IMPAQ Health News
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This edition of IMPAQ Health News highlights stories on the racial and ethnic disparities of the pandemic, job and health insurance loss, and shifts in hospital operations due to COVID-19. Be sure to read original COVID-19 analysis from IMPAQ health policy experts, including new blogs examining whether our ACA net safety will hold amidst record unemployment and how COVID may affect new HHS interoperability rules .
The first in a new IMPAQ blog series focused on the intersection of COVID-19 and pressing policy issues, this post analyzes COVID-19’s impact on job loss and corresponding loss of employer-based health insurance, the health insurance options created by the ACA to protect Americans without employer-based coverage, and how those options vary greatly by state. The post also provides the latest guidance from US officials and consumer advocates.

IMPAQ and Maher & Maher health and workforce development experts Kevin Van Dyke, Talia Fish, Emily Baranski, and Beth Brinly author this inaugural series post.
Government Response
As data reveals that the COVID-19 infection rate is flattening in states across the country, some state governors are eager to lift restrictions despite warnings from public health experts. The White House advises that the country will not quickly return to normal as social distancing mandates will likely remain for months. In response to testing shortages hindering the safe reopening of states, the White House created a blueprint for states to increase testing capacity with the federal government providing coordination support. To further address the pandemic, Congress passed their fourth measure, a $484 billion relief package with funding for small businesses, hospitals, and expanded testing. Additionally, the CDC is ramping up contact tracing efforts by expanding the public health workforce to contain the virus.
Here are some resources for following the latest coronavirus news:
  • Johns Hopkins developed a frequently updated worldwide map of confirmed COVID-19 cases and deaths.

  • Kaiser Family Foundation developed a dashboard of the United States to track confirmed COVID-19 cases and deaths by race/ethnicity.

  • STAT News created a guide for coronavirus treatment and vaccine progress. Early results of Remdesivir, an antiviral medication, show promise of improving recovery time in patients.
Over the past two weeks, CMS has released a number of press releases detailing actions they are taking to address the COVID-19 outbreak. The most significant CMS updates include:
COVID-19 Amplifies Racial & Ethnic Health Inequities
Since the CDC originally released the data on April 17, race is still unspecified in over 50 percent of cases . The United States is unable to report national mortality rates by race/ethnicity because many overwhelmed testing centers are not relaying these details to health departments and reporting inconstancies exist across localities. Politico (4/20)
The tribe is struggling to implement contact tracing among a population living in a large geographic area and where many do not have telephones. Additionally, many households do not have clean, running water to properly wash their hands. NPR (4/24)
It is widely known that the African American community is being hard-hit by the coronavirus. However, some fear that a historical distrust of the medical system, originating with the Tuskegee study, may make African Americans hesitant to get the coronavirus vaccine when one becomes available. A 2019 study found that African Americans were 40 percent less likely than white Americans to get a flu shot, which could be explained by mistrust and ineffective outreach to this community. USA Today (4/20)
Though Latinos are only 16 percent of the population in Rhode Island, they account for 44 percent of positive COVID-19 cases. In response, the state is now ramping up outreach to the Spanish-speaking community. WPIR (4/26)
Job & Health Insurance Loss Create Payment Challenges for COVID-19 Treatment
In the United States, health coverage is commonly tied to employment, which is problematic during a pandemic when unemployment is on the rise. Forecasts estimate that between 12 to 35 million people will lose job-based health insurance during the pandemic. Free clinics are already overwhelmed and project that next month will be worse as people’s health benefits end. The Washington Post (4/18)

  • A new Commonwealth Fund survey reports that 32 percent of people are facing job insecurity during the pandemic. Of these people, 3 percent already lost their health insurance and 20 percent did not have health insurance before the crisis.
The CARES Act includes Pandemic Unemployment Compensation of $600 to supplement traditional unemployment insurance. These payments count as income for individual market subsidies, but are not included when determining eligibility for Medicaid and CHIP. Though CMS has created guidance to provide flexibility, these payments create complications for state implementation. NASHP (4/20)
Hospitals Adjust to Treat COVID-19
In areas where COVID-19 peaks are believed to have passed, hospitals are mobilizing to resume profitable elective surgeries to counteract coronavirus treatment losses. CMS and other organizations have released guidance for hospitals to re-open, with all including a recommendation to wait until coronavirus infection rates decline for at least 14 days. Modern Healthcare (4/20)
As coronavirus patients fill hospitals, people with heart attack and stroke symptoms are nowhere to be found. Doctors worry that unaddressed health issues will add to the damage of the pandemic. The Washington Post (4/19)

  • In a similar article, The New York Times covers the additional victims of coronavirus—those not receiving proper medical care as our medical system is overwhelmed.
As the virus spreads across the United States, doctors learned that it is attacking the kidneys in addition to the lungs. Roughly one third of the most critically ill patients are developing acute kidney injury and require intensive care unit (ICU) dialysis machines. To care for patients in crowded hospitals, New York City doctors are being forced to rotate coronavirus patients on the ICU machines that are intended to be used for continuous, 24-hour treatment. NPR (4/19)
Beyond the Headlines
Both US agencies caution against the use of hydroxychloroquine and chloroquine for COVID-19 treatment outside a hospital or clinical trial setting due to the high risk for patients. Large studies are underway to determine if there is evidence that these antimalarial medications help coronavirus patients, though early results show signs of no effect and a few trials have been halted due to patient safety concerns. Business Insider (4/24)
Isolation, uncertainty, and economic despair are adding up, and the current US mental health system may be unable to meet the rising demand for services. Some hotlines have experienced a 50 percent surge since the beginning of the pandemic, with increased activity from those who are low income or lost their jobs. The Guardian (4/24)

A New York City survey revealed that 20 percent of residents carried COVID-19 antibodies, leading to the belief that the virus may be less deadly than expected. However, antibody tests are often inaccurate and it is unclear if those who carry antibodies are immune. The New York Times (4/26)
Spotlight on IMPAQ
IMPAQ health policy experts Leah Dillard, Surakshya Karki, Craig Schneider, and Kevin Van Dyke explore new rules aimed at increasing patient access to health data on their smartphones. Learn how COVID-19 is impacting the implementation of the rules—while also proving the importance of telehealth.
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.

  • Factory workers volunteered to live in a factory for 28 days to make raw PPE materials. The Washington Post (4/23)

Additional Eye-Catching Headlines
The court decided that the federal government is obligated to pay health insurers for funds owed through a temporary, and now expired, ACA risk-corridor program. Through this program, insurers paid into a government fund that was intended to be redistributed to insurers with significant losses during the early years of the ACA to stabilize premiums. However, the federal government did not return that money in full to insurers. Modern Healthcare (4/27)
Amid climbing unemployment due to the pandemic, Oklahoma is set to expand Medicaid on July 1 with complications regarding how to finance the state’s share of the expansion. The state recently submitted to CMS a Healthy Adult Opportunity waiver application to delay the expansion and implement work requirements and premiums on the newly eligible recipients. The Oklahoman (4/27)
Some health systems are recognizing that stable employment and health insurance supports health outcomes. In response, they are hiring local residents, many of whom have criminal records. Their hiring initiatives show promise with successful job performance and retention when hospitals also incorporate wraparound support services. Modern Healthcare (4/18)
In March, the Trump Administration suspended a law that prevented patients from obtaining medication-assisted treatment (MAT) to support their sobriety through telehealth. This change will expand access to treatment for patients living in areas with shortages of physicians who are eligible to prescribe MAT, which is estimated to be 40 percent of US counties. Kaiser Health News (4/23)
Graphic of the Week
Though we are physically isolating from others, there are still ways to stay connected during the pandemic. The Coalition to End Social Isolation & Loneliness provides some tips. Click the image below to view full details.
Upcoming Events, Trainings, Tools, & Webinars
The National Institute for Health Care Management (NIHCM) Foundation is bringing together experts to provide insights on the science of well-being and how we can strengthen our own happiness during this time of physical distancing and uncertainty. Register here .
The University of Southern California’s Center for Health Journalism is hosting Kaiser Health News data editor Liz Lucas to discuss data sources that can inform the overall trend of the pandemic, the infrastructure needs to overcome it, and the people most vulnerable. Register here .
The Agency for Healthcare Research and Quality (AHRQ) is hosting a webinar to share resources for using evidence to combat the opioid crisis; evidence syntheses on what works to manage pain and Opioid Use Disorder (OUD); and tools to integrate the latest guidelines at the point of care. Additional webinars are being held weekly throughout the month of May. Learn more about event and register here .
Prior to COVID-19, it was estimated that 1 in 9 Americans were food insecure and lacked consistent access to enough food and nutritious options, including 11 million children. This webinar will bring together experts to provide insights on the longstanding issues surrounding food insecurity in the United States and how these issues have been exacerbated by the COVID-19 pandemic. Register here .
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.