Category Archives: Health Policy

The Memo: Scale of economic crisis sends shudders through nation

Posted on by • Posted in Budget, Cash, Cash Reserves, Coronavirus, Credit Ratings, Crisis, Crisis Management, Economic Stimulus, Economy, Emergency Preparedness, Expectations, Financially Distressed, Health Policy, Health System, Pandemic, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Unintended Consequences, Unrealistic Expectations • Leave a comment

The Memo: Scale of economic crisis sends shudders through nation

Pandemic derails resilient US economy | TheHill

New data released Thursday revealed the scale of the economic devastation wrought by the coronavirus crisis — and experts say there is no end in sight.

More than 6.6 million new unemployment claims were filed during the week ending March 28, according to the Department of Labor. The figure was double that of the previous week, which had itself been by far the highest since records began.

The stark reality is that roughly 10 million people have been dumped from their jobs in two weeks. A previously robust economy has been scythed down by the virus. A nation that had been enjoying its lowest unemployment rate for decades is now virtually certain to see jobless totals surpass those of the Great Recession a decade ago.

“The present economic situation is awful,” said Jason Furman, a Harvard University professor who served as chairman of President Obama’s Council of Economic Advisers. “The data is just telling us what we can see with our own eyes — there is very little business happening.”

Economists who had already been deeply worried about the immediate outlook are now wondering if their earlier projections were in fact too rosy.

“In our earlier scenario, we had expected 6.5 million job losses by May,” said Beth Ann Bovino, the chief U.S. economist at Standard & Poor’s. That figure will be exceeded, she now believes, given that there were “more lockdowns, more business closures and more businesses just trying to keep themselves alive” by laying off workers.

Heidi Shierholz, senior economist and director of policy at the Economic Policy Institute, said that even the 10 million figure for new unemployment claims was “likely a massive undercount” of actual losses because, during that period, self-employed people and workers in the so-called “gig economy” were generally not eligible to apply. This is changing as a consequence of the package recently passed by Congress that extends eligibility for unemployment benefits, as well as providing other aid for businesses and individuals.

“Our estimate is that by the end of June, 20 million people will have lost their jobs — and I am wondering if even that is optimistic,” Shierholz said.

The political ramifications of such a huge economic shock are unknowable.

President Trump had been looking forward to using the economy as his strongest card as he seeks a second term in November. That card has been shredded.

Trump has promised repeatedly during his White House briefings on the crisis that the nation can bounce back very fast once the public health dangers have receded.

Trump’s approval ratings have also ticked up modestly since the crisis began in many polls. He may be benefitting from the traditional “rallying around the flag” effect that has occurred in previous moments of crisis.

President George W. Bush, for example, hit 90 percent approval in a Gallup poll — the highest result for any president in the polling organization’s history — right after the terrorist attacks of Sept. 11, 2001.

In a statement on Thursday, probable Democratic nominee Joe Biden hit Trump for “failing to prepare our nation” for the ramifications of the coronavirus crisis. Biden called on Trump to allow open enrollment in the Affordable Care Act and also jabbed at Treasury Secretary Steven Mnuchin for having referred to previous unemployment figures as “not relevant.”

In response, Trump campaign communications director Tim Murtaugh blasted back at Biden for “ineffectively sniping from the sidelines, stumbling through television interviews, and hoping for relevance and political gain.”

Economic experts caution that Trump’s promises of a v-shaped recovery, in which the nation jolts itself back into strong economic shape quickly, are almost certainly unrealistic. It will not be a matter of the nation simply rolling the shutters back up and returning to business as usual.

“The economy is not symmetrical,” said Furman. “It is easier to separate someone from a job than to connect someone to a job. In recessions, the unemployment rate can go up very quickly and it comes down very slowly. The worry is that this will be like that.”

Several economic experts who spoke with The Hill made similar points, unprompted, as to the ways the federal government could ease the crisis.

One refrain was that huge assistance needs to be made available to states. States are generally required to balance their budgets. In a situation like the current one, where their tax revenue is cratering, this means they are obligated to severely cut spending — something that most economists believe would deepen and prolong the recession.

Another theme was the need to tie together financial assistance for businesses and the retention of employees.

The recently passed stimulus package makes some effort to do that, particularly in the case of small businesses. The Paycheck Protection Program extends loans to small businesses based upon eight weeks of payroll costs plus an additional 25 percent of the total.

The payroll portion of the loans would be forgiven — rendering them in effect a grant, not a loan — so long as the workforce was maintained at existing levels.

Economic experts praise the principle but worry that the total amount of money in the pot for these loans — $349 billion — may not be enough. 

“The small business subsidies will be critical,” said Steven Hamilton, an assistant professor of economics at The George Washington University. “The government needs to get the word out on those, and Congress will likely need to pass an expansion both to adequately fund the existing scheme and to make the scheme more generous to businesses to keep them from laying off workers.”

The public seems to share the view that the aid package, which also includes checks of up to $1,200 for individuals, is a move in the right direction — but unlikely to suffice.

A CBS News poll released late Thursday afternoon indicated 81 percent of Americans support the recent legislation but 57 percent also say it likely won’t be enough.

The same trepidation is shared by the experts, given the unprecedented nature of the coronavirus and the economic crisis it has created.

“It’s like nothing we have ever seen before,” said Shierholz.

 

 

 

 

Federal pandemic money fell for years. Trump’s budgets didn’t help

Posted on by • Posted in Bioterrorism, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Emergency Preparedness, Health Policy, Health System, Hospital, Hospital Industry, Pandemic, Public Health, Public Safety • Leave a comment

https://www.politifact.com/article/2020/mar/30/federal-pandemic-money-fell-years-trumps-budgets-d/?fbclid=IwAR3Z3CZ-bU6n4Q5IxIVgsFey0ELs2F6uplsqCHpkLlHN61m5-yQ637SKqeM

PolitiFact (@PolitiFact) | Twitter

IF YOUR TIME IS SHORT

  • Federal support to build state and local capacity to manage a new viral crisis fell by 50% after 2003.
  • The decline in federal aid spans three presidencies and many sessions of Congress.
  • President Donald Trump sought $100 million in cuts that would have made the situation harder.

President Donald Trump’s critics have charged that he undermined efforts that could have helped the nation respond faster and better to the coronavirus. He’s been criticized for downgrading the focus on pandemic threats on the National Security Council and chastised for seeking budget cuts at the Centers for Disease Control and Prevention.

That isn’t the full story of U.S. pandemic preparedness.

The broader picture is that money to prepare for this day has steadily dwindled over the past 15 years — across three presidents and many sessions of Congress.

The funds for pandemics remained about the same under Trump (and would have been lower if his budgets were enacted). But compared with where funding stood in 2003, support to build state and local capacity has fallen by half.

As hospitals and public health agencies aimed for leaner, more efficient operations, the combination of fewer federal dollars and market pressures left them with little cushion to meet the explosive demands of the novel coronavirus.

Over the years, Washington put more emphasis on fighting predictable problems, like the seasonal flu, and outright aggression in the form of chemical, biological and radiological terrorism.

Sandro Galea, dean of Boston University’s School of Public Health, said people like him have been hamstrung in the debate.

“Public health has been on the defensive,” Galea said. “There’s been no space except for talk of bioterrorism. The discussion about investing in the public health system has been utterly sidelined.”

The long-term decline

Frontline readiness for a pandemic depends on many factors.

There have to be enough people with the right skills; enough beds, equipment and materials to treat patients; and the right practices to coordinate efforts across a region. Federal money helps support all of that.

The Centers for Disease Control and Prevention distributes grants to state and local public health agencies, labs and hospitals. In nominal dollars, the funding for the CDC’s Public Health Emergency Preparedness grants went from $939 million in 2003 to $675 million in 2020.

Private health providers get money through a hospital preparedness program within the Health and Human Services Department. It helps local coalitions of hospitals, public health agencies and emergency managers plan and get ready for a sudden health threat. That money went from $515 million to $275 million in the same 17-year period.

Corrected for inflation, combined spending went from over $2 billion in 2003 to a bit under $1 billion in 2020.

These programs came to the fore after the Sept. 11 attacks when concern over bioterrorism spiked. For lawmakers, the concern was personal — letters tainted with anthrax reached Capitol Hill.

But the money gradually faded, and the capacity of state and local public health departments and labs did not keep pace with the likelihood of a viral disease like COVID-19.

“Health departments can’t retain workforce or modernize their disease surveillance and laboratory capacity without adequate, long-term funding,” said Dara Lieberman, director of government relations with Trust for America’s Health, a public health advocacy group. “Today, we’re paying the price.”

Local health systems needed to do their part, but the federal government was uniquely positioned to help.

“The purchasing power of the federal government is second to none, and it has failed to stockpile or otherwise negotiate pipelines to get access to the personal protective gear and medical equipment that it has known with certainty would be needed in a respiratory pandemic,” said Ellen Carlin at Georgetown University’s Center for Global Health Science and Security.

But the news hasn’t been all bad. 

After the Ebola scare in 2014, Washington and the states showed renewed interest in preparing for a naturally occurring viral threat.

Congress provided a bit of extra money, and according to a Health and Human Services study the improvement was striking: In 2014, about 70% of hospital administrators said they were unprepared for an emerging infectious disease like Ebola. Three years later, only 14% said they weren’t ready.

But hospital leaders also warned that it was hard for them to maintain that level “given competing priorities for hospital resources and staff time.”

Local hospitals and public health agencies have come a long way since 2003, said Crystal Watson, assistant professor, at the Johns Hopkins Center for Health Security and former staffer at the Homeland Security Department.

But she said they faced multiple pressures. In addition to falling federal support, Watson said the demand to maintain a healthy bottom line helped shape the situation today.

“Hospitals are under pressure to be efficient,” Watson said. “They don’t stockpile tons of equipment and materials and they don’t have tons of empty beds because that is not profitable. When you need more supplies, and more personnel, that’s when you learn what you lack.”

Today, Watson said, the lesson is clear.

“In retrospect, none of this has been funded at the level it should have been,” she said.

A thinly stocked stockpile

This crisis has also revealed the cracks in the Strategic National Stockpile, the current go-to source for ventilators, masks and other essential needs. States have clamored for supplies, and so far, deliveries have lagged far behind demand.

During her time with Homeland Security, Watson contributed to an assessment of the Strategic National Stockpile. Watson said the stockpile was designed with a long list of threats in mind, from chemical and biological terrorism to natural disasters. Something like COVID-19 would be just one threat among many.

“It’s primary purpose, and where it had more of a focus, was on bioterrorism,” Watson said. “That’s understandable. Who else but the government is going to buy a vaccine to protect the population against smallpox?”

The most recent strategic plan for the stockpile reflects the competing demands.

It mentions emerging infectious disease 15 times. Preparing for anthrax shows up nearly 50 times.

Criticisms of Trump need context

As the first cases emerged in the United States, Democrats criticized Trump’s preparedness on two fronts: He eliminated a key office in the National Security Council, and he tried to cut the CDC’s budget. 

The budget claims have merit. The complaints about the National Security Council  are reasonable, but could be more organizational streamlining than a loss of capability.

Until the spring of 2018, the National Security Council had an office that focused on global health and biodefense. When John Bolton took the lead on the council, he crafted an overall organizational reshuffle.

The functions of the global health division were absorbed into the council’s division that dealt with weapons of mass destruction and biodefense. The White House established a Biodefense Steering Committee headed by the Health and Human Services secretary, and issued a National Biodefense Strategy.

At the time, the Center for Strategic and International Studies think tank said the White House should name a senior-level leader to oversee the policy. The White House did not follow that advice.

The Trump campaign pointed to arguments from Bolton and the former senior director of the council, Tim Morrison, rejecting the idea that they lost their focus on this kind of threat.

On the budget, Trump unsuccessfully pressed for cuts in programs that relate directly to the current crisis. In his 2018 budget, he proposed cutting over $100 million from programs aimed specifically at strengthening public hospitals and labs — a 17% reduction. For fiscal year 2020, he wanted to cut $100 million, again about 17%, from programs that target emerging and zoonotic infectious diseases.

Congress ignored the president’s budget plans and largely kept the flow of dollars steady, even increasing them slightly. 

In 2018, Congress created a new Infectious Diseases Rapid Response Reserve Fund to provide quick money between the time when a crisis strikes and Congress delivers aid with real heft. The fund held $135 million when HHS secretary Alex Azar declared a health emergency in early February, which freed up that money.

That doesn’t mean the Trump administration’s preferences had no effect, said Tony Mazzaschi, with the Association of Schools and Programs of Public Health, a group that lobbies Congress on behalf of public health schools. The threat of cuts made the status quo seem like a win when it wasn’t.

“One of the perverse things that happens is the public health community has to play defense and can’t argue for increases,” Mazzaschi said.

 

 

Anthony Fauci’s security is stepped up as doctor and face of U.S. coronavirus response receives threats

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Courage, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Dept of Justice (DOJ), Health Policy, Honesty, Integrity, Nonpartisan, Pandemic, Security, Social Distancing, Trust, Truth • Leave a comment

https://www.washingtonpost.com/politics/anthony-faucis-security-is-stepped-up-as-doctor-and-face-of-us-coronavirus-response-receives-threats/2020/04/01/ff861a16-744d-11ea-85cb-8670579b863d_story.html?utm_campaign=wp_news_alert_revere&utm_medium=email&utm_source=alert&wpisrc=al_news__alert-hse–alert-national&wpmk=1

Nation's top coronavirus expert Dr. Anthony Fauci forced to beef ...

Anthony S. Fauci, the nation’s top infectious-diseases expert and the face of the U.S. response to the novel coronavirus pandemic, is facing growing threats to his personal safety, prompting the government to step up his security, according to people familiar with the matter.

The concerns include threats as well as unwelcome communications from fervent admirers, according to people with knowledge of deliberations inside the Department of Health and Human Services and the Department of Justice.

Fauci, 79, is the most outspoken member of the administration in favor of sweeping public health guidelines and is among the few officials willing to correct President Trump’s misstatements. Along with Deborah Birx, the coordinator for the White House’s task force, Fauci has encouraged the president to extend the timeline for social-distancing guidelines, presenting him with grim models about the possible toll of the pandemic.

“Now is the time, whenever you’re having an effect, not to take your foot off the accelerator and on the brake, but to just press it down on the accelerator,” he said Tuesday as the White House’s task force made some of those models public, warning of 100,000 to 240,000 deaths in the United States.

The exact nature of the threats against him was not clear. Greater exposure has led to more praise for the doctor but also more criticism.

Fauci has become a public target for some right-wing commentators and bloggers, who exercise influence over parts of the president’s base. As they press for the president to ease restrictions to reinvigorate economic activity, some of these figures have assailed Fauci and questioned his expertise.

Last month, an article depicting him as an agent of the “deep state” gained nearly 25,000 interactions on Facebook — meaning likes, comments and shares — as it was posted to large pro-Trump groups with titles such as “Trump Strong” and “Tampa Bay Trump Club.”

Alex Azar, the HHS secretary, recently grew concerned about Fauci’s safety as his profile rose and he endured more vitriolic criticism online, according to people familiar with the situation. In recent weeks, admirers have also approached Fauci, asking to him sign baseballs, along with other acts of adulation. It was determined that Fauci should have a security detail. Azar also has a security detail because he is in the presidential line of succession.

Asked Wednesday whether he was receiving security protection, Fauci told reporters, “I would have to refer you to HHS [inspector general] on that. I wouldn’t comment.”

The president interjected, saying, “He doesn’t need security. Everybody loves him.”

HHS asked the U.S. Marshals Service to deputize a group of agents in the office of the HHS inspector general to provide protective services for the doctor, according to an official with knowledge of the request.

The U.S. Marshals Service conveyed the request to the deputy attorney general, who has authority over deputations for the purpose of providing protective services, with the recommendation that it be approved, according to the official, who spoke on the condition of anonymity to reveal sensitive plans that the person was not authorized to discuss.

A Justice Department official signed paperwork Tuesday authorizing HHS to provide its own security detail to Fauci, according to an administration official.

An HHS spokesperson declined to discuss details of the doctor’s security but said: “Dr. Fauci is an integral part of the U.S. Government’s response against covid-19. Among other efforts, he is leading the development of a covid-19 vaccine and he regularly appears at White House press briefings and media interviews.”

At the briefings, Fauci, who has advised presidents of both parties as director of the National Institute of Allergy and Infectious Diseases, has spoken authoritatively about the spread of the coronavirus and the sacrifices involved in mitigating its effects.

He has at times corrected the president, in particular when prompted by reporters. After Trump said a covid-19 vaccine would be available in a couple of months, Fauci said it would in fact be available in about a year to a year and a half, at best.

His role has turned him into a hero for some. When he was absent from a briefing last month, followers who had grown accustomed to his frank assessments of the outbreak were alarmed that he might have been sidelined for his forthrightness. Many took to Twitter to ask, “Where is Dr. Fauci?” causing the question to trend on the platform.

He gained viral attention two days later when he placed his hand in front of his face in a gesture of apparent disbelief as Trump referred to the State Department as the “deep state department” from the White House briefing room.

Fauci has also given several interviews in which he has tempered praise for the president with doubts about his pronouncements, including about the viability of anti-malarial drugs as a treatment for the novel coronavirus. Most notably, he told the journal Science that he attempts to guide Trump’s statements but “can’t jump in front of the microphone and push him down.”

These moves have inspired fandom. But they have also drawn scorn from some of the president’s most vocal supporters, even as both men have sought to tamp down the appearance of tension.

“The president was right, and frankly Fauci was wrong,” Lou Dobbs said last week on his show on the Fox Business Network, referring to the use of experimental medicine.

Right-wing news and opinion sites have gone further, launching baseless smears against the doctor that have gained significant traction within pro-Trump communities online.

Outlets such as the Gateway Pundit and American Thinker seized on a 2013 email — released by WikiLeaks as part of a cache of communications hacked by Russian operatives — in which Fauci praised Hillary Clinton’s “stamina and capability” during her testimony as secretary of state before the congressional committee investigating the attacks in Benghazi, Libya.

The headline in the American Thinker referred to Fauci as a “Deep-State ­Hillary Clinton-loving stooge.” The author, Peter Barry Chowka, didn’t respond to requests for comment. When asked about the relevance of Fauci’s emails to his role in advising the White House’s coronavirus response, Jim Hoft, the editor of the Gateway Pundit, said, “I don’t have a problem with more information being shared about the doctor.”

The outlet has continued to criticize Fauci in recent days, saying that by offering new predictions about the possible death toll, Fauci and others were “going to destroy the U.S. economy based on total guesses and hysterical predictions.”

Several senior administration officials said that Trump respects Fauci and that the two generally have a good working relationship. Trump heeded the guidance of Fauci and Birx this week when he announced his administration would extend social-distancing guidelines for another 30 days. Last week, many health officials and experts grew worried when Trump said he hoped to reopen the country by Easter, even as coronavirus cases in the United States continue to rapidly climb.

The immunologist, who graduated first in his class from Cornell’s medical school, has been the director of the National Institute of Allergy and Infectious Diseases since 1984. Between 1983 and 2002, he was the 13th-most-cited scientist among the 2.5 million to 3 million authors worldwide and across all disciplines publishing in scientific journals, according to the Institute for Scientific Information.

 

 

 

Jobless claims spike to another weekly record amid coronavirus crisis

Posted on by • Posted in Bad Debt Expense, Coronavirus, Crisis, Crisis Management, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Out of Pocket Expenses, Pandemic, Rev Cycle Management, Uncompensated Care, Underinsured, Uninsured • Leave a comment

https://www.axios.com/jobless-claims-unemployment-coronavirus-e54561c2-ed25-4f1e-8e32-7fbec81a9a24.html?stream=top&utm_source=alert&utm_medium=email&utm_campaign=alerts_all

Jobless claims spike to 6.6 million, another weekly record amid ...

6.6 million people filed for unemployment last week, a staggering number that eclipses the record set just days ago amid the coronavirus pandemic, according to government data released Thursday.

Why it matters: Efforts to contain the outbreak are continuing to create a jobs crisis, causing the sharpest spikes in unemployment filings in American history.

  • The colossal number of unemployment filings is worse than most Wall Street banks were expecting.

The big picture: Nearly 10 million Americans have filed for unemployment claims in recent weeks, as businesses around the country shut down in response to the pandemic.

  • But the data lags by a week, so it’s almost certain labor departments around the country are still processing claims and people are still applying.

 

 

 

At the population level, the coronavirus is almost literally everywhere

Posted on by • Posted in Coronavirus, Crisis Management, Critical Access Hospitals, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety • Leave a comment

https://www.washingtonpost.com/business/2020/04/01/population-level-coronavirus-is-almost-literally-everywhere/?fbclid=IwAR3yWJR5JNinRfMPebVblOi74KdH3klfAKwdf4x_-c6Wf2X0Zt1AyCjkugM&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

At the population level, the coronavirus is almost literally ...

95 percent of Americans live in a county that has reported at least one case.

More than 6 in 10 Americans live in counties where people have died of the disease caused by the coronavirus, and about 95 percent live in places reporting at least one case, according to a Washington Post analysis of data compiled by Johns Hopkins University.

At the population level, in other words, the virus is almost literally everywhere, turning the epidemic into a crisis directly affecting the lives of nearly every single person in the United States.

Image without a caption

The first coronavirus case in the United States was confirmed on Jan. 20 in a man in Snohomish County, Wash., who had recently visited the epicenter of the global pandemic in Wuhan, China. In just over two months, the virus has spread to more than 2,000 counties representing at least 95 percent of the U.S. population, according to tracking data maintained by Johns Hopkins.

March 13 marks an inflection point in the virus’s spread. That day, it was reported in counties representing more than half the population. Coincidentally, it was a day after Americans woke up to news of travel restrictions on Europe, the cancellation of March Madness and Tom Hanks’s covid-19 diagnosis in Australia.

The virus continued its rapid spread to new segments of the population until about March 21, when confirmed cases reached counties representing 80 percent of Americans. Since then the rate of county-level exposure has slowed somewhat, if only because the virus is running out of new population centers to infect.

As of March 30, nearly every county in the United States with a population of 100,000 or more is reporting at least one coronavirus infection.

These numbers come with caveats. The virus is almost certainly already present in a number counties where no cases have yet been confirmed via testing. Many people who become infected show no or only mild signs of infection, so they may not seek testing. In many regions of the country, there still aren’t enough tests for every potential patient.

Image without a caption

Nevertheless, it’s instructive to see where the virus has not yet been reported. The map above, in which counties with no confirmed cases are in orange, is essentially an inverse population map. The orange counties are some of the least populated in the United States, including the wide belt of sparsely populated counties in the central plains.

These counties represent well over half the country’s land area, but only about 5 percent of its population. Their lack of cases illustrates an obvious but easy to forget point: The virus has a harder time spreading in places with fewer people. Density is one of cities’ great strengths, but during a pandemic it becomes a weakness, allowing an infection to spread rapidly among a tightly packed population.

It’s worth pointing out that while rural counties may be remote, they are not necessarily isolated. People living in these places often routinely travel to cities and towns to shop, receive health care and visit friends and family. Rural areas pride themselves on self-sufficiency, but they are nevertheless connected to the rest of the country via travel and trade.

Some rural areas, particularly vacation and second home destinations, are growing concerned at the prospect of city-dwellers fleeing to the country to ride out the pandemic, potentially bringing the virus with them. Many rural counties lack hospitals, making health care access a challenge even in normal times.

If city transplants cause a coronavirus outbreak disproportionate to the availability of hospital beds in a rural area, the results could be catastrophic.

 

 

 

Trump rejects Obamacare special enrollment period amid pandemic

Posted on by • Posted in 2020 Election Issues, ACA, Center for Medicare and Medicaid Services (CMS), COBRA Coverage, Coronavirus, Economic Stimulus, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Medicare for All, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans, Supreme Court, Underinsured, Uninsured • Leave a comment

https://www.politico.com/news/2020/03/31/trump-obamacare-coronavirus-157788?fbclid=IwAR1nbCE7Uwvo2CNi6d6W5NG9zEIQulyh-noy1RXdk_0RJstMM0C5VYJ8mO4

Trump rejects opening ObamaCare special enrollment period amid ...

Before the coronavirus outbreak, nearly 30 million Americans were uninsured and as many as 44 million were under-insured, paying for bare-bones plans with soaring deductibles and copays. Today, millions more Americans will begin losing their employer-based health insurance because they’ve lost their jobs during this pandemic.

Meanwhile, the Trump administration is still actively trying to repeal the entirety of the Affordable Care Act in court, which would cause an additional 20 million people to lose insurance *in the middle of a pandemic*.

And today, Trump refused to reopen ACA enrollment to those millions of uninsured Americans for a special enrollment window, leaving them without any affordable options to get covered. People are going to die because they can’t afford to seek treatment or end up saddled with thousands of dollars of medical debt if they do. Remember this the next time someone tries to tell you Medicare for All is too radical.

What do you think?

The Trump administration has decided against reopening Obamacare enrollment to uninsured Americans during the coronavirus pandemic, defying calls from health insurers and Democrats to create a special sign-up window amid the health crisis.

President Donald Trump and administration officials recently said they were considering relaunching HealthCare.gov, the federal enrollment site, and insurers said they privately received assurances from health officials overseeing the law’s marketplace. However, a White House official on Tuesday evening told POLITICO the administration will not reopen the site for a special enrollment period, and that the administration is “exploring other options.”

The annual enrollment period for HealthCare.gov closed months ago, and a special enrollment period for the coronavirus could have extended the opportunity for millions of uninsured Americans to newly seek out coverage. Still, the law already allows a special enrollment for people who have lost their workplace health plans, so the health care law may still serve as a safety net after a record surge in unemployment stemming from the pandemic.

Numerous Democratic-leaning states that run their own insurance markets have already reopened enrollment in recent weeks as the coronavirus threat grew. The Trump administration oversees enrollment for about two-thirds of states.

Insurers said they had expected Trump to announce a special enrollment period last Friday based on conversations they had with officials at the Centers for Medicare and Medicaid Services, which runs HealthCare.gov enrollment. It wasn’t immediately clear why the Trump administration decided against the special enrollment period. CMS deferred comment to the White House.

Trump confirmed last week he was seriously considering a special enrollment period, but he also doubled down on his support of a lawsuit by Republican states that could destroy the entire Affordable Care Act, along with coverage for the 20 million people insured through the law.

People losing their workplace coverage have some insurance options outside of the law’s marketplaces. They can extend their employer plan for up to 18 months through COBRA, but that’s an especially pricey option. Medicaid is also an option for low-income adults in about two-thirds of states that have adopted Obamacare’s expansion of the program.

Short-term health insurance alternatives promoted by Trump, which allow enrollment year-round, is also an option for many who entered the crisis without coverage. Those plans offer skimpier coverage and typically exclude insurance protections for preexisting conditions, and some blue states like California and have banned them or severely restricted them. The quality of the plans vary significantly and, depending on the contract, insurers can change coverage terms on the fly and leave patients with exorbitant medical bills.

Major insurers selling Obamacare plans were initially reluctant to reopen the law’s marketplaces, fearing they would be crushed by a wave of costs from Covid-19, the disease caused by the novel coronavirus. But the main insurance lobby, America’s Health Insurance Plans, endorsed the special enrollment period roughly two weeks ago while also urging lawmakers to expand premium subsidies to make coverage more affordable for middle-income people.

Congress in last week’s $2 trillion stimulus passed on that request, as well as insurers’ petition for an open-ended government fund to help stem financial losses from an unexpected wave in coronavirus hospitalizations.

Democrats pushing for the special enrollment period are also grappling with the high costs facing many people with insurance despite new pledges from plans to waive cost-sharing. Obamacare plans and a growing number of those offered by employers impose hefty cost-sharing and high deductibles that could still burden infected Americans with thousands of dollar in medical bills.

House Energy and Commerce Chairman Frank Pallone (D-N.J.) on a press call Monday contended that “we also need to have free treatment” after Congress eliminated out-of-pocket costs for coronavirus tests.

“We did the testing, which is now free, and everybody, regardless of their insurance, gets it,” Pallone said. “But that has to be for the treatment as well.”

 

 

 

 

An explosion of coronavirus cases cripples a federal prison in Louisiana

Posted on by • Posted in American Civil Liberties Union (ACLU), Clinical Testing, Coronavirus, Crisis, Crisis Management, Hazard Pay, Health Policy, Infection Control, Infectious Virus, Labor Union, Leadership, Pandemic, Preexisting Conditions, Prison Safety, Public Health, Public Safety, Quarantine • Leave a comment

https://www.washingtonpost.com/national/an-explosion-of-coronavirus-cases-cripples-a-federal-prison-in-louisiana/2020/03/29/75a465c0-71d5-11ea-85cb-8670579b863d_story.html?fbclid=IwAR2rjY1fk7FF2H1vhUxaeZ4c8F3_Vi1HUJhCUkhP-bjFdc_tbuHV8KrKN80&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Federal prison in Louisiana crippled by coronavirus cases as ...

A federal prison in Louisiana has, within days, exploded with coronavirus cases, leading to the death of one inmate on Saturday, the admission of a guard into a hospital intensive care unit, and positive test results for another 30 inmates and staff.

Patrick Jones, 49, was the first inmate in the Federal Bureau of Prisons diagnosed with the novel coronavirus, which causes covid-19, and the first to die.

At least 60 inmates at the Oakdale prison are in quarantine and an unknown number of staff are self-quarantining at home, said Corey Trammel, a union representative for correctional officers at the 1,700-inmate facility about 110 miles northwest of Baton Rouge.

“It’s been simultaneous, just people getting sick back to back to back to back,” Trammel said. “We don’t know how to protect ourselves. Staff are working 36-hour shifts — there’s no way we can keep going on like this.”

The prison bureau is not releasing the names of other infected inmates or staff, citing medical and privacy concerns. Jones complained of a “persistent cough” on March 19, the prison bureau said, and was transported to a hospital where he was diagnosed and placed on a ventilator.

The prison bureau also said Jones had “long-term, preexisting medical conditions” that increased his risk of developing the disease. Jones was convicted in 2017 of possession with intent to distribute crack cocaine within 1,000 feet of a junior college. He was serving a 27-year sentence.

Louisiana ranks 10th highest among states for reported coronavirus cases, with more than 3,300 people who have tested positive and another 137 who have died, government reports show. A week before the Oakdale prison had its first positive case, Gov. John Bel Edwards (D) issued a stay-at-home order and closed all public schools.

Trammel said the prison bureau has been slow to respond to the crisis across the country. The bureau last week banned family and friends from visiting inmates, but the officers’ union had lobbied the federal prison system to take this action for weeks to keep the disease from infiltrating the prison walls.

The Bureau of Prisons updates confirmed coronavirus cases most afternoons on its website, but there has been a lag between cases reported by the officers’ union and prison officials. As of Sunday afternoon, the prison system had only confirmed 14 inmates and 13 staff have tested positive.

At Oakdale, Trammel said staff also asked prison officials — weeks before the first coronavirus case — to shut down a prison labor program within the facility, where more than 100 prisoners make inmate clothing. The program, Trammel said, was not shut down until after the first inmate tested positive.

The Bureau of Prisons — which operates 122 prisons with more than 175,000 inmates — did not immediately respond Sunday to a request for comment. Oakdale Warden Rod Myers could also not be reached for comment.

Trammel said he asked the prison bureau on Saturday to send specialized medical teams to the facility to help with staffing shortages. He’s also asking for hazard pay, which would increase their salaries by 25 percent as they respond to the crisis. And he’s asking for more robust protective gear, including masks with respirators and perhaps face shields.

“We are bringing inmates to the hospitals and are staying right beside them around the clock,” Trammel said. “All we have is these itty bitty masks — a piece of towel over our faces — and nurses are coming into the room for a few minutes and they are all suited up.”

He also said he believes all Oakdale prison staff have now been exposed to the virus. Days ago, he interacted with an inmate who had a fever and still doesn’t know if the prisoner has received a test.

“We should all be in quarantine,” Trammel said. “We should not be going in to spread this monster of a virus.”

Prison reform advocates, who have been pushing for the early release of elderly and severely ill inmates due to covid-19, said the death of a federal inmate illustrates why government officials need to be doing a better job of protecting people like Jones.

“The conditions and reality of incarceration make prisons and jails tinderboxes for the spread of disease,” said Udi Ofer, director of the American Civil Liberties Union’s Justice Division. “A prison sentence should not become a death sentence. Our leaders must immediately take steps to release those identified by the CDC as most vulnerable to covid-19. With every hour of inaction that passes, the greater the human tragedy.”

 

 

 

 

Dr. Birx predicts up to 200,000 coronavirus deaths ‘if we do things almost perfectly’

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Emergency Preparedness, Health Policy, Infection Control, Infectious Virus, Intensive Care (ICU), Pandemic, Public Health, Public Safety, Social Distancing, Ventilators • Leave a comment

https://www.yahoo.com/news/dr-birx-predicts-200-000-115800421.html

Dr. Birx predicts up to 200,000 U.S. coronavirus deaths 'if we do ...

The White House coronavirus response coordinator said Monday that she is “very worried about every city in the United States” and projects 100,000 to 200,000 American deaths as a best case scenario.

In an interview on “TODAY,” Dr. Deborah Birx painted a grim message about the expected fatalities, echoing that they could hit more than 2 million without any measures, as coronavirus cases continue to climb throughout the country.

“I think everyone understands now that you can go from five to 50 to 500 to 5,000 cases very quickly,” Birx said.

“I think in some of the metro areas we were late in getting people to follow the 15-day guidelines,” she added.

Birx said the projections by Dr. Anthony Fauci that U.S. deaths could range from 1.6 million to 2.2 million is a worst case scenario if the country did “nothing” to contain the outbreak, but said even “if we do things almost perfectly,” she still predicts up to 200,000 U.S. deaths.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, reiterated Monday on CNN that “I don’t want to see it, I’d like to avoid it, but I wouldn’t be surprised if we saw 100,000 deaths.”

Politics

Birx said the best case scenario would be for “100 percent of Americans doing precisely what is required, but we’re not sure that all of America is responding in a uniform way to protect one another,” referencing images circulating online of people still congregating in big groups and ignoring guidelines from the Centers for Disease Control and Prevention.

Birx was also on “Meet the Press” on Sunday warning that “no state, no metro area will be spared,” a message she repeated Monday. Even if metro or rural areas don’t see the virus in the community now, by the time it does appear, the outbreak will be significant, she added.

How long Americans will be expected to comply with measures, including socially distancing and sheltering in place, remains unclear in this growing pandemic after several states and larger cities began implementing measures over the past couple of weeks.

President Trump announced Sunday that the administration’s guidelines on social distancing have been extended until April 30. Trump said last week that he wanted to see much of the country return to normal by Easter, April 12, despite warnings from top health experts that easing guidelines early could cause mass deaths. Now, Trump said he expects “great things to be happening” by June 1.

Birx said on Sunday that the choice to extend the guidelines had not been made lightly.

“We know it’s a huge sacrifice for everyone,” she added.

 

 

 

 

Nurse dies in New York hospital where workers are reduced to using trash bags as protective medical gear

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Emergency Preparedness, Health Policy, Infection Control, Infectious Virus, Intensive Care (ICU), Pandemic • Leave a comment

https://www.businessinsider.com/kious-kelly-hospital-nurse-dies-trash-bags-2020-3?utmSource=twitter&utmContent=referral&utmTerm=topbar&referrer=twitter&fbclid=IwAR3BPkAbdFrHQBM1UiV3o23sIqDsBxkhLBNJ7kV9sCmqU3zpKndGKHc0gY8

Nurse dies in New York hospital where workers are reduced to using ...

A nurse at Mount Sinai Hospital in New York died from COVID-19 after learning he was infected by the novel coronavirus almost two weeks ago. Protective medical gowns are in such short supply in the Mount Sinai system that some nurses have started to use Hefty-brand garbage bags instead, according to photos on social media.

The New York Post reported that Kious Kelly, an assistant nursing manager at Mount Sinai Hospital in Manhattan, died Tuesday. He was 48 years old.

His sister confirmed his death to the Post, saying that she was told he had been in the intensive-care unit but that he did not think it was serious. The Post did not specify how he contracted the virus.

“We are deeply saddened by the passing of a beloved member of our nursing staff,” Renatt Brodsky, a representative for the Mount Sinai Health System, told Business Insider in a statement. Brodsky did not provide any further details.

New York state has become the epicenter for the US’s coronavirus outbreak, with more than 33,000 infections and more than 360 deaths. In New York and other areas in the US with large outbreaks, healthcare workers are reporting shortages of personal protective equipment like masks, gowns, face shields, and gloves.

At Mount Sinai West, in the same hospital system where Kelly worked, nurses published a photo on social media showing them fashioning plastic trash bags into protective outfits, according to the Post.

“NO MORE GOWNS IN THE WHOLE HOSPITAL,” they wrote on Facebook. “NO MORE MASKS AND REUSING THE DISPOSABLE ONES … NURSES FIGURING IT OUT DURING COVID-19 CRISIS.” One nurse is seen holding a box of Hefty Strong 33-gallon bags, more commonly used for lining household trash cans.

 

 

 

What the U.S. can learn from other countries in the coronavirus fight

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Testing, Communication, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Emergency Preparedness, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Public Health, Public Safety, Quarantine, Trust, Truth, Universal Healthcare System • Leave a comment

https://www.axios.com/coronavirus-lessons-other-countries-24794264-1653-4500-922c-7f1c66efa011.html

Coronavirus lessons that the U.S. can learn from other countries ...

The countries that have most successfully fended off the novel coronavirus have mainly done it with a combination of new technology and old-school principles.

Why it matters: There’s a lot the U.S. can learn from the way other countries have handled this global pandemic — although we may not be able to apply those lessons as quickly as we’d like.

The big picture: A handful of Asian countries, including South Korea, Singapore and Taiwan, have succeeded where the U.S. and Europe have failed.

  • They were able to quickly bring the virus under control, reducing the number of new cases that cropped up each day. And they did it largely without shutting down schools, businesses and public life.

The bad news: It’s too late for the U.S. to simply do what worked in those countries. We’ve already made too many mistakes.

  • But there are still lessons for the U.S. to learn for future outbreaks — and, hopefully, there are some pieces of those countries’ larger strategies that we can adapt to our coronavirus response now.
Lesson 1: The playbook works

As a new infection begins to spread, you want to quickly test the people who might have it, and quarantine the ones who do. Then you want to figure out who else they might have infected, and test those people, and quarantine the ones who are indeed sick. This process gets repeated.

  • “If you don’t know what your population is that you’re supposed to be monitoring, you don’t have a chance,” said Claire Standley, an infectious-disease expert at Georgetown University’s Center for Global Health Science and Security.

This test-and-trace process is nothing new. It’s the standard playbook. South Korea, Singapore and Taiwan just executed it a lot better than the United States.

  • Testing and contact tracing are particularly important with this strain of coronavirus because people can spread it before they start to feel sick — so if you’re only testing the sickest patients, the virus is still spreading unchecked.
  • And it’s important to do this early. It’s a lot easier to stop five people from infecting another 15 than it is to stop 20,000 people from infecting another 60,000.

Next time a mysterious virus starts spreading abroad, better testing and a much faster response will be imperative.

Lesson 2: Technology can help

Singapore has gotten pretty draconian with its track-and-trace process.

  • The government tracks the location of residents’ smartphones, so it knows exactly who had come within a few feet of an infected or potentially infected person.
  • It uses the same location data to help enforce mandatory quarantines.

That might be too Big Brother for the U.S., but a voluntary version of it might work — we already consent to a whole lot of location tracking for much less important ends.

  • And researchers are already using population-level smartphone data to see, for example, which cities are flouting stay-at-home orders. That can help inform local response even without individualized tracking.
  • “I think we’re further along that pathway than maybe people think,” Standley said.

Taiwan, meanwhile, aided its coronavirus response by making better use of data it already had. It quickly merged its immigration and health care databases, giving authorities a real-time view of who was getting sick and where they had traveled.

  • That might be hard to copy in the U.S., though, because the relevant data are scattered across multiple local, state and federal agencies with little to no integration. And we have no centralized health data.
Lesson 3: Messaging matters

Public communication is one of the big things Italy — a leading example of what not to do — got wrong.

  • Some Italian officials downplayed the virus for too long. Leaders often contradicted each other, and sometimes themselves, about piecemeal interventions before finally locking down the entire country as cases skyrocketed.

Singapore, by contrast, came out early with a clear message: This was going to be bad for a while, and people needed to stick together and do their part.

The U.S., so far, looks a lot more like Italy.

  • President Trump has sent similarly mixed messages here, initially downplaying the virus and saying it would go away on its own before changing his tone as cases mounted.
What’s next

The U.S. can’t go back in time to get things right at the beginning. So we can’t match the success of places like South Korea.

  • Our best backup plan is to stick with aggressive social distancing and give our testing capacity more time to ramp up.
  • We don’t seem to be on track to ever achieve the kind of sophisticated track-and-trace programs Asia employed, but hopefully some cruder version can help us find our way out of this if we keep the number of new cases low in the meantime.

The bottom line: “If we had got on top of this thing two months ago, America would look very, very different,” Ashish Jha, director of Harvard’s Global Health Institute, said in a recent interview with the New Yorker.