Category Archives: Unemployment Insurance

A growing number of Americans are going hungry

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economic Stimulus, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Financial Viability, Financially Distressed, Food Bank, Hunger, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Out of Control, Out of Pocket Expenses, Pandemic, Public Health, Public Schools, Social Determinants of Health, Thanks, Thanksgiving, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment
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A growing number of Americans are going hungry – Washington Sources

26 million now say they don’t have enough to eat, as the pandemic worsens and holidays near.

It was 5 a.m., not a hint of sun in the Houston sky, as Randy Young and his mom pulled into the line for a free Thanksgiving meal. They were three hours early. Hundreds of cars and trucks already idled in front of them outside NRG Stadium. This was where Young worked before the pandemic. He was a stadium cook. Now, after losing his job and struggling to get by, he and his 80-year-old mother hoped to get enough food for a holiday meal.

“It’s a lot of people out here,” said Young, 58. “I was just telling my mom, ‘You look at people pulling up in Mercedes and stuff, come on.’ If a person driving a Mercedes is in need of food, you know it’s bad.”

More Americans are going hungry now than at any point during the deadly coronavirus pandemic, according to a Post analysis of new federal data — a problem created by an economic downturn that has tightened its grip on millions of Americans and compounded by government relief programs that expired or will terminate at the end of the year. Experts say it is likely that there’s more hunger in the United States today than at any point since 1998, when the Census Bureau began collecting comparable data about households’ ability to get enough food.

One in 8 Americans reported they sometimes or often didn’t have enough food to eat in the past week, hitting nearly 26 million American adults, an increase several times greater than the most comparable pre-pandemic figure, according to Census Bureau survey data collected in late October and early November. That number climbed to more than 1 in 6 adults in households with children.

“It’s been driven by the virus and the unpredictable government response,” said Jeremy K. Everett, executive director of the Baylor Collaborative on Hunger and Poverty in Waco, Tex.

Nowhere has there been a hunger surge worse than in Houston, with a metro-area population of 7 million people. Houston was pulverized in summer when the coronavirus overwhelmed hospitals, and the local economy was been particularly hard hit by weak oil prices, making matters worse.

More than 1 in 5 adults in Houston reported going hungry recently, including 3 in 10 adults in households with children. The growth in hunger rates has hit Hispanic and Black households harder than White ones, a devastating consequence of a weak economy that has left so many people trying to secure food even during dangerous conditions.

On Saturday, these statistics manifested themselves in the thousands of cars waiting in multiple lines outside NRG Stadium. The people in these cars represented much of the country. Old. Young. Black. White. Asian. Hispanic. Families. Neighbors. People all alone.

Inside a maroon Hyundai Santa Fe was Neicie Chatman, 68, who had been waiting since 6:20 a.m., listening to recordings of a minister’s sermon piped into large earphones.

“I’ve been feeding my spirit,” she said.

Her hours at her job as an administrator have been unsteady since the pandemic began. Her sister was laid off. They both live with their mother, who has been sick for the past year. She planned to take the food home to feed her family and share with her older neighbors.

“It’s been hard to survive. Money is low. No jobs. Hard to find work.”

— Randy Young

“I lost my business and I lost my dream.”

— Adriana Contreras

Now, a new wave of coronavirus infections threatens more economic pain.

Yet the hunger crisis seems to have escaped widespread notice in a nation where millions of households have weathered the pandemic relatively untouched. The stock market fell sharply in March before roaring back and has recovered all of its losses. This gave the White House and some lawmakers optimism about the economy’s condition. Congress left for its Thanksgiving break without making any progress on a new pandemic aid deal even as food banks across the country report a crush of demand heading into the holidays.

“The hardship is incredibly widespread. Large parts of America are saying, ‘I couldn’t afford food for my family,’ ” said Stacy Dean, who focuses on food-assistance policy at the Center on Budget and Policy Priorities. “It’s disappointing this hasn’t broken through.”

No place has been spared. In one of the nation’s richest counties, not far from Trump National Golf Club in Virginia, Loudoun Hunger Relief provided food to a record 887 households in a single week recently. That’s three times the Leesburg, Va.-based group’s pre-pandemic normal.

“We are continuing to see people who have never used our services before,” said Jennifer Montgomery, the group’s executive director.

Hunger rates spiked nationwide after shutdowns in late March closed large chunks of the U.S. economy. The situation improved somewhat as businesses reopened and the benefits from a $2.2 trillion federal pandemic aid package flowed into people’s pockets, with beefed-up unemployment benefits, support for food programs and incentives for companies to keep workers on the payroll.

But those effects were short-lived. The bulk of the federal aid had faded by September. And more than 12 million workers stand to lose unemployment benefits before year’s end if Congress doesn’t extend key programs.

“Everything is a disaster,” said Northwestern University economist Diane Whitmore Schanzenbach, a leading expert on the economics of food insecurity. “I’m usually a pleasant person, but this is just crazy.”

Economic conditions are the main driver behind rising rates of hunger, but other factors play a role, Schanzenbach said. In the Great Recession that began in 2008, people received almost two years of unemployment aid — which helped reduce hunger rates. Some long-term unemployed workers qualified for even more help.

But the less-generous benefits from the pandemic unemployment assistance programs passed by Congress in March have already disappeared or soon will for millions of Americans.

Even programs that Congress agreed to extend have stumbled. A program giving families additional cash assistance to replace school meals missed by students learning at home was renewed for a year on Oct. 1. But the payments were delayed because many states still needed to get the U.S. Agriculture Department’s approval for their plans. The benefit works out to only about $6 per student for each missed school day. But experts say the program has been a lifeline for struggling families.

One program that has continued to provide expanded emergency benefits is the Supplemental Nutrition Assistance Program, or SNAP. The Agriculture Department issued an emergency order allowing states to provide more families the maximum benefit and to suspend the time limit on benefits for younger unemployed adults without children.

The sharpest rise in hunger was reported by groups who have long experienced the highest levels of it, particularly Black Americans. Twenty-two percent of Black U.S. households reported going hungry in the past week, nearly twice the rate faced by all American adults and more than two-and-a-half times the rate for White Americans.

The Houston area was posting some of its lowest hunger rates before the pandemic, thanks to a booming economy and a strong energy sector, Everett said. Then, the pandemic hit. Hunger surged, concentrated among the city’s sizable low-income population, in a state that still allows for the federally mandated minimum wage of $7.25 an hour. Houston’s hunger rates — like those nationwide — fell significantly after the $1,200 stimulus checks were mailed out in April and other pandemic aid plans took effect, Everett said.

But most of the effects of that aid are gone.

“Without sustained aid at the federal level, we’ll be hard pressed to keep up,” said Celia Call, chief executive of Feeding Texas, which advocates for 21 food banks in the state. “We’re just bracing for the worst.”

Schools are one of the most important sources of food for low-income families in Houston. The Houston Independent School District has 210,000 students — many of whom qualify for free or reduced-priced meals. But the pandemic closed schools in the spring. They reopened in the fall with less than half of the students choosing a hybrid model of in-school and at-home instruction. That has made feeding these children a difficult task.

“We’ve made an all-out effort to capture these kids and feed them,” said Betti Wiggins, the school district’s nutrition services officer.

The district provided curbside meal pickups outside schools. Anyone could come, not just schoolchildren. School staffers set up neighborhood distribution sites in the areas with the highest need. They started a program to serve meals to children living in apartment buildings. Sometimes the meal program required police escorts.

“I’m doing everything but serving in the gas station when they’re pumping the gas,” Wiggins said.

Wiggins said the normal school meals program she ran before the pandemic has been transformed into providing food for entire families far beyond a school’s walls. She has noticed unfamiliar faces in her meal lines. The “new poor,” she calls them, parents who might have worked in the airline or energy industries crushed by the pandemic.

“I’m seeing folks who don’t know how to handle the poverty thing,” she said, adding that it became her mission to make sure they had food.

The Houston Food Bank is the nation’s largest, serving 18 counties in Southeast Texas with help from 1,500 partner agencies. Last month, the food bank distributed 20.6 million pounds of food — down from the 27.8 million pounds handed out in May, but still 45 percent more than what it distributed in October 2019, with no end in sight.

The biggest worry for food banks right now is finding enough food, said Brian Greene, president of the Houston Food Bank. Food banks buy bulk food with donations. They take in donated food items, too. Food banks also benefited from an Agriculture Department program that purchased excess food from U.S. farmers hurt by the ongoing trade war with China, typically apples, milk and pork products. But funding for that program ended in September. Other federal pandemic programs are still buying hundreds of millions of dollars in food and donating it to food banks. But Greene said he worries about facing “a commodity cliff” even as demand grows.

Teresa Croft, who volunteers at a food distribution site at a church in the Houston suburb of Manvel, said the need is still overwhelming. She handles the paperwork for people visiting the food bank for the first time. They’re often embarrassed, she said. They never expected to be there. Sometimes, Croft tries to make them feel better by telling her own story — how she started at the food bank as a client, but got back on her feet financially more than a decade ago and is now a food bank volunteer.

“They feel so bad they’re having to ask for help. I tell them they shouldn’t feel bad. We’re all in this together,” Croft said. “If you need it, you need it.”

The pandemic changed how the Houston Food Bank runs. Everything is drive-through and walk-up. Items are preselected and bagged. The food bank has held several food distribution events in the parking lots outside NRG Stadium — a $325 million, retractable-roof temple to sports and home to the National Football League’s Houston Texans.

Last weekend, instead of holding the 71st annual Thanksgiving Day Parade in Houston, the city and H-E-B supermarkets decided to sponsor the food bank’s distribution event at NRG Stadium. The plan was to feed 5,000 families.

The first cars arrived at the stadium around 1 a.m. Saturday, long before the gates opened for the 8 a.m. event. By the time Young and his mother drove up, the line of vehicles stretched into the distance. Organizers opened the gates early. The cars and trucks began to slowly snake through the stadium’s parking lot toward a series of white tents, where the food was loaded into trunks by volunteers. The boxes contained enough food for multiple meals during the holiday week, with canned vegetables such as corn and sweet potatoes, a package of rolls, cranberry sauce and a box of masks. People picking up food were also given a bag of cereal and some resealable bags, a ham, a gallon of milk, and finally a turkey and pumpkin pie.

The food for 5,000 families ran out. The Houston Food Bank — knowing that would not be enough — was able to assemble more.

It provided food to 7,160 vehicles and 261 people who walked up to the event.

Troy Coakley, 56, came to the event looking for food to feed his family for the week. He still had his job breaking apart molds at a plant that makes parts for oil field and water companies. But his hours were cut when the economy took a hit in March. Coakley went from working overtime to three days a week.

He was struggling. Behind on rent. Unsure what was to come.

But for the moment, his trunk filled with food, he had one less thing to worry about.

“Other than [the pandemic], we were doing just fine,” Coakley said. “But now it’s getting worse and worse.”

What healthcare executives can expect under Biden presidency

Posted on by • Posted in ACA, Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Clinical Research, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Employer-Based Health Insurance, Essential Health Benefits, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Interoperability, Leadership Alignment, Leadership Cares, Leadership Commitment, Leadership Intent, Market Consolidation, Market Power, Market Trends, Medicaid, Medicaid Expansion, Medicare, Medicare Advantage, Mergers & Acquisitions, Mortality, National Strategy, Pandemic, Pharmaceutical Industry, Preexisting Conditions, Price Transparency, Public Health, Public Opinion, Public Option, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Supply Chain, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Value Creation, Value-Based Contracting, Value-Based Healthcare, Workforce Strategy, World Health Organization (WHO) • Leave a comment

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https://www.pwc.com/us/Biden2020healthagenda

President-elect Joe Biden’s healthcare agenda: building on the ACA, value-based care, and bringing down drug prices.

In many ways, Joe Biden is promising a return to the Obama administration’s approach to healthcare:

  • Building on the Affordable Care Act (ACA) through incremental expansions in government-subsidized coverage
  • Continuing CMS’ progress toward value-based care
  • Bringing down drug prices
  • Supporting modernization of the FDA

Bolder ideas, such as developing a public option, resolving “surprise billing,” allowing for negotiation of drug prices by Medicare, handing power to a third party to help set prices for some life sciences products, and raising the corporate tax rate, could be more challenging to achieve without overwhelming majorities in both the House and the Senate.

Biden is likely to mount an intensified federal response to the COVID-19 pandemic, enlisting the Defense Production Act to compel companies to produce large quantities of tests and personal protective equipment as well as supporting ongoing deregulation around telehealth. The Biden administration also will likely return to global partnerships and groups such as the World Health Organization, especially in the area of vaccine development, production and distribution.

What can health industry executives expect from Biden’s healthcare proposals?

Broadly, healthcare executives can expect an administration with an expansionary agenda, looking to patch gaps in coverage for Americans, scrutinize proposed healthcare mergers and acquisitions more aggressively and use more of the government’s power to address the pandemic. Executives also can expect, in the event the ACA is struck down, moves by the Biden administration and Democratic lawmakers to develop a replacement. Healthcare executives should scenario plan for this unlikely yet potentially highly disruptive event, and plan for an administration marked by more certainty and continuity with the Obama years.

All healthcare organizations should prepare for the possibility that millions more Americans could gain insurance under Biden. His proposals, if enacted, would mean coverage for 97% of Americans, according to his campaign website. This could mean millions of new ACA customers for payers selling plans on the exchanges, millions of new Medicaid beneficiaries for managed care organizations, millions of newly insured patients for providers, and millions of covered customers for pharmaceutical and life sciences companies. The surge in insured consumers could mirror the swift uptake in the years following the passage of the ACA.

Biden’s plan to address the COVID-19 pandemic

Biden is expected to draw on his experience from H1N1 and the Ebola outbreaks to address the COVID-19 pandemic with a more active role for the federal government, which many Americans support. These actions could shore up the nation’s response in which the federal government largely served in a support role to local, state and private efforts.

Three notable exceptions have been the substantial federal funding for development of vaccines against the SARS-CoV-2 virus, Congress’ aid packages and the rapid deregulatory actions taken by the FDA and CMS to clear a path for medical products to be enlisted for the pandemic and for providers, in particular, to be able to respond to it.

Implications of Biden’s 2020 health agenda on healthcare payers, providers and pharmaceutical and life sciences companies

The US health system has been slowly transforming for years into a New Health Economy that is more consumer-oriented, digital, virtual, open to new players from outside the industry and focused on wellness and prevention.  The COVID-19 pandemic has accelerated some of those trends.  Once the dust from the election settles, companies that have invested in capabilities for growth and are moving forcefully toward the New Health Economy stand to gain disproportionately.

Shortages of clinicians and foreign medical students may continue to be an issue for a while

The Trump administration made limiting the flow of immigrants to the US a priority. The associated policy changes have the potential to exacerbate shortages of physicians, nurses and other healthcare workers, including medical students. These consequences have been aggravated by the pandemic, which dramatically curtailed travel into the US.

  • Healthcare organizations, especially rural ones heavily dependent on foreign-born employees, may find themselves competing fiercely for workers, paying higher salaries and having to rethink the structure of their workforces.
  • Providers should consider reengineering primary care teams to reflect the patients’ health status and preferences, along with the realities of the workforce on the ground and new opportunities in remote care.

Focus on modernizing the supply chain

Biden and lawmakers from both parties have been raising questions about life sciences’ supply chains. This focus has only intensified because of the pandemic and resulting shortages of personal protective equipment (PPE), pharmaceuticals, diagnostic tests and other medical products.

  • Investment in advanced analytics and cybersecurity could allow manufacturers to avoid disruptive stockouts and shortages, and deliver on the promise of the right treatment to the right patient at the right time in the right place.

Drug pricing needs a long-term strategy

Presidents and lawmakers have been talking about drug prices for decades; few truly meaningful actions have been implemented. Biden has made drug pricing reform a priority.

  • Drug manufacturers may need to start looking past the next quarter to create a new pricing strategy that maximizes access in local markets through the use of data and analytics to engage in more value-based pricing arrangements.
  • New financing models may help patients get access to drugs, such as subscription models that provide unlimited access to a therapy at a flat rate.
  • Companies that prepare now to establish performance metrics and data analytics tools to track patient outcomes will be well prepared to offer payers more sustainable payment models, such as mortgage or payment over time contracts, avoiding the sticker shock that comes with these treatments and improving uptake at launch.
  • Pharmaceutical and life sciences companies will likely have to continue to offer tools for consumers like co-pay calculators and use the contracting process where possible to minimize out-of-pocket costs, which can improve adherence rates and health outcomes.

View interoperability as an opportunity to embrace, not a threat to avoid or ignore

While the pandemic delayed many of the federal interoperability rule deadlines, payers and providers should use the extra time to plan strategically for an interoperable future.

  • Payers should review business partnerships in this new regulatory environment.
  • Digital health companies and new entrants may help organizations take advantage of the opportunities that achieving interoperability may present.
  • Companies should consider the legal risks and take steps to protect their reputations and relationships with customers by thinking through issues of consent and data privacy.

Health organizations should review their policies and consider whether they offer protections for customers under the new processes and what data security risks may emerge. They should also consider whether business associate agreements are due in more situations.

Plan for revitalized ACA exchanges and a booming Medicare Advantage market

The pandemic has thrown millions out of work, generating many new customers for ACA plans just as the incoming Biden administration plans to enrich subsidies, making more generous plans within reach of more Americans.

  • Payers in this market should consider how and where to expand their membership and appeal to those newly eligible for Medicare. Payers not in this market should consider partnerships or acquisitions as a quick way to enter the market, with the creation of a new Medicare Advantage plan as a slower but possibly less capital-intensive entry into this market.
  • Payers and health systems should use this opportunity to design more tailored plan options and consumer experiences to enhance margins and improve health outcomes.
  • Payers with cash from deferred care and low utilization due to the pandemic could turn to vertical integration with providers as a means of investing that cash in a manner that helps struggling providers in the short term while positioning payers to improve care and reduce its cost in the long term.
  • Under the Trump administration, the FDA has approved historic numbers of generic drugs, with the aim of making more affordable pharmaceuticals available to consumers. Despite increased FDA generics approvals, generics dispensed remain high but flat, according to HRI analysis of FDA data.
  • Pharmaceutical company stocks, on average, have climbed under the Trump administration, with a few notable dips due to presidential speeches criticizing the industry and the pandemic.
  • Providers have faced some revenue cuts, particularly in the 340B program, and many entered the pandemic in a relatively weak liquidity position.  The pandemic has led to layoffs, pay cuts and even closures. HRI expects consolidation as the pandemic continues to curb the flow of patients seeking care in emergency departments, orthopedic surgeons’ offices, dermatology suites and more.

Lawmakers and politicians often use bold language, and propose bold solutions to problems, but the government and the industry itself resists sudden, dramatic change, even in the face of sudden, dramatic events such as a global pandemic. One notable exception to this would be a decision by the US Supreme Court to strike down the ACA, an event that would generate a great deal of uncertainty and disruption for Americans, the US health industry and employers.

11 hospitals laying off workers

Posted on by • Posted in Cash, Cash Management, Cash Reserves, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Elective Procedures, Elective Surgery, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Salary Freeze, Employer-Based Health Insurance, Financial Viability, Financially Distressed, Health Insurance Coverage Adequacy, Health System, Hospital, Hospital Industry, Job, Job Growth, Job Loss, Job Market, Job Search, Job Security, Key Performance Indicators, Labor Spend Management, Net Income, Nonoperating Income, Operating Expense Reduction, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue, Pandemic, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

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Layoffs costing hundreds of people their jobs in NC but notices don't capture true scope of cuts | WRAL TechWire

The financial challenges caused by the COVID-19 pandemic have forced hundreds of hospitals across the nation to furlough, lay off or reduce pay for workers, and others have had to scale back services or close. 

Lower patient volumes, canceled elective procedures and higher expenses tied to the pandemic have created a cash crunch for hospitals. U.S. hospitals are estimated to lose more than $323 billion this year, according to a report from the American Hospital Association. The total includes $120.5 billion in financial losses the AHA predicts hospitals will see from July to December. 

Hospitals are taking a number of steps to offset financial damage. Executives, clinicians and other staff are taking pay cuts, capital projects are being put on hold, and some employees are losing their jobs. More than 260 hospitals and health systems furloughed workers this year and dozens of others have implemented layoffs. 

Below are 11 hospitals and health systems that announced layoffs since Sept. 1, most of which were attributed to financial strain caused by the pandemic. 

1. NorthBay Healthcare, a nonprofit health system based in Fairfield, Calif., is laying off 31 of its 2,863 employees as part of its pandemic recovery plan, the system announced Nov. 2. 

2. Minneapolis-based Children’s Minnesota is laying off 150 employees, or about 3 percent of its workforce. Children’s Minnesota cited several reasons for the layoffs, including the financial hit from the COVID-19 pandemic. Affected employees will end their employment either Dec. 31 or March 31.

3. Brattleboro Retreat, a psychiatric and addiction treatment hospital in Vermont, notified 85 employees in late October that they would be laid off within 60 days. 

4. Citing a need to offset financial losses, Minneapolis-based M Health Fairview said it plans to downsize its hospital and clinic operations. As a result of the changes, 900 employees, about 3 percent of its 34,000-person workforce, will be laid off.

5. Lake Charles (La.) Memorial Health System laid off 205 workers, or about 8 percent of its workforce, as a result of damage sustained from Hurricane Laura. The health system laid off employees at Moss Memorial Health Clinic and the Archer Institute, two facilities in Lake Charles that sustained damage from the hurricane.

6. Burlington, Mass.-based Wellforce laid off 232 employees as a result of operating losses linked to the COVID-19 pandemic. The health system, comprising Tufts Medical Center, Lowell General Hospital and MelroseWakefield Healthcare, experienced a drastic drop in patient volume earlier this year due to the suspension of outpatient visits and elective surgeries. In the nine months ended June 30, the health system reported a $32.2 million operating loss. 

7. Baptist Health Floyd in New Albany, Ind., part of Louisville, Ky.-based Baptist Health, eliminated 36 positions. The hospital said the cuts, which primarily affected administrative and nonclinical roles, are due to restructuring that is “necessary to meet financial challenges compounded by COVID-19.”

8. Cincinnati-based UC Health laid off about 100 employees. The job cuts affected both clinical and non-clinical staff. A spokesperson for the health system said no physicians were laid off. 

9. Mercy Iowa City (Iowa) announced in September that it will lay off 29 employees to address financial strain tied to the COVID-19 pandemic. 

10. Springfield, Ill.-based Memorial Health System laid off 143 employees, or about 1.5 percent of the five-hospital system’s workforce. The health system cited financial pressures tied to the pandemic as the reason for the layoffs. 

11. Watertown, N.Y.-based Samaritan Health announced Sept. 8 that it laid off 51 employees and will make other cost-cutting moves to offset financial stress tied to the COVID-19 pandemic.

More Than Politics On The Line For Voters With Preexisting Conditions

Posted on by • Posted in 2020 Election Issues, ACA, Bad Debt Expense, Chronic Care Management, Chronic Conditions, Chronic Diseases, Deferred Healthcare, Election, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Medicaid, Medicaid Expansion, Medicare, Out of Pocket Expenses, Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans, Supreme Court, Uncompensated Care, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment
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More Than Politics On The Line For Voters With Preexisting Conditions | WAMU

In swing states from Georgia to Arizona, the Affordable Care Act — and concerns over protecting preexisting conditions — loom over key races for Congress and the presidency.

“I can’t even believe it’s in jeopardy,” says Noshin Rafieei, a 36-year-old from Phoenix. “The people that are trying to eliminate the protection for individuals such as myself with preexisting conditions, they must not understand what it’s like.”

In 2016, Rafieei was diagnosed with colon cancer. A year later, her doctor discovered it had spread to her liver.

“I was taking oral chemo, morning and night — just imagine that’s your breakfast, essentially, and your dinner,” Rafieei says.

In February, she underwent a liver transplant.

Rafieei does have health insurance now through her employer, but she fears whether her medical history could disqualify her from getting care in the future.

“I had to pray that my insurance would approve of my transplant just in the nick of time,” she says. “I had that Stage 4 label attached to my name and that has dollar signs. Who wants to invest in someone with Stage 4?”

“That is no way to feel,” she adds.

After doing her research, Rafieei says she intends to vote for Joe Biden, who helped get the ACA passed in this first place.

“Health care for me is just the driving factor,” she says.

Even 10 years after the Affordable Care Act locked in a health care protection that Americans now overwhelmingly support — guarantees that insurers cannot deny coverage or charge more based on preexisting medical conditions — voters once again face contradicting campaign promises over which candidate will preserve the law’s legacy.

A majority of Democrats, independents and Republicans say they want their new president to preserve the ACA’s provision that protects as many as 135 million people from potentially being unable to get health care because of their medical history.

President Trump has pledged to keep this in place, even as his administration heads to the U.S Supreme Court the week after Election Day to argue the entire law should be struck down.

“We’ll always protect people with preexisting,” Trump said in the most recent debate. “I’d like to terminate Obamacare, come up with a brand new, beautiful health care.”

And yet the Trump administration has not unveiled a health care plan or identified any specific components it might include. In 2017, the administration joined with congressional Republicans to dismantle the Affordable Care Act, but none of the GOP-backed replacement plans could summon enough votes. The Republicans’ final attempt, a limited “skinny repeal” of parts of the ACA, failed in the Senate because of resistance within their own party.

In an attempt to reassure wary voters, Trump recently signed an executive order that asserts protections for preexisting conditions will stay in place, but legal experts say this has no teeth.

“It’s basically a pinky promise, but it doesn’t have teeth,” says Swapna Reddy, a clinical assistant professor at Arizona State University’s College of Health Solutions. “What is the enforceability? The order really doesn’t have any effect because it can’t regulate the insurance industry.”

Since the 2017 repeal and replace efforts, the health care law has continued to gain popularity.

Public approval is now at an all-time high, but polling shows many Republicans still don’t view the ACA as synonymous with its most popular provision — protections for preexisting conditions.

Democrats hope to change that.

“If you have a preexisting condition — heart disease, diabetes, breast cancer — they are coming for you,” said Biden’s running mate, California Sen. Kamala Harris, during her recent debate with Vice President Pence.

Voters support maintaining ACA’s legal protections

In key swing states, many voters say protecting preexisting conditions is their top health concern.

Rafieei, the Phoenix woman with colon cancer, still often has problems getting her treatments covered. Her insurance has denied medications that help quell the painful side effects of chemotherapy or complications related to her transplant.

“During those chemo days, I’d think, wow, I’m really sick, and I just got off the phone with my pharmacy and they’re denying me something that could possibly help me,” she says.

Because of her transplant, she will be on medication for the rest of her life, and sometimes she even has nightmares about being away and running out of it.

“I will have these panic attacks like, ‘Where’s my medicine? Oh my god, I have to get back to get my medicine?'”

Election season and talk of eliminating the ACA has not given Rafieei much reassurance, though.

“I cannot stomach politics. I am beyond terrified,” she says.

And yet she plans to head to the polls — in person — despite having a compromised immune system.

“It might be a long day. But you know what? I want to fix whatever I can,” she says.

A few days after she votes, she’ll get a coronavirus test and go in for another round of surgery.

A key health issue in political swing states

Rafieei’s home state of Arizona is emblematic of the political contradictions around the health care law.

The Republican-led state reaped the benefits of the ACA. Arizona’s uninsured rate dropped considerably since 2010, in part because it expanded Medicaid.

But the state’s governor also embraced the Republican effort to repeal and replace the law in 2017, and now Arizona’s attorney general is part of the lawsuit that will be heard by the Supreme Court on Nov. 10 that could topple the entire law.

Depending on how the Supreme Court rules, ASU’s Reddy says any meaningful replacement for preexisting conditions would involve Congress and the next president.

“At the moment, we have absolutely no national replacement plan,” she says.

Meanwhile, some states have passed their own laws to maintain protections for preexisting conditions, in the event the ACA is struck down. But Reddy says those vary considerably from state to state.

For example, Arizona’s law, passed just earlier this year, only prevents insurers from outright denying coverage — consumers with preexisting conditions can be charged more.

“We are in this season of chaos around the Affordable Care Act,” says Reddy. “From a consumer perspective, it’s really hard to decipher all these details.”

As in the congressional midterm election of 2018, Democrats are hammering away at Republican’s track record on preexisting conditions and the ACA.

In Arizona, Mark Kelly, the Democratic candidate running for Senate, has run ads and used every opportunity to remind voters of Republican Sen. Martha McSally’s votes to repeal the law.

In Georgia, Democratic challenger Jon Ossoff has taken a similar approach.

“Can you look down the camera and tell the people of this state why you voted four times to allow insurance companies to deny us health care coverage because we may suffer from diabetes or heart disease or have cancer in remission?” Ossoff said during a debate with his opponent, Republican Sen. David Purdue.

Republicans have often tried to skirt health care as a major issue this election cycle because there isn’t the same political advantage to pushing the repeal and replace argument, says Mark Peterson, a professor of public policy, political science and law at UCLA.

“It’s political suicide, there doesn’t seem to be any real political advantage anymore,” says Peterson.

But the timing of the Supreme Court case — exactly a week after election day — has somewhat obscured the issue for voters.

Republicans have chipped away at the health care law by reducing the individual mandate — the provision requiring consumers to purchase insurance — to zero dollars.

The premise of the Supreme Court case is that the ACA no longer qualifies as a tax because of this change in the penalty.

“It is an extraordinary stretch, even among many conservative legal scholars, to say that the entire law is predicated on the existence of an enforced individual mandate,” says Peterson.

The court could rule in a very limited way that does not disrupt the entire law or protections for preexisting conditions, he says.

Like many issues this election, Peterson says there is a big disconnect between what voters in the two parties believe is at stake with the ACA.

“Not everybody, particularly Republicans, associates the ACA with protecting preexisting conditions,” he says. “But it is pretty striking that overwhelmingly Democrats and Independents do — and a number of Republicans — that’s enough to give a significant national supermajority.”

The virus doesn’t care about November 3rd

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Credibility, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Election, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Transparency, Trust, Truth, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vaccine • Leave a comment

https://mailchi.mp/2480e0d1f164/the-weekly-gist-october-30-2020?e=d1e747d2d8

8 Big Reasons Election Day 2020 Could Be a Disaster - POLITICO

As the “third wave” of coronavirus continued to gain steam across the US this week, the nation passed another grim milestone, with more than 9M Americans now having tested positive for the virus, and the seven-day average number of new cases hitting a pandemic record of almost 72,000 new diagnoses daily. In states that we’ll surely be discussing a lot in the next week, cases were up 33 percent in Pennsylvania, 25 percent in Michigan, 23 percent in Wisconsin, 21 percent in Florida, and 16 percent in Arizona.

In a sign that the magnitude of case growth is not just an artifact of more testing, hospitalizations for COVID have risen 46 percent since the beginning of October, and are up 12 percent just this week. Nevertheless, as part of its “closing argument” to voters, the Trump administration this week touted “ending the COVID-19 pandemic” as one of its signature first-term accomplishments, although new polling data from Axios/Ipsos show that 62 percent of Americans believe the federal government is making the recovery worse, and 46 percent say the response has gotten worse since the first surge of cases in March and April.

Dr. Anthony Fauci, the talismanic director of the National Institute of Allergy and Infectious Diseases, told CNBC this week that “if things do not change, if they continue on the course we’re on, there’s gonna be a whole lot of pain in this country with regard to additional cases, and hospitalizations, and deaths.”
 
In separate remarks, Fauci pulled back from earlier predictions for the timing of a safe and effective vaccine against the coronavirus. In comments made Thursday, he said he now expects a vaccine to be available to those in high-priority groups “by the end of December or the beginning of January.” 

The CEO of drug maker Pfizer, which is among the furthest along in vaccine development, urged patience as its Phase 3 trial nears full enrollment, and researchers prepare to review and submit safety data to the Food and Drug Administration. He again assured investors that the vaccine timeline would remain apolitical, stating “This is not going to be a Republican vaccine or a Democratic vaccine. It would be a vaccine for citizens of the world.” AstraZeneca, also ahead in development of a coronavirus vaccine, reported promising results regarding immune responses among participants in its clinical trials, being conducted jointly with Oxford University.

With the Presidential election just a few days away, it remains clear that neither the virus nor the scientific community’s efforts to combat it are conforming to the best-laid plans of political leaders.

The outcome of the looming political battle, however, will surely determine the context in which the larger fight against this pandemic takes place. Again, please vote—it’s a matter of life and death.

Cartoon – Just Two on the Front Lines

Posted on by • Posted in 2020 Election Issues, Cartoon, Coronavirus, Economic Crisis, Economic Recovery, Election, Employee Benefits, Employee Protections, Employer-Based Health Insurance, Front Lines, Health Insurance Coverage Adequacy, Health Policy, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Sick Leave, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment
health insurance

Cartoon – The Market Cure

Posted on by • Posted in 2020 Election Issues, Cartoon, Deferred Healthcare, Election, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Market Consolidation, Market Failure, Market Outlook, Market Power, Out of Pocket Expenses, Preexisting Conditions, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment
Cartoon – The Market will Cure It | HENRY KOTULA

Cartoon – Doctors without borders, meet patient without insurance

Posted on by • Posted in 2020 Election Issues, Cartoon, Chronic Care Management, Chronic Conditions, Chronic Diseases, Deferred Healthcare, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses, Physician, Preexisting Conditions, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment
Healthcare Cost Cartoons and Comics - funny pictures from CartoonStock

TrumpCare Versus BidenCare: A Potential Shift For 45 Million Americans

Posted on by • Posted in 2020 Election Issues, ACA, Access & Quality of Healthcare, Coronavirus, Deferred Healthcare, Election, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Medicaid, Medicaid Block Grants, Medicaid Expansion, Medicare, Out of Pocket Expenses, Pandemic, Severability, Short Term Health Insurance, Skinny Health Plans, Supreme Court, Uncompensated Care, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://mailchi.mp/burroughshealthcare/april-16-3240709?e=7d3f834d2f

Healthcare policy is a defining issue for America | Financial Times

Less than three months from now, either Donald Trump will begin his second term as President, or Joe Biden will begin his first. What the U.S. healthcare system on that date and moving forward could be starkly different depending on who is sworn in.
 
The policy differences between the two men are essentially on opposite poles. If fully enacted, Trump’s policies could potentially cause tens of millions of Americans to lose their healthcare coverage. Biden’s policies would likely provide healthcare access to tens of millions more Americans compared to today.
 
In November, the U.S. Supreme Court will hear arguments in a case called California v. Texas. It stems from the 2017 tax bill that zeroed out the penalty individuals paid if they did not obtain health insurance. The argument put forth by the 20 Republican state attorney generals in that case is if the individual mandate no longer has taxing power, the entire law should be declared unconstitutional based upon a lack of severability of the entire law.
 
Many legal scholars have noted that this case is premised on a shaky argument. But with a 6-3 majority of conservative justices now on the high court, many bets are off as to the ACA’s survival. And President Trump just said in an interview with “60 Minutes” he fervently hoped the ACA is eliminated. He put forth no alternatives to the ACA in that interview.
 
Should the ACA be declared unconstitutional, health insurance for some 23 million people would be imperiled. That includes some 12 million Americans who are eligible for Medicaid under the ACA’s expanded income guidelines, and another 11 million who purchase insurance on the state and federal health insurance exchanges – roughly 85% of whom receive premium subsidies that make it more affordable. Moreover, another 14 million Americans who are estimated to have lost their employer-based health plans during the COVID-19 pandemic may not have another place to turn for coverage.
 
Before the ACA case, the Trump administration also promoted so-called “off-exchange” health plans, and health sharing ministries. The first is often a form of short-term health insurance, the second operates as a cooperative serving those of the same religious stripe. Both offer health coverage that is potentially cheaper that what is offered on the exchanges, but both also tend to cap it at low dollar levels. Many also bar applicants for a variety of claims, such as for maternity or cancer care, or if they have pre-existing medical conditions – practices prohibited for ACA plans.
 
Should Trump be re-elected and the ACA survives constitutional muster, expect to see many states apply for more waivers from that law. Georgia just received approval to modestly expand Medicaid eligibility, primarily for those poor already working 80 hours or more a month. The state is also on the cusp of being able to opt out of the healthcare.gov exchange entirely and have consumers work directly with insurance brokers to purchase coverage. However, there is nothing in the pending waiver to prevent those brokers from offering stripped-down coverage without the ACA protections that the Trump administration is already promoting.
There could also be more block grants to states for their Medicaid budgets, which most experts have concluded would reduce the number of enrollees in that program.
 
If Biden is elected and both incoming houses of Congress are also Democratic, the entire Supreme Court case can be mooted simply by reattaching a financial penalty to the individual mandate. That hasn’t been mentioned at all during the campaign, presumably because Biden does not want to discuss what would essentially be a promise to raise taxes. But it is the most direct way to skirt the risk of an adverse Supreme Court decision.
 
Biden’s campaign has also put forth numerous proposals to enlarge the ACA and the Medicare program. They include expanded premium subsidies for individuals and families to purchase coverage, and a public health plan option – which would allow those who live in the states that have yet to expand Medicaid to obtain coverage. Biden has also proposed a buy-in to Medicare at age 60.
 
The estimates are that an expanded ACA and other Biden plans could net another 20 to 25 million Americans healthcare coverage. That would leave fewer than 10 million – 2% to 3% of the population – without access to coverage. It would probably be as close to universal healthcare as the United States could get given its current political realities.
 
The two different approaches will either lead to a country where virtually everyone has access to healthcare coverage and services, or one where 50 million or more people could potentially be uninsured. It’s a shift that could impact a minimum of 45 million people – and that’s not even counting those who lost their coverage during the current public health crisis. 
 
Elections have consequences. Less than three months from now, this one will determine whether the U.S. healthcare system will take one consequential path over another.

COVID response leads voters’ healthcare concerns

Posted on by • Posted in 2020 Election Issues, ACA, Asymptomatic Transmission, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Election, Essential Health Benefits, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Supreme Court, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Safety • Leave a comment

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

The upcoming election has huge implications for healthcare, far beyond how COVID is managed, ranging from how care is covered to how it’s delivered. The graphic above shows a continuum of potential policy outcomes of the November 3rd vote.

If President Trump wins a second term and Republicans control at least one house of Congress, there will likely be more attempts to dismantle the ACA, as well as continued privatization of Medicare coverage.

 If Democrats win the presidency and sweep Congress, actions to expand the Affordable Care Act (ACA), or even create a national public option, are on the table—although major healthcare reform seems unlikely to occur until the second half of a Biden term.

In the short term, we’d expect to see more policy activity in areas of bipartisan agreement, like improving price transparency, ending surprise billing and lowering the cost of prescription drugs, regardless of who lands in the White House.
 
While healthcare emerged as the most important issue for voters in the 2018 midterm elections, the COVID pandemic has overshadowed the broader healthcare reform platforms of both Presidential candidates heading into the election. As shown in the gray box, many Americans view the election as a referendum on the Trump administration’s COVID response. Managing the pandemic is one of the most important issues for voters, especially Democrats, who now rank the issue above reducing the cost of healthcare or lowering the cost of drugs. 

In many aspects, the COVID policies of Biden and Trump are almost diametrically opposed, especially concerning the role of the federal government in organizing the nation’s pandemic response.

The next administration’s actions to prevent future COVID-19 surges, ensure safe a return to work and school, accelerate therapies, and coordinate vaccine delivery will remain the most important aspect of healthcare policy well into 2021.