In May 2024 a set of articles were published in the journal Science that focused on the intersection of misinformation and social media. The results, while preliminary in the grand scheme of things, were really interesting (and maybe a little alarming).
A surge in COVID-19 infections has swept the country this summer, upending travel plans and bringing fevers, coughs and general malaise. It shows no immediate sign of slowing.
While most of the country and the federal government has put the pandemic in the rearview mirror, the virus is mutating and new variants emerging.
Even though the Centers for Disease Control and Prevention (CDC) no longer tracks individual infection numbers, experts think it could be the biggest summer wave yet.
So far, the variants haven’t been proven to cause a more serious illness, and vaccines remain effective, but there’s no certainty about how the virus may yet change and what happens next.
The highest viral activity right now is in the West, according to wastewater data from the CDC, but a “high” or “very high” level of COVID-19 virus is being detected in wastewater in almost every state. And viral levels are much higher nationwide than they were this time last year and started increasing earlier in the summer.
Wastewater data is the most reliable method of tracking levels of viral activity because so few people test, but it can’t identify specific case numbers.
Part of the testing decline can be attributed to pandemic fatigue, but experts said it’s also an issue of access. Free at-home tests are increasingly hard to find. The government isn’t distributing them, and private insurance plans have not been required to cover them since the public health emergency ended in 2023.
COVID has spiked every summer since the start of the pandemic. Experts have said the surge is being driven by predictable trends like increased travel and extreme hot weather driving more people indoors, as well as by a trio of variants that account for nearly 70 percent of all infections.
Vaccines and antivirals can blunt the worst of the virus, and hospital are no longer being overwhelmed like in the earliest days of the pandemic.
But there remains a sizeable number of people who are not up-to-date on vaccinations. There are concerns that diminished testing and low vaccination rates could make it easier for more dangerous variants to take hold.
“One of the things that’s distinctive about this summer is that the variants out there are extraordinarily contagious, so they’re spreading very, very widely, and lots of people are getting mild infections, many more than know it, because testing is way down,” said William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University.
That contagiousness means the virus is more likely to find the people most vulnerable — people over 65, people with certain preexisting conditions, or those who are immunocompromised.
In a July interview with the editor-in-chief of MedPage Today, the country’s former top infectious diseases doctor, Anthony Fauci, said people in high-risk categories need to take the virus seriously, even if the rest of the public does not.
“You don’t have to immobilize what you do and just cut yourself off from society,” Fauci said. “But regardless of what the current recommendations are, when you are in a crowded, closed space and you are an 85-year-old person with chronic lung disease or a 55-year-old person who’s morbidly obese with diabetes and hypertension, then you should be wearing a mask when you’re in closed indoor spaces.”
Schaffner said hospitalizations have been increasing in his region for at least the past five weeks, which surprised him.
“I thought probably they had peaked last week. Wrong. They went up again this week. So at least locally, we haven’t seen the peak yet. I would have expected this summer increase … to have plateaued and perhaps start to ease down. But we haven’t seen that yet,” he said.
Still, much of the country has moved on from the pandemic and is reacting to the surge with a collective shrug. COVID-19 is being treated like any other respiratory virus, including by the White House.
President Biden was infected in July. After isolating at home for several days and taking a course of the antiviral Paxlovid, he returned to campaign trial.
Biden is 81, meaning he’s considered high risk for severe infection. He received an updated coronavirus vaccine in September, but it’s not clear if he got a second one, which the CDC recommends for older Americans.
Updated vaccines that target the current variants are expected to be rolled out later this fall, and the CDC recommends everyone ages 6 months and older should receive one.
As of May, only 22.5 percent of adults in the United States reported having received the updated 2023-2024 vaccine that was released last fall and tailored to the XBB variant dominant at that time.
The immunity from older vaccines wanes over time, and while it doesn’t mean people are totally unprotected, Schaffner said, the most vulnerable should be cautious. Many people being infected now have significantly reduced immunity to the current mutated virus, but reduced immunity is better than no immunity.
People with healthy immune systems and who have previously been vaccinated or infected are still less likely to experience the more severe infections that result in hospitalization or death.
Almost “none of us are naive to COVID, but the people where the protection wanes the most are the most frail, the immunodeficient, the people with chronic underlying illnesses,” Schaffner said.
https://www.advisory.com/daily-briefing/2024/06/03/flirt-variant
Although COVID-19 cases are currently declining, some health experts have voiced concerns that circulating FLiRT variants could lead to a spike in cases as more people gather in the summer months.
Over the winter, the dominant COVID-19 variant was JN.1, which spread globally. However, a new variant called KP.2, or FLiRT due to the location of its mutations, began to emerge in March.
There are several different FLiRT variants, including KP.2, KP.1.1, and KP.3. In a two-week period ending May 11, KP.2 made up 28.2% of COVID-19 cases in the United States, while KP.1.1 made up over 7% of cases.
According to some health experts, KP.2 and KP.1.1 could be more transmissible than previous COVID-19 variants. So far, early data suggests that KP.2 may be “rather transmissible” since its new mutations help “its ability to transmit, but also now evades some of the pre-existing immunity in the population,” said Andrew Pekosz, a virologist at Johns Hopkins University.
Currently, there’s no evidence to suggest that the FLiRT variants cause more severe illness than previous COVID-19 variants. Some of the symptoms associated with the FLiRT variants include fever or chills, cough, sore throat, fatigue, a loss of taste or smell, and brain fog.
“The CDC is tracking SARS-CoV-2 variants KP.2 and KP.1.1, sometimes referred to as ‘FLiRT,’ and working to better understand their potential impact on public health,” the agency said. “Currently, KP.2 is the dominant variant in the United States, but laboratory testing data indicate low levels of SARS-CoV-2 transmission overall at this time. That means that while KP.2 is proportionally the most predominant variant, it is not causing an increase in infections as transmission of SARS-CoV-2 is low.”
Currently, COVID-19 cases and deaths are declining, but health experts say the FLiRT variants’ potential to evade immunity could lead to a spike in cases as people gather for summer holidays.
Immunity may also be waning since few people received updated COVID-19 vaccines last fall. According to CDC, only 22.6% of adults reported receiving an updated vaccine since September 2023, though vaccination increased by age and was highest among those ages 75 and older.
“We’ve got a population of people with waning immunity, which increases our susceptibility to a wave,” said Thomas Russo, chief of infectious disease at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.
Otto Yang, associate chief of infectious diseases at the University of California, Los Angeles‘ David Geffen School of Medicine, said that while healthcare systems can manage COVID-19 waves, immunocompromised and older adults at a higher risk of developing severe disease are often overlooked.
“Those people unfortunately carry a heavy burden,” Yang said. “I’m not sure there is a good solution for them, but one thing could be better preventive measures.”
However, COVID-19 protections that were common in the past, including testing before events and mask requirements, have now fallen by the wayside, the Washington Post reports. Even events with preventive measures in place have faced difficulties enforcing them.
“Culturally we are coming away from it as a society, so it gets much harder to ask people to really be consistent, because they aren’t doing it anywhere else,” said D Schwartz, who organized a large LGBTQ+ community gathering event in Washington, D.C. “You go into a movie theater now, you see maybe five people wearing a mask.”
Declining data collection has also impacted how people view the current COVID-19 situation. Although CDC still tracks coronavirus levels in wastewater and the percentage of ED visits with a diagnosed case of COVID-19, hospitals stopped reporting confirmed COVID-19 cases in April.
“We’re kind of shooting blind now,”
said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development. Hotez also noted that a lack of data collection will make it harder to convince Americans that COVID-19 is enough of a threat to require continued vaccination.
“If a wave materializes this summer, we’re less poised to navigate the rough waters,” said Ziyad Al-Aly, an epidemiologist and long COVID researcher at the Veterans Affairs health system in St. Louis.
https://www.yahoo.com/lifestyle/respiratory-virus-activity-high-rising-192815114.html
As seasonal virus activity surges across the United States, experts stress the importance of preventive measures – such as masking and vaccination – and the value of treatment for those who do get sick.
Tens of thousands of people have been admitted to hospitals for respiratory illness each week this season. During the week ending December 23, there were more than 29,000 patients admitted with Covid-19, about 15,000 admitted with the flu and thousands more with respiratory syncytial virus, or RSV, according to data from the US Centers for Disease Control and Prevention.
Nationally, Covid-19 levels in wastewater, a leading measure of viral transmission, are very high – higher than they were at this time last year in every region, CDC data shows. Weekly emergency department visits rose 12%, and hospitalizations jumped about 17% in the most recent week.
And while Covid-19 remains the leading driver of respiratory virus hospitalizations, flu activity is rising rapidly. The CDC estimates that there have been more than 7 million illnesses, 73,000 hospitalizations and 4,500 deaths related to the flu this season, and multiple indicators are high and rising.
RSV activity is showing signs of slowing in some parts of the US, but many measures, including hospitalization rates, remain elevated. Overall, young children and older adults are most affected.
“It’s a wave of winter respiratory pathogens, especially respiratory viruses. So it’s Covid, it’s flu, and we can’t diminish the importance of RSV,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. “So it’s a triple threat, and arguably a fourth threat because we also have pneumococcal pneumonia, which complicates a lot of these virus infections.”
Respiratory virus activity has been on the rise for weeks. Now, flu-like activity is high or very high in two-thirds of the United States, including California, New York City and Washington, as well as throughout the South and Northeast, according to the CDC.
“Remember, all of these numbers are before people got together for the holidays,” Hotez said. “So don’t be disappointed or surprised that we even see a bigger bump as we head into January.”
Vaccines can help prevent severe illness and death, but uptake remains low this season – despite a historic first, with vaccines available to protect against each of the three major viruses. Just 19% of adults and 8% of children have gotten the latest Covid-19 vaccine, and 17% of adults 60 and older have gotten the new RSV vaccine, CDC data shows. Less than half of adults and children have gotten the flu vaccine this season.
“We have, as a population, underutilized both influenza and the updated Covid vaccines, unfortunately,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. “But it’s not too late to get vaccinated, because these viruses are going to be around for a while yet.”
According to the CDC, hospital bed capacity remains “stable” nationally, including within intensive care units. But with high levels of respiratory viruses, hospitals in at least five states are returning to requiring masks.
Mass General Brigham spokesman Timothy Sullivan said it will require masking for health-care staff who interact directly with patients starting Tuesday, and patients and visitors will be “strongly encouraged to wear a facility-issued mask.”
In Wisconsin, UW Health and UnityPoint Health – Meriter have expanded mask policies to cover more people. UW requires all staff, patients and visitors to wear a mask for patient interactions in clinic settings, including waiting areas and exam rooms.
UnityPoint Health – Meriter says masks continue to be required for team members and visitors in patient rooms.
Bellevue, a public hospital in New York City, said on social media last week that it had reinstated its mandatory masking policy due to an uptick in respiratory illnesses.
In Pennsylvania, the University of Pittsburgh Medical Center has required everyone to wear a mask when entering or inside since December 20. The systemwide masking policies were adjusted to “address the increase of respiratory virus cases” but may change when there is a “marked decrease in respiratory health cases,” according to the health care system.
An order posted last week by the Los Angeles County Health Officer requires all health-care personnel and visitors to mask while in contact with patients or in patient-care areas, based on the CDC’s categorization of Covid-19 hospital admission levels.
During the week ending December 23, more than 230 US counties were considered to have “high” levels of Covid-19 hospital admissions, defined by the CDC by at least 20 new hospital admissions for every 100,000 people. Nearly a thousand other counties, about a third of the country, have “medium” Covid-19 hospital admission levels, with at least 10 admissions for every 100,000 people.
Vaccines and masks can help reduce the risk of severe illness before getting sick, but treatments are also available to help prevent people from getting very sick if they do become infected.
Antiviral treatments for Covid-19, such as Paxlovid, and flu, such as Tamiflu, can be especially helpful for people who are more likely to get very sick, including people who are 50 or older and those with certain underlying conditions, such as a weakened immune system, heart disease, obesity, diabetes or chronic lung disease.
“If more people at higher risk for severe illness get treatment in a timely manner, we will save lives,” the CDC said in a recent blog post. But “not enough people are taking them.”
Seasonal respiratory virus activity can be hard to predict, but CDC forecasts suggest that hospitalization rates will continue at elevated levels for weeks and that this season, overall, will probably result in a similar number of hospitalizations as last season.
“One of the ways to help us all go into a happy new year is for us to be as protected as we can against these viruses,” Schaffner said.
“Of course, I continue to recommend vaccination, prudent use of the mask by high-risk people and, should you become sick, do not go to work and spread the virus further. Call your health care provider, because you may have some treatment available that will get you healthier sooner.”
Virus activity is picking up again as millions of Americans crisscross the country for Thanksgiving, taking fewer precautions to protect themselves against illness as concerns about COVID-19 fade away.
Why it matters:
Indoor holiday gatherings are expected to fuel a spike in cases of COVID-19, RSV and the flu — and with vaccinations against all three respiratory viruses lagging, health experts worry hospitals could be slammed again this winter.
What they’re saying:
“The concern here with this vaccination gap is: Could this get worse as the number of transmissions increases from November, December, into January?” Marc Watkins, chief medical officer for Kroger Health, told Axios.
State of play:
Health officials are urging vaccinations to head off a repeat of last winter’s “tripledemic,” when particularly nasty RSV and flu seasons collided with a COVID surge.
Meanwhile, flu vaccinations for adults and kids are slightly behind last year’s pace.
Zoom in:
Texas is among the states that have been hit particularly hard by RSV early on, as emergency departments filled up with young patients in recent weeks.
Be smart:
Those who are traveling should mask up in crowded areas like airports, have a game plan for getting tested or treated, and skip gatherings if feeling sick, recommended Mary Jacobson, chief medical officer at primary care company Alpha Medical.
The bottom line:
Expect a post-Thanksgiving spike in illness as respiratory virus season picks up and fewer people take precautions.
Two pioneers of mRNA research — the technology that helped the world tame the virus behind the Covid-19 pandemic — won the 2023 Nobel Prize in medicine or physiology on Monday.
Overcoming a lack of broader interest in their work and scientific challenges, Katalin Karikó and Drew Weissman made key discoveries about messenger RNA that enabled scientific teams to start developing the tool into therapies, immunizations, and — as the pandemic spread in 2020 — vaccines targeting the SARS-CoV-2 coronavirus. Moderna and the Pfizer-BioNTech partnership unveiled their mRNA-based Covid-19 shots in record time thanks to the foundational work of Karikó and Weissman, helping save millions of lives.
Karikó, a biochemist, and Weissman, an immunologist, performed their world-changing research on the interaction between mRNA and the immune system at the University of Pennsylvania, where Weissman, 64, remains a professor in vaccine research. Karikó, 68, who later went to work at BioNTech, is now a professor at Szeged University in her native Hungary, and is an adjunct professor at Penn’s Perelman School of Medicine.
The duo will receive 11 million Swedish kronor, or just over $1 million. Their names are added to a list of medicine or physiology Nobel winners that prior to this year included 213 men and 12 women.
The award was announced by Thomas Perlmann, secretary general of Nobel Assembly, in Stockholm. Perlmann said he had spoken to both laureates, describing them as grateful and surprised even though the pair has won numerous awards seen as precursors and had been tipped as likely Nobel recipients at some point.
Every year, the committee considers hundreds of nominations from former Nobel laureates, medical school deans, and prominent scientists from fields including microbiology, immunology, and oncology. Members try to identify a discovery that has altered scientists’ understanding of a subject. And according to the criteria laid out in Alfred Nobel’s will, that paradigm-shifting discovery also has to have benefited humankind.
The Nobel committee framed Karikó and Weissman’s work as a prime example of complementary expertise, with Karikó focused on RNA-based therapies and Weissman bringing a deep knowledge about immune responses to vaccines.
But it was not an easy road for the scientists. Karikó encountered rejection after rejection in the 1990s while applying for grants. She was even demoted while working at Penn, as she toiled away on the lower rungs of academia.
But the scientists persisted, and made a monumental discovery published in 2005 based on simply swapping out some of the components of mRNA.
With instructions from DNA, our cells make strands of mRNA that are then “read” to make proteins. The idea underlying an mRNA vaccine then is to take a piece of mRNA from a pathogen and slip it into our bodies. The mRNA will lead to the production of a protein from the virus, which our bodies learn to recognize and fight should we encounter it again in the form of the actual virus.
It’s an idea that goes back to the 1980s, as scientific advances allowed researchers to make mRNA easily in their labs. But there was a problem: The synthetic mRNA not only produced smaller amounts of protein than the natural version in our cells, it also elicited a potentially dangerous inflammatory immune response, and was often destroyed before it could reach target cells.
Karikó and Weissman’s breakthrough focused on how to overcome that problem. mRNA is made up of four nucleosides, or “letters”: A, U, G, and C. But the version our bodies make includes some nucleosides that are chemically modified — something the synthetic version didn’t, at least until Karikó and Weissman came along. They showed that subbing out some of the building blocks for modified versions allowed their strands of mRNA to sneak past the body’s immune defenses.
While the research did not gain wide attention at the time, it did catch the attention of scientists who would go on to found Moderna and BioNTech. And now, nearly 20 years later, billions of doses of mRNA vaccines have been administered.
For now, the only authorized mRNA products are the Covid-19 shots. But academic researchers and companies are exploring the technology as a potential therapeutic platform for an array of diseases and are using it to develop cancer vaccines as well as immunizations against other infectious diseases, from flu to mpox to HIV. An mRNA vaccine is highly adaptable compared to earlier methods, which makes it easier to alter the underlying recipe of the shot to keep up with viral evolution.
As she gained global fame, Karikó has been open about the barriers she encountered in her scientific career, which raised broader issues about the challenges women and immigrants can face in academia. But she’s said she always believed in the potential of her RNA research.
“I thought of going somewhere else, or doing something else,” Karikó told STAT in 2020, recalling the moment she was demoted. “I also thought maybe I’m not good enough, not smart enough. I tried to imagine: Everything is here, and I just have to do better experiments.”
https://mailchi.mp/e1b9f9c249d0/the-weekly-gist-september-15-2023?e=d1e747d2d8
On Monday, the Food and Drug Administration authorized new COVID vaccines from Moderna and Pfizer-BioNTech, and the Centers for Disease Control and Prevention followed Tuesday by recommending the shots be given as a single dose for most people five years of age and older. Children older than six months but younger than five, as well as completely unvaccinated people of any age, may be eligible for multiple doses.
These vaccines were formulated to target the XBB.1.5. variant,
which was the dominant strain in January but has since receded, although initial results suggest they remain effective against all currently circulating variants. Pharmacies and healthcare providers are expected to have the updated vaccines available by early next week.
The Gist: Due to the end of the COVID public health emergency in May, this COVID vaccination campaign will be the first not directly bankrolled by the federal government.
While insurers are still required to cover vaccinations without cost-sharing, the uninsured may find free shots, which the Biden administration says it will still provide at certain locations, harder to access.
Unlike past COVID boosters, reframing this shot as an annual vaccine that patients receive along with their flu shots should help with the rollout, as around 50 percent of Americans got a flu shot in 2022 while only 17 percent received the bivalent COVID booster.
With COVID cases and hospitalizations currently rising, promoting widespread uptake is critical to dampening a likely winter COVID spike.
However, public health officials will have to overcome many Americans’ wearied indifference toward COVID to motivate them to get vaccinated.
https://mailchi.mp/377fb3b9ea0c/the-weekly-gist-august-4-2023?e=d1e747d2d8
After experiencing steadily declining numbers across 2023, the country is currently seeing an uptick in COVID-19 hospitalizations, which increased 12 percent week-over-week, to approximately 8,000 in the week ending July 22. This rise, the largest since December, follows an increase in national wastewater levels of COVID across the past month, particularly in the Northeast and South. Given that most health agencies are no longer tracking COVID case levels, and many Americans are no longer getting tested or testing themselves, actual case counts are unclear.
The Gist: Though COVID hospitalizations are up, weekly totals are still among the lowest the nation has seen since the pandemic began. And while COVID deaths are a lagging indicator, the most recent Centers for Disease Control and Prevention (CDC) data charts them at their lowest level since the start of the pandemic.
Nonetheless, if this COVID uptick continues into fall, we could once again be facing a “tripledemic” of COVID, flu, and respiratory syncytial virus (RSV) circulating at high levels all at once, straining hospital resources.
Fortunately, an updated COVID vaccine is coming this fall. Urging Americans, particularly older and vulnerable patients, to get vaccinated for all three viruses will be critical—although convincing individuals to get three separate shots will increase the challenge.
Headlines recently blared about the new review that looked at how effective masks are at preventing the transmission of flu-like disease. Cochrane reviews are well respected, and the media coverage about the recent review has been hard to parse. So is that it, end of story on masks? Not if you skip the media headlines and read the actual review!
President Joe Biden last night highlighted several healthcare priorities during his State of the Union address, including efforts to reduce drug costs, a universal cap on insulin prices, healthcare coverage, and more.
In his speech, Biden acknowledged the progress the country has made with COVID-19 over the last few years.
“Two years ago, COVID had shut down our businesses, closed our schools, and robbed us of so much,” he said. “Today, COVID no longer controls our lives.”
Although Biden noted that the COVID-19 public health emergency (PHE) will come to an end soon, he said the country should remain vigilant and called for more funds from Congress to “monitor dozens of variants and support new vaccines and treatments.”
Biden highlighted several provisions of the Inflation Reduction Act (IRA), which passed last year, that aim to reduce healthcare costs for millions of Americans.
“You know, we pay more for prescription drugs than any major country on earth,” he said. “Big Pharma has been unfairly charging people hundreds of dollars — and making record profits.”
Under the IRA, Medicare is now allowed to negotiate the prices of certain prescription drugs, and out-of-pocket drug costs for Medicare beneficiaries are capped at $2,000 per year. Insulin costs for Medicare beneficiaries are also capped at $35 a month.
“Bringing down prescription drug costs doesn’t just save seniors money,” Biden said. “It will cut the federal deficit, saving tax payers hundreds of billions of dollars on the prescription drugs the government buys for Medicare.”
Although the IRA limits costs for seniors on Medicare, Biden called for the policy to be made universal for all Americans. According to a 2022 study, over 1.3 million Americans skip, delay purchasing, or ration their insulin supply due to costs.
“[T]here are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives,” Biden said. “… Let’s cap the cost of insulin at $35 a month for every American who needs it.”
With the end of the COVID-19 PHE, HHS estimates that around 15 million people will lose health benefits as states begin the process to redetermine eligibility.
Biden also addressed the ongoing opioid crisis in the United States and noted the impact of fentanyl, in particular.
“Fentanyl is killing more than 70,000 Americans a year,” he said. “Let’s launch a major surge to stop fentanyl production, sale, and trafficking, with more drug detection machines to inspect cargo and stop pills and powder at the border.”
He also highlighted efforts by to expand access to effective opioid treatments. According to a White House fact sheet, some initiatives include expanding access to naloxone and other harm reduction interventions at public health departments, removing barriers to prescribing treatments for opioid addiction, and allowing buprenorphine and methadone to be prescribed through telehealth.
In his speech, Biden called on Congress to “restore” abortion rights after the U.S. Supreme Court overturned Roe v. Wade last year.
“The Vice President and I are doing everything we can to protect access to reproductive healthcare and safeguard patient privacy. But already, more than a dozen states are enforcing extreme abortion bans,” Biden said.
He also added that he will veto a national abortion ban if it happens to pass through Congress.
Biden also highlighted the Cancer Moonshot, an initiative launched last year aimed at advancing cancer treatment and prevention.
“Our goal is to cut the cancer death rate by at least 50% over the next 25 years,” Biden said. “Turn more cancers from death sentences into treatable diseases. And provide more support for patients and families.”
According to a White House fact sheet, the Cancer Moonshot has created almost 30 new federal programs, policies, and resources to help increase screening rates, reduce preventable cancers, support patients and caregivers and more.
“For the lives we can save and for the lives we have lost, let this be a truly American moment that rallies the country and the world together and proves that we can do big things,” Biden said. “… Let’s end cancer as we know it and cure some cancers once and for all.”
Biden commended the fact that “more American have health insurance now than ever in history,” noting that 16 million people signed up for plans in the Affordable Care Act marketplace this past enrollment period.
In addition, Biden noted that a law he signed last year helped millions of Americans save $800 a year on their health insurance premiums. Currently, this benefit will only run through 2025, but Biden said that we should “make those savings permanent, and expand coverage to those left off Medicaid.”
Advisory Board’s take
President Biden extolled economic optimism in the State of the Union address, touting the lowest unemployment rate in five decades. With job creation on the rise following the incredible job losses at the beginning of the COVID-19 pandemic, there is still a question of whether the economy will continue to work for those who face losing Medicaid coverage at some point in the next year.
The public health emergency (PHE) is scheduled to end on May 11. During the PHE, millions of Americans were forced into Medicaid enrollment because of job losses. Federal legislation prevented those new enrollees from losing medical insurance. As a result, the percentage of uninsured Americans remained around 8%. The safety net worked.
Starting April 1, state Medicaid plans will begin to end coverage for those who are no longer eligible. We call that the Medicaid Cliff, although operationally, it will look more like a landslide. Currently, state Medicaid regulators and health plans are still trying to figure out exactly how to manage the administrative burden of processing millions of financial eligibility records. The likely outcome is that Medicaid rolls will decrease exponentially over the course of six months to a year as eligibility is redetermined on a rolling basis.
In the marketplace, there is a false presumption that all 15 million Medicaid members will seamlessly transition to commercial or exchange health plans. However, families with a single head of household, women with children under the age of six, and families in both very rural and impoverished urban areas will be less likely to have access to commercial insurance or be able to afford federal exchange plans. Low unemployment and higher wages could put these families in the position of making too much to qualify for Medicaid, but still not making enough to afford the health plans offered by their employers (if their employer offers health insurance). Even with the expansion of Medicaid and exchange subsidies, it, is possible that the rate of uninsured families could rise.
For providers, this means the payer mix in their market will likely not return to the pre-pandemic levels. For managed care organizations with state Medicaid contracts, a loss of members means a loss of revenue. A loss of Medicaid revenue could have a negative impact on programs built to address health equity and social determinants of health (SDOH), which will ultimately impact public health indicators.
For those of us who have worked in the public health and Medicaid space, the pandemic exposed the cracks in the healthcare ecosystem to a broader audience. Discussions regarding how to address SDOH, health equity, and behavioral health gaps are now critical, commonplace components of strategic business planning for all stakeholders across our industry’s infrastructure.
But what happens when Medicaid enrollment drops, and revenues decrease? Will these discussions creep back to the “nice to have” back burners of strategic plans?
Or will we, as an industry, finish the job?
HENRY KOTULA 