New State-by-State Reports Reveal Huge Human, Economic Toll of Osteoporosis

 A new series of state-by-state reports released today by the National Osteoporosis Foundation (NOF) highlights substantial differences across the states in the number of fractures caused by osteoporosis and their resulting costs and deaths. The reports also document racial disparities in screening and outcomes, including lower screening rates and higher rates of death for Black Medicare FFS beneficiaries following a bone fracture.

The NOF contracted with the independent actuarial firm Milliman to analyze the state-by-state economic and clinical impact of bone fractures suffered by Americans insured by Medicare. The 50 individual state reports being released today provide a first-ever detailed state-level review of the incidence of osteoporotic fractures, their health care impact and associated Medicare costs.

Key findings include:

• Approximately 2.1 million osteoporotic fractures were suffered by 1.8 million Americans covered by Medicare in 2016. The incremental annual allowed medical cost for osteoporotic fractures was $21,564 per Medicare FFS beneficiary in 2016.  
• Medicare FFS beneficiaries suffered additional subsequent fractures within one year of the initial fracture at over three times the annual rate of new osteoporotic fractures for all Medicare FFS beneficiaries. In the six-month period following subsequent fractures that were suffered up to three years following an initial fracture in 2016 the cost was $5.7 billion. 
• Preventing between 5% and 20% of these subsequent fractures could have saved between $272 million and $1.1 billion for the Medicare FFS program during a follow-up period that lasted up to three years after a new osteoporotic fracture.

State Variations:

• After adjusting for differences in age and sex, Medicare FFS beneficiaries in Hawaii had 24% lower rates of osteoporotic fractures than the national average, while Kentucky and Florida had the highest rates of fractures, 13% and 12% higher than the national average respectively.   
• While the national average estimated 180-day incremental cost of a subsequent fracture was about  $20,400, this varied significantly among states from a low of about $17,000 in Arkansas to a high of $26,200 in Wyoming.

Ethnic/Race Variations:

• While Black Medicare FFS beneficiaries had lower rates of fracture, only 5% received screening for osteoporosis with a bone mineral density (BMD) test within 6 months of a new osteoporotic fracture – when the need for treatment and action is highest – compared to 8% of all Medicare FFS beneficiaries with a fracture.
• 22% of Black Medicare FFS beneficiaries died within 12 months of a fracture, exceeding the national average rate of 19% and rates for White (19%), Asian (16%), Hispanic (18%) and North American Native (18%) beneficiaries.   
• About 6% and 7% of North American Native and Hispanic Medicare FFS beneficiaries, respectively, received a BMD test within 6 months of a new fracture compared to 8% among all Medicare FFS beneficiaries.

"The health care system is failing the more than 54 million people who have osteoporosis or low bone density and are at high risk of breaking bones," said Claire Gill, CEO of NOF. "We have the tools to substantially reduce the enormous burden of osteoporotic fractures, and there are simple steps the Biden Administration and Congress can take to incentivize their use."

The NOF made several recommendations based on the report, including:

• Congress and CMS should make changes to Medicare payments to incentivize widespread use of model secondary fracture prevention/care coordination practices for beneficiaries who have suffered an osteoporosis-related fracture and are thus at risk for another fracture.
• Cuts to Medicare payment rates for osteoporosis screening which have reduced access should be reversed either administratively or by legislation.
• Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut secondary (repeat) fractures by about half. But about 80 percent go untreated, even after a fracture. Congress should mandate and fund a national education and action initiative aimed at reducing fractures among older Americans.

Pamela Pelizzari, a Milliman co-author, said, "The findings in this report highlight the substantial disease burden resulting from osteoporosis-related fractures among Medicare FFS beneficiaries. The state-level reports highlight both variability across populations and opportunities for improvements in osteoporosis management."

For a full copy of the report, please visit NOF's National Bone Health Policy Institute website: https://www.bonehealthpolicyinstitute.org/

https://www.biospace.com/article/releases/new-state-by-state-reports-reveal-the-huge-human-and-economic-toll-of-osteoporosis/

AMA unit Health2047 spins out obesity testing startup to speed personalized medicine

 The American Medical Association innovation subsidiary Health2047 has spun off a company that uses personalized medicine to fight obesity.

Phenomix Sciences is a phenotype testing company that carries out the AMA’s mission to confront chronic diseases such as obesity.

Phenomix uses a blood test called MyPhenome that it has licensed from the Mayo Clinic to allow doctors to prescribe individualized therapies. MyPhenome measures DNA as well as a person’s metabolites and hormones. These biomarkers make up a person’s phenotype, according to Phenomix.

A 2020 Columbia University study found that 60% of people who were extremely obese were more likely to require ventilation or pass away from COVID-19. Overall, 42% of American adults live with obesity, according to a report by Trust for America’s Health, which also incorporated data from the Centers for Disease Control and Prevention.

The company’s blood-based test uses phenotype-driven multi-omics technology to predict responses to obesity interventions that the Food and Drug Administration (FDA) has approved. A multi-omics test is important because testing for obesity involves multiple factors, including genetics, metabolomics and environmental aspects, according to Phenomix CEO Mark Bagnall.

“Properly identifying obesity phenotypes requires more sophisticated testing than a simple genetic or DNA test,” Bagnall told Fierce Healthcare.

In 2018, the AMA announced a $27.2 million investment in Health2047. At the time, Health2047 planned to use the funds to commercialize its products and develop the company around chronic disease reduction, productivity and value-based care. Now Phenomix will commercialize its AI-powered multi-omics biomarker. according to the company’s co-founder and physician-scientist Andres Acosta.

“This technology could help more than a billion people in the world currently struggling with excess weight,” Acosta told Fierce Healthcare. “Thus, it was essential to spin out this technology to accelerate its commercialization and help overweight people and those with obesity.”

Because patients respond differently to obesity treatment, the Phenomix founders turned to AI to personalize this treatment. AI can personalize a multi-omics obesity test and analyze single-nucleotide polymorphisms, metabolites and hormones that correspond with a certain obesity phenotype, according to Bagnall.

AI can help identify a specific obesity phenotype so patients can receive the right treatment.

“[We] demonstrated in several clinical studies that knowing a patient’s phenotype doubles the likelihood of weight loss and doubles the amount of weight lost,” Bagnall said.  

Since it was launched in 2016, Health2047 has spun out several other companies, including First Mile Care, a company that created a platform to reverse prediabetes, and Akiri, a secure network-as-a-service company that facilitates health data sharing in real-time.

Another company that Health2047 launched, Zing Health, aids doctors and communities in coordinating care for chronically underserved populations. Meanwhile, Medcurio enables healthcare organizations to gain value from healthcare data and protects data privacy.

A 2019 survey of healthcare executives by KLAS Research and the Center for Connected Medicine (CCM) revealed that healthcare organizations have been slow to adopt precision medicine, which focuses on precise treatment for groups. CIOs interviewed for the report cited limited funding and a lack of reimbursement from payers as factors holding back precision medicine.

Bagnall says the work in personalized medicine for people with obesity will lead to treatments for other chronic diseases. AI and multi-omic tests can make this possible.

“In chronic disease, where environmental factors play a large part, the analysis of the underlying condition is more complex, thus requiring new tools like AI and multi-omics,” he said. ”As Phenomix’s approach to personalized medicine improves outcomes for patients with obesity, we expect these tools to be used in the treatment of other chronic diseases.”

https://www.fiercehealthcare.com/tech/ama-unit-health2047-spins-out-obesity-testing-startup-to-accelerate-personalized-medicine

Law enforcement scrutinizing CARES Act Provider Relief Fund Uninsured Program

 The Department of Health and Human Services appears to have begun conducting an outlier analysis on its reimbursement to healthcare providers for treating uninsured COVID-19 patients. Providers have who have received payments from the COVID-19 Uninsured Program should take steps to ensure that they are in full compliance with the terms and conditions for payment, including the balance billing restriction.

On March 27, 2020, the Coronavirus Aid, Relief and Economic Security (CARES) Act appropriated $100 billion to HHS to issue pandemic relief payments to healthcare providers. Using this funding, supplemented with additional appropriations, HHS created a program to reimburse providers for treatment of uninsured COVID-19 patients and COVID-19 testing and vaccination for uninsured individuals. 

According to a public database last updated on March 25, 2021, the COVID-19 Uninsured Program, which is implemented by the Health Resources & Services Administration, has distributed over $2.2 billion in reimbursement to healthcare providers for COVID-19 treatment, on top of payments for testing and administering vaccines.  

Each payment from the COVID-19 Uninsured Program is governed by a set of terms and conditions. By applying for, receiving, and retaining payments, HRSA expects each recipient to be in “ongoing compliance with these terms and conditions.” Furthermore, the terms and conditions state that each recipient’s “full compliance with all Terms and Conditions is material to the Secretary’s decision to disburse funds to the Recipient.”

The term “material” mirrors an element of many False Claims Act theories of liability and strengthens the government’s position that even discrete violations of the Terms and Conditions can serve as the predicate for a False Claims Act case. This is also consistent with public remarks from senior Department of Justice officials that “going forward the False Claims Act will play a central role in the Department’s pursuit of COVID-19 related fraud.”

So far, there has been little publicly announced scrutiny by either HHS or law enforcement of the COVID-19 Uninsured Program, despite DOJ making clear through repeated announcements—including an update on March 26 “on criminal and civil enforcement efforts to combat COVID-19 related fraud”—that it is prioritizing fraud on pandemic relief programs. And while HRSA has announced reporting requirements for General and Targeted Distributions from the CARES Act Provider Relief Fund, the Uninsured Program is not included in these reporting requirements, seemingly creating a lack of auditing visibility for the government. 

But HHS officials recently announced that they had referred to the HHS Office of Inspector General a provider that is an outlier on reimbursement for treatment claims from the COVID-19 Uninsured Program. This dovetails with a recent DOJ commitment that the “Civil Division is working closely with various Inspector Generals and other agency stakeholders to identify, monitor, and investigate the misuse of critical pandemic relief monies, and we expect this collaborative effort to translate into significant cases and recoveries.”

HHS’ announcement underscores the importance for providers that have received significant aggregate reimbursement from the COVID-19 Uninsured Program—whether for testing, treatment, or vaccination—to assess their data for outliers. 

Proactive internal data analytics are particularly important because both DOJ Civil and Criminal Division leadership have recently acknowledged a new reliance on data analytics to identify targets for investigation, explaining that they have “increasingly been undertaking sophisticated analyses of Medicare data to uncover potential fraud schemes that have not been identified by whistleblower suits, as well as to help analyze and support the allegations that we do receive from such suits.” HRSA’s payment database appears ripe for DOJ and whistleblower scrutiny, and a year into the COVID-19 Uninsured Program, DOJ may finally be turning its new analytical skills on this reimbursement information.   

Providers can assess outlier status on an array of metrics, which can vary based on provider type and structure.  Of course, situational factors such as the percentage of the population that is uninsured in the region must be taken into account while assessing outlier status. After identifying outliers, providers can perform targeted medical record reviews to assess whether documentation supports compliance with HRSA’s billing requirements.

Depending on the results, self-disclosure and administrative repayment to HRSA may be appropriate.

Providers should also ensure they have policies and procedures in place to drive compliance with ancillary provisions of the Terms and Conditions. For example, the Terms and Conditions impose a commitment that providers “not engage in ‘balance billing’ or charge any type of cost-sharing for any items or services” provided to uninsured individuals for whom the provider received reimbursement for administering a COVID-19 vaccine or treatment.

The same requirement applies to reimbursement for testing and permissible related services. Many providers may be in the process of updating their billing procedures to come into compliance with the new balance billing prohibitions imposed by the No Surprises Act, signed into law as part of the Consolidated Appropriations Act of 2021. However, particularly during the early chaos of the pandemic, providers may not have had billing safeguards in place to avoid balance billing where required by the Terms and Conditions.

HHS’ announcement serves as a signal that as the COVID-19 Uninsured Program has matured, HRSA may now be in a position to more actively work with HHS-OIG and DOJ to scrutinize provider compliance with the Terms and Conditions. Providers should ensure their compliance programs have a line of sight into reimbursement from the COVID-19 Uninsured Program.

Brenna Jenny is a partner in the Healthcare practice at Sidley Austin LLP. This article has been prepared for informational purposes only and does not constitute legal advice. This information is not intended to create, and the receipt of it, does not constitute a lawyer-client relationship. Readers should not act upon this without seeking advice from professional advisers. The content therein does not reflect the views of the firm.

https://www.fiercehealthcare.com/finance/industry-voices-law-enforcement-scrutiny-cares-act-provider-relief-fund-uninsured-program

HHS flags mask issue with fogging glasses in innovation challenge

 Like much of the rest of the world, the U.S. Department of Health and Human Services has just about had it with mask-induced acne and eczema, glasses fog, indecipherable conversations and stifled breathing.

In a last-ditch attempt to solve these societal ills, HHS’ Biomedical Advanced Research and Development Authority—known as BARDA, the specialized agency that typically takes on viral outbreaks, bioterrorist attacks and nuclear incidents—has put out the call for new mask designs that battle both discomfort and coronavirus-carrying droplets, with $500,000 in prizes.

With help from the equipment-certifying National Institute for Occupational Safety and Health (NIOSH), the “Mask Innovation Challenge” is now accepting submissions for what can only be described as a miracle in face mask form.

They must be cheap and simple to mass-produce, while also being widely accessible and effective in blocking transmission of COVID-19. Bonus points go to those that solve the challenges of unreadable facial expressions, intelligible speech, incompatibility with glasses, irritating contact dermatitis, discomfort caused by prolonged wear and the feeling of being suffocated.

After the submission period closes April 21, the creative geniuses found to have invented “tomorrow’s mask” will move on to a “Shark Tank”-style pitch competition. Up to 10 finalists will receive up to $10,000 each, plus access to BARDA’s scientific expertise to build their prototypes.

Those finalists will then advance to testing in NIOSH labs, and up to five of the best designs will split a $400,000 grand prize.

“We know that properly and consistently worn face masks help reduce the spread of SARS-CoV-2 and other respiratory infections, but many people are reluctant to wear them for a variety of reasons,” Nikki Bratcher-Bowman, HHS’ acting assistant secretary for preparedness and response, said in a release. “With this mask challenge, we want to get people across the country involved in developing new masks that are both effective and comfortable.”

Crowdsourcing has been a popular method for creating masks that people will actually wear. In December, the XPrize Foundation closed a similar competition, which called on inventors between the ages of 15 and 24 to design “the next generation of face masks.”

The winning design, which was awarded $500,000 and was designed by a team of students from Arizona State University, features adjustable elastic straps around the ears and chin, an outer mesh layer that can be customized with different colors and patterns, and a dual-chamber design separating exhaled air from the face, preventing fogging and overheating.

https://www.fiercebiotech.com/medtech/still-looking-for-perfect-face-mask-hhs-new-mask-innovation-challenge-too

Biden's Infrastructure Package Is Designed to Boost Unions

 President Biden's $2.3 trillion plan to invest in infrastructure, clean energy and caregiving over the coming decade would be a boon for construction workers, truck drivers, electricians and home health aides.

Both critics and supporters of the initiative say it will also benefit another group: labor unions.

Some business groups, employment law experts and Republican lawmakers say provisions aimed at bolstering union membership and expanding labor protections could increase costs, limit the number of projects that can be completed with the proposed funding and reduce the gains in economic growth.

For Mr. Biden, those provisions are key to ensuring the package creates millions of "good-paying union jobs of the future." In 2020, just 10.8% of U.S. workers belonged to unions, half the share in 1983, but those workers earned a dollar for every 84 cents earned by nonunion workers.

"The president has made very clear that he wants to be the most labor-friendly president in history, and the steps that he's taking in many different ways are designed to accomplish that," said Michael Lotito, co-chairman of the Workplace Policy Institute at Littler Mendelson, an employment law firm based in San Francisco.

The Democratic administration's plan includes spending on an array of industries over eight years. The proposal includes $621 billion to modernize transportation infrastructure, $300 billion to boost the manufacturing industry, $213 billion on retrofitting and building affordable housing and $100 billion to expand broadband access, among other investments.

Many of the new jobs are likely to be union positions, because the plan targets sectors that already have high levels of union participation, said Greg Regan, president of the Transportation Trades Department, a coalition of unions in industries such as aviation and rail transit.

Even within those industries, a minority of workers are union members, including 20.6% of utility workers, 17% of transportation and warehousing workers and 14.3% of telecommunications workers, according to 2020 Labor Department data.

"There is a very glaring need for this type of big investment, and if done with the right policies -- in many ways, existing programs already have them -- that will not only improve our transportation systems across the board, but also build union jobs and middle-class jobs," Mr. Regan said.

Bill Spriggs, chief economist at the AFL-CIO, said implementation of the package, particularly for construction projects, should gravitate toward unions if the goal is to promote racial equity -- a stated priority for the Biden administration. Black workers are more likely to be represented by a union than other racial groups, according to Labor Department data.

The overall fall in union membership is a sign of the decline in power of organized labor in the U.S. and reflects slower employment growth in traditionally more unionized industries, such as manufacturing, transportation and utilities, compared with healthcare and other services.

Economists have pointed to the decline as a reason why wage growth in the U.S. was relatively soft in the years leading up to the coronavirus pandemic, despite low unemployment and steady hiring. Median weekly pay for full-time union members was $1,144 last year versus $958 for nonmembers, the Labor Department said.

Mr. Regan said provisions in the package -- such as a measure that seeks to have more goods shipped on U.S.-flag vessels staffed by American workers -- would also be a boon for union positions.

The package proposes tying federal investments to prevailing wages, echoing existing law that requires federal contractors and subcontractors on public works projects to offer workers pay commensurate with local wages.

It also includes a provision that would require employers benefiting from the plan's investments "to follow strong labor standards and remain neutral when their employees seek to organize a union and bargain collectively."

"It's not just about getting people off the unemployment rolls, it's about getting people in good-paying jobs so they can raise their families," Labor Secretary Marty Walsh said in an interview with The Wall Street Journal on Friday.

Those provisions could benefit other sectors targeted in the proposal where union membership is slimmer, including among caregivers. Mr. Biden's plan would allocate $400 billion in funding for long-term care for the elderly and disabled.

Leslie Frane, executive vice president of Service Employees International Union, estimated the caregiving provision could create close to a million new jobs and improve the jobs of current home care workers, a total of 3.2 million jobs in 2020, according to the Labor Department. Those workers are the lowest paid among healthcare sector employees, with a median wage of $28,060 last year.

Low pay and lack of benefits are two reasons the rapidly growing sector faces a labor shortage, said Ms. Frane, who added the Biden plan would make it easier to unionize and subsequently attract new hires. The changes would especially benefit women and women of color, who make up the majority of home care workers, she added.

There are potential drawbacks to the labor provisions, detractors said. They will likely raise project costs, meaning the government can't build as much for a given dollar of spending, said University of Missouri professor Aaron Hedlund, who served as chief domestic economist for former Republican President Donald Trump's Council of Economic Advisers.

"If we don't build as much, that means we aren't going to get as much economic benefit out of it," Mr. Hedlund said.

Mr. Lotito said nonunion contractors may also be wary of bidding for projects that could open them up to a potential unionizing effort among their workers. "The big winners here are the union-building trades," he said.

The package also would include legislation that would make it easier for workers to unionize and toughen enforcement of the National Labor Relations Act. The bill, known as the Pro Act, passed the House on a near-party-line vote with nearly all Republicans voting against it and faces an uncertain future in the evenly divided Senate.

Many GOP lawmakers say the Pro Act would stifle business and empower union leaders. While most Democrats support it, some centrist Democrats, such as Sen. Joe Manchin of West Virginia and Sens. Kyrsten Sinema and Mark Kelly of Arizona, haven't signed on as co-sponsors.

The Biden package could also create some frictions in the labor market due to mismatches between the skills required for some of the new jobs and the skills of unemployed workers. The White House has proposed $100 billion in new training programs to help bridge the gap.

Ken Simonson, chief economist for the Associated General Contractors of America, said it was unlikely the package -- which could take most of the year to make its way through Congress -- would run up against an immediate worker shortage.

While construction employment hasn't fully recovered last year's losses, job growth in the sector has been much stronger than in most other industries, adding more than 100,000 jobs last month, and some construction firms report labor shortages. Training will be essential, Mr. Simonson said. For example, there are a limited number of tower crane operators who would be able to work on projects such as wind turbines.

It could take quite a while to find enough workers to do some of the jobs to be created by the package, Mr. Simonson said. "On the other hand, we think there will be a fairly long lead time to actually get these projects launched."

https://www.marketscreener.com/news/latest/Biden-s-Infrastructure-Package-Is-Designed-to-Boost-Unions--32882882/

Medicaid Expansion Under Reconsideration in Red States

 Some GOP-led states that previously declined to expand Medicaid are reconsidering that decision now that the $1.9 trillion pandemic-relief package has made billions of dollars available to enlarge the program.

The legislation passed by Congress last month boosts federal funding for two years to states that expand Medicaid, more than covering a state's cost for increasing eligibility for the program, which is currently used by almost 79 million low-income and disabled people.

The availability of more federal funds is putting pressure on Republican leaders in some of the 12 states that haven't expanded the program.

In Georgia, advocacy groups such as Cover Georgia recently ran ads urging Gov. Brian Kemp to fully expand Medicaid because the state would receive more than $1 billion in new federal funds over two years. The governor "has already rolled out significant reforms aimed at expanding access," according to a statement from Mr. Kemp's office.

Alabama Gov. Kay Ivey's office has signaled she is open to discussing the funding for expansion.

A bill expanding Medicaid recently advanced in Wyoming. Gov. Mark Gordon "is still considering the long-term implications of the bill, but he understands the opportunities before Wyoming, including the new federal funding," his spokesman said.

The interest is raising hopes in the Biden administration, which is looking to expand Medicaid following the Trump administration's initiatives to curtail the program's spending. But the push to reboot Medicaid could falter because the administration is also rescinding Trump-era policies, such as Medicaid work requirements, which GOP-led states have sought in exchange for expansion, according to conservatives.

Biden administration officials declined to comment.

"The Biden administration is being pretty shortsighted here," said Brian Blase, who developed health policy as a special assistant in the Trump administration. "Many conservative states are concerned about federal overreach."

The Biden administration told Arkansas and New Hampshire last month that it would be withdrawing federal approval for their work requirements, which generally mandate that beneficiaries log 20 or more hours on a job, look for work, perform community service or take educational classes to get their Medicaid benefits. Both states expanded Medicaid but added the requirements on some beneficiaries.

The rescinded agreements are a blow to other Republican-led states that want work requirements or more local control of Medicaid as part of any future expansion.

Some Tennessee lawmakers who have opposed expansion have said they are open to discussing it now because of the new funding.

But they want the Biden administration to preserve a Trump administration agreement that lets Tennessee convert the open-ended funding for the program to a block grant, which would essentially cap the federal funding.

Democrats say the change would harm beneficiaries, while Republicans argue it gives the state more autonomy over Medicaid spending.

Tennessee Lt. Gov. Randy McNally, who is also speaker of the Republican-controlled state Senate, "believes the proposal is one that should be studied. While the broad strokes have been released, the details still need to be fleshed out," according to a statement from his spokesman.

The spokesman added: "Before the state can make any decision about how to proceed, more information about what flexibility would be offered and how an expansion would interact with our block grant is needed."

A spokesman for Tennessee Gov. Bill Lee, also a Republican, didn't respond to an email seeking comment.

The Biden administration released information in a recent call with state leaders about the total federal funding for expansion that is now available.

Under the $1.9 trillion relief package, states that hadn't expanded when the bill passed would be eligible for a 5-percentage-point increase in their traditional federal funding match for Medicaid for two years. States can opt to expand at any time.

That amount is in addition to the 6.2-percentage-point increase in the match rate provided under previous Covid-19 pandemic legislation.

Texas stands to get more $3.9 billion under the funding boost over two years and could see more than two million uninsured people become eligible for coverage, according to the Centers for Medicare and Medicaid Services. Some state lawmakers who would have to approve any expansion have introduced bills to enlarge Medicaid, although the effort faces a tough road to passage, according to some Republicans.

Florida would reap more than $2.5 billion and expansion could provide healthcare to more than one million people, according to CMS.

"The governor remains opposed to the expansion of Medicaid in Florida," said Cody McCloud, a spokesman for Gov. Ron DeSantis.

Some Republican state leaders have also opted not to enlarge Medicaid because they oppose the Affordable Care Act, which set up Medicaid expansion. Others are concerned that federal expansion funding could eventually be reduced and leave states shouldering more costs.

Medicaid advocates are planning to push the remaining 12 states to expand Medicaid, saying it's essential for lowering the U.S. uninsured rate and improving healthcare.

"This is a change moment in history," said Joan Alker, executive director and co-founder of Georgetown University's Center for Children and Families, an advocacy group. "A lot of things are happening, and this is a very fast-moving environment. Having just lived through a pandemic, it's even harder now to argue against expansion."

https://www.marketscreener.com/news/latest/Medicaid-Expansion-Is-Under-Reconsideration-in-Red-States--32882953/

Amazon acknowledges issue of drivers urinating in bottles in apology

 

Amazon.com Inc has apologized to U.S. Representative Mark Pocan, admitting to scoring an "own goal" in its initial denial of his suggestion that its drivers were sometimes forced to urinate in bottles during their delivery rounds.

"We know that drivers can and do have trouble finding restrooms because of traffic or sometimes rural routes, and this has been especially the case during Covid when many public restrooms have been closed," the company said in a blog post.

Its admission came a week after the Democrat criticised Amazon's working conditions, saying in a tweet: "Paying workers $15/hr doesn't make you a 'progressive workplace' when you union-bust & make workers urinate in water bottles."

Amazon initially issued a denial, saying in a tweet: "You don't really believe the peeing in bottles thing, do you? If that were true, nobody would work for us." But it subsequently walked back those comments.

"This was an own goal, we're unhappy about it, and we owe an apology to Representative Pocan," Amazon said in its blog post, adding that its previous response only referred to staff at its warehouses or fulfillment centers.

The company said the issue was industry-wide and it would look for solutions, without specifying what these might be.

Amazon's apology comes at a time when workers at an Alabama warehouse are waiting for a vote count that could result in the online retailer's first unionized facility in the United States and mark a watershed moment for organized labor.

Amazon has long discouraged attempts among its more than 800,000 U.S. employees to organize. Allegations by many workers of a grueling or unsafe workplace have turned unionizing the company into a key goal for the U.S. labor movement.

https://www.marketscreener.com/quote/stock/THE-WAREHOUSE-GROUP-LIMIT-6491364/news/Amazon-acknowledges-issue-of-drivers-urinating-in-bottles-in-apology-to-Rep-Pocan-32882883/