IMPAQ Health News
From our experts to your inbox. Every two weeks.
In this edition, learn about health equity, new Medicaid studies and expansions, threats to the ACA, and the latest efforts to address the impacts of COVID-19. Don’t miss the new whitepaper from Ernst & Young featuring IMPAQ President Adaeze Enekwechi’s insights on the business case for health equity.  
A new Forbes article highlights an important study on COVID-19 disparities published by IMPAQ researcher Dr. Xi Cen and colleagues at the University of Rochester Medical Center. The study, titled Racial and Ethnic Disparities in COVID‐19 Infections and Deaths Across U.S. Nursing Homes, was published on September 21 in the Journal of the American Geriatrics Society.

Dr. Cen and her colleagues analyzed CMS data of 12,576 nursing homes across the country to determine the racial/ethnic breakdown of COVID-19 case counts and deaths among staff and residents. They found that nursing homes with a higher proportion of minority residents have higher rates of coronavirus infections and deaths. The study was also featured by CNN.
On September 28, the global COVID-19 death toll surpassed one million deaths and over 32 million reported cases. The US remains one of the hardest hit countries in the world and continues to see rising case numbers. Since late August, more than half of all states have reported increases in their seven-day average of new confirmed cases, with record highs seen in six Midwest states and Puerto Rico.

  • Private and public stakeholders are ramping up the supply of influenza vaccines due to an anticipated increase in demand. Experts agree flu vaccinations could reduce additional strain on health care systems during flu season amid the pandemic.

  • The DOJ announced legal action against fraudulent claims totaling more than $6 billion related to telehealth billing, substance abuse treatment facilities, and illegal opioid distribution.
Here are some resources for following health policy trends and the latest efforts to address COVID-19: 
  • IMPAQ researchers developed a dashboard to provide a comprehensive overview of COVID-19 clinical trial data. This dashboard is updated with new data and infographics every two weeks. 

Health Equity in 2020
Black, Latino, and Indigenous communities remain disproportionately impacted by COVID-19, yet are underrepresented in vaccine trials. Researchers seek to increase study diversity through increasing study sample sizes, running studies out of mobile clinics, and building trust with members of these communities. STAT (9/25)
Migrant farmworkers, mainly from Mexico and other Latin American nations, continue to work and travel throughout the pandemic. Conditions of this work make them especially susceptible to COVID-19 due to crowded living situations, lack of health insurance, and for many, the additional difficulties of their status as undocumented workers. There is evidence that the agriculture industry has attempted to hide positive cases and avoid protective measures, such as access to PPE or COVID-19 testing. Washington Post (9/24)
People of color are disproportionately uninsured in the United States and therefore incur higher costs of care. According to a NASHP report, states can address these inequitable structures by implementing a global hospital budget approach, which can protect revenue despite declines in care utilization or implementing cost-growth benchmarks to cap annual per capita health spending growth. NASHP (9/28)
Medicaid & Medicare Updates
Nearly two years after voters in Nebraska approved Medicaid expansion, low-income Nebraskans will now be able to enroll in Medicaid to access their benefits. Enrollment currently sits at 9,780 participants, but is expected to rise to 90,000 participants. Omaha World Herald (9/27)
Medicaid and CHIP saw a marked decrease in the vaccinations, primary care, and preventive service utilization among children enrolled in the programs between March and May 2020 as compared to last year. CMS notes that vaccination rates are now on the rise, but do not compensate for the drop earlier in the year. CMS (9/23)
CMS announced that Medicare Advantage premiums are set to fall in 2021 to an average of $21. This would be the lowest level since 2007. Additionally, across Medicare Advantage and Part D sponsors, 1,600 plans will implement a $35 monthly copay cap for insulin. HealthLeaders (9/25)
CMS recently finalized the Specialty Care Models to Improve Quality of Care and Reduce Expenditures rule. The rule implements a new payment model for End-Stage Renal Disease (ESRD) beneficiaries called the ESRD Treatment Choices (ETC) Model, which will last from January 1, 2021 through June 30, 2027. The new model seeks to improve uptake of home dialysis and transplants while reducing Medicare expenditures. CMS (9/18)

  • In 2019, IMPAQ was awarded the ETC Model Operations contract under the RMADA2 IDIQ, continuing our support of all three of CMMI’s kidney disease-related Alternative Payment Models (in addition to ETC, IMPAQ supports operations for the Comprehensive ESRD Care Model and the Kidney Care Choices Model).
ACA & Drug Pricing
The passing of Justice Ruth Bader Ginsburg in September has moved the upcoming SCOTUS case on the ACA, California v. Texas, into the spotlight. Set to take place in November, the Supreme Court could possibly adjudicate (1) the individual mandate is unconstitutional, but not overturn the law; (2) a deadlock and postpone judgment; or (3) the ACA is overturned. Experts believe the first two options are more likely than the third, but a decision will not be announced until 2021. The New York Times (9/21)

  • President Trump nominated Judge Amy Coney Barrett to fill the vacant Supreme Court seat. Judge Barret has previously written an opinion on the ACA individual mandate, where she indicated that it should have been considered a penalty rather than a tax, which would have made it unconstitutional because that action lies outside of Congress’ powers.
President Trump recently signed an executive order that outlines a commitment to protecting the health insurance of people with preexisting conditions, a provision enacted by the ACA. However, the order provides no substantive details on how the administration plans to achieve this benchmark. Questions have also arisen as to how preexisting conditions would be protected without additional policies in place if the ACA is repealed by SCOTUS. The Washington Post (9/24)
The FDA approved a final rule that would allow states to import drugs from Canada, excluding biologics. Opponents to the rule claim importation could make it easier for patients to access unsafe or counterfeit medications. The Canadian government has expressed concern that this importation rule could exacerbate shortages in the country. Six states across the US have begun the process of seeking federal approval for importation. KHN (9/25)
Controlling COVID-19:
Reopening, Testing, and Vaccines
A large study of 28,500 dialysis patients across 46 states estimates that only 9.3 percent of the US adult population would test positive for COVID-19 antibodies. Higher rates of antibodies were found in participants from predominantly Black, Latino, lower-income, or high-population density areas, which have been particularly impacted by the virus. Researchers are still learning how protective COVID-19 antibodies are and how long they can stay in the body. Current research suggests that reaching herd immunity for COVID-19 through community spread is unrealistic. CNN (9/25)
Vaccine developers responding to concerns about the safety of rushed vaccines and trials released documents detailing testing protocols. Scientists identified the three most influential factors of COVID-19 vaccine development to be safety and transparency, political processes and approvals, and the vaccine’s goals and efficacy. Nature (9/25)

As COVID-19 cases continue to trend upwards, experts have identified several factors that can increase the likelihood of another surge in the upcoming fall and winter months. These include holiday season travel and gatherings, reopening of high-risk indoor spaces like restaurants, bars, and schools, and social distancing fatigue. Immediate government action and stricter adherence to public health guidelines could help lessen the surge. States and countries that have followed public health advice—testing, contact tracing, isolating cases, quarantining close contact, and proper mask wearing—have all been able to successfully suppress virus transmission to manageable levels. Vox (9/28)
Millions of rapid COVID-19 antigen tests are set to be delivered across the world thanks to the WHO’s Access to COVID-19 Tools Accelerator. This includes 120 million tests earmarked for low- and middle-income countries. These tests can deliver results within 15-30 minutes and may be used for screenings in schools and workplaces. The Guardian (9/28)
Spotlight on IMPAQ
IMPAQ President Adaeze Enekwechi Addresses Health Equity through Business Lens
Dr. Enekwechi’s insights on health equity are featured in a new white paper from Ernst & Young, How Organizations can Unlock the Business Case for Health Equity. In the paper, which follows an Ernst & Young webcast on the same topic, Dr. Enekwechi emphasized that to comprehend the business case for health equity, employers must take a long-term perspective. The dual benefits of a healthier workforce—higher productivity and lower costs of health coverage—should be top of mind for proactive employers and providers alike.
At the September 22 Pittsburgh Business Group on Health symposium on health equity, Dr. Enekwechi led a panel discussion uniting both local and national business leaders to explore the employers’ case for advancing health equity. The Pittsburgh Business Times featured insights from Dr. Enekwechi’s session in the article, Why We're at an Inflection Point in Pittsburgh with Maternal Health, Racial Disparities.
Through inequitable policies and practices, Black Americans are forced into conditions that elevate their risk for COVID-19, and consequently, place Black children at the epicenter of loss in multiple domains of life. In a new brief co-authored by AIR Researcher Erin Bogan, learn about the impact of the pandemic on Black children at the school, family, and individual levels, including how the pandemic affects academic performance and engagement, family economics and health, and psychological well-being.
Graphic of the Week
Photo: "Associate Supreme Court Justice Ruth Bader Ginsburg Visits WFU" by Wake Forest School of Law
Upcoming Events, Trainings, & Webinars
Join NASHP for a discussion with Maine and Pennsylvania officials on incarceration-based opioid use disorder treatment programs that link individuals to treatment upon their release. Register.
Join Duke Science & Society and an esteemed panel of experts as they discuss the suitability of the EUA process for a COVID vaccine and the safety and efficacy that we can expect from vaccines authorized on an accelerated timeframe. Register.
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.