IMPAQ Health News
From our experts to your inbox. Every two weeks.
This edition of IMPAQ Health News highlights stories on testing and contact tracing efforts, the racial and ethnic disparities of COVID-19, possible effects on Medicaid providers and beneficiaries, and the toll the pandemic has taken on Americans’ mental health. 
The Kaiser Family Foundation recently found that 45 percent of adults in the United States report worsened mental health due to pandemic-related stress. In the latest IMPAQ Blog post, IMPAQ Health experts examine the mental health crisis that existed before COVID-19, the latest efforts to reach patients during the pandemic, and what still needs to be done by the government and providers to achieve mental health care parity.
Government Response
All 50 states have begun to ease social distancing restrictions, but there is wide variation in the states’ reopening plans , testing data , and contact tracing efforts . As COVID-19 cases top 1.5 million confirmed US infections and surpass 100,000 deaths , concerns are rising over surges in new cases in reopened regions. Surges have been linked to gatherings and “superspreader” events , such as those that occurred over Memorial Day weekend . These surges could throw off COVID-19 models that had largely reached consensus, and present a dire threat to vulnerable communities such as nursing homes . Meanwhile, the race to produce a vaccine continues: the United Nations identified several top contenders , a Moderna trial shows promising results (albeit with incomplete data ), and the CDC is planning an antibody study in 25 metropolitan areas. To further mitigate the economic impact of COVID-19, Congress would like to pass another rescue package , but the parties disagree on the package’s provisions and dollar amount, as evidenced by the rejection of House Democrats’ most recent $3 trillion COVID-19 bill . For an overview of the coverage proposals recently released in Congress, read here .
Here are some resources for following the latest COVID-19 news:
  • George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity created a tool that estimates the number of contact tracers needed in each US state.

  • Opportunity Insights created a tracker of the economic impacts of COVID-19 policies on local and national communities.

  • The New York Times is tracking how states are reopening as many roll back stay-at-home orders and open select businesses.

  • STAT News created a guide that tracks COVID-19 treatment and vaccine progress.

  • Johns Hopkins developed a frequently updated worldwide map of confirmed COVID-19 cases and deaths.
COVID-19 & the Mental Health Crisis
Fewer than 50 percent of Americans with mental illness reported receiving treatment in the last year. Now social distancing orders, job loss, and limited access to virtual care options all threaten access to health insurance and mental health care for those who had mental illness before the pandemic. Stress associated with the pandemic will likely create new patients in search of treatment from a limited pool of providers. Associated Press (5/18)
Data from the Census Bureau released last week finds that 34 percent of all Americans now experience symptoms of clinical anxiety, depression, or both, highlighting the toll that the COVID-19 pandemic has had on Americans’ mental health. Anxiety and depression rates were highest among young adults, the poor, and women. Washington Post (5/26) 
A Kaiser Family Foundation poll conducted May 13–18 shows that 48 percent of respondents skipped or postponed medical care in the previous three months. Of those who postponed or skipped care, 11 percent reported that their condition worsened as a result. Almost half (40 percent) of Americans also reported negative mental health as a result of the virus. Kaiser Health News (5/27)
COVID-19 Stresses Medicaid System
Medicaid providers were left out of the $100 billion allocated by Congress in March 2020 to assist health care providers. State Medicaid directors warn that without immediate funding, many providers that serve Medicaid patients, and even providers who largely serve privately insured patients, could close permanently. As the economy falls and more individuals qualify for Medicaid coverage, this will further stress the nation’s health care infrastructure if there is no intervention. Kaiser Health News (5/18)
Many states expect Medicaid budget shortfalls in both 2020 and 2021 as a result of increased projected enrollment stemming from millions of lost jobs. By January 2021, an estimated 17 million people could be newly eligible for Medicaid and six million people could be eligible for subsidies in the ACA marketplaces. Multiple groups call for a higher federal match rate in anticipation of the upcoming fiscal year, which begins July 1 in most states.   Healthcare Dive (5/18)
Democrats aim to boost support for Medicaid expansion on ballots this year in the 14 states that have not expanded the program, including Oklahoma and Missouri. State GOP lawmakers say states cannot afford the Medicaid expansion due to pandemic-induced tax revenue shortfalls, though more than seven million Americans are projected to lose their health insurance by the end of June. Wall Street Journal (5/11)

  • A Kaiser Family Foundation analysis examines the potential loss of employer-sponsored insurance among individuals and estimates their eligibility for ACA coverage as they lose state and federal unemployment insurance benefits. (5/13)
COVID-19 Amplifies Racial & Ethnic Health Inequities Across the Country
While some states have developed guidelines to foster equal distribution of COVID-19 treatment, criteria often favors healthier patients, which can perpetuate existing discriminatory treatment practices. The state of Oregon offers an example of successful health care prioritization. Health Affairs (5/14)
The NYC neighborhood with the most COVID-19 fatalities contains the largest percentage of elderly people in the city, a majority black residential population (nearly 63 percent of the community), and the largest federally subsidized housing development in the United States. This newly released data echoes reports from other parts of NYC, which show that impoverished areas have fatality rates of more than twice that of wealthier areas, reinforcing the relation between poverty, race, and death. Associated Press (5/18)
COVID-19 Testing and Contact Tracing
The CDC posted new guidance on the use and production of antibody tests, and stated the tests are not accurate enough to guide policy decisions. The guidance outlines the connection between a relatively low expected prevalence of COVID-19 across the whole country and a greater likelihood of false positive results. CNN (5/26)
A smartphone app built by a team of scientists had people check off their symptoms between March 24 and April 21. The team’s model allowed them to predict with 80 percent accuracy whether an app user would test positive for COVID-19 based on their age, sex and any combination of four common symptoms, most notably loss of taste and smell. New York Times (5/11)

  • An Associated Press article outlines the difficulties state governments are experiencing while rolling out smartphone apps for infection tracking, including technical glitches, accuracy issues, privacy concerns, and lack of community interest. (5/19)
State health departments are hiring thousands of contact tracers to control the rate of transmission as states reopen. This often-used public health strategy is viewed as less invasive than tracing methods used in other countries and doesn’t have to be perfect to be effective. ProPublica (5/19)
Beyond the Headlines
In response to COVID-19 and lobbying from employer groups, the IRS gave companies the option to opt into a rare divergence from strict enrollment rules so their employees can change their health insurance or flexible spending accounts outside their usual enrollment periods. These changes will likely benefit workers who are furloughed, workers who did not buy health insurance earlier in the year, or employees who otherwise feel unsafe returning to work. New York Times (5/12)
As families avoid doctors’ offices amid the pandemic, states like Michigan reported a drop in child vaccination rates. This may increase the likelihood of a vaccine-preventable outbreak if vaccine coverage falls below 90 percent of the population. Reuters (5/18)
Spotlight on IMPAQ
American Institutes for Research Issues Brief on Telehealth during the Pandemic
How is "telehealth" different than "telemedicine," and why does it matter? Our colleagues at AIR recently published an issue brief which answers this question and explores how COVID-19 is pushing policymakers to make changes for these services.
IMPAQ Provides Expertise for AHA Changing Workforce Task Force
In the fall of 2019, the  American Hospital Association  (AHA) launched the Changing Workforce Task Force. The Task Force provides input to the AHA Board to develop strategic thought leadership on the future of the health care workforce. The Task Force is charged with exploring health care workforce challenges, identifying future trends, recommending policy and advocacy changes as well as key operational considerations, and helping raise awareness of workforce issues among the health care field. IMPAQ provides subject matter expertise to support the bold solutions the Task Force is working to develop.  View an infographic  released by AHA on the Task Force and   listen to the podcast .
Feel-Good News Stories
Below are a few feel-good stories to remind us that no matter what, people always find a way to help one another, even in times of crisis.
  • Two nurses used their stimulus checks to fund a concert-turned-dance party outside New Orleans East Hospital for frontline workers. Nine members of the New Orleans Jazz Orchestra provided upbeat music for the occasion. Associated Press (5/19)

  • A photographer particularly at-risk for COVID-19 held a photo shoot in his home while social distancing and had plenty to capture. Washington Post (5/20)
Additional Eye-Catching Headlines
The National Association of ACOs (NAACOS) asked the Center for Medicare & Medicaid Innovation (CMMI) for information on the highly anticipated Direct Contracting Model, which did not open up its application period as expected in March. NAACOS is also inquiring about the Next Generation ACO Model, which is scheduled to end this year after four performance years without any information from CMMI on next steps. Modern Healthcare (5/20)
Nearly four million homes in the US are overcrowded, one million do not have complete kitchens, and 470,000 have inadequate plumbing -- all factors in disease prevention and general physical and mental health. These housing issues are especially prominent in rural America, where we are now seeing surges in COVID-19 cases. Kaiser Health News (5/12)
Deaths from cocaine and methamphetamine both more than doubled between 2015 and 2018, and opioid deaths from 2008-2018 increasingly involved stimulants. This second hidden drug crisis could contend with and/or exacerbate the opioid crisis if unchecked. NIHCM (5/20)
Graphic of the Week
May is Mental Health Awareness Month—a reminder that you are not alone. For more information, email , call the NAMI HelpLine at 1-800-950-NAMI, or in a crisis, text “NAMI” to 741741.
Upcoming Events, Trainings, Tools, & Webinars
Join the Robert Wood Johnson Foundation as they discuss the policies, programs and budgets being implemented across the globe that place the wellbeing of people and the planet at the center of all decisions. Register here .
This webinar will discuss how public health plays a role in advancing long-term policies regarding health equity. Register here .
Community-Campus Partnerships for Health (CCPH) and the UNC Center for Health Equity Research at the University of North Carolina at Chapel Hill have partnered highlight the disparate impact of COVID-19 in the nation’s most vulnerable communities. Each session will be recorded and transcribed and linked on this webpage. Subscribe to the CCPH mailing list here to be notified of upcoming sessions.
NOTE: The information, analyses, and opinions expressed in the articles, publications, or comments contained therein are those of the authors and should not be considered verified or endorsed by IMPAQ or any of our partners or clients.