Category Archives: 2020 Election Issues

6 months in: Following the flow of CARES hospital funding

Posted on by • Posted in 2020 Election Issues, Compliance, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Financial Pressure, Financial Transparency, Financial Viability, Financially Distressed, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, The CARES Act • Leave a comment

https://www.healthcaredive.com/news/6-months-cares-hospital-funding-covid/581506/

Congress has allocated $175 billion to help providers respond to the COVID-19 crisis, but HHS has been hit with multiple complaints about distribution as that money goes out the door.

The COVID-19 pandemic created massive upheaval for the nation’s healthcare system still evident six months after the U.S. declared it a national public health crisis.

The virus continues to surge, reaching new heights with more than 4 million confirmed cases and more than 143,000 deaths. No other country has experienced more deaths or cases than the U.S., data with Johns Hopkins Coronavirus Research Center show.

Parts of the country are facing the prospect of another lockdown as cases overwhelm healthcare facilities.

Forced into quickly responding to the pandemic, health systems have taken substantial financial hits. While the impact has been far from even, one estimate from the American Hospital Association estimates the nation’s health systems’ financial losses in the first four months of the outbreak reached nearly $203 billion.

To help staunch the free fall, Congress earmarked $175 billion in two pieces of legislation in an attempt to keep providers afloat as the virus wreaked havoc on the economy. The majority of that was from the Coronavirus Aid, Relief, and Economic Security Act passed in late March.

Yet, about 65% of the money has yet to go out to providers, with just $61 billion delivered and attested to by providers by mid-July, a senior HHS official told Healthcare Dive.

Still, with no end in sight for the pandemic, at least on U.S. shores, providers are ramping up lobbying in an effort to secure more funding as case counts soar. AHA is asking for another $100 billion in the next round of congressional relief now under discussion.

Many healthcare providers stopped profitable elective procedures as stay-at-home orders blanketed parts of the country to contain the spread of the disease. This also allowed providers to conserve much needed resources such as personal protective equipment that proved hard to procure amid the crisis.

But revenue quickly plummeted as providers delayed care in preparing for a surge of COVID-19 patients.

“The funding hospitals and health systems have received to date, while helpful, is just a small fraction of what we estimate they will lose this year,” Lisa Kidder Hrobsky, group vice president of federal relations for AHA, told Healthcare Dive in a statement.

Where did the money go?

So far, HHS has outlined a spending plan for $125 billion of the $175 billion in provider relief funds.

The program has been met with an array of criticism, including whether the distribution of funds went to those most in need and whether the fine print has deterred providers from taking a piece of the massive financial package.

https://www.datawrapper.de/_/7PvZ4/

In response to those critiques, HHS has sent out additional federal funding in more targeted waves since April.

The first tranche of money — $30 billion in April — was designed to get out the door quickly, as providers were struggling. From there, HHS has attempted to pinpoint the money to certain providers and geographic areas to appease the needs of various providers.

To even out distribution, HHS began sending targeted funding, such as to hospitals overrun with COVID-19 patients, mainly in New York and other hard hit areas. The agency also funneled money to rural providers and skilled-nursing facilities, among others.

After HHS was met with the argument that wealthier hospitals, or those that had larger shares of privately-insured patients, received more funding, it allocated money for those taking care of the neediest.

At the same time, as the agency doles out the rest of the $175 billion, it has promised to reimburse providers for uninsured COVID-19 patients. That has raised questions about whether HHS will have enough for uninsured care and additional tranches.  

However, a senior HHS official said it has only paid out $340 million to providers for uninsured COVID-19 patients, less than what they had expected. So low, that HHS has been trying to encourage providers to apply for such funding.

Timeline of HHS funding

  • AprilHHS​ released $30 billion from the first tranche of money based on a provider’s 2018 Medicare fee-for-service revenue. By the end of April, an additional $20 billion from general distribution was released, for a total of $50 billion.
  • MayMore than $26 billion was sent to rural, skilled-nursing facilities and those hit hard by the virus.
  • JuneHHS released an additional $25 billion earmarked for safety-net providers and those that cater to large populations of Medicaid patients.
  • JulyHHS​ said it would release another $4 billion for safety-net providers and certain specialty rural providers missed in earlier rounds, along with another $10 billion for those in hot spots.

Fears eased over fine print

Some providers declined or returned funding they had received, worried about the fine print or the terms and conditions, like how to appropriately spend the money.

However, HHS has relaxed some of those conditions, easing the fears of some.

For a lot of providers, it was a sigh of relief, causing many to say, “‘Great, we can feel comfortable participating in this program’,” Tim Fry, an attorney with McGuireWoods, told Healthcare Dive.

In particular, HHS recently said that if at the end of this pandemic, providers didn’t use all of the funding for lost revenue or healthcare related expenses, there will be a process to return the money. Initially, providers expressed concern that it was an all-or-nothing program.

Plus, HHS provided clarity on how the money can be used, stipulating that the funds go to healthcare-related expenses or lost revenue attributable to the coronavirus. HHS has provided more guidance and examples of appropriate uses, a relief to many, Fry said.

Earlier, health systems were overwhelmed by the administrative burden and fearful over how to appropriately spend the money without running afoul of new rules.

“We are not infinitely flexible around those requirements, but when we hear from providers of issues that they’re having — and we think we can be reasonably [accommodating], we try to be,” a senior HHS official said.

 

 

 

 

Cartoon – All Lives Matter

Posted on by • Posted in 2020 Election Issues, Cartoon, Coronavirus, Free Speech, Freedom, Freedom of the Press, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Protest, Public Debate, Public Good, Public Health, Public Safety, Quarantine, Racism, Social Distancing • Leave a comment

Cartoons: U.S. 'underestimated' COVID-19 spread; Disney reopens

Cartoon – The 2nd Wave

Posted on by • Posted in 2020 Election Issues, Cartoon, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

Editorial cartoon for April 23, 2020 - Winnipeg Free Press

Every sport has a coronavirus plan. MLB’s lasted four days.

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Denial, Economic Crisis, Economic Recovery, Economy Reopening, Employee Protections, Epidemic, False Hope, Fear, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Wishful Thinking, Worker Protection, Worker Rights • Leave a comment

https://www.washingtonpost.com/sports/2020/07/27/every-sport-has-coronavirus-plan-mlbs-lasted-four-days/

Cancel the MLB year, maybe by the end of this week.

Forget about the NFL season; it’s never going to happen.

The idea of attempting a college football season — putting amateur athletes at risk — is obscenely unthinkable.

Within days or a couple of weeks, we also may find out just how feasible it is for the NBA, in its Florida bubble, or the NHL, playing in two hub cities in Canada, to finish truncated seasons and crown champions.

Sure, none of that is certain, but Monday morning’s news that at least 14 members of the Miami Marlins and their staff have tested positive for the novel coronavirus in recent days was a Category 5 covid-19 hurricane alert. You couldn’t have a worse MLB start or a grimmer predictor for other games.

With lots of inherent social distancing, baseball was supposed to be the easiest major American team sport to resume, just as leagues in Japan and South Korea have functioned smoothly for months. But MLB couldn’t go even a week without the serious prospect that its 60-game season should be canceled.

“Hey, I’m going to be honest with you: I’m scared. I really am,” said Washington Nationals Manager Dave Martinez, 55, who has a heart condition.

Why is MLB creating a situation where Dusty Baker, 71, the survivor of multiple life-threatening conditions in the past 15 years, manages Houston every day while Texas is a national coronavirus hot spot?

Martinez added that before long his team may see more players “opt out,” as Ryan Zimmerman and Joe Ross already have. Once the defections start, the cascade won’t stop until the sport must call a halt.

“Now we REALLY get to see if MLB is going to put players health first,” tweeted Los Angeles Dodgers left-hander David Price, who passed on $11.8 million by opting out of this partial season. “Remember when [Commissioner Rob] Manfred said players health was PARAMOUNT?! Part of the reason I’m at home right now is because players health wasn’t being put first. I can see that hasn’t changed.”

Underneath all the discussions and elaborate plans to reopen various sports — MLB, the NBA and NHL now, and the NFL and college football by the end of next month — has been one naive assumption: If the virus hit a team, it would infect one or two players. Maybe three. But the sense was things still would be manageable. You could still field a team.

When did this become the highest of all human goals?

The danger and the damage would not be “too bad.” In this, we see Americans’ national tendency toward willful pandemic ignorance being played out on a small, crystal-clear stage so everyone can get the message.

For months, we have watched healthy people, mostly young, swarm into bars or hit the beaches with an apparent sense that community spread was a fiction or not something that applied to them. Maybe, the fantasy went, one person in the wrong bar would get the virus.

Now we learn differently. Now we see the truth.

Over a dozen Marlins and counting.

The immediate consequences of the Marlins’ outbreak were the postponements of their home opener against the Baltimore Orioles and the Philadelphia Phillies’ home game against the New York Yankees, who would have been occupying the clubhouse those Marlins just showered and dressed in Sunday.

The wider effect: Back to normal, or even semi-normal, in sports was shattered just days after being reintroduced.

What does this mean?

Some events have ambiguous consequences. We won’t know their impact for some time. But in rare cases, one event may have enormous impact, just as the positive virus test for the NBA’s Rudy Gobert in mid-March resulted in the shutdown of every major sport within 48 hours.

This is such a moment — but perhaps bigger.

Why are we here? The answer is simple yet inexplicably unacknowledged in wide swaths of this country: The pandemic is not under control until you stop it, suppress it, dominate it and crush the curve.

Though many other countries have done it, America has not come within a million miles of that outcome.

As I pointed out in a column last week, when a league says, Given what we are seeing with covid-19 hitting our teams, maybe we should cancel the season, the correct response is “get rid of the word ‘maybe.’ ”

The entire American experience of this pandemic has been: Don’t embolden the virus by acknowledging its threat. Try to outrun it, hide from it, say it’s not so bad and will go away.

That just breeds a disaster, and now that disaster has hit MLB just days into its season. The Cincinnati Reds also have multiple positive tests. The Atlanta Braves have been without two catchers who have symptoms, though no positive tests. Nationals star Juan Soto is inactive after a positive test.

Do we need a longer list?

You can’t be much healthier, as a group, than a pro baseball team. You can’t be much better protected or tested more often than an MLB team. The Marlins are close to the safest possible case. And now, less than a week into their season, at least half of the team has the coronavirus!

That is what is meant by “community spread.” That is what is meant by an “outbreak” in an epidemic. All of us have worried that one or two players — or people in the MLB community — would have bad outcomes from the virus if a 60-game season was played. Time to blow up that assumption. If half of the Marlins team can test positive within a few days, then the scale of danger to health — the number of people who may get sick and the severity of the damage they may suffer, including prime-of-life pro athletes — just shot through the ceiling.

Our assumptions, while well-intentioned, have been blown to pieces. And in short order, so will the season of one, or perhaps several, of our sports.

The Marlins are just the latest — but one of the most vivid — illustrations of what America is facing. And how little we are willing to take seriously the true measure of our fearsome enemy.

 

 

 

 

Employers Require COVID Liability Waivers as Conflict Mounts Over Workplace Safety

Posted on by • Posted in 2020 Election Issues, Coronavirus, Coronavirus Liability, Employee Protections, Infection Control, Infection Control Plan, Infectious Virus, Liability, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, School Reopening, Uncategorized, Worker Protection, Worker Rights • Leave a comment

https://khn.org/news/employers-require-covid-liability-waivers-as-conflict-mounts-over-workplace-safety/

After spending a May day preparing her classroom to reopen for preschoolers, Ana Aguilar was informed that the tots would not have to wear face masks when they came back. What’s more, she had to sign a form agreeing not to sue the school if she caught COVID-19 or suffered any injury from it while working there.

Other teachers signed the form distributed by the Montessori Schools of Irvine, but Aguilar said she felt uncomfortable, although it stipulated that staff members would be masked. At 23, she has a compromised immune system and was also worried that she could pass the coronavirus on to her fiancé and other family members.

Aguilar refused to sign, and a week later she was fired. “They said it was my choice to sign the paper, but it wasn’t really my choice,” said Aguilar, who’s currently jobless and receiving $276 a week in unemployment benefits. “I felt so bullied.”

As employers in California and across the country ask employees to return to the workplace, many have considered and some are requiring employees to sign similar waivers, employment lawyers say. And many employees, mostly lower-wage and minority workers in essential jobs, are calling lawyers to complain about the waivers.

“These are illegal agreements that are totally unfair to workers,” said Christian Schreiber, a San Francisco lawyer who represents Aguilar and other employees.

The California State Legislature last year passed a law, AB-51, prohibiting employers from requiring employees or job applicants to sign away their right to pursue legal claims or benefits under state law. The law, which also prohibits firing any employee for refusing to sign, is being challenged in court by business groups.

Only a few employers have forced employees to sign liability waivers, at least partly because these waivers likely would be held unenforceable by courts, lawyers who represent employers say.

“Courts don’t recognize them because of the unequal bargaining power between employers and employees,” said Isaac Mamaysky, a partner at the Potomac Law Group in New York City. “With so many unemployed, people would sign just about anything to get a job.”

Another reason they are considered unenforceable: Workers who get sick or injured on the job generally are compensated through state workers’ compensation systems rather than through the courts, and state laws don’t allow employers to force employees to sign away their right to pursue workers’ comp claims, Mamaysky said.

Companies may have the right to require nonemployees working on their premises to sign COVID waivers. When the New York Stock Exchange reopened in late May, it made floor traders sign a form clearing the exchange of liability if they contracted COVID-19. That was legally permissible because the traders were not exchange employees, an NYSE spokesman said. He declined to say whether any traders have become infected with the virus.

The Las Vegas-based restaurant chain Nacho Daddy, which did require employees to surrender their right to sue over COVID-19, reportedly fired some who refused. Following negative media coverage, Nacho Daddy removed the language that waived legal rights and instead had employees agree to follow safety rules such as masking and social distancing. The company did not respond to a request for comment.

Having employees agree to comply with safety rules is a more common and legally acceptable approach than waivers.

“I suggest my clients go to this reasonable middle ground: Here’s what we promise to you, here’s what we want you to promise to us,” said David Barron, an employment lawyer with Cozen O’Connor in Houston.

Business groups hope Senate Majority Leader Mitch McConnell will make liability waivers unnecessary. He has proposed a Senate bill with broad liability protection for employers for five years against a range of coronavirus-related claims, and says he won’t back any COVID relief bill that doesn’t include such protections. President Donald Trump has said he supports the liability protection.

At least 10 states already have enacted laws providing some form of immunity for businesses from lawsuits brought by employees and others who contract COVID-19. Similar bills are pending in about 10 more states, according to the National Employment Law Project. The California Assembly is considering a liability protection bill for public K-12 schools.

Federal legislation to provide COVID liability relief for employers should protect only those that follow applicable health and safety guidelines, said John Abegg, executive vice president of the U.S. Chamber Institute for Legal Reform, which supports McConnell’s proposal.

But even if McConnell is able to overcome Democratic opposition and pass liability protection as part of a new pandemic economic relief bill, that still wouldn’t shield employers from lawsuits claiming gross negligence or reckless or intentional conduct in failing to implement COVID-19 safety precautions.

Across the country, hospitals and nursing homes, as well as companies like McDonald’s, Walmart and Safeway, have been hit with wrongful death lawsuits filed by families of employees who died from the virus. They typically cite egregious conduct that goes beyond ordinary negligence, potentially erasing any statutory liability relief.

Nearly 50 COVID-related lawsuits have been filed relating to conditions of employment, including exposure to the coronavirus or the lack of protective equipment, according to data collected by the law firm Hunton Andrews Kurth.

In many states, alleging intentional misconduct also may allow workers harmed by COVID-19, and their families, to file lawsuits rather than go through the workers’ compensation system, and thus seek bigger damage awards.

For instance, a suit filed in Alameda County Superior Court in June by the widow of a longtime employee of Safeway’s distribution center in Tracy, California, alleged that the company had concealed a COVID-19 outbreak from workers and informed them that personal protective equipment was not recommended, contrary to guidelines from federal and state authorities.

“I don’t know of any jurisdiction that would allow a waiver against intentional misconduct,” said Louis DiLorenzo, head of the labor and employment practice for Bond Schoeneck & King in New York, who represents employers. “That would encourage misconduct.”

Worker advocates argue that lawsuits like the one against Safeway should be encouraged — rather than blocked by waivers or immunity laws — to bring to light serious public safety problems. Cases against McDonald’s in Oakland and Chicago — in which workers claimed the restaurants had created a “public nuisance” by not taking steps to adequately protect workers and customers from COVID-19 — resulted in court orders in late June for those McDonald’s restaurants to implement safety measures such as masks, social distancing and temperature checks.

“A very tiny number of cases are being filed by workers, and those cases are valuable,” said Hugh Baran, a staff lawyer at the National Employment Law Project. “These are the kinds of claims we should want workers to bring.”

Schreiber said he contacted the Montessori school about Aguilar’s firing, and it offered to reinstate her without having her sign the waiver. But Aguilar declined, saying the school was putting teachers at risk by not requiring pupils to wear masks. The school then offered her six weeks of severance pay, which she is considering.

By refusing to sign the waiver or accept her job back, she said, she was standing up for all the teachers at the school, many of whom have children and can’t afford to lose their job.

“I liked my job and I needed the paycheck,” Aguilar said. “But making you sign these papers is telling you that whatever happens, they really don’t care.”

 

 

 

The COVID-19 Downturn Triggers Jump in Medicaid Enrollment

Posted on by • Posted in 2020 Election Issues, ACA, Center for Medicare and Medicaid Services (CMS), Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Job, Job Loss, Job Market, Medicaid, Medicaid Expansion, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://khn.org/news/the-covid-19-downturn-triggers-jump-in-medicaid-enrollment/

Reversing a three-year decline, the number of people covered by Medicaid nationwide rose markedly this spring as the impact of the recession caused by the outbreak of COVID-19 began to take hold.

Yet, the growth in participation in the state-federal health insurance program for low-income people was less than many analysts predicted. One possible factor tempering enrollment: People with concerns about catching the coronavirus avoided seeking care and figured they didn’t need the coverage.

Program sign-ups are widely expected to accelerate through the summer, reflecting the higher number of unemployed. As people lose their jobs, many often are left without workplace coverage or the money to buy insurance on their own.

Medicaid enrollment was 72.3 million in April, up from 71.5 million in March and 71 million in February, according to the latest enrollment figures released last week by the Centers for Medicare & Medicaid Services. The increase in March was the first enrollment uptick since March 2017.

About half of the people enrolled in Medicaid are children.

The increases varied widely around the country. Kentucky had the largest jump at nearly 7% from March to April. In addition, enrollment rose to 1.4 million in April from 1.2 million in February, according to the CMS data. That has continued, and today it’s up to 1.5 million, state officials said in an interview.

Kentucky has an aggressive outreach strategy using email or phone calls to contact thousands of residents who applied for state unemployment insurance, designed to make sure they know about Medicaid. “It’s been very effective, and in the past few weeks we’ve been enrolling 8,000 to 10,000 people a week,” said Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services, which oversees Medicaid.

The Bluegrass State has also made enrollment easier by developing a one-page online form instead of having people fill out a 20-page application, he added.

“This is the right thing to do to help people get signed up for health care coverage and it supports the health industry in our state,” Friedlander said. “The health industry would collapse without Medicaid.”

Joan Alker, executive director of the Center for Children and Families at Georgetown University in Washington, D.C., said she expects Medicaid enrollment to keep rising this summer. “Given that there are no signs that the virus is coming under control anytime soon, job losses will become more permanent, and more folks will become eligible for Medicaid over time,” she said.

One reason Medicaid numbers have not grown faster, she suggested, is because people have more immediate needs than securing health coverage, especially if they are feeling well.

Many people are worried about getting unemployment insurance or getting evicted from their home, she noted. “That’s combined with the fact that many people are reluctant to go to their doctor because of safety concerns,” she said. “And, as a consequence, applying for Medicaid may not be at the top of their list.”

Chris Pope, a senior fellow at the Manhattan Institute for Policy Research, a conservative think tank, said the slower-than-expected growth in Medicaid could signal that people who were laid off had coverage through a spouse or a parent.

In addition, he said, “many jobs that went away did not offer health insurance,” citing millions of service-sector positions in industries such as hotels and restaurants that have been lost.

Beyond the surge in unemployment, Medicaid rolls have risen because states cannot discontinue coverage to people enrolled as of March 18, 2020, as a condition of receiving higher federal Medicaid funding included in a coronavirus relief package passed by Congress.

Medicaid is a countercyclical program, meaning enrollment typically rises during an economic downturn. But that forces states to face the fiscal challenge of paying for their share of the program even as tax revenue dries up.

An exception to this rule was the jump in enrollment starting in 2014 when the Affordable Care Act allowed states to expand Medicaid to cover everyone with incomes below 138% of the federal poverty level, or about $17,609 for an individual this year.

Enrollment soared by about 15 million people from 2014 to 2017, peaking at about 75 million as nearly three dozen states expanded the program. Since then, a strong economy and steadily declining unemployment levels led to a drop in Medicaid rolls until April.

Enrollment changes in April varied across the country.

California, which has the highest Medicaid enrollment in the country, saw its level hold relatively steady at 11.6 million people in April.

Nevada and Oklahoma posted nearly 4% enrollment growth rates between March and April’s data.

Florida’s Medicaid numbers jumped to 3.7 million in April from 3.6 million in March, nearly a 2.5% increase, the CMS data showed. Since then, Florida data shows enrollment has topped 4.1 million.

The Trump administration has been criticized by consumer advocates for not establishing a national campaign to promote Medicaid during the economic downturn and health crisis.

One indicator that Medicaid enrollment is still going up is the growing number of recipients in managed care plans in 16 states that reported data from March to May. Those plans have increased by a total of nearly 4%, according to a KFF report. (KHN is an editorially independent program of KFF.) Most states have shifted many of their Medicaid enrollees into these private health plans.

KFF estimated that nearly 13 million people who became uninsured after losing their jobs in March are eligible for Medicaid.

Robin Rudowitz, a KFF vice president, said there is typically a lag time of weeks or months before people who have lost their jobs and health coverage seek to enroll in Medicaid. The impact on Medicaid enrollment also lasts well after the immediate effect of a downturn, she said.

“There is a long tail,” she said.

 

 

 

 

 

KHN’s ‘What The Health?’: Trump Twists on Virus Response

Posted on by • Posted in 2020 Election Issues, ACA, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economic Stimulus, Employer-Based Health Insurance, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Food and Drug Administration (FDA), Health Insurance Coverage Adequacy, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Medicaid, Medicaid Expansion, Mixed Message, Mortality, National Strategy, Opioid Epidemic, Pandemic, Partisanship, Public Health, Public Safety, Quarantine, Scientists, Short Term Health Insurance, Skinny Health Plans, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://khn.org/news/khn-podcast-what-the-health-trump-twists-on-virus-response/

KHN's 'What The Health?': Trump Twists on Virus Response | Kaiser ...

President Donald Trump — who has spent the past six months trying to play down the coronavirus pandemic — seems to have pivoted. In back-to-back briefings on July 21 and 22, Trump cautioned that the U.S. is in a dangerous place vis-a-vis the pandemic. He urged the public to wear masks — although he has rarely worn one in public.

Meanwhile, Republicans in the Senate are scrambling to put together a package for the next COVID-19 relief bill, facing a July 31 deadline, when some of the benefits passed in the spring expire. House Democrats passed their bill in May.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Tami Luhby of CNN.

Among the takeaways from this week’s podcast:

  • Although Trump’s renewed emphasis on COVID-19 has surprised some of his critics, it may persuade his supporters to take actions promoted by public health officials. Trump’s emphasis on the importance of face coverings, perhaps coupled with the rising number of cases in parts of the country, could convince people who were otherwise dismissive of masks. People who do not necessarily trust public health officials may listen to Trump.
  • Republicans on Capitol Hill are in disarray on how to approach the next coronavirus relief bill. They are not in lockstep with the White House and are not supporting Trump’s call for a payroll tax cut.
  • One reason members of Congress are not eager to cut the payroll taxes is that the economic downturn has spurred concerns the Medicare and Social Security trust funds are being depleted faster than expected. However, analysts point out that when employment rises again, some of those concerns could dissipate.
  • A key sticking point in the economic relief package is whether to extend the bump in unemployment benefits that Congress approved in the spring. Lawmakers are facing a hard deadline on the issue because that money runs out next week, and the prohibition on evictions that was also part of an earlier COVID-19 relief bill ends even sooner. With rent, mortgages and other bills coming due Aug. 1, unemployed consumers could face a tough beginning of the month.
  • The Food and Drug Administration has approved limited use of pool testing for COVID-19. That allows approved labs to put together a small number of tests to run at once, thus conserving some of the materials needed for the process. If the pool tests positive, then those people whose results were pooled have to be tested again individually. The efforts have limited usefulness when rates of transmission are high in a community, but they may be helpful in specific settings, such as schools or workplaces.
  • New data shows that opioid addiction ticked back up in 2019, after a slight decline. Part of the problem is the growing use of the powerful — and dangerous — drug fentanyl. Economic woes also play a role. Addiction is often referred to as an epidemic of despair.
  • Although it’s unlikely the judicial system will overrule the administration’s efforts to bolster short-term insurance plans — which are generally less expensive but don’t offer as much protection for consumers as policies sold on the Affordable Care Act’s marketplaces — they could be circumvented if Democrats take over the White House. Even still, Democrats would likely have to find a way to make ACA plans more affordable.

 

 

 

 

 

Dental and Doctors’ Offices Still Struggling with COVID Job Loss

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Dentist, Economic Crisis, Economic Recovery, Job, Job Loss, Job Market, Job Search, Job Security, Office Visit, Outpatient Care, Physician, Physician Practice Management, Primary Care, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://khn.org/news/dental-and-doctors-offices-still-struggling-with-covid-job-loss/

Dental and Doctors' Offices Still Struggling with COVID Job Loss ...

California’s outpatient health care practices largely shrugged off two recessions, adding more than 400,000 jobs during a two-decade climb from the start of 2000 to early 2020. It was an enviable growth rate of 85% and a trend largely mirrored on the national level.

Then came COVID-19.

Anecdotal stories abound about the crushing impact the pandemic has had on a range of outpatient medical services, from pediatric and family medical practices to dental offices, medical labs and home health care. In California, as in many other states, thousands of doctors, dentists and other health care providers temporarily closed offices this spring as state health officials directed them to suspend non-urgent visits. Many others sat open but largely idle because patients were too scared to visit the doctor given the risk of running into someone with COVID-19 in the waiting room.

As the economy has reopened, so have many medical offices. But the latest state and federal employment data underscores the lingering toll the pandemic has taken on the health care sector.

Doctors’ Offices Shed Jobs Amid COVID

In California, and across the nation, the number of workers in doctors’ offices grew by more than 50% in the past 20 years, before seeing rapid declines amid COVID-19. This chart shows proportional growth in employment over time, with percentages relative to January 2000.

In California, employment in medical offices providing an array of outpatient care fell by 159,300 jobs, or 18%, from February to April, according to California’s Employment Development Department. The sector has recovered some, but job totals in June remained 7% below pre-crisis levels, the latest figures show. Data is not yet available for July, when COVID-19 cases in California again began to rise sharply and communities across much of the state reverted to partial shutdowns.

Nationwide, employment in outpatient care fell by about 1.3 million jobs, or 17%, from February to April, and in June also remained 7% below pre-crisis levels.

Doctors’ offices typically rely on patient volume for revenue. Without it, they can’t make payroll. Many small medical clinics weren’t flush with cash before the crisis, making COVID-19 an existential threat.

“Never in our history have we had more than a month’s cash on hand,” said Dr. Sumana Reddy, owner of the Acacia Family Medical Group in Monterey County. “Think of it that way.”

Reddy operates two clinics, one in Salinas and the other in the town of Prunedale. Many of her clients come from rural areas where poverty is common. When COVID-19 hit and stay-at-home orders took effect, the number of patients coming to the practice fell by about 50%, Reddy said. To keep her patients safe and her business afloat, Reddy largely shifted to telehealth so she could provide care online.

She also turned to federal aid. “I took the stimulus money,” she said. “I asked for advances from anywhere I could get that. So, now I’m tapped out. I’ve done every single thing that I can think of to do. And there’s nothing more to do.”

By late June, patient volume at Reddy’s practice stood at roughly 70% of the level seen before the crisis.

Dental Offices Hit Hard by COVID

The coronavirus pandemic prompted steep declines in dental office employment, undoing 20 years of steady growth. This chart shows proportional growth in dental employment over time, with percentages relative to January 2000.

Many dental offices have been hit even harder. From February to April, the number of dental office employees in California fell by 85,000, or 60%, a rate of decline that outpaced even job losses in the state’s restaurant industry. Nationwide, dental employment fell by about 546,000 from February to April, a 56% decline.

“March, April, mid-May — we were pretty much closed except for emergency care,” said Dr. Natasha Lee, who owns Better Living Through Dentistry, a practice in San Francisco’s Inner Sunset neighborhood. “While dental offices were considered essential, most were closed due to guidance from health departments and the CDC to postpone routine and preventative medical and dental care and just to limit things to emergency.”

Lee has reopened her clinic but is doing less business. She and her staff need extra time to clean tools and change their personal protective equipment.

“With the social distancing, the limiting [of] patients in the office at a time and the slowdown we’ve had, we’re probably seeing about, I’d say, two-thirds of our normal capacity in our practice,” she said in late June.

As for employment, California hospitals have fared better than outpatient medical offices. Hospitals shed about 2% of jobs from February to June.

“They have more capacity in a large organization to withstand the same shock,” said John Romley, a professor and economist at the University of Southern California’s Leonard D. Schaeffer Center for Health Policy and Economics.

Romley said he is optimistic the health care sector overall will recover faster than some other sectors of the economy, since health care remains a necessity.

Still, red flags abound. The recent spike in COVID-19 cases and deaths in many parts of the nation raises the specter of future shutdowns and, with them, additional health care layoffs. In California, Gov. Gavin Newsom recently ordered a second shutdown for dine-in restaurants, movie theaters and bars statewide, as well as churches, gyms and barbershops in much of the state. For now, dental and doctors’ offices can continue operating.

Older Californians Are Postponing Care

A recent census survey found that 42% of California respondents had put off medical care because of the pandemic.

But it’s uncertain when patients will feel comfortable returning to the doctor for routine and preventive care. A series of Census Bureau surveys conducted between June 11 and July 7 found that 42% of Californians who responded had put off medical care in the previous four weeks because of the pandemic. About 33% said they needed medical care for something unrelated to COVID-19 but did not get it.

“I’ve been telling my staff and patients that we should prepare for things to stay not too different for six months to a year,” Reddy said, “which is pretty depressing for most people to think about.”

 

 

 

 

 

 

 

US coronavirus data will now go straight to the White House. Here’s what this means for the world

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Credibility, Crisis, Crisis Management, Data, Data Analytics, Data Control, Data Gathering, Data Governance, Data Integrity, Data Interpretation, Data Ownership, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, False Hope, False Narrative, Honesty, Infection Control, Infection Control Plan, Infectious Virus, Integrity, Misinformation, Misinterpret, Mislead, Misleading, Mistrust, Mixed Message, Pandemic, Public Good, Public Health, Public Safety, Quarantine, Scientists, Silence, Silencing, Silencing Speech, Social Distancing, Transparency, Trust, Truth • Leave a comment

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US coronavirus data will now go straight to the White House ...

Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.

For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.

On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.

Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.

Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”

The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.

In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.

Diminished role

When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.

This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.

As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.

The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.

The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.

But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.

“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”

What does it mean for the world?

The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.

Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.

This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.

The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.

This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.

It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.

What happens next?

Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.

In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.

COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.

 

 

 

When a winner becomes a loser: Winston Churchill was kicked out of office in the British election of 1945

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When a winner becomes a loser: Winston Churchill was kicked out of ...

The end of World War II in Europe and the defeat of Hitler and Nazi Germany in early May 1945 turned British Prime Minister Winston Churchill into the world’s most eminent statesman. He was feted and celebrated everywhere he went and had an approval rating of 83%.

Yet he suffered a humiliating election defeat in 1945.

Churchill’s electoral fate shows, I believe, that democratic elections are not won due to past achievements, personal glory and celebrity status, but because of a persuasive and realizable program for the next four or five years. Winning parties or candidates need a vision that addresses the genuine concerns and deep anxieties of the voters.

In 1945, it seemed a foregone conclusion that Churchill and his Conservative Party would win the next general election. No election had taken place during the war. The members of the British Parliament, the House of Commons, had been elected as far back as 1935.

While Churchill wanted to delay a general election until the end of the war in Asia, the Labour Party decided to leave Britain’s national unity government soon after victory in Europe was achieved, which sparked an election that took place on July 5, 1945.

Ballots weren’t counted until July 26, to allow votes from soldiers and residents of Britain’s far-flung overseas empire to arrive by mail.

Labour won a landslide victory. As soon as the election result was announced, Churchill went to Buckingham Palace to submit his resignation to King George VI. Labour leader Clement Attlee arrived at the palace within minutes of Churchill’s departure and was appointed new prime minister.

But at first he was greeted by an uncomfortable silence. Attlee finally told the king, “I’ve won the election.” The king, greatly displeased by the socialist Labour Party’s victory, said, “I know. I heard it on the six o’clock news.”

Watershed election

The magnitude of the loss was historic.

The Labour Party received 47.7% of the vote, compared to the Conservatives’ 36.2% and the Liberal party’s 9%.

This was a crushing blow for the Tories. Due to Churchill’s immense personal popularity, he was easily reelected in his Woodford constituency in Essex, but his party was decimated. Labour had a massive majority of 146 seats in the new Parliament.

The Labour government of 1945 would radically change British society by embarking on decolonization, which quickly led to the dissolution of the British Empire, and the creation of a new, progressive social and economic consensus that would last until Margaret Thatcher’s election victory in 1979.

Churchill took the defeat very badly.

He was just short of his 71st birthday, exhausted, in ill health and demoralized. He fell into a deep depression (his “black dog,” as he called it) and spent much time in the south of France to pursue his hobbies of painting and bricklaying.

When the king later offered him the country’s highest honor, The Order of the Garter, Churchill declined, saying that he couldn’t possibly accept such an honor, as the British voters had given him the “order of the boot.”

Churchill now was the official leader of the opposition, but it took him more than a year to overcome his apathy and reengage with politics. It was only U.S. President Harry S. Truman’s invitation to give a speech at Westminster College in Fulton, Missouri, in March 1946 – this was the “Iron Curtain speech” – that revived his political instincts and made him become politically active again.

How to lose an election

Until the last few days before the vote was held, Churchill and much of the country had been firmly convinced that he and his party would be returned to power with a large majority.

On occasion, however, Churchill realized that he had little to contribute to the raging debate about the future of British society.

“I have no message for them,” he said.

As a scholar who has written a book on Churchill’s politics, “Churchill’s Cold War: The Politics of Personal Diplomacy,” I see several reasons for the loss he and his party experienced.

The six-week election campaign in June and July 1945 sought to sway voters exhausted by six devastating years of war. They wanted a view of a bright future.

Soldiers in the field, too, were fed up with fighting and looked forward to a new age of prosperity and peace. Labour proposed a progressive social reform program that would transform the future of British society. The Conservative program was much more vague and focused on Churchill’s leadership.

Churchill and his party also conducted a poor election campaign. Symbolic of this was Churchill’s first campaign broadcast on June 4, 1945, in which he accused Attlee of harboring socialist dictatorial ambitions and even compared him to the Nazis. Outrageously, Churchill declared that Labour “would have to fall back on some sort of a Gestapo” to push through its reforms.

Attlee pointed out that the speech showed Churchill to be ill-suited to being a leader in peaceful times.

Labour had more attractive and persuasive ideas, such as government-supported full employment, the introduction of a free national health service and the nationalization of many key industries such as steel, coal and railways.

And Labour seemed to know how to implement these policies: Churchill had put senior Labour leaders in charge of running the country’s economic ministries during the war.

Housing, full employment, social welfare and the health system stood at the top of the list of most voters’ needs. Foreign affairs and national security policy, which Churchill emphasized, ranked much lower.

Another problem for the Conservatives was their poor image, which Churchill was not immune from. Despite the tremendous esteem he was held in, the elderly Churchill, with his elite background and paternalistic Victorian habits, was seen by many as out of touch with the modern world.

He also had outdated views about race and empire that for many – even back in 1945 – sounded not quite right for the new postwar era. Canadian Prime Minister MacKenzie King, who knew him well, concluded that maintaining “the British Empire and Commonwealth is a religion to him.”

Running on a bad record

Except for the years 1924 and 1929-31, Britain had been led by Conservative governments for more than two decades. The Tories could hardly avoid being seen as responsible for the high unemployment and miserable social and economic conditions of these years, especially because the conditions continued well into the 1950s.

The Conservatives were also viewed as the party of the appeasers who had, in the runup to the war, downplayed the Nazi threat, with Prime Minister Neville Chamberlain even having weakly given in to Hitler’s territorial demands.

Taking all these elements into account, it was little wonder that Churchill and the Tories lost the 1945 election.

But Churchill did not give up. In 1950 Churchill also narrowly lost the next general election. Just over a year later, with the Labour government in deep internal crisis and running out of steam, yet another election was called.

This time Churchill was victorious. In October 1951, he became prime minister again and felt greatly vindicated. He used his remaining four years as peacetime prime minister to reengage with the Soviet Union and attempt to negotiate an early end to the Cold War. Churchill retired in 1955 at the age of 80.