Affordable Care Act, Drugs, FDA, HHS, Long term care, Medicaid, Medicare, The Lancet

US election 2020: the future of the Affordable Care Act

Volume 396, Number 10260     31 October 2020 

WORLD REPORT   President Donald Trump pledges to replace the Affordable Care Act while his Democratic opponent Joe Biden offers detailed proposals to improve it. Susan Jaffe reports from Washington, DC.

Since winning the presidency in 2016 in large part by promising to eliminate Obamacare, otherwise known as the Affordable Care Act (ACA), Donald Trump has promised more than a dozen times that his replacement plan would be ready soon. The plan would be released in 2 weeks, a White House spokeswoman said 2 months ago.

“We’re going to have a health-care plan that will be second to none”, Trump said in 2017. “It’s going to be great and the people will see that.” And at last week’s final presidential debate, he vowed “to terminate Obamacare, [and] come up with a brand new beautiful health care”.

A decade after the ACA—President Barack Obama’s signature achievement—became law, repealing and replacing Obamacare is again central to Trump’s re-election. And improving and expanding the law is a crucial part of the campaign of his challenger, former Vice President Joe Biden. [Continued here.]     

CDC, FDA, NIH, The Lancet

US election 2020: research and health institutions

Volume 396, Number 10259

24 October 2020

 

WORLD REPORT   How will the NIH, CDC, and FDA change if President Donald Trump wins a second term or if his Democratic challenger, Joe Biden, defeats him? Susan Jaffe reports from Washington, DC. 

Whoever wins the presidency needs to “restore the CDC and improve it by letting [scientists] know that they will have an opportunity to do the best science and make the best recommendations…” says James Curran, dean of the Rollins School of Public Health at Emory University in Atlanta. [Continued here.]

Affordable Care Act, CDC, Drugs, Global Health, The Lancet

US election 2020: public health

Volume 396, Number 10256

3 October 2020

 

WORLD REPORT   In the race for the White House, where do US President Donald Trump and his Democratic challenger, former Vice President Joe Biden, stand on public health? Susan Jaffe reports from Washington, DC. 

Analyzing the candidates’ plans to address the opioid epidemic, gun violence, women’s health, global health and COVID-19.

Unlike more conventional presidential candidates, Trump does not intend to issue formal policy proposals or position papers. With less than 5 weeks remaining before the election, his campaign says he will share “details about his plans through policy-focused speeches on the campaign trail”. …Joe Biden’s campaign has released a total of 51 policy proposals outlining how he will accomplish his goals if he wins in November. [Continued here.]

CDC, Drugs, HHS, The Lancet

Media reports reveal political interference at the US CDC

Volume 396, Number 10255

26 September 2020

 

WORLD REPORT  News accounts say that Trump administration officials wanted to edit and approve COVID-19 studies and publish guidance without the usual scientific review. Susan Jaffe reports.

After news stories about attempts by members of the Trump administration to manipulate COVID-19 reports published by the US Centers for Disease Control and Prevention (CDC) and over-rule its scientists, one top official is taking a sudden leave of absence for health reasons. Another’s government contract has abruptly ended. The 2-month absence of Michael Caputo, chief spokesman for the US Department of Health and Human Services (HHS), comes after he claimed that a CDC “resistance unit” seeks to undermine Trump. He and an adviser reportedly demanded the right to revise and approve COVID-19 studies published in the CDC’s highly respected Morbidity and Mortality Weekly Report journal.  [Continued here.]

Medicaid, Medicare

Pandemic Deals Another Blow To Nursing Homes: Plummeting Occupancy

BY SUSAN JAFFE  |  CONNECTICUT HEALTH INVESTIGATIVE TEAM   |  SEPTEMBER 16, 2020    
       

While the deadly coronavirus seems to be subsiding in Connecticut for now, its impact on nursing homes has not. More than 6,700 beds are empty, and it may take many months of financial struggle before occupancy climbs back to pre-pandemic levels.

Of the approximately 200 nursing homes in Connecticut that receive payments from Medicaid, the government health insurance program for  low-income people, only 15 were 

 70% or less occupied in January, according to the Connecticut Health Investigative Team’s analysis of state data. By August, almost five times as many facilities saw occupancy drop to that level or less….

Owners say the state and federal governments aren’t doing enough to shore up their industry and protect residents during the pandemic. And in some cases, policies intended to control the virus can make things worse.  [Continued here, with map and table of dangerously low occupancy nursing homes.]

Long term care, Medicare

CMS Warns of COVID-19 Spike in Nursing Homes

Medicare chief says “significant deficiencies in infection control practices” in nursing homes have doubled weekly COVID-19 cases, but “this isn’t a time of fines and being punitive.”

By Susan Jaffe  | Contributing Writer | MedPageToday  | August 20, 2020

The Centers for Medicare & Medicaid Services (CMS) wants nursing homes to ramp up efforts to control COVID-19 inside facilities after the number of residents infected with the highly contagious virus has reached a record high, and as new deaths have started rising once again.

In the early spring, the number of virus cases in nursing homes was about 11,000 a week, which dropped to 6,319 cases by the end of June, CMS Aministrator Seema Verma told facility operators last week in a conference call. But CMS strike force teams have found “significant deficiencies in infection control practices” that have pushed up weekly cases to about 12,000 by the end of July, she said. “And we’re seeing an uptick unfortunately in the losses.”

Residents in about half the nation’s nursing homes have been infected, Verma told MedPage Today in an exclusive interview on Tuesday. [Continued here.]

CMS, Medicare, Medicare costs

House Committee Approves Bill to Ease Medicare Part B Enrollment

Seniors would be notified about eligibility to avoid late fees, coverage gap

By Susan Jaffe  | Contributing Writer | MedPageToday  | July 15, 2020

A House committee unanimously approved legislation Wednesday that would make changes for the first time in 50 years to the complex rules for enrolling in Medicare’s Part B, which covers doctor visits and other outpatient care.

Currently, seniors who don’t get Part B when they first become eligible for Medicare pay permanent, recurring late enrollment penalties and can only sign up during the first 3 months of the year for coverage that begins July 1, unless they qualify for an exception. To make matters worse, they cannot buy other health insurance during their months-long wait. [Continued here.]

HHS, The Lancet

US Supreme Court upholds abortion rights, for now

Volume 396, Number 10244

11 July 2020

 

WORLD REPORT The court’s decision means that Louisiana’s three abortion clinics will remain open. Susan Jaffe reports.

The US Supreme Court delivered the Trump administration’s third defeat in as many weeks when it overturned a Louisiana law requiring physicians who provide abortions to have local hospital-admitting privileges.

In an opinion written by Justice Stephen Breyer, the court declared on June 29 that “enforcing the admitting privileges requirement would drastically reduce the number and geographic distribution of abortion providers, making it impossible for many women to obtain a safe, legal abortion in the State and imposing substantial obstacles on those who could”.  [Continued here.]

Affordable Care Act, HHS, The Lancet

LGBTQ discrimination in US health care under scrutiny

Volume 395    Number 10242     
27 June 2020                          
WORLD REPORT  A US Supreme Court ruling could undermine the Trump Administration’s plan to roll back some protections against sex discrimination. Susan Jaffe reports. 

The Trump administration suffered a major defeat last week a major defeat last week in the US Supreme Court, which could undermine its attempt to scrap protections under the Affordable Care Act (ACA) against sex discrimination. In a landmark decision on June 15, the court ruled that the Civil Rights Act protects gay and transgender workers from discrimination by their employers. But days later, Trump Administration officials at the Department of Health and Human Services (HHS) finalised a more permissive standard for discrimination in health care. [Continued here.]  

CMS, HHS, Long term care

Whether By Luck Or Safety Protocols, Some Nursing Homes Remain COVID-19 Free

BY SUSAN JAFFE  |  CONNECTICUT HEALTH INVESTIGATIVE TEAM   |  JUNE 15,2020           

The coronavirus has decimated many of the nation’s nursing homes, and elderly, chronically ill residents of these facilities account for 64% of the state’s 4,201 death toll. They are roughly 100 times more likely to die of the virus than other people in the state.

So, the fact that some 41 of Connecticut’s 214 nursing homes have managed to keep out the virus, according to an analysis by C-HIT, is both remarkable and mystifying. Did they just get lucky?

This article also ran on Connecticut Public Radio.

Administrators at several COVID-19-free facilities use the word “fortunate” to describe a situation they acknowledge could change at any time. [Continued here, with map and table of COVID-19 free nursing homes.]

CMS, Long term care, Medicare

Hundreds Died of COVID at NYC Nursing Homes With Spotless Infection Inspections

By Susan Jaffe   |    THE CITY    |    May 27, 2020     

More than 600 residents have died from COVID-19 at 25 New York City nursing homes that received clean bills of health for controlling the spread of infections, state Department of Health inspection reports obtained by THE CITY show.

Those facilities include homes with some of the highest coronavirus death tolls in the nation — including the Sapphire Center for Rehabilitation and Nursing in Flushing, which reports 54 residents died of confirmed or presumed COVID….

At the Franklin Center for Rehabilitation and Nursing, also in Flushing, 60 residents — nearly one in five — succumbed to the virus. Its May 4 inspection report found no problems.

Also passing its May 11 infection-control inspection was New York State Veterans Home in St. Albans, Queens. Staff there previously told THE CITY that the state Health Department-run home failed to separate COVID-positive and uninfected residents, something that was a violation at other facilities….

“It’s very shocking that at the apex of this pandemic, our inspectors went in and reported that that there’s nothing out of the ordinary when it’s clear that the infection rate had spread,” said Assemblymember Ron Kim (D-Queens), whose district includes Sapphire and the Franklin Center.   [continued here].

CMS, Long term care

As Congress Weighs COVID Liability Protections, States Shield Health Providers

By Susan Jaffe  | Kaiser Health News | May 14, 2020 | This story also ran on 

Coronavirus patients and their families who believe a doctor, nurse, hospital or other provider made serious mistakes during their care may face a new hurdle if they try to file medical malpractice lawsuits.

Under pressure from health provider organizations, governors in Connecticut, Maryland, Illinois and several other states have ordered that most providers be shielded from civil ― and, in some cases, criminal— lawsuits over medical treatment during the C OVID-19 health emergency. In New York and New Jersey, immunity is now part of state law….

Some legal experts and seniors’ advocates worry that the state immunity guarantees go too far, leaving patients with no way to hold providers accountable. Supporters argue that health care providers and facilities deserve protection from lawsuits as they battle a deadly virus during an unprecedented public health emergency.  [Continued at Kaiser Health News and Daily Beast. ]  

CMS, Federal agencies, Long term care

Nursing Home Watchdogs Scarce At NYC Facilities As Hundreds Die Within

CLOSED  DOORS    |    THE CITY    |    April 23, 2020     

By Susan Jaffe 

Eyes and ears usually trained on New York’s nursing homes and adult care facilities have been nearly locked out as the coronavirus has claimed the lives of more than 3,500 residents statewide.

Almost entirely out of the picture are nursing home inspectors,employed by the state Department of Health and

 coordinated by the federal government, who are responsible for ensuring that the facilities comply with federal health and safety requirements.

“Nursing facilities are essentially free of public scrutiny right now, at a time when scrutiny is more important than ever,” said Susan Dooha, executive director of the Center for Independence of the Disabled in New York [continued here].

Drugs, FDA, Global Health, The Lancet

Federal Regulators split on antimalarials for COVID-19

Volume 395    Number 10231     
11 April 2020                          
WORLD REPORT   US and French authorities have authorised the use of chloroquine and hydroxychloroquine, but the EU regulator and WHO say the science doesn’t support the decision. Susan Jaffe reports. 
With no “adequate, approved and available” alternative, the US Food and Drug Administration (FDA) is allowing the use of the antimalarial drugs hydroxychloroquine and chloroquine to treat coronavirus disease 2019 (COVID-19).

The FDA’s emergency use authorisation (EUA) issued last week gives physicians the option to prescribe the drugs, which President Donald Trump has recommended. However, both drugs are unproven and untested for COVID-19, and have rare but potentially deadly side-effects.  The decision bypassed the usual drug approval process including doubleblind, placebo-controlled clinical trials, stoking a worldwide debate about whether the drugs are appropriate for treating the disease.

“I think it was resorted to more out of a sense of desperation”, said Joseph Masci, an infectious disease specialist and director of global health at Elmhurst Hospital in Queens, a borough of New York City, which is at the centre of the epidemic in the USA. “It is just an indication of how sudden and massive this outbreak has been.” [Continued here.]  

Appeals, CMS, DOJ, Medicare, Observation care

Federal Judge Rules Medicare Patients Can Challenge ‘Observation Care’ Status

By Susan Jaffe  | Kaiser Health News | March 30, 2020| This story also appeared in  

Hundreds of thousands of Medicare beneficiaries who have been denied coverage for nursing home stays because their time in the hospital was changed from “inpatiKHN logo for widget.JPGent” to “observation care” can now appeal to Medicare for reimbursement, a federal judge in Hartford, Connecticut, ruled last week.

If the government does not challenge the decision and patients win their appeals, Medicare could pay them millions of dollars for staggeringly high nursing home bills….

“If I had gone home, I would have died,” said Ervin Kanefsky, 94, a plaintiff [in a class action lawsuit against Medicare] from suburban Philadelphia. He was admitted to the hospital as an inpatient after fracturing his shoulder in a fall. When he was about to leave after five days to recuperate at a nursing home, a hospital official told him his status had changed to observation. With one arm in a sling, stitches in the other and unable to hold onto his walker, he learned Medicare wouldn’t pay for the nursing home.  [Continued at Kaiser Health News or The Philadelphia Inquirer.]