Category Archives: Social Distancing

COVID-19 Update: The N̶e̶w̶s̶ Data is Mostly Good

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Economy, Health Policy, Infection Control, Infectious Virus, Pandemic, Recovery, Social Distancing • Leave a comment

COVID-19 Update: The N̶e̶w̶s̶ Data is Mostly Good

First off, it’s time to call a spade a spade. When the Trump administration publicly projected 100,000 to 240,000 deaths in the U.S. last week, we couldn’t come up with a model that aligned with these numbers. Either they are/were seeing something in the data that we are not, or…they were managing expectations. This is an election year, after all. Even in the daily briefings since that forecast, the number of new cases reported have generally been lower than feared.

According to our forecasts, which were based on Italy and other countries leading virus-progressions (which were intentionally overestimated when compared to the probable U.S. trajectory), the U.S. would likely never plateau at rates above 50,000 new cases a day. The U.S. has 5.5 times as many people than Italy. Even if we overestimated that Italy was a model for the U.S. (which, as we projected, peaked two weeks ago at less than 7,000 cases a day), it was hard to model the U.S. peaking at more than 50,000 cases a day and likely that number will be closer to 40,000 or less. Italy maintained 85% of peak for nearly three weeks before declining. If we ascribe that to 40,000 new cases a day, the U.S. will likely add less than 750,000 new cases before meaningful decent. We believe we are already into that peak phase (currently with 400,000 cases). By our models, the U.S. will reach a total of approximately 1.5 million cases (or less), using the Italian infection model. With an above average fatality rate of 5% (we expect it will be lower), you would anticipate less than 75,000 deaths in the U.S., with the bulk of those coming in the next 4 weeks.

Importantly, Italy has one of the oldest populations in the developed world with an average age over 7 years older than the U.S. at 45.5 and a meaningful population in the most susceptible zone of the virus (above 70). Societally, they also live multi-generationally, which increases cross spread within families. Italy also failed to take protective measures until there was a considerable outbreak. They continued to allow flights in from China, their key textile trade partner, for over a week longer than the U.S., despite cases coming into Northern Italy directly through China. Further, Italy’s hospitals in the north were overrun with cases, which is not anticipated in most of the U.S. (see state by state data here). As such, we expect and hope that our estimates for U.S. data for the virus will prove to be higher than reality when the virus is eventually suppressed…at least this go around.

popitaly

With expectations that Italy’s progression may represent the worst pattern to date, we again look to Italy (and its close neighbors) to see if our indicators have continued on their paths of peak, plateau, and eventual decline. So far, with each new data point, we continue to be encouraged – with one troublesome outlier. Italy continues to report fewer and fewer new cases, as do their immediate neighbors to the north, Austria and Switzerland. In fact, Austria and Switzerland are already seeing the number of active cases in their countries decline.

dailyitaly
dailyswau
As we have stated before, Spain, Germany, and France were the next countries to see the number of cases of the virus mushroom. There the recent reports are only partially good. Spain and Germany are following the pattern that we predicted just a few short days ago. Spain’s drop in new cases is especially encouraging, as many were beginning to compare its outbreak to that which was seen in Italy.

germanydailyspain

daily fran

Most of the other European countries we are following are exhibiting similar patterns, although earlier in their progression. The outlier is France. France has posted up some alarming and quite possibly anomalistic numbers in the last several days. North Pier will investigate this data in more detail in our full weekly update. We hope that this will prove to be atypical and that we will see the virus’s trajectory in France moderate soon.

The U.S. stock market seems to have turned its attention to this new phase of virus-related data. For the time being, the fear of the abyss seems to have abated. Ultimately, the real test will come when we finally turn our attention to the economy, and what the post-virus world will look like. However, those days are far off. There will likely be bouts of fear and euphoria between now and then. Along the way, we will do our best to keep you informed.

 

 

 

Fauci: ‘Looks like’ US deaths will be lower than original projection

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Social Distancing • Leave a comment

Fauci: ‘Looks like’ US deaths will be lower than original projection

Fauci: 'Looks like' US deaths will be lower than original ...

Dr. Anthony Fauci said Wednesday morning that he thinks the number of U.S. deaths from coronavirus will end up being less than the original projection of 100,000 to 200,000. 

Fauci, the government’s top infectious disease expert, attributed the drop to the success of social distancing measures that have directed people to stay home and closed many businesses.

“Although one of the original models projected 100- to 200,000 deaths, as we’re getting more data and seeing the positive effect of mitigation, those numbers are going to be downgraded,” Fauci said on Fox News. “I don’t know exactly what the numbers are going to be, but right now it looks like it’s going to be less than the original projection.”

By the end of March, the White House was projecting 100,000 to 240,000 deaths as America’s best-case scenario for the pandemic.

Centers for Disease Control and Prevention Director Robert Redfield made similar comments on Tuesday, saying he expected the number of deaths to be “much lower” than what was predicted by the models.

A closely watched University of Washington model is now projecting about 60,000 deaths in the U.S. 

Despite some hopeful signs, Fauci emphasized that now is not the time to ease up on social distancing measures, the best way to keep improving the outlook. 

“We’re going to start to see the beginning of a turnaround, so we need to keep pushing on the mitigation strategies because there’s no doubt that that’s having a positive impact,” he said.

“Now’s not the time to pull back at all,” he added. “It’s a time to intensify.”

President Trump has been eager to reopen the economy, and Fauci said planning for that is underway at the White House, where late Tuesday night there was a meeting on the subject in the Roosevelt Room.

“If in fact we are successful it makes sense to at least plan what a reentry into normality would look like,” Fauci said. “That doesn’t mean we’re going to do it right now, but it means we need to be prepared to ease into that. And there’s a lot of activity going on.”

 

 

 

 

Wisconsin Election: Voters Find Long Lines and Closed Polling Sites

Posted on by • Posted in 2020 Election Issues, Absentee Ballots, Coronavirus, Crisis, Crisis Management, Gerrymandering, Health Policy, Infection Control, Infectious Virus, Pandemic, Partisanship, Public Health, Public Safety, Social Distancing, Voter Suppression • Leave a comment

Wisconsin Election: Voters Find Long Lines and Closed Polling ...

The state is the first to hold a major election with in-person voting since stay-at-home orders were widely instituted because of the coronavirus.

Many voters say they never received the absentee ballots they requested.

  • Wisconsin is the first state to hold a major election with in-person voting despite stay-at-home orders for Americans protecting themselves from the coronavirus.

  • Polls will close at 9 p.m. Eastern time. Long lines have been seen in cities like Milwaukee, which has only five polling places open, and social distancing is a concern.

  • Wisconsin is holding its presidential primary between former Vice President Joseph R. Biden Jr. and Senator Bernie Sanders. Mr. Biden had a strong lead in a recent, widely respected poll.

  • The state’s elections commission has ordered municipal clerks not to release any results until April 13, in compliance with a federal court ruling.

  • Wisconsin Democrats wanted to extend absentee voting and even postpone the election altogether, but Republicans successfully blocked both in court. As a result, Democratic turnout is likely to be depressed because of the virus and the deadlines for absentee voting. A crucial seat on the State Supreme Court is on the ballot.

A morning of voting brings disruption and confusion.

MILWAUKEE — After a morning of voting across Wisconsin, in an election that has drawn derision from public health experts and inflamed partisan tensions, a picture is emerging of long lines, some flaring tempers and a dose of chaos and confusion in the state’s most heavily populated areas.

Voters in Milwaukee, the state’s Democratic base and most populous city, have experienced significant disruptions at polling places. Election workers in the city expected more than 50,000 voters on Tuesday, but the number of polling locations was drastically reduced, from more than 180 to just five. Some voters waited in line for more than two hours, spread out over blocks as they tried to practice social distancing to guard against the coronavirus.

In other parts of the state, especially in smaller communities that tend to be less Democratic, the in-person voting process was running relatively smoothly, with wait times more closely resembling a normal election.

Democratic officials in Wisconsin have lashed out at Republicans, saying they created an atmosphere that amounts to voter suppression with a key statewide Supreme Court race on the ballot. It remains to be seen how the disruptions could affect the Democratic presidential primary contest between Mr. Biden and Mr. Sanders.

Many voters say their absentee ballots never arrived.

Across Wisconsin, would-be voters complained that the absentee ballots they requested had never arrived in the mail, even though figures released by the state seemed to indicate the problem was not widespread.

Representative Gordon Hintz, the Democratic minority leader in the State Assembly, said there may have been a glitch in the system, perhaps because of overwhelmed elections offices. “It appears that people who requested their ballots between March the 20th and 24th, or maybe the 25th, have not received their ballots,” Mr. Hintz said.

Official state figures showed that of 1,282,762 ballots requested, 1,273,374 had been sent, a shortfall of about 9,000.

But Mr. Hintz estimated that hundreds, it not thousands, of voters in his Oshkosh district alone had not received the ballots they asked for, leaving them in a predicament over whether to vote in person and risk contracting or spreading the coronavirus.

One of them was Mr. Hintz himself, who had decided not to vote Tuesday because the ballot he requested on March 22 had not arrived. The Wisconsin Elections Commission’s website says it was mailed to him on March 24.

Roger Luhn, a psychiatrist in Milwaukee, said Tuesday that he was also among the voters who had not received an absentee ballot.

“According to the website, they mailed the ballot to me on March 23,” said Dr. Luhn, who is medical director of a psychiatric hospital. “Yesterday, I gave up. I called the election commission. They put you on extended hold.”

Dr. Luhn said he would not go to the polls on Tuesday out of concern for his family, his patients and his fellow staff members. “There is no good outcome for today’s election,” he said. “No matter what happens, not enough people will have had an opportunity to safely cast their ballots.”

Voters encounter long lines — and social distancing.

The effects of shuttering so many polling sites in Milwaukee were immediately apparent on Tuesday morning: Across the city, lines stretched for blocks even before 7 a.m. local time.

On the South Side of the city, the parking lot of Alexander Hamilton High School was already full as daylight broke. By 8 a.m., more than 300 voters waited in a line that snaked through the parking lot and down the street.

At other locations nearby that would have normally been open for voting, signs were posted directing voters to Hamilton High School. But many of the locations were in heavily immigrant neighborhoods, predominantly Spanish or Hmong, and the only signs posted were in English.

At Marshall High School, in the northern part of Milwaukee, the line stretched for more than three blocks, with voters keeping six feet of space between each other. Most wore masks or other facial coverings.

The northern part of the city, which is predominantly black, has been hit the hardest by the coronavirus. Yet hundreds of voters had already queued by early morning.

The lines weren’t limited to Milwaukee. In Waukesha, a suburb just outside of Milwaukee, only one polling location was open for a city of 70,000. A similarly long line wrapped around a parking lot, as cones denoting a safe distance between voters helped break up the line.

A woman sick with coronavirus is unable to vote.

Hannah Gleeson is a health care worker who lives in Milwaukee, is 17 weeks pregnant and recently tested positive for the coronavirus. She says she has voted in every election she has been eligible for — “I enjoy going in person. I like getting my sticker,” she said — but since contracting the virus she realized that going to a polling place would not be an option.

“I feel like especially right now, when there are so many things that can make you feel hopeless, voting is one of the only things that is still within your power,” Ms. Gleeson, 34, said.

So she requested an absentee ballot a week ago, well within the deadlines set by the state. But she never received one. When she saw that the U.S. Supreme Court had struck down an extension of the deadlines, she called the state elections commission.

“They kind of said, yeah, that really sucks, hopefully you’ll have better luck with the next election,” Ms. Gleeson said. She said that some friends in Milwaukee had also not received ballots: one who made a request on March 26, and another on March 9.

Now, Ms. Gleeson and her husband, who is not showing symptoms but is also isolating himself since Ms. Gleeson is sick, are not able to vote, or at least not able to do so without putting hundreds of people at risk. “I’ve always said that every vote matters, every vote counts, and it’s your one chance to have your voice heard,” she said. “And it’s now something that I really feel has been taken away from me, and my husband as well.”

A missing absentee ballot snaps a 30-year voting streak.

In the city of Oshkosh, where officials have implemented curbside voting, Brian Binder, 49, was one of many Wisconsin voters who reported not receiving the absentee ballots they applied for. Mr. Binder’s wife, who applied at the same time, received hers.

“There’s a large number of people who just did not get them,” said Mr. Binder, an employee of a food packaging company.

As a result of all the confusion and the coronavirus, Mr. Binder said he would not vote in this election, breaking a 30-year streak.

“I vote in every election, local primaries, since I was 18. I’m a person that takes it very seriously, your right and your responsibility to vote. However, given the situation with the virus I’m not sure I want to endanger myself or other people at the polls,” said Mr. Binder, who has been working from home for the past two weeks.

He also expressed frustration with the state’s deeply entrenched political division.

“I feel that this is something they shouldn’t play politics with,” said Mr. Binder, a lifelong Republican who said his support for the party had waned since President Trump’s election. “I don’t know why we couldn’t postpone to keep people safe. I don’t know what the goal was.”

Partisan brawling and a logistical tangle have led to chaos.

Like so much else in Wisconsin over the last decade, the state’s coronavirus response and opinions about moving the election broke along partisan lines.

Democrats, aiming to expand turnout especially in the state’s largest cities, Milwaukee and Madison, sought to expand mail voting and delay the election until June. Republicans, wary of affording new powers to a Democratic governor and content with suppressing turnout in urban centers where the coronavirus has struck hardest, refused to entertain proposals for relief.

“Thousands will wake up and have to choose between exercising their right to vote and staying healthy and safe,” Gov. Tony Evers said Monday after the state’s Supreme Court blocked his effort to postpone the election.

But Dean Knudson, a Republican former state legislator who is chairman of the Wisconsin Elections Commission, said late Monday that voters who wished to participate in Tuesday’s contest would have no recourse but to venture to the polls — even if they had requested but had not yet received an absentee ballot.

“If they haven’t got their ballot in the mail,” he said, “they are going to have to go to the polling place tomorrow.”

Other Republicans have played down the danger to public health of voting during a pandemic. One Republican county chair, Jim Miller of Sawyer County, said the process would be similar to people picking up food to eat during the state’s stay-at-home order.

“If you can go out and get fast food, you can go vote curbside,” Mr. Miller said. “It’s the same procedure.”

Why are Wisconsin Republicans so adamant about holding Tuesday’s elections?

It’s not just a presidential primary on the ballot in Wisconsin. Also at stake is the makeup of the Wisconsin Supreme Court — the very court that struck down Mr. Evers’s effort to delay Tuesday’s elections.

Statewide races in Wisconsin tend to be close, and Supreme Court elections, which come with 10-year terms, are often even closer.

Last year Brian Hagedorn, a conservative judge, defeated a liberal challenger by less than 6,000 votes out of 1.2 million cast. In 2011, another conservative, David T. Prosser Jr., won by 7,000 votes after officials in Waukesha County found 14,000 overlooked ballots the day after the election.

For now, conservatives hold five of seven seats on the officially nonpartisan court. The incumbent in Tuesday’s contest, Justice Daniel Kelly, was appointed to replace Justice Prosser by Gov. Scott Walker in 2016 and is seeking his first full term. He faces Jill Karofsky, a liberal circuit court judge.

President Trump has posted several messages on Twitter endorsing Justice Kelly in recent days.

If Justice Kelly wins, it will cement the conservative majority’s ability to block future Democratic efforts to change the state’s strict voting laws and litigate an expected stalemate over congressional and state legislative boundaries during post-2020 redistricting.

Liberals would need to flip just one of the conservatives’ votes if Judge Karofsky wins. Unless a justice retires or resigns, they would not have an opportunity to win a court majority until the 2023 elections.

Polls will close at 9 p.m. Eastern, but that’s unlikely to be the end of the elections.

Though voting may end on Tuesday night, there will most likely be a new round of lawsuits challenging both the results and the disenfranchisement of many voters. Many allied groups in Wisconsin were already gathering accounts of voters unable to get a ballot or vote in anticipation of litigation.

Adding to the uncertainty, the results themselves will most likely be delayed by almost a full week: The Wisconsin Elections Commission has directed local municipal and county clerks not to release results until next Monday afternoon, in compliance with a federal court ruling.

“Instead of having Iowa-style results where no one knows what to expect, if we stick to this we’re going to have a clean election tomorrow but we’re not going to report the results until the following week,” said Mr. Knudson, the elections commission chairman.

 

 

 

 

TED Esther Choo. Emergency physician and public health advocate. Life on the medical front lines of the pandemic

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Health Policy, Health System, Healthcare Providers, Hospital, Hospital Bed Shortage, Hospital Industry, Housing for Healthcare Workers, Hydroxychloroquine, Infection Control, Infectious Virus, Intensive Care (ICU), Pandemic, Public Health, Public Safety, Quarantine, Rural Health, Rural Hospital, Social Distancing • Leave a comment

https://www.ted.com/about/programs-initiatives/ted-connects-community-hope

Doctors give OHSU's Esther Choo a standing ovation for gender bias ...

Esther Choo is an emergency physician and associate professor at the Oregon Health & Science University. She is a popular science communicator who has used social media to talk about racism and sexism in healthcare. She was the president of the Academy of Women in Academic Emergency Medicine and is a member of the American Association of Women Emergency Physicians.

As the coronavirus pandemic sweeps the globe, it’s hard to know where to turn or what to think. TED Connects is a free, live, daily conversation series featuring experts whose ideas can help us reflect and work through this uncertain time with a sense of responsibility, compassion and wisdom.

 

 

Ascension will protect pay of employees shifted, unable to work during pandemic, CEO says

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Employee Daycare Subsidies, Employee Furlough, Employee Furlough Pay, Employee Pay Continuation, Employee PTO Advance, Health System, Pandemic, Short Term Disability, Social Distancing, Workers Compensation • Leave a comment

https://www.beckershospitalreview.com/compensation-issues/ascension-will-protect-pay-of-employees-shifted-unable-to-work-during-pandemic-ceo-says.html?utm_medium=email

St. Vincent's Health System | LinkedIn

In an email to 160,000 employees, Ascension’s CEO said the St. Louis-based hospital system will protect their pay if they’re temporarily assigned to different jobs or unable to work for reasons linked to COVID-19.

In the April 3 email, Ascension President and CEO Joseph R. Impicciche said the protection will come through such programs as furlough pay, pay continuation, PTO advance, worker’s compensation and short-term disability.

Ascension also will offer daycare subsidies and reimbursements for employees who care for infected patients and may need to stay in a hotel for social-distancing purposes, the email stated.

“We are blessed to be able to make this commitment and appreciate the tremendous work and flexibility of our associates, leaders and physicians in providing compassionate, personalized care,” Mr. Impicciche wrote. “I am proud to witness the way all associates have come together to address the challenges of today, just like we have throughout our history.”

 

 

 

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

Posted on by • Posted in Coronavirus, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Social Distancing • Leave a comment

https://www.arcgis.com/apps/opsdashboard/index.html?fbclid=IwAR0_aL9oQ-cR8-7VSEQxs67k0l23vovw05NmdESU9cFFL7PveSEoWPyuwGU#/bda7594740fd40299423467b48e9ecf6

UPDATE: Over 1 million COVID-19 cases worldwide; U.S. now at 234 ...

Medicaid nearing ‘eye of the storm’ as newly unemployed look for coverage

Posted on by • Posted in ACA, Access, Access & Quality of Healthcare, Coronavirus, Crisis, Crisis Management, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, Medicaid, Medicaid Expansion, Medicare for All, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Social Distancing, Underinsured, Unemployment, Uninsured • Leave a comment

https://www.fiercehealthcare.com/payer/medicaid-nearing-eye-storm-as-newly-unemployed-look-for-coverage?mkt_tok=eyJpIjoiTXpaa1pEa3pOVGN5T1RnMiIsInQiOiJNbUdDbys5YmFjZDh2MjB2WTd6T0ZRTUg1cGlIYnAyTjNhdzBHdnpEblpZVGxjZEpQM0xPSEFvVG9RdGJQbzdcL21KcmxGV2Vkb1RzWTQ4TnlQQlcxU1BIMXkrZEFMRWwxUDZpTGdpQVlpMVJMR01CRWFDMk1OSGpRSDlLK3RNUTEifQ%3D%3D&mrkid=959610

Medicaid nearing 'eye of the storm' as newly unemployed look for ...

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers.

The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and healthcare in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

Meeting those needs will require hefty investments―both in money and manpower.

Medicaid—which is run jointly by the states and federal government and covers about 70 million Americans―is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act (ACA). That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus—an autoimmune disorder that requires regular doctor appointments and prescription medication―quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33—who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel―qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income—currently zero―to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees—who are now working remotely―to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states―which will experience shrinking tax revenue because of the plunging economy—have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs (PDF) for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18 (PDF), Congress agreed to bump up what Washington pays by 6.2 percentage points (PDF) as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

 

 

 

‘I just don’t understand why we’re not doing that’: Fauci calls for nationwide stay-at-home order, despite Trump’s resistance

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Public Health, Public Safety, Social Distancing • Leave a comment

https://www.washingtonpost.com/politics/2020/04/03/i-just-dont-understand-why-were-not-doing-that-fauci-calls-nationwide-stay-at-home-despite-trumps-resistance/?fbclid=IwAR0wkT53s_ATpUIp8aOHIU00KufxsoX8m5HgukQYwAtdZFMMhEJbmBsjTg0&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Fauci differs with Trump on nationwide stay-at-home orders - The ...

Trump has said certain states can treat the coronavirus outbreak differently. Fauci publicly disagreed Thursday night.

As certain states have continued to lag behind others in issuing stay-at-home orders, the White House has also resisted a more drastic step: demanding that states get with the program.

Vice President Pence made it clear Wednesday that President Trump has decided he doesn’t want to tell states what to do. “At the president’s direction, the White House coronavirus task force will continue to take the posture that we will defer to state and local health authorities on any measures that they deem appropriate,” Pence said.

Pressed again on Thursday after Georgia Gov. Brian Kemp (R) finally got on board with a stay-at-home order, Trump again signaled that the task force won’t seek to compel states. “I think it’s about 85 percent of the states have got the stay at home,” Trump said. “Brian’s a great governor; it’s his decision.”

The thing is, though, Trump is wrong. Eighty-five percent of states are not on board. A New York Times compilation shows that 12 states still have not taken this step. Localities within some of those state have, and the vast majority of the United States is under such orders, population-wise, but this is still not a blanket policy being applied across the country.

And for the first time, Anthony S. Fauci is signaling his frustration with that. After the White House had for days played off this question, the director of the National Institute of Allergy and Infectious Diseases appeared on CNN on Thursday night and for the first time made his position on that issue clear.

“If you look at what’s going on in this country, I just don’t understand why we’re not doing that,” he told Anderson Cooper. “We really should be.”

The question was about a federal mandate and not whether states should take this step themselves, and Fauci was careful to recognize valid questions about states’ rights. But he was also clear that he thinks this should be a nationwide policy, one way or another.

“I think so, Anderson,” Fauci added at another point. “I don’t understand why that’s not happening.”

Part of the reason it’s not happening is that this request has not been enunciated by the president like it was by Fauci on Thursday night. Florida Gov. Ron DeSantis (R) said earlier this week that he was waiting for Trump to tell him what to do. DeSantis eventually succumbed to the pressure himself, but in making his announcement, he cited Trump’s tone about the severity of the issue.

In other words, what the president says matters. And just like Florida and Georgia, all of the 12 remaining holdout states are run by Republican governors. Trump’s say-so would likely carry significant weight with them.

But Trump isn’t just declining to lean on them; he also continues to cling to the idea that certain areas of the country can treat the outbreak differently because they aren’t yet as hard-hit. Asked Wednesday why he wasn’t telling every state to do this, Trump said it was “because states are different.”

“There are some states that don’t have much of a problem,” Trump said. “There is some — well, they don’t have the problem. They don’t have thousands of people that are positive or thousands of people that even think they might have it, or hundreds of people in some cases.”

Trump added: “You have to give a little bit of flexibility. We have a state in the Midwest or if Alaska, as an example, doesn’t have a problem, it’s awfully tough to say close it down.”

About 24 hours later, Fauci offered a diametrically opposed view on this question, saying that every state should have a stay-at-home order. The statement both reinforced that there are certain disconnects between the president and his top health officials and added to pressure on everyone to fall in line.

Plenty of governors have resisted this step, only to succumb to the realities in their states. Fauci is essentially asking: Why are you waiting to be the next one?