Month: April 2022

When the end of the COVID-19 pandemic comes, it could create major disruptions for a cumbersome U.S. health care system made more generous, flexible and up-to-date technologically through a raft of temporary emergency measures.

Winding down those policies could begin as early as the summer. That could force an estimated 15 million Medicaid recipients to find new sources of coverage, require congressional action to preserve broad telehealth access for Medicare enrollees, and scramble special COVID-19 rules and payment policies for hospitals, doctors and insurers. There are also questions about how emergency use approvals for COVID-19 treatments will be handled.

The array of issues is tied to the coronavirus public health emergency first declared more than two years ago and periodically renewed since then. It’s set to end April 16 and the expectation is that the Biden administration will extend it through mid-July.

Some would like a longer off-ramp.

Transitions don’t bode well for the complex U.S. health care system, with its mix of private and government insurance and its labyrinth of policies and procedures. Health care chaos, if it breaks out, could create midterm election headaches for Democrats and Republicans alike.

“The flexibilities granted through the public health emergency have helped people stay covered and get access to care, so moving forward the key question is how to build on what has been a success and not lose ground,” said Juliette Cubanski, a Medicare expert with the nonpartisan Kaiser Family Foundation, who has been researching potential consequences of winding down the pandemic emergency.

Medicaid churn

Medicaid, the state-federal health insurance program for low-income people, is covering about 79 million people, a record partly due to the pandemic.

But the nonpartisan Urban Institute think tank estimates that about 15 million people could lose Medicaid when the public health emergency ends, at a rate of at least 1 million per month.

Congress increased federal Medicaid payments to states because of COVID-19, but it also required states to keep people on the rolls during the health emergency. In normal times states routinely disenroll Medicaid recipients whose incomes rise beyond certain levels, or for other life changes affecting eligibility. That process will switch on again when the emergency ends, and some states are eager to move forward.

Virtually all of those losing Medicaid are expected to be eligible for some other source of coverage, either through employers, the Affordable Care Act or — for kids — the Children’s Health Insurance Program.

But that’s not going to happen automatically, said Matthew Buettgens, lead researcher on the Urban Institute study. Cost and lack of awareness about options could get in the way.

People dropped from Medicaid may not realize they can pick up taxpayer-subsidized ACA coverage. Medicaid is usually free, so people offered workplace insurance could find the premiums too high.

“This is an unprecedented situation,” said Buettgens. “The uncertainty is real.”

The federal Centers for Medicare and Medicaid Services, or CMS, is advising states to take it slow and connect Medicaid recipients who are disenrolled with other potential coverage. The agency will keep an eye on states’ accuracy in making eligibility decisions. Biden officials want coverage shifts, not losses.

“We are focused on making sure we hold on to the gains in coverage we have made under the Biden-Harris administration,” said CMS Administrator Chiquita Brooks-LaSure. “We are at the strongest point in our history and we are going make sure that we hold on to the coverage gains.”

ACA coverage — or “Obamacare” — is an option for many who would lose Medicaid. But it will be less affordable if congressional Democrats fail to extend generous financial assistance called for in President Joe Biden’s social legislation. Democrats stalling the bill would face blame.

Republicans in mostly Southern states that have refused to expand Medicaid are also vulnerable. In those states, it can be very difficult for low-income adults to get coverage and more people could wind up uninsured.

State Medicaid officials don’t want to be the scapegoats. “Medicaid has done its job,” said Matt Salo, head of the National Association of Medicaid Directors. “We have looked out for physical, mental and behavioral health needs. As we come out of this emergency, we are supposed to right-size the program.”

Telehealth static

Millions of Americans discovered telehealth in 2020 when coronavirus shutdowns led to the suspension of routine medical consultations. In-person visits are again the norm, but telehealth has shown its usefulness and gained broader acceptance.

The end of the public health emergency would jeopardize telehealth access for millions enrolled in traditional Medicare. Restrictions predating COVID-19 limit telehealth mainly to rural residents, in part to mitigate health care fraud. Congress has given itself 151 days after the end of the public health emergency to come up with new rules.

“If there are no changes to the law after that, most Medicare beneficiaries will lose access to coverage for telehealth,” the Kaiser Foundation’s Cubanski said.

A major exception applies to enrollees in private Medicare Advantage plans, which generally do cover telehealth. However, nearly 6 in 10 Medicare enrollees are in the traditional fee-for-service program.

Tests, vaccines, treatments, payments & procedures

Widespread access to COVID-19 vaccines, tests and treatments rests on legal authority connected to the public health emergency.

One example is the Biden administration’s requirement for insurers to cover up to eight free at-home COVID-19 tests per month.

An area that’s particularly murky is what happens to tests, treatments and vaccines covered under emergency use authorization from the Food and Drug Administration.

Some experts say emergency use approvals last only through the duration of the public health emergency. Others say it’s not as simple as that, because a different federal emergency statute also applies to vaccines, tests and treatments. There’s no clear direction yet from health officials.

The FDA has granted full approval to Pfizer-BioNTech’s COVID-19 vaccine for those 16 and older and Moderna’s for those 18 and older, so their continued use would not be affected.

But hospitals could take a financial hit. Currently Medicare pays them 20% more for the care of COVID-19 patients. That’s only for the duration of the emergency.

And Medicare enrollees would have more hoops to jump through to be approved for rehab in a nursing home. A suspended Medicare rule requiring a prior three-day hospital stay would come back into effect.

Health and Human Services Secretary Xavier Becerra recently told The Associated Press that his department is committed to giving “ample notice” when it ends the public health emergency.

“We want to make sure we’re not putting in a detrimental position Americans who still need our help,” Becerra said. “The one that people are really worried about is Medicaid.”
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The oldest active park ranger in the United States is hanging up her hat at the age of 100.

Betty Reid Soskin retired Thursday after more than 15 years at the Rosie the Riveter/WWII Home Front National Historical Park in Richmond, California, the National Park Service announced.

Soskin “spent her last day providing an interpretive program to the public and visiting with coworkers,” a Park Service statement said.

She led tours at the park and museum honoring the women who worked in factories during wartime and shared her own experience as a Black woman during the conflict.

She worked for the U.S. Air Force in 1942 but quit after learning that “she was employed only because her superiors believed she was white,” according to a Park Service biography.

“Being a primary source in the sharing of that history – my history – and giving shape to a new national park has been exciting and fulfilling,” Soskin said in the Park Service statement. “It has proven to bring meaning to my final years.”

Soskin won a temporary Park Service position at the age of 84 and became a permanent Park Service employee in 2011. She celebrated her 100th birthday last September.

“Betty has made a profound impact on the National Park Service and the way we carry out our mission,” Director Chuck Sams said. “Her efforts remind us that we must seek out and give space for all perspectives so that we can tell a more full and inclusive history of our nation.”

Soskin was born Betty Charbonnet in Detroit in 1921 but recalled surviving the devastating Great Mississippi Flood of 1927 while living with her Creole family in New Orleans, according to the Park Service biography.

Her family then moved to Oakland, California, and Soskin remained in the San Francisco Bay Area, where in 1945 she and her first husband founded one of the first Black-owned record stores in the area, the biography said.

She also was a civil rights activist and took part in meetings to develop a general management plan for the Home Front park. She has received several honors.

She was named California Woman of the Year in 1995.

In 2015, Soskin received a presidential coin from President Barack Obama after she lit the National Christmas tree at the White House.

In June 2016, she was awakened in her home by a robber who punched her repeatedly in the face, dragged her out of her bedroom and beat her before making off with the coin and other items. Soskin, then 94, recovered and returned to work just weeks after the attack. The coin was replaced.

Soskin also was honored with entry into the Congressional Record. Glamour Magazine named her woman of the year in 2018.
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Former White House aide Jared Kushner, the son-in-law of former U.S. President Donald Trump, answered questions Thursday from the House panel investigating last year’s assault on the Capitol. 

Kushner, the highest-ranking Trump adviser and the first family member to testify so far, appeared in private by video link voluntarily and was not subpoenaed. 

The House of Representatives committee is piecing together a detailed account of the events of the January 6 insurrection itself, but also of efforts to overturn the 2020 presidential election and the misinformation campaign falsely claiming widespread fraud that led to the violence.  

Kushner was returning from Saudi Arabia on the day of January 6 and did not spend the night at the White House upon his return to the United States.  

Committee member Elaine Luria told MSNBC after Kushner’s appearance that he “was able to voluntarily provide information to us, to verify and substantiate his own take” on the election. 

“It was really valuable to have the opportunity to speak to him,” she said. 

Texts from justice’s wife

Kushner’s testimony caps an intense period of almost daily revelations from the investigation. 

It was revealed last week that conservative political activist Ginni Thomas, wife of Supreme Court Justice Clarence Thomas, sent more than two dozen texts pushing wild conspiracy theories and urging then-White House chief of staff Mark Meadows to help overturn the 2020 election. 

Kushner’s name appeared in a message from Thomas dated November 13, 2020, when she told Meadows, “Just forwarded to yr gmail an email I sent Jared this am … improved coordination now will help the cavalry come and Fraud exposed and America saved.” 

It also emerged that White House logs given to investigators from the day of the insurrection show a gap of nearly eight hours in Trump’s records of calls, including the period covering the violence. 

The committee is investigating whether it has the full record and if Trump communicated that day through phones of aides or personal disposable “burner” phones. 

The select committee has also asked for testimony from Kushner’s wife, Ivanka Trump, who was in the White House on January 6 and pleaded with her father to speak out against the violence, according to reports.  

No executive privilege

The White House said on Tuesday it would reject any assertion of executive privilege, which allows presidents to keep certain work-related conversations with aides private — from Kushner or Ivanka Trump.   

The committee is approaching the end of its investigative phase and is planning public hearings this spring.   

The parallel but separate Department of Justice probe “has expanded to examine the preparations for the rally that preceded the riot,” including those who “assisted in planning, funding and executing” the event, The Washington Post reported.
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Laura Purdy is a U.S. doctor on Ukraine’s front lines. In her case, that’s a computer screen in Tennessee.

“Patients that I have talked to from some of the larger cities in Ukraine are fearful of leaving their homes because of air raid sirens or offshore attacks,” said Purdy, a surgeon who, until 2016, served in the U.S. Army’s units that provide health care to civilians worldwide. “They need/want to speak to a physician but are fearful to venture out to do so.”

Purdy now cares for patients in Kyiv and other cities under Russian attack through Starlink, an internet constellation of some 2,000 satellites operated by billionaire Elon Musk’s private firm SpaceX.

Russia invaded Ukraine on February 24, and as of March 30, 1,189 Ukrainians had been killed and 1,901 injured, according to the U.N. Human Rights Office.

U.S. doctors are stepping up to provide much-needed advice via telehealth, a practice honed during the pandemic, to the Ukranian soldiers, civilians and refugees injured in the fighting or attempting to manage chronic diseases amid the chaos.

Purdy is just one of the many physicians who have joined Aimee, a 10-year-old telehealth platform headquartered in Silicon Valley. Having built the telehealth systems for the International Space Station and SpaceX, Aimee is staffed by self-described “nerds who want to make a difference” and are now partnering with Ukraine’s Ministry of Health to provide Ukrainians with free telemedicine visits.

By using the Aimee app, Purdy said, patients can get advice and treatment recommendations from a U.S. physician while they remain in a safe location.

Milton Chen, founder and CEO of VSee, the telehealth company that launched Aimee, said a “couple thousand” physicians and a “couple hundred” translators have joined the platform to provide 24/7 telecare in Ukraine. The doctors provide care for battlefield trauma injuries as well as basics such as prenatal care, chronic disease management and mental health services.

“You could do a remote ultrasound; you could connect to a digital stethoscope to listen to someone’s heart and lung sound. All these medical signals will stream live to the physicians — so other than physically touching the patient — and the physician could get quite a bit of information on the patient,” he said via video.

Through telemedicine, Purdy treated a legally blind man who relies on his family for all his daily needs. Purdy helped him set up a free consultation with an ophthalmologist to interpret tests he underwent in Ukraine.

“This occurred in a city that was actively under attack, and we were able to provide advice and support to the patient while allowing him to stay safely sheltered in place,” she told VOA Mandarin.

The lack of medicine is one of the biggest hurdles for patients in Ukraine, said Purdy, who earned her medical degree at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

“The pharmacies have run out of medication, or they are closed. So, many times we find patients who we can give medical recommendations to, but they may not have access to the pharmaceuticals that they need to treat the condition they are experiencing,” she said.

And while remote doctors can’t solve challenges such as the lack of insulin for patients with diabetes, they can provide much-needed assistance. Dr. Mohamed Aburawi, founder and CEO of Speetar, a telehealth platform founded in 2017 to operate in Libya, told Forbes that “every day a conflict lasts, the situation worsens, and telehealth provides care, relief and stability to communities and people that need it most. Our own experience in protracted conflict highlights how telehealth maintains continuity of care for refugees, migrants and internally displaced populations.”

Telemedicine can also include teaching patients how to stop bleeding from wounds and injuries, a challenge for citizens in war zones, said Patricia Turner, executive director of the American College of Surgeons, which since 2015 has trained people without medical backgrounds through the Stop the Bleed initiative launched by the White House.

“When you bleed … you can actually die in as quickly as five minutes, so stopping the bleeding helps … save a life,” she told VOA Mandarin.

Two doctors who have family ties to Ukraine and work at Brigham and Women’s Hospital in Boston, Massachusetts, turned to telemedicine and developed a training video for Ukrainians.

Dr. Nelya Melnitchouk, a Ukraine native, came up with the idea for the video, and Dr. Eric Goralnick, who is of Ukrainian descent, helped organize the collaboration between the hospital and the Stop the Bleed initiative, according to The Boston Globe.

The training course can be finished in a few hours, Turner said, and can help health care workers and the public learn how to effectively stop bleeding.

“More than 100 people are being trained every other day,” she said. “We’re doing it via video so you can watch them on YouTube. We’re also doing them live remotely so that we can answer questions.”
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China on Thursday said it would impose visa restrictions on U.S. officials in retaliation for the U.S. restriction of visas for Chinese officials.

Earlier this month, U.S. Secretary of State Antony Blinken announced the restriction on Chinese officials who he said had been involved in “repressive acts” against ethnic and religious minorities.

Wang Wenbin, a spokesman for the Chinese Foreign Ministry, did not say who the U.S. officials were, but said they had lied about China’s human rights record.

“The United States uses the pretext of so-called human rights issues to concoct malicious lies and uses them as excuses to interfere in China’s internal affairs, smear China’s image and suppress Chinese officials,” said Wang. “These actions have no moral bottom line and seriously violate international law and the basic norms of international relations. China firmly opposes this.

“In order to safeguard China’s sovereignty, security and development interests, and to protect the legitimate rights and interests of Chinese officials … China has decided to impose reciprocal visa restrictions on U.S. officials who concocted lies on human rights issues involving China, advocated sanctions on China and harmed China’s interests.”

Earlier this month, Wang demanded the U.S. lift its restrictions on Chinese officials or face “countermeasures.”

The U.S. and other Western countries have accused Beijing of conducting genocide against the Muslim Uyghur minority in China’s western Xinjang province. Beijing has denied the accusation.

Blinken last week accused China of attempting to “harass, intimidate, surveil and abduct members of ethnic and religious minority groups, including those who seek safety abroad, and U.S. citizens who speak out on behalf of these vulnerable populations.”

Some information for this report came from Reuters.
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Blue Origin, the space tourism venture launched by entrepreneur Jeff Bezos, completed its fourth flight with a crew on Thursday, landing successfully in rural west Texas after taking a half dozen passengers for a 10-minute suborbital joyride.

The New Shepard spacecraft blasted off at 8:59 a.m. CDT (1359 GMT), and the crew capsule separated from the six-story-tall rocket a short time later as it soared to an altitude of 66 miles (106 km).

The crew members experienced a few minutes of weightlessness at the very apex of their brief ride before the capsule fell back to Earth to the desert floor under a canopy of three parachutes, landing safely outside the west Texas town of Van Horn.

“What an amazing mission from Launch Site One. Congrats to all of Team Blue on executing and supporting today’s flight,” Blue Origin said on Twitter.

The flight came two days after it was initially scheduled, with poor weather conditions forcing the mission to be postponed on Tuesday.

Unlike Blue Origin’s first three crewed flights, which featured passenger rosters including “Star Trek” actor William Shatner, morning TV host Michael Strahan and Bezos himself, nobody on Thursday’s flight was particularly famous.

“Saturday Night Live” comic Pete Davidson had been confirmed as a non-paying promotional guest on the latest flight. But he dropped out earlier this month when the planned launch was postponed from its original March 23 date to allow time for additional pre-flight tests.

Days later the company announced that Davidson, 28, the boyfriend of reality TV star Kim Kardashian, had been replaced on the latest “crew” manifest by veteran Blue Origin designer Gary Lai, architect of the New Shepard reusable launch system.

Lai flew for free. He joined five previously announced paying customers – angel investor Marty Allen, real estate veteran Marc Hagle and his wife Sharon Hagle, entrepreneur and University of North Carolina professor Jim Kitchen and George Nield, founder and president of Commercial Space Technologies.

Bezos, the billionaire founder of online retail giant Amazon AMZN.O, was part of Blue Origin’s inaugural crewed flight to the edge of space last July. He accompanied his brother, Mark Bezos, trailblazing octogenarian female aviator Wally Funk and an 18-year-old Dutch high school graduate.
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