How West Virginia Became a U.S. Leader in Vaccine Rollout
West Virginia has used 83 percent of its allotted vaccines, among the best in the nation. But even efficient operations face a major problem: There simply are not enough shots to go around.
by Sarah Mervosh - NYT - January 24, 2021
CHARLESTON, W.Va. — Carolyn Zain had heard horror stories about the nation’s coronavirus vaccine rollout: long waits, clunky websites, people being turned away. So when her health department announced it was expanding appointments, she armed herself with two phones — cellphone in one hand, landline in the other — and held her breath.
Within 20 minutes, she secured a slot for the next day. She arrived for her 2 p.m. appointment and was resting in a chair, a fresh shot in her arm, by 2:21 p.m.
“It went wonderfully,” said Ms. Zain, 79, who, after a year spent mostly home alone, wore a sequined face mask that shimmered like confetti for her appointment at a Charleston clinic last week.
Since the nation began distributing vaccines more than a month ago, it has moved far more slowly than officials hoped and has been stymied by widespread logistical problems. But West Virginia has stood out for its success in getting people vaccinated. About 9 percent of all West Virginians have received a first dose of the coronavirus vaccine, a larger segment than in every state but Alaska and double the rate of some. No state has given a larger share of its residents second doses, a crucial step to securing the best chance at immunity.
While many states are struggling to hand out the shots that the federal government has provided to them, West Virginia has given out 83 percent of its doses, by far among the highest. The patchwork system of distribution in the country is in its early weeks, and experts say operations may change significantly as vaccinations gear up further, but many states so far have struggled to give even half of their allotted vaccines. California and Rhode Island have used just 45 percent of their shots.
“West Virginia is about at the top of the charts,” said Dr. Mark McClellan, a former commissioner of the U.S. Food and Drug Administration. “We need to get more states to the point that they have the vaccination capacity of West Virginia.”
As many states struggle with logistical and bureaucratic challenges, leaving vaccines unused, West Virginia offers a remarkable example of a state that has successfully given out almost all of its shots. Yet it provides perhaps the clearest picture of a more fundamental problem that looms ahead for the country: Even the most efficient state vaccine operations do not have enough shots for all who want them.
“It’s not like it’s a cake walk, but we have efficiency,” said Dr. Clay Marsh, the state coronavirus czar. He estimated that West Virginia has the capacity to handle 125,000 doses a week, but is getting just 23,600. At the current pace, officials said, it could take up to five months to finish vaccinating people 65 and older, let alone younger people in the general population.
“We can push a lot more,” Dr. Marsh said. “We just don’t have anything to push.”
The race to vaccinate millions of Americans comes as the country confronts worrying new variants of the virus. The stakes are particularly high in West Virginia, where residents are among the oldest and least healthy in the nation. Two in 10 West Virginians are 65 or older, and nearly half of adults have a higher risk of developing a serious case of Covid-19.
“People are dying every day,” said Albert L. Wright Jr., the chief executive of WVU Medicine, the state’s largest health care provider, which opened a mega-clinic in Morgantown last week. “We just realized, the only way out of this is to vaccinate our way out.”
While the rollout in West Virginia has not been without its frustrations for the many residents who are desperate to receive the vaccine, the state’s approach offers insight into what has worked.
Early on, the state got a significant head start because it initially opted out of a federal program to vaccinate people in nursing homes and other long-term care facilities.
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While other states chose the federal plan, which partnered with Walgreens and CVS to inoculate people in nursing homes around the country, officials decided the idea made little sense in West Virginia, where many communities are tucked into the hills, miles from the nearest big box store, and about half of pharmacies are independently owned.
West Virginia created a network of pharmacies in the state, pairing them with about 200 long-term care facilities. As a result, West Virginia finished its first round of vaccinations at nursing homes last month, while many states were just getting started. By the end of this week, officials expect to have delivered a second round of shots to all nursing homes.
A growing number of governors and state health officials have voiced frustration with the speed of the federal program, which has been slow in part because of the sheer number of long-term care facilities nationwide. Some states, like Maine, have also begun looking to local pharmacies as a resource.
While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.
The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.
No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell's enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
“Using your local partners and really having more control over where the vaccine is going, that’s what has been successful for West Virginia,” said Claire Hannan, executive director of the Association of Immunization Managers.
The approach in some ways reflects the scrappy outlook that has become embedded in West Virginia, a state that is used to being labeled in broad strokes by outsiders. After years of coming in at the bottom of various national rankings — highest rate of cigarette smokers, largest share of adults with multiple chronic conditions, among the highest prevalence of diabetes and obesity — there is a sense of proud defiance around the state’s vaccine plan.
“Our state motto is montani semper liberi — mountaineers are always free,” said Stephen New, a lawyer in Beckley, whose father, a former coal miner, is scheduled to get vaccinated at a local clinic this week. “There is a fierce sense of independence here that we don’t need to follow others.”
Central to West Virginia’s strategy, too, is putting the National Guard at the helm of vaccine operations.
“They are logistical experts,” said Jim Kranz, a vice president at the West Virginia Hospital Association, who described a military approach far different than typical government bureaucracies jammed up by memos and lengthy meetings. “The Guard just says, ‘I don’t need a written plan, this is what we’re doing.’”
In recent weeks, other states have increasingly been turning to the National Guard for assistance.
Inside a former drill hall on the National Guard’s gated campus in Charleston, a core state team of representatives from various agencies meets at a command center, working amid a labyrinth of computer screens, white boards and plexiglass dividers, in the shadow of an enormous American flag.
Officials in West Virginia say the in-person command center, which runs counter to pandemic-era Zoom meetings and may come with health risks, has also helped quickly resolve problems. For instance, a recent brainstorming meeting led to a swift change: To avoid a mix-up between Pfizer-BioNTech and Moderna vaccines, officials changed the colors of cards showing that a resident had been vaccinated — red for Moderna, blue for Pfizer.
“It’s a person at a table,” said Joe Peal, a retired colonel and the chief of staff for the vaccine task force. “We absolutely could not do it virtually.”
Officials say they have also learned what not to do — including not promising shots that they don’t yet have.
After a crowd of people in their 80s unexpectedly showed up outside the health department in Charleston one shivering winter night, officials there decided clinics could not be first-come, first-served. They required appointments, and to avoid later rescinding those appointments, as has happened in states like New York and Florida, appointments are not made until the county officials have that week’s allotment of vaccines on hand, sitting in their own freezer.
Some of West Virginia’s success also may partly be explained by characteristics of the state. Its population, 1.8 million people, is tiny compared to states like Texas, which are handling far more vaccines. West Virginia is also among only a handful of states that do not allow philosophical exemptions for vaccines for school, according to the Immunization Action Coalition, suggesting a culture where acceptance of vaccines may be more prevalent.
West Virginia’s rollout has by no means been without hiccups. And some of the problems have been similar to those in states with far worse records in distributing shots: Phone lines have been mobbed and many West Virginians have spent hours calling to get appointments without success.
The health department in Kanawha County, which includes Charleston, was so overloaded with phone calls last week, its phone system crashed and its Facebook page was flooded with complaints. “I’ve called 250+ times but still unable to get through,” one person wrote.
The distribution of vaccines — mainly to health care workers and older residents so far — also has been concentrated in urban centers, raising concerns about equal access in rural and more impoverished areas. Of the state’s 10 poorest counties, just one had a vaccine clinic in recent weeks, according to an analysis by the nonprofit newsroom Mountain State Spotlight.
But the main problem, officials say, is not logistical but a matter of supply: They need more vaccine.
Dr. Sherri Young, the health officer in Kanawha County, said one big reason phone lines are overrun is because the county cannot reliably schedule clinics weeks in advance. If there were more vaccine, she said, “people wouldn’t be as panicked.”
Pfizer and Moderna have pledged to deliver a combined 200 million doses for use in the United States by the end of March, with an additional 200 million doses to be delivered by the end of July. A third vaccine maker, Johnson & Johnson, could put millions more doses on the market if approved.
West Virginia had hoped to make the case that because it is moving through its vaccines, it deserved to get more, but so far states have been allocated doses based on population.
Jim Doria, 69, a retired epidemiologist, had gone months without seeing his grandchildren who live in Philadelphia and was eager to be among the first to get vaccinated after the state opened the system to people in his age group last week. He estimated that he called as many as 700 times.
“I won the lottery,” he said, after getting off a wait list.
But for every person like Mr. Doria, countless others were left disappointed. Statewide, West Virginia has given shots to around 70,000 of its senior citizens, with more than 250,000 left to go.
https://www.nytimes.com/2021/01/24/us/west-virginia-vaccine.html?
Why Medical Tourism Is Drawing Patients, Even in a Pandemic
The coronavirus pandemic has devastated medical tourism, but pent-up demand remains for affordable treatment in foreign lands.
On a cold February morning last year, as she lay curled up in a fetal position on her kitchen floor, Melissa Jackson called her manager at a New Jersey beauty salon to ask for some unpaid time off.
It was the sixth consecutive week that the 39-year-old beauty technician was unable to work full time because of the debilitating pain in her pelvis caused by endometriosis, a chronic condition triggered by the growth of uterine tissue outside of the uterus.
As her symptoms worsened, she started exploring options to get less costly medical care abroad.
In recent years, while still on her ex- husband’s health insurance policy, she had received hormonal treatments to ease the pain so she could go about her daily life. But since her divorce last year and the coronavirus restrictions placed on the beauty industry in March, those treatment costs have become prohibitive, especially with no insurance.
“There is no real cure for endometriosis, but if I want to free myself from this pain then I need to get a hysterectomy,” Ms. Jackson said, her voice shaking as she described the procedure to remove her uterus. “As if the surgery isn’t bad enough, I need to find 20,000 bucks to pay for it, which is just crazy so I’m going to have to find a way to go to Mexico.”
The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million American workers of their health insurance, according to a study by the nonpartisan consumer advocacy group, Families USA. Many people like Ms. Jackson have experienced a significant deterioration in their health because they have delayed medical procedures. The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.
“We are seeing a pent-up demand for medical tourism during the pandemic, particularly in the U.S. where a fast-growing number of Americans are traveling across the land border with Mexico for health purposes,” said David G. Vequist IV, the founder of the Center for Medical Tourism Research, a group based in San Antonio, Texas, and a professor at the University of the Incarnate Word in San Antonio.
Even before the pandemic, millions of Americans traveled to other countries for savings of between 40 to 80 percent on medical treatments, according to the global medical tourism guide Patients Without Borders. Mexico and Costa Rica have become the most popular destinations for dental care, cosmetic surgery and prescription medicines while Thailand, India and South Korea draw in patients for more complex procedures including orthopedics, cardiovascular, cancer and fertility treatment.
In 2019, 1.1 percent of Americans traveling internationally did so for health treatments, according to the National Travel and Tourism Office, although that figure only accounts for those who traveled by air and does not include the thousands of travelers who crossed the United States-Mexico border. Definitive statistics on medical tourism are hard to come by because countries have different recording methods and definitions of the sector.
Medical tourism has been decimated by coronavirus restrictions, but, even so, the twin crises of the economy and the enormous strain that Covid-19 has placed on the already faulty American health care system are pushing many patients to travel. Demand for nonessential surgeries has also been building up after more than 177,000 scheduled surgeries were postponed in the United States between March and June in 2020, according to the Center for Medical Tourism Research.
“Our market has always been what I call the ‘working poor’ and they just keep getting poorer,” said Josef Woodman, the chief executive of Patients Without Borders. “The pandemic has gutted low-income and middle-class people around the world and for many of them the reality is that they have to travel to access affordable health care.”
In April, following the initial global lockdown to curb the spread of the coronavirus, medical travel bookings were down by more than 89 percent in the most popular destinations, including Mexico, Thailand, Turkey and South Korea, according to Medical Departures, a Bangkok-based medical travel agency. Since August, the numbers have slowly been rebounding, but bookings in Mexico, which has seen an uptick in American travelers in recent months, are still down by 32 percent compared to the same period of August to December in 2019.
“Covid-19 has devastated the whole medical tourism ecosystem because of all the uncertainty over travel restrictions and quarantine measures that keep changing across the world,” said Paul McTaggart, the founder of the agency.
“Despite this, we are still seeing a growing number of people traveling and booking trips to address their urgent health needs, especially between the U.S. and Mexico border where patients can travel safely by car,” Mr. McTaggart said. The Center for Medical Tourism Research found that Google searches in the United States for the terms “Mexico medical tourism” went up by 64 percent since July, compared to pre-pandemic levels before travel restrictions were imposed in March.
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“Google searches are almost directly correlated with consumer behavior when it comes to travel across borders,” Mr. Vequist said.
Before the winter resurgence of the coronavirus, Ms. Jackson had started to plan and save for a trip to Mexicali, a border city in northern Mexico, where she can get a hysterectomy for $4,000, one-fifth the cost of the procedure offered in New Jersey. Her best friend had offered to drive her there and pay for the gas and accommodations.
“We wanted to make a vacation out of it and have some fun before the surgery because it’s such a heavy and dark thing with real consequences,” Ms. Jackson said. “At 39, I have to come to terms with the reality that I’ll never have kids. That’s even more painful than my condition.”
For now, Ms. Jackson has put the surgery on hold and will wait until the virus is brought under control. Her doctor had pointed to cheaper options for the operation in New Jersey, starting at $11,000 in a local outpatient facility. But Ms. Jackson is adamant about having it in the hospital and says the aftercare is more thorough in Mexico.
“Going for the cheaper option at home means getting lower quality care and taking a risk. That just isn’t the experience for people who do this in specialized hospitals in Mexico,” she said. “It’s cheap and safe.” (Many hospitals and clinics in Mexico and other countries have accreditation to ensure their standards are equivalent to medical facilities in the United States.)
In recent weeks, Ms. Jackson has had a flare up of symptoms, which is common when the condition goes untreated.
“I’m not sure if I will be able to wait for Covid to get better,” she said. “This thing cripples every part of my life.”
The land border with Mexico — closed to tourists — has remained open for essential travel, which includes all medical treatment, and a handful of Americans cross the border every day into Los Algodones (also known as Molar City) to receive dental treatment or purchase pharmaceuticals.
“It’s just Americans over there getting dental care,” said Jeff Somerville, a Delta Air Lines flight attendant who visited the Supreme Dental Clinic in Los Algodones in September to get his crowns replaced. “You park on the U.S. side and just walk across. It’s easy and felt very safe.” He said the procedure would have cost around $25,000 in Tampa, Fla., close to where he lives in the city of Clearwater. In Mexico, he paid $7,000.
Now, Mr. Somerville, 47, is preparing to travel to Turkey in February for a hair and beard transplant, which will cost $3,000 and includes plasma treatments, medications, hotel lodging for three nights and a translator.
“I’m going to live my life, but I’m going to take my precautions while I do that,” he said. “I’m not going to sit at home and be scared.”
Turkey has remained open to tourists throughout the latest surge of the pandemic in Europe and only visitors from Britain are required to take a test as a precaution against a new, more transmissible variant of the virus. On weekends in Turkey a strict curfew is imposed on local residents to curb the spread of the virus, but foreign visitors are allowed to roam free without any restrictions. On Istanbul’s main Istiklal Avenue, men recovering from hair transplant procedures can easily be spotted with bandages around their heads.
“This is the best time to get surgery,” said Martin Wright, a British tourist, who had a hair transplant in Istanbul in December, before the new variant of the virus was identified in Britain. “Hotels are cheap, sites are empty and you get to have down time in a foreign city where you don’t have to explain to anyone why or how you got a hair transplant.”
Over the summer, when lockdown restrictions were eased across Europe, Britons traveled to the continent to receive medical treatment, after waiting lists for elective surgery on the National Health Service reached record levels. With British hospitals operating at reduced capacity to accommodate patients with Covid-19, hundreds of thousands of patients, who have been waiting for more than a year for non-urgent surgery, are facing further delays, N.H.S. figures show.
Cynthia Hedges, a 77-year-old retired nurse from Plymouth in southwest England, traveled to France in August for a knee replacement after waiting more than 19 months to get the procedure at her hospital.
“It just became hopeless, I could barely walk and was just living off pain medication, which is not good for my health,” she said in a telephone interview. “I know we can’t go far these days, but I became very depressed not even being able to walk to my garden. I know it was risky to travel at the time, but it was the best thing I did. It was worth it.”
Even as travel restrictions tighten, experts in the medical tourism industry see an opportunity as demand builds and health care becomes more inaccessible in people’s home countries.
“It doesn’t matter if you’re in Europe or the Americas,” said Mr. McTaggart of Medical Departures. “Financially challenged individuals will seek out and be more receptive to the idea that you can travel abroad and see substantial savings for medical treatment and get past the line.”
Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. @CeylanWrites • Facebook
Top Democratic Consultants Working for Anti–Medicare for All Campaign
The industry-led Partnership for America’s Health Care Future, which has assailed Democratic presidential candidates’ reform plans, is drawing on Democratic firms for assistance.
As health insurance, pharmaceutical and hospital companies fight to prevent more politicians from backing Medicare for All, the industry’s front group has turned to top Democratic consulting firms and pro-business nonprofits for help, according to its 2018 tax return. The array of consultants includes presidential candidate Joe Biden’s pollster.
The Partnership for America’s Health Care Future (PAHCF), a nonprofit created last year to oppose plans to create a comprehensive, universal health care system, paid almost $760,000 to Bully Pulpit Interactive, a communications and digital marketing firm that has worked with the Democratic National Committee and the Democratic Senatorial Campaign Committee (DSCC).
The dark money organization paid almost $185,000 to Anzalone Liszt Grove Research, a polling firm that has been working with former Vice President Biden’s Democratic presidential campaign, the DSCC, and the Democratic Congressional Campaign Committee. The firm recently tested attack lines on Medicare for All for Third Way, a centrist Democratic think tank. PAHCF also paid $140,000 to Blue Engine Message & Media, a firm that was founded by former campaign staffers for President Barack Obama. (Blue Engine is now known as Seven Letter.)
PAHCF’s biggest vendor was Forbes Tate, a bipartisan lobbying firm with ties to moderate Democrats. It paid the firm more than $1.7 million. The organization separately contributed almost $520,000 to Center Forward, a centrist think tank that hosted a luxury retreat last year where senior Democratic congressional staffers were invited to listen to Center Forward board member Libby Greer, a Forbes Tate partner who works for PAHCF, talk with a hospital lobbyist about health care. The organization also paid $192,000 to Business Forward, a trade group that has been warning that business leaders are worried about Medicare for All.
Despite its Democratic consultant roster, PAHCF has spent much of the past year and a half criticizing the party’s leading presidential contenders. The organization has regularly slammed the Medicare for All proposals offered by Senators Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts. It has also attacked former Vice President Joe Biden and South Bend, Ind., Mayor Pete Buttigieg for their plans to create a public health insurance option.
“While Medicare for All would eliminate private health coverage overnight, Joe Biden’s public option and other new government health insurance systems would eliminate it over time,” the organization tweeted during the September Democratic debate.
In response to questions, Anzalone Lizst Grove partner John Anzalone said via email, “ALG is a polling firm and we did a project in mid-2018 for PAHCF assessing voters’ views of the healthcare system, including keeping and improving on Obamacare and baseline knowledge and views on Medicare for All. This was the only project we conducted for PAHCF and have done no work for them since then.”
Jana Plat, the programming director at Business Forward, said her group hasn’t worked with PAHCF this year either. “We worked with the Partnership in 2018, have not worked with them this year,” she wrote in an email. “Our programming has focused on the ACA and reproductive health care. We’ve spent ten years on the [Affordable Care Act], from helping pass it, to protecting it to improving it.”
PAHCF’s list of members includes dozens of trade organizations and companies, but its tax return shows the organization has been led by executives at a few of the nation’s most influential health-care lobbying groups -- America’s Health Insurance Plans (AHIP), which represents health insurers in Washington; Pharmaceutical Research and Manufacturers of America (PhRMA), D.C.’s top drug lobby; the Federation of American Hospitals (FAH), a trade group for investor-owned hospitals; and the American Medical Association, which represents physicians.
The PAHCF filing lists AHIP executive vice president David Merritt as its president and PhRMA lobbyist Scott Olsen as its treasurer. The board of directors list also includes Jeff Cohen, but he left FAH this summer and is no longer on the board, according to a PAHCF spokesperson. Richard Deem, a senior vice president of the American Medical Association (AMA) named in the filing, has left the board as well, the spokesperson said. The AMA dropped out of the organization over the summer.
It’s not clear how much any of these organizations have donated to PAHCF. Tax returns filed by PhRMA and FAH for 2018 didn’t list any grants to the group. As MapLight previously reported, trade groups can finance front groups’ advocacy efforts without naming the organizations in their tax returns.
PAHCF reported raising $5.1 million in 2018. While the organization isn’t required to disclose its donors in its tax return, its filing shows its largest donor was $500,000. It received eight contributions of $300,000.
The American College of Radiology Association contributed at least $300,000 to PAHCF in 2018, according to their tax return. Tenet Healthcare, an investor-owned hospital company, donated $41,000 last year before kicking in $588,000 earlier this year
PAHCF has ramped up its spending in recent months, running television advertisements during Democratic presidential debates and making big ad buys in Iowa. “The politicians may call it Medicare for All, Medicare buy-in or the public option,” the ads claim. “But they mean the same thing. Higher taxes or higher premiums, lower quality care.”
Americans experience worse health outcomes than people in wealthy countries that have adopted single-payer style health care systems. Medicare for All would require people to pay more in taxes, but they would no longer have to pay health insurance premiums, deductibles or co-payments.
On Monday, PAHCF released a study by FTI Consulting asserting that a public option could “eventually cause the elimination” of all private health insurance plans offered on state exchanges created under the Affordable Care Act, the 2010 Democratic health care law.
Their reasoning: “The government would be expected to set premiums for the public option approximately 25 percent below market value for comparable private insurance plans.”
https://www.blogger.com/blog/post/edit/3936036848977011940/5477601677983189805
Coronavirus: How to help workers who become uninsured?
by Diane Archer - JustCare - January 18, 2021
Back in April 2020, early in the pandemic, the US suffered from tremendous unemployment. With that, came millions of uninsured. Paul Fronstin and Stephen Woodbury report for The Commonwealth Fund that even though millions of Americans lost their jobs since March 2020, fewer than anticipated lost their health insurance. Whatever the number of uninsured, the Biden administration should ensure coverage for the uninsured and offer workers the choice of health coverage not tied to their work.
President Biden proposes that the government pay the health insurance premiums–COBRA–for people who have lost their health insurance along with their jobs during this pandemic. That will definitely help the insurers. But, giving people back the high-deductible, high-copay health insurance they had when they were employed is a far cry from helping them when they have little or no income and limited savings.
Recent estimates suggest that about 7.7 million people who lost their jobs during the pandemic also lost their employer coverage. Including their family members who lost coverage, closer to 14.6 million people lost employer insurance. Both for their individual health and the public health, they should be able to get care without worry about the cost.
Paying people’s COBRA premiums is out of line with Biden’s desire to provide free COVID-19 testing and treatment for everyone. To provide this coverage, there’s a far better proposal on the table, the Health Care Emergency Guarantee Act. sponsored by Congresswoman Pramila Jayapal, Senator Bernie Sanders and others. It would have the Department of Health and Human Services cover the full cost of care for everyone who lacks health insurance, along with the copays, deductibles and other out-of-pocket costs for people with public or private insurance. That policy solution would ensure that everyone got free COVID care.
Biden to tap nurse as acting surgeon general
Susan Orsega would be among the first nurses to serve in the role of ‘the nation’s doctor'
by Dan Diamond - The Washington Post - January 25, 2021
The Biden administration has selected nurse Susan Orsega to serve as the nation’s acting surgeon general, said two people with knowledge of her selection who spoke on the condition of anonymity because they were not authorized to discuss the announcement.
Orsega, a career-commissioned officer in the U.S. Public Health Service corps and a longtime infectious-disease specialist, would be among the first nurses to serve in the role of surgeon general, which is often referred to as “the nation’s doctor.” The announcement of Orsega’s selection could come as soon as Tuesday, one of the people said.
Surgeon General Jerome Adams, a Trump appointee, resigned last week at Biden’s request, and Deputy Surgeon General Erica Schwartz, a career official, chose to retire after being passed over as acting surgeon general.
Frequently viewed as the nation’s spokesperson on public health matters, the surgeon general oversees the U.S. Public Health Service, more than 6,000 uniformed public health personnel who work in various parts of the federal government, but has limited ability to make policy. In her current role, Orsega oversees the corps’s personnel, operations and readiness.
Orsega did not immediately respond to request for comment. A spokesperson for the Health and Human Services Department declined to confirm that Orsega had been selected as acting surgeon general but said the department is expecting an announcement as soon as Tuesday.
Biden has nominated Vivek H. Murthy, a close adviser who served as surgeon general in the Obama administration, to return to his previous role as the nation’s top doctor. However, Murthy’s confirmation hearings have yet to be scheduled, said an aide with the Senate Health, Education, Labor and Pensions committee.
“The committee is ready to go with an aggressive scheduling of hearings once we organize, with nominations being a top priority,” committee spokesperson Madeleine Russak said.
Orsega is not the first nurse to serve as surgeon general. Former president Donald Trump in 2017 tapped nurse Sylvia Trent-Adams to serve as acting surgeon general after abruptly firing Murthy. Richard Carmona, who served in the Bush administration, was a physician as well as a nurse.
https://www.washingtonpost.com/health/2021/01/25/biden-appoints-nurse-acting-surgeon-general/
Biden to reopen ACA insurance marketplaces as pandemic has cost millions of Americans their coverage
by Amy Goldstein - The Washington Post - January 25, 2021
President Biden is scheduled to take executive actions as early as Thursday to reopen federal marketplaces selling Affordable Care Act health plans and to lower recent barriers to joining Medicaid.
The orders will be Biden’s first steps since taking office to help Americans gain health insurance, a prominent campaign goal that has assumed escalating significance as the pandemic has dramatized the need for affordable health care — and deprived millions of Americans coverage as they have lost jobs in the economic fallout.
Under one order, HealthCare.gov, the online insurance marketplace for Americans who cannot get affordable coverage through their jobs, will swiftly reopen for at least a few months, according to several individuals inside and outside the administration familiar with the plans. Ordinarily, signing up for such coverage is tightly restricted outside a six-week period late each year.
Another part of Biden’s scheduled actions, the individuals said, is intended to reverse Trump-era changes to Medicaid that critics say damaged Americans’ access to the safety-net insurance. It is unclear whether Biden’s order will undo a Trump-era rule allowing states to impose work requirements, or simply direct federal health officials to review rules to make sure they expand coverage to the program that insures about 70 million low-income people in the United States.
The actions are part of a series of rapid executive orders the president is issuing in his initial days in office to demonstrate he intends to steer the machinery of government in a direction far different from that of his predecessor.
Biden has been saying for many months that helping people get insurance is a crucial federal responsibility. Yet until the actions planned for this week, he has not yet focused on this broader objective, shining a spotlight instead on trying to expand vaccinations and other federal responses to the pandemic.
The most ambitious parts of Biden’s campaign health-care platform would require Congress to provide consent and money. Those include creating a government insurance option alongside the ACA health plans sold by private insurers, and helping poor residents afford ACA coverage if they live in about a dozen states that have not expanded their Medicaid programs under the decade-old health law.
A White House spokesman declined to discuss the plans. Two HHS officials, speaking on the condition of anonymity about an event the White House has not announced, said Monday they were anticipating that the event would be held on Thursday.
According to a document obtained by The Washington Post, the president also intends to sign an order rescinding the so-called Mexico City rule, which compels nonprofits in other countries that receive federal family planning aid to promise not to perform or encourage abortions. Biden advisers last week previewed an end to this rule, which for decades has reappeared when Republicans occupied the White House and vanished under Democratic presidents.
The document also says Biden will disavow a multinational antiabortion declaration that the Trump administration signed three months ago.
The actions to expand insurance through the ACA and Medicaid come as the Supreme Court is considering two cases that could shape the outcome. One case is an effort to overturn rulings by lower federal courts, which have held that state rules, requiring some residents to work or prepare for jobs to qualify for Medicaid, are illegal. The other case involves an attempt to overturn the entire ACA.
According to the individuals inside and outside the administration, the order to reopen the federal insurance marketplaces will be framed in the context of the pandemic, essentially saying that anyone eligible for ACA coverage who has been harmed by the coronavirus will be allowed to sign up.
“This is absolutely in the covid age and the recession caused by covid,” said a health-care policy leader who has been in discussions with the administration. “There is financial displacement we need to address,” said this person, who spoke on the condition of anonymity to describe plans the White House has not announced.
The reopening of HealthCare.gov will be accompanied by an infusion of federal support to draw attention to the opportunity through advertising and other outreach efforts. This, too, reverses the Trump administration’s stance that supporting such outreach was wasteful. During its first two years, it slashed money for advertising and for community groups known as navigators that helped people enroll.
It is not clear whether restoring outreach will be part of Biden’s order or will be done more quietly within federal health-care agencies.
Federal rules already allow people to qualify for a special enrollment period to buy ACA health plans if their circumstances change in important ways, including losing a job. But such exceptions require people to seek permission individually, and many are unaware they can do so. Trump health officials also tightened the rules for qualifying for special enrollment.
In contrast, Biden is expected to open enrollment without anyone needing to seek permission, said Eliot Fishman, senior director of health policy for Families USA, a consumer health-advocacy group.
In the early days of the pandemic, the health insurance industry and congressional Democrats urged the Trump administration to reopen HealthCare.gov, the online federal ACA enrollment system on which three dozen states rely, to give more people the opportunity to sign up. At the end of March, Trump health officials decided against that.
During the most recent enrollment period, ending the middle of last month, nearly 8.3 million people signed up for health plans in the states using HealthCare.gov. The figure is about the same as the previous year, even though it includes two fewer states, which began operating their own marketplaces.
Leaders of groups helping with enrollment around the country said they were approached for help this last time by many people who had lost jobs or income because of the pandemic.
The order involving Medicaid is designed to alter course on experiments — known as “waivers” — that allow states to get federal permission to run their Medicaid programs in nontraditional ways. The work requirements, blocked so far by federal courts, are one of those experiments. Another was an announcement a year ago by Seema Verma, the Trump administration’s administrator of the Centers for Medicare and Medicaid Services, that states could apply for a fundamental change to the program, favored by conservatives, that would cap its funding, rather than operating as an entitlement program with federal money rising and falling with the number of people covered.
“You could think about it as announcing a war against the war on Medicaid,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.
Dan Mendelson, founder of Avalere Health, a consulting firm, said Biden’s initial steps to broaden insurance match his campaign position that the United States does not need to switch to a system of single-payer insurance favored by more liberal Democrats.
The orders the president will sign “are going to do it through the existing programs,” Mendelson said.
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