‘Medicaid for All’ is rapidly becoming a reality in New York

 In New York, it looks like the Democrats’ dream of “Medicare for All” is rapidly becoming a reality. Or at least “Medicaid for All.”

Since COVID struck, enrollment in the government-funded health-insurance program has shot up by 1.5 million people, as The Post reported this week. And the numbers were soaring even before that: By January 2020, 6.1 million of the state’s 19.8 million residents were enrolled; now, health officials estimate 7.6 million people will be getting benefits by March. That’s nearly 40 percent of the state’s population.

Add in other state health programs, from Child Health Plus to the Essential Plan, and it comes to 8.4 million New Yorkers, or 42 percent of the population, getting aid, the Empire Center reports.

And this is supposed to be a backstop program for just the poorest New Yorkers.

Gotham enrolls an even higher share of its residents in Medicaid: more than 4 million people, or nearly half of the city’s 8.8 million people.

New York has long been a national leader, both in terms of the number of enrollees and how much it spends on them — around $75 billion last year, including federal, state and local funds. And as the Empire Center also notes, more New Yorkers above the poverty line qualify for Medicaid than those under it. Even as New York’s poverty rate declined, its Medicaid rolls grew by 1.4 million from 2010 to 2019.

Clearly, the state needs to better screen applicants. But it also needs to rethink how this program “for the poor” works. Because soon, the state won’t be able to afford anything else but this.

https://nypost.com/2021/12/27/medicaid-for-all-is-rapidly-becoming-a-reality-in-new-york/

Punishing Conservative States: Payment Cuts to Hospitals Where Federal Spending is Already Low

 

Key Takeaways

• Through Medicaid’s disproportionate share hospital (DSH) program, states are supposed to use federal funds to make payments to hospitals that provide uncompensated care to a high percentage of uninsured and low-income patients.
• The DSH program fails to equitably target public resources to safety net hospitals, ultimately failing low-income individuals and the uninsured.
• In 1992, Congress locked in a formula for calculating DSH funding to states which has—for three decades—rewarded states that had used gimmicky financing schemes to maximize DSH payments, thereby disadvantaging states that had not employed such schemes.
• States that expanded Medicaid under the Affordable Care Act have been much more likely to benefit from DSH’s perverse funding structure. In 2021, Medicaid expansion states received 171 percent more federal DSH funding per uninsured person and 66 percent more federal DSH funding per low-income individual. Federal DSH funds cover 48 percent of the uncompensated care provided by hospitals in Medicaid expansion states compared to just 17 percent in non-expansion states.
• Irrationally, the Build Back Better Act would cut federal DSH funds only to non-Medicaid expansion states. These are typically states with already low DSH payments that also collectively saved the federal government hundreds of billions of dollars from 2014 to 2021 by not expanding Medicaid.
• Medicaid financing reform is necessary to equitably distribute federal aid to where it is most needed and to incentivize states to focus on providing value instead of maximizing the federal funds they can receive. Reforming DSH, as well as other Medicaid supplemental payment programs, to better target federal funds to safety net hospitals would be a good place to begin.

Full Report:

https://paragoninstitute.org/wp-content/uploads/2021/12/Punishing-Conservative-States.pdf

https://paragoninstitute.org/report-punishing-conservative-states/

Time to Revive the Principles of Operation Warp Speed

 Experienced leaders, whether in combat, on the gridiron, or in business, may not be able to fully anticipate every possible outcome, but they learn and adapt without hesitation.

It’s a lesson lost on the Biden administration. Instead, the White House continues to implement a March 2020 approach to diminishing the COVID pandemic by focusing singularly on vaccines, recommending the use of masks even when outdoors, and, recently, banning flights from countries where the omicron variant had escaped weeks before.

Rather than anticipating and adapting to changing conditions, the White House is “leading from behind.” The two latest examples are the huge imbalance between supply and demand for rapid tests and the failure to invest in the manufacturing of promising oral therapeutics such as Pfizer’s Paxlovid prior to it receiving an emergency-use authorization from the FDA. What’s worse is that the White House call for testing appeared to be a function of  politics over science as it panicked at the prospect of damage to its approval ratings from omicron. Nevertheless, the Biden team was caught flatfooted when pharmacy shelves were empty and lines for testing in major American cities stretched around the block.

Team Biden reportedly rejected offers months ago to ramp up production of rapid tests, focusing instead on mandating vaccines. It then suggested that Americans buy the tests at the pharmacy and submit claims for reimbursement through their health insurers. Rube Goldberg would be proud. The president announced last week that the government would provide 500 million at-home tests for free starting in January, and that people could order through a new government website. However, omicron will likely have peaked before the end of January, and besides, several experts have suggested we would need at least 1 billion tests per month to fulfill the purpose of properly screening the population.   

President Biden casually dismissed a question about not anticipating the latest COVID mutation: “Nobody saw it coming. Nobody in the whole world. Who saw it coming?" And he said later: “What happened was the omicron virus spread even more rapidly than anybody thought.” Dr. Anthony Fauci said on Sunday, “We’ve obviously got to do better. I mean, I think things will improve greatly as we get into January, but that doesn’t help us today and tomorrow.” Nice candor , but no foresight and no leadership.

The Biden administration needs to adopt the spirit and principles of Operation Warp Speed. This Trump-led effort anticipated what would be needed months in advance, starting by expanding America’s industrial capacity to produce vaccines, then by procuring the equipment and raw materials necessary to manufacture them long in advance of FDA authorization. It placed advanced orders not only for the vaccines but also for temperature-controlled storage containers, vials that could withstand minus 80-degree Celsius temperatures, a billion syringes and needles, and then developed distribution plans to get millions of doses of the vaccine to over 50,000 destinations across the country as soon as it was approved using an advanced information technology system to track every dose.

The principles guiding Operation Warp Speed were simple but compelling: Never let the federal government perform tasks the private sector can perform better; engage and utilize experts from the private sector to complement talented career government officials; distribute accountability and decision rights as close to where the action is as possible; assume financial risks the private sector is unwilling to take; and, if one does not get it right the first time, learn and adapt quickly. On this last point, the first three to four weeks of vaccine administration in December 2020 and early January 2021 admittedly did not go as we had planned. We did not fully anticipate that 30% of health care workers would refuse the vaccine. That is why HHS Secretary Alex Azar and CDC Director Dr. Robert Redfield, on Jan. 12, 2021, opened up vaccinations to a much broader swath of Americans at many more vaccination sites than originally recommended. Eight days later, we were vaccinating over 1.6 million Americans per day — a pace scarcely maintained by the Biden team.

If the Biden administration is ever going to lead rather than follow, it will need to alter its federal government-centered authoritarian impulses, assume financial risks the private sector will not, de-centralize the management of the COVID response from the West Wing to the experts who know what’s happening on the ground, and become comfortable with admitting when it is wrong and adapt quickly. To wit, it needs to follow in the footsteps of Operation Warp Speed, the most successful public-private partnership since World War II.

Paul Mango was the deputy chief of staff for policy at the U.S. Department of Health and Human Services from 2019-2021, serving as Secretary Alex Azar’s formal liaison to Operation Warp Speed. His forthcoming book is “Warp Speed: Inside the Operation That Beat COVID, the Critics, and the Odds” (Republic Book Publishers, March 15, 2022).

https://www.realclearpolitics.com/articles/2021/12/29/its_time_to_revive_the_principles_of_operation_warp_speed_146956.html

USDA criticized over new, uniform 'bioengineered' label for foods

 As the U.S. Department of Agriculture (USDA) changes its labeling rules for genetically modified foods in the new year, critics say the new move adds work for consumers and creates large loopholes for suppliers.  

Starting on Saturday, foods containing “genetically engineered” (GE) ingredients or “genetically modified organisms” (GMOs) will now simply be marked as “bioengineered,” according to The Washington Post.  

A phone number or QR code on the packaging may also direct consumers to more information, a decision some argue discriminates against people without access to a cell phone or smartphone, the Post added. 

The USDA has said the change "avoids a patchwork of state labeling regulations" to provide a national standard for the labels that were once set on a state-by-state basis. But critics say the term could create confusion among consumers.

“The worst part of this law is the use of the term ‘bioengineered’ because that’s not a term most consumers are familiar with,” Gregory Jaffe, director of Center for Science in the Public Interest's biotechnology project, told the Post.

The Center for Food Safety has also criticized the rules, saying it will leave the majority of genetically modified foods unlabeled, the Post added.

Specifically, the USDA sets an exemption threshold at 5 percent of "unintended" genetically engineered ingredients. In the European Union, the standard is markedly lower at 0.9 percent. 

“Consumers are left not knowing if it’s not present or if a food company just chose not to disclose,” Peter Lurie, president of Center for Science in the Public Interest, told the Post.

The Hill has reached out to USDA for comment. 

https://thehill.com/policy/healthcare/food-safety/587883-usda-criticized-over-new-uniform-bioengineered-label-for-foods

Massive sewage spill closes beaches around LA

 Beaches were closed in the Los Angeles area this weekend following a historic spill of up to 7 million gallons of untreated sewage.

A 48-inch sewer main line failed on Thursday, sending millions of gallons into the Dominguez Channel, which flows into the Los Angeles harbor, the city of Long Beach said in a Friday press release.

After the spill, Los Angeles County ordered the closure of multiple beaches, ABC 7 reported. The city of Long Beach temporarily closed seven miles of its beaches and Orange County closed off Seal Beach.

Sewage even made its way into city streets after the spill.

Reporter Jessica De Nova wrote on Twitter that one neighborhood was "filled w/awful odors & this river of raw sewage running through their street Thursday," adding that residents "hope their government leaders do more to improve quality of life here."

Los Angeles County Supervisor Janice Hahn called for an investigation into the pipelines and sewer infrastructure to determine whether it was faulty.

"A spill of this magnitude is dangerous and unacceptable, and we need to understand what happened," said in a statement.

https://thehill.com/policy/energy-environment/587884-massive-sewage-spill-closes-beaches-around-los-angeles

Biden goal of 500M free tests will require major production scale-up, months

 Meeting President Joe Biden’s goal of offering 500 million free at-home Covid-19 tests for Americans will require a massive scale-up in test manufacturing that may take months to achieve — falling short of demand as the omicron variant drives a surge in infections.

The U.S. had a supply of around 200 million at-home rapid tests in December. Test-makers have indicated they will be able to increase that to just over 500 million a month by March with added capacity from current manufacturers and the recent clearance of two new tests from Roche and Siemens, according to estimates from Mara Aspinall, a health professor at Arizona State University who tracks the testing market.

Not all of those tests will go to the federal government’s free testing effort. A White House official said the 500 million free at-home tests will come from additional supply the administration is anticipating will be added.

But even with new tests being approved and manufacturers racing to expand capacity, the number of new tests available is expected to grow just modestly in January while Roche and Siemens begin packaging and shipping their products, ramping up more significantly in February. That means it could take several months for the federal government to meet its goal, according to production targets from the manufacturers and Aspinall’s estimates.

"I am much more confident than I was a week ago that we can meet the need," Aspinall said. "The challenge is how quickly we can get those tests shipped out and how quickly we can meet that 500 million goal."

Administration officials haven’t said when they expect to have all 500 million tests available for the public, beyond saying the first batch of tests will start going out sometime in January. Officials with the Defense Department and Department of Health and Human Services are aiming to finalize contracts with test manufacturing companies late next week and are working on an “accelerated contracting timeline,” White House Covid response coordinator Jeffrey Zients said Wednesday. Officials are also still working on the website where people will be able to request a test and a system for distributing them, he said.

It also remains unclear how the tests will be distributed, which agency will be tasked with that process and how many tests each person will be able to get.

“There are a lot of unanswered questions,” Aspinall said. “It’s the combination of understanding the supplying pathways, then on top of that figuring out what the supply chain looks like, what the distribution looks like and how the whole process comes together.”

Biden has made testing a priority for this administration in recent months, committing to spend $3 billion in the fall on at-home tests to spur companies to scale up production as the government distributes millions of at-home tests to food banks and health clinics. Administration officials have urged Americans to get tested before holiday gatherings as an added layer of protection and enforced testing programs in schools to keep children in the classroom.

Even before Biden announced his plan for the federal government to buy 500 million tests, representatives for test manufacturers had been pushing to ramp up production further, hiring more workers, adding shifts and tapping subcontractors to help, with production going from 80 million tests in November to just over 200 million in December.

Abbott, maker of BinaxNow, said it plans to increase capacity to 70 million tests per month from 50 million, and Quidel is increasing its production of the QuickVue test to the same amount. Access Bio said it was targeting 25 million tests for December and planned to produce an additional 40 million in the coming months. Ellume said it will start making 15 million more tests a month after production launches at its new facility in Frederick, Maryland, in January.

The Food and Drug Administration also gave clearance in the last week to new tests from Roche and Siemens, with each company saying the plan is to have “tens of millions” of the new tests available each month, without offering a specific timeline for how many tests would be delivered when.

Having the federal government ready to purchase such a large amount of tests could give the test-makers an incentive to ramp up production even further than planned, though demand from consumers and local governments for the tests has already outstripped the available supply, Aspinall said.

While the federal push is helping bolster the market for manufacturers, it has also raised questions about what effect it could have on the wider availability of tests. Arkansas Gov. Asa Hutchinson told Biden earlier this week on a call that he was worried his state won’t have enough of the rapid tests for its test-to-stay program for schools, where students exposed to an infected classmate are able to remain in class if they test negative.

The Association of State and Territorial Health Officials raised a similar concern to Biden administration officials, questioning whether the federal government's massive purchasing of tests might cut into their ability to access tests for their own programs. Michael Fraser, the group's CEO, said administration officials assured him that the federal government's efforts won't hinder states' plans.

Also competing for tests will be employers and their workers, if Biden’s vaccine mandate survives legal challenges. Under that rule, unvaccinated employees would have to show proof of a negative Covid test every week.

Hutchinson warned Biden that the administration should not "let federal solutions stand in the way of state solutions."

"The production of 500 million rapid tests that will be distributed by the federal government is great," the Arkansas Republican said, "but obviously that dries up the supply chain for the solutions that we might offer as governors.”

https://www.nbcnews.com/politics/white-house/biden-s-goal-500-million-free-tests-will-require-major-n1286768

Taiwan rejects US CDC guidance on 5-day quarantine

 The Central Epidemic Command Center (CECC) on Thursday (Dec. 30) announced that it will not follow U.S. Centers for Disease Control and Prevention (CDC) guidance on shortened quarantines because some imported Omicron cases have been found to be infectious up to 12 days after testing positive.

On Monday (Dec. 27), the U.S. CDC shortened the recommended period that asymptomatic people should undergo quarantine after testing positive from 10 days to five, as long as they wear a mask for another five. It also shortened the isolation period for vaccinated people who have been exposed to the virus to five days.

During a press conference on Dec. 30, Philip Lo (羅一鈞), deputy head of the CECC’s medical response division, announced that a total of 59 imported Omicron cases have been detected in Taiwan. Of these cases, 55 were breakthrough infections, three had received one dose of a vaccine, and one had not been vaccinated.

More than 80% of these cases were detected upon arrival in Taiwan, while the rest tested positive within six days after entering the country.

CECC head Chen Shih-chung (陳時中) said that at present, it appears the incubation period of the Omicron variant is relatively short. Therefore, he stressed that the first seven days after entry are a very important line of defense.

He warned that if a cluster infection appears in a quarantine center or epidemic prevention hotel and is not detected in time, it could quickly spread into the community. If community transmission occurred, it would be a daunting task to contain, and the risk to society would increase substantially, Chen said.

A study by the New England Journal of Medicine released on Dec. 23 found vaccine recipients infected with COVID "may clear the infection more quickly than unvaccinated persons." When asked to comment on this study, Lo explained that the research had been carried out on subjects infected with the Alpha and Delta variants and that vaccine efficacy with the Omicron strain remains to be seen.

Regarding the U.S. CDC's recommendation to shorten quarantines from 10 to five days, Lo said 23 imported Omicron cases have been tracked for more than five days. He pointed out that of these cases, 17 had a Ct level of 30 or higher, meeting the standard to be released from quarantine.

Lo added that these cases did not reach this Ct level until at least eight days after they had fallen ill or tested positive. He said the longest it has taken for an Omicron case to reach the standard for release is 12 days after diagnosis.

Lo stated that after discussions with a panel of experts from the Ministry of Health and Welfare’s Advisory Committee for Immunization Practices (ACIP), the conclusion was that if quarantine stays were shortened to five days, there may still be a risk of infection and impact on community safety. Therefore, the experts advised that Taiwan not follow the U.S. guidance but continue to maintain the current quarantine regulations.

He explained that the current standard for releasing a COVID case from isolation is either 10 days after the onset of symptoms or a positive test followed by two consecutive tests resulting in a Ct value equal to or greater than 30.

https://www.taiwannews.com.tw/en/news/4393548