boomers continue to age into Medicare each day, Medicare Advantage (MA) enrollment keeps accelerating. The graphic above highlights growth in the MA ranks across the last decade, showing that enrollment has more than doubled since 2010. By the end of this year, an estimated 42 percent of Medicare beneficiaries will get their benefits through a private health insurer. 

While seniors like MA plans for the growing number of supplemental benefits they can offer—which now include adult day care services, home-based palliative care, and in-home support services—health insurers are gravitating to these plans due to their attractive economics. 

Health insurers’ average gross margin per member, per month (PMPM) for MA plans is significantly higher than in individual or group market plans, a spread that increased in 2020 due to reduced utilization. PMPM margins for MA plans were up an average of 35 percent through September 2020 compared to 2019.

Payers have been blanketing the market with plan options in recent years; the number of MA plans offered has increased 49 percent since 2017, although the MA market is increasingly concentrated. In spite of numerous headlines about venture-backed startups like Oscar, Bright Health Plan, and Devoted Health posting double- or triple-digit growth numbers, the MA market is still dominated by UnitedHealthcare and Humana, which together account for 44 percent of all MA enrollees nationwide.

Health Care Unions Find a Voice in the Pandemic

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Faced with the urgent need to protect nurses and other frontline workers, labor organizations are pushing hospitals to do more.

The unions representing the nation’s health care workers have emerged as increasingly powerful voices during the still-raging pandemic.

With more than 100,000 Americans hospitalized and many among their ranks infected, nurses and other health workers remain in a precarious frontline against the coronavirus and have turned again and again to unions for help.

“It’s so overwhelming. It’s unlike anything I’ve ever seen before,” said Erin McIntosh, a nurse at Riverside Community Hospital in Southern California, a part of the country that has been among the hardest hit by a surge in cases. “Every day I’m waist-deep in death and dying.”

In her hospital’s intensive care unit, Mrs. McIntosh said, nurses have sometimes cared for twice as many patients. “We’re being told to take on more than we safely can handle.”

Her union, the Service Employees International Union, and another union, National Nurses United, which has a powerful presence in California, have pushed back against the state’s decision to let hospitals assign nurses more patients during the crisis.

HCA Healthcare, the for-profit hospital chain that owns Riverside, responded that it had recruited additional nurses and was keeping its employees safe.

Health care workers say they have been bitterly disappointed by their employers’ and government agencies’ response to the pandemic. Dire staff shortages, inadequate and persistent supplies of protective equipment, limited testing for the virus and pressure to work even if they might be sick have left many workers turning to the unions as their only ally. The virus has claimed the lives of more than 3,300 health care workers nationwide, according to one count.

A patient arrived in March at the University of Illinois Hospital in Chicago.

“We wouldn’t be alive today if we didn’t have the union,” said Elizabeth Lalasz, a Chicago public hospital nurse and steward for National Nurses United. The country’s largest union of registered nurses, representing more than 170,000 nationwide, National Nurses was among the first to criticize hospitals’ lack of preparation and call for more protective equipment, like N95 masks.

Despite the decades-long decline in the labor movement and the small numbers of unionized nurses, labor officials have seized on the pandemic fallout to organize new chapters and pursue contract talks for better conditions and benefits. National Nurses organized seven new bargaining units last year, compared to four in 2019. The S.E.I.U. also says it has seen an uptick in interest.

Nurses across the country from various unions have participated in dozens of strikes and protests. National Nurses held a “day of action” on Wednesday with demonstrations in more than a dozen states and Washington, D.C., as it starts negotiations at hospitals owned by big systems like HCA, Sutter Health and CommonSpirit Health.

Hospitals claim the unions are playing politics during a public health emergency and say they have no choice but to ask more of their workers. “We are in a moment of crisis that we’ve never seen before, and we need flexibility to care for patients,” said Jan Emerson-Shea, a spokeswoman for the California Hospital Association.

At the University of Illinois Hospital in Chicago, the deaths of two nurses from the virus helped galvanize employees to strike for the first time last fall, said Paul Pater, an emergency room nurse and union official with the Illinois Nurses Association. “People really took that to heart, and it really fomented a lot of disdain for the current administration at the hospital.”

In their most recent contract, nurses there won provisions ensuring the hospital would hire more staff and keep sufficient supplies of protective equipment, Mr. Pater said. “We’ve been able to make, honestly, just huge strides in protecting our people.”

The hospital did not respond to requests for comment.

A yard sign in Asheville, N.C., supporting Mission Hospital’s nurses, who voted to unionize last September.

Some nurses remain highly skeptical of the unions’ efforts, and even those who favor organizing acknowledge there are serious limits to what they can accomplish. “I’m not sure that the union is enough, because it can only take us so far” since staffing conditions remain overwhelming, said Mrs. McIntosh, the Riverside nurse.

Many health care workers view vaccines as the beginning of the end of the pandemic. But large numbers — especially those who work in nursing homes and outside hospitals, who tend to have higher rates of vaccine hesitancy — are refusing to be immunized. During a crisis that disproportionately threatens health care workers of color, one recent analysis found that they are getting vaccinations at rates far below those of their white colleagues.

The unions find themselves treading a fine line between encouraging their members to get vaccinated and protecting them against policies that would force them to do so.

“There are still unanswered questions,” said Karine Raymond, a nurse at Montefiore Medical Center in the Bronx and a New York State Nurses Association official. “The union believes that all nurses should seriously consider being vaccinated,” said Ms. Raymond, who would not say whether she personally would accept the vaccine. “But, again, it’s the individual’s choice.”

The nurses and their unions do want to keep pressuring employers to safeguard workers and patients. “Just because a vaccine is rolling out doesn’t mean that we can let up on other important protections,” said Michelle Mahon, a National Nurses United official, during a Facebook Live event last month.

The past year has created conditions ripe for organizing to address longstanding issues like inadequate wages, benefits and staffing, a problem exacerbated by health care workers falling ill, burning out or retiring early for fear of getting sick. The unions “have successfully been able to use the pandemic to rebrand those same conflicts as very urgent safety concerns,” said Jennifer Stewart, a senior vice president at Gist Healthcare, a consulting firm that advises hospitals.

They have also shifted many nurses’ view of their employers, she said. “The perceptions and the experiences are being crystallized and starting to be viewed through a certain lens. And I think that lens is very favorable to unions.”

At Mission Hospital in Asheville, N.C., safety concerns created by the pandemic added urgency to the nurses’ push to join forces with National Nurses United.

Some questioned the union’s ability to deliver better working conditions and raised concerns about the union creating divisions within the hospital. A group of 25 Mission nurses signed a letter before the vote saying “an outside third party, like the N.N.U., is not the solution.”

But last September, 70 percent of nurses approved the union, one of the largest wins at a hospital in the South in decades. Susan Fischer, a Mission nurse who helped lead the organizing drive, called National Nurses United “instrumental in helping us find our voice.”

She said the union was already proving its worth, pushing management in bargaining talks this month to provide better access to protective equipment and to assign nurses fewer patients.

In a statement, HCA, which owns Mission Hospital, said its highest priority was to protect workers and that the unions were “exploiting the situation in an attempt to gain publicity and organize new dues-paying members.”

In addition to staging protests and strikes, unions have defended workers who are speaking up against their employers. Some unions have sued hospitals, including one lawsuit against Riverside by the S.E.I.U. Similar cases have been dismissed in court, and HCA called the Riverside suit a publicity stunt.

Industry executives say the unions are unfairly blaming hospitals for the horrors of the pandemic. While some had difficulty providing protective equipment early on, hospitals have done their best to follow government guidelines and to protect workers, said Chip Kahn, the president of the Federation of American Hospitals, which represents for-profit hospitals.

Mr. Kahn said the unions were leveraging the crisis to achieve their agenda of organizing workers. “They’ll push whatever pressure points they can to try to force their way into hospitals, because that’s what they do.”

Nurses protesting outside Good Samaritan Hospital in San Jose.Credit…

About 17 percent of nurses and 12 percent of other U.S. health care workers are covered by a union, according to an analysis of government data, and rates of union coverage have remained largely unchanged during the pandemic. The share of hospital workers with union representation has declined from above 22 percent in 1983 to below 15 percent in 2018, reflecting a decades-long decline in organized labor.

Some unions, including the outspoken National Nurses, have often seemed to occupy the fringes of the labor movement. For years it was better known for advocating proposals like Medicare for All, which would replace private insurance with government-run health care, and for enthusiastically backing Senator Bernie Sanders of Vermont for president.

The pandemic, and the union’s decision to endorse Joseph R. Biden Jr. after Senator Sanders left the race last year, have tempered that reputation. Mission nurses said that politics was not part of the allure of National Nurses United. “Of all the unions we could’ve gone to, they had the best track record,” Ms. Fischer said.

The Biden presidency may give the unions an opportunity to flex their newfound muscle. Mary Kay Henry, the international president of the S.E.I.U., was among the labor leaders who met virtually with Mr. Biden last year.

“In my 40 years of organizing health care workers, I have never experienced a time when people are more willing to take risks and join together to take collective action,” Ms. Henry said. “That’s a sea change.”