California Will Begin Setting Aside 10% Of COVID-19 Vaccine Doses For Teachers

California to reserve 10% of vaccine first doses for teachers | The  Sacramento Bee

Source: NPR, by Rob Stein

California is planning to start setting aside 10% of the COVID-19 vaccine the state receives each week to vaccinate teachers, day care workers and other school employees in the hopes of getting more students back in the classroom.

“It must be done, and it must be done much sooner than the current path we are on. And we believe this will advance that cause,” Gov. Gavin Newsom said Friday as he announced the plan at an Oakland vaccination site.

The plan will begin March 1 by setting aside about 75,000 vaccine doses from the state’s current weekly allotment, Newsom said.

The vaccine will be used to inoculate “the ecosystem that is required to reopen our schools for in-person instruction,” including teachers, day care workers and other public school employees, such as bus drivers and cafeteria workers, Newsom said.

Most of the state’s large school districts have been teaching students remotely for most of the school year.

But 35 of California’s counties are already prioritizing vaccinating teachers and other educators.

“We want to operationalize that as a standard for all 58 counties in the state,” Newsom said

The announcement came a day after Newsom said a plan by Democrats in the state legislature aimed at opening schools by April 15 was not aggressive enough.

“While the Legislature’s proposal represents a step in the right direction, it doesn’t go far enough or fast enough,” Newsom said in a statement. “I look forward to building on the growing momentum to get our schools open and continuing discussions with the legislature to get our kids back in school as safely and quickly as possible.”

The issue of vaccinating teachers has become one of the most contentious issues as the nation grapples with the pandemic.

The Centers for Disease Control and Prevention’s new guidelines for how schools can safely offer in-person learning recommends vaccinating school staff, but does not require it. That has drawn criticism from powerful teachers’ unions.

A representative of the California Teachers Association described the 10% allotment as “an important step to ensuring teachers and school staff have access to the vaccine before opening schools and worksites for in-person instruction,” according to the Los Angeles Times.

Newsom has come under fire for how he has handled the pandemic, especially for imposing strict lockdowns.

Newsom says the state can begin setting aside vaccine doses because the Biden administration has begun providing more reliable projections for how much vaccine the state receives each week.

California has been hit particularly hard by the pandemic. But the move comes as the number of people getting infected by the coronavirus has finally started falling in the state, along with the number of people hospitalized with COVID-19 and dying from the disease.

Federal Watchdog Raises Concerns About Increasing Telehealth Fraud During Pandemic

Federal watchdog raises concerns about increasing telehealth fraud during  pandemic - Medill News Service

Source: Medill News Service, by Alicia Diaz

A federal government watchdog is sounding the alarm that Americans’ growing enthusiasm for telehealth services during the coronavirus pandemic has led to a worrying parallel: a “dramatic increase” in telehealth related fraud.

The health department’s independent inspector general criticized policymakers for failing to put regulatory safeguards in place when they expanded access to telehealth in the Medicare program. Michael Cohen, the OIG’s director of operations, said the changes created an “open season” for vulnerabilities.

They “should have taken a couple of years to think about before it got rolled out, not roll it out, and then try to walk it back,” Cohen said. “This was probably not the best way to implement telemedicine.”

Cohen said his office had seen a clear, measurable escalation of scams where providers might exploit the idea of a telehealth visit to get information out of patients that they could use to bill Medicare for unnecessary medical equipment or services, or telehealth companies paying providers to prescribe services without ever interacting with the patients themselves. He said the office was still studying whether other types of telehealth related fraud had increased during the pandemic, like legitimate companies overbilling or providing less effective care.

“There’s so many things that need to be protected [against fraud], not only the finances, but also potential patient harm,” he added.

Before the pandemic, most Medicare beneficiaries did not have access to virtual medical appointments or other telehealth services. Instead, patients needed to be at a provider’s office to receive reimbursement for telehealth or live in a designated rural area.

But in March, the Trump administration significantly expanded coverage to include a wider range of telehealth services like psychotherapy and nursing home discharge visits. During this temporary expansion, Medicare beneficiaries can pay for virtual visits at the same rate as an in-person visit. Some telehealth providers are also reducing or waiving copays.

The Trump administration also relaxed HIPAA requirements, allowing providers to use communication platforms like Facetime, Skype, and Zoom to conduct visits with their patients in good faith.

The moves led to a huge increase in telehealth visits. But the OIG worries it also opened the door for criminals to freely initiate contact with patients.

Right now, the federal government estimates that there were $4.5 billion worth of telehealth-related fraud losses in fiscal year 2020, the largest of any category and a record for Medicare fraud. More than 80 percent of the DOJ’s fraud recoveries in 2020 were health care related, the largest number of government-initiated cases against health entities ever reported.

Several of those major cases were telehealth related. In one case in Florida, the CEO of two telehealth companies pled guilty to soliciting bribes in exchange for encouraging telehealth providers to order unnecessary medical equipment. In another, a physician allegedly paid his friends to sign telehealth orders for medically unnecessary genetic testing and medical equipment.

The OIG is planning an investigation into the specific issues surrounding the relaxation of regulatory requirements during the pandemic; the reports on this will likely be made public over the next year, Cohen said.

The Center for Medicare Services is also assessing the regulations to determine whether to make permanent changes to telehealth services under Medicare after the pandemic, a spokesperson told STAT.

Still, some experts said that the benefits of expanded telehealth coverage outweigh the potential for abuse and fraud, especially when treating high-risk patients.

“Even those that are saying that there’s this great increase [in fraud], we have not heard the DOJ or the OIG say that they lack the tools or the resources or the capability under current rules and laws to effectively do their jobs,” said Kyle Zebley, director of public policy at the American Telehealth Association, which is lobbying Congress to make the policy shifts permanent.

Tina Hershey, assistant professor in the department of health policy and management at the University of Pittsburgh, said that going forward, providers should educate patients and beneficiaries about potential fraudulent schemes. “We just need to be vigilant,” Hershey said. “That vigilance will allow the expanded accessibility.”

While Politically Divided, Americans United in Fear of Affording Retirement

While Politically Divided, Americans United in Fear of Affording Retirement  - 401K Specialist

Source: 401k Specialist, by Brian Anderson

Everyone knows how politically divided the country is these days, but Americans can agree on some things: The pandemic has increased concerns about financial security in retirement, and they want Social Security to be around for the long haul to help.

A new report from the National Institute on Retirement Security shows the vast majority of Democrats (70%), Independents (70%) and Republicans (62%) agree that the nation faces a retirement crisis, exacerbated by the COVID-19 pandemic. There also is bipartisan agreement that the average worker cannot save enough on their own to guarantee a secure retirement.

The national survey of working-age Americans found 51% of Americans say the pandemic has increased concerns about achieving financial security in retirement. And the COVID-19 concern is high across party lines: 57% among Democrats; 50% for Independents; and at 44% for Republicans.

The survey, “Retirement Insecurity 2021 | Americans’ Views of Retirement,” was conducted by Greenwald Research to measure sentiment on a broad range of retirement issues. The full report is available here, and it will also be the subject of a webinar scheduled for Thursday, Feb. 25, at 2 p.m. ET to review the findings.

“Today’s COVID-19 job losses, furloughs and pay cuts will further damage Americans’ ability to have a secure retirement. This new research shows the deep economic impacts of the pandemic have only increased Americans’ retirement anxiety,” said Dan Doonan, NIRS executive director and report co-author.

“We also found that retirement anxiety transcends political affiliation. Across party lines, Americans are frustrated with policymakers and that they can’t save enough on their own to be self-sufficient in retirement,” Doonan said. “As such, enacting retirement policy solutions would be a win-win for policymakers and the country, delivering financial relief for working families on an issue that concerns Americans on both sides of the aisle.”

The research indicates Americans see several factors contributing to their struggle to prepare for retirement. The escalating cost of healthcare (59%) and long-term care top the list (56%). Other factors include longer life spans (53%), stagnant salaries (51%), fewer pensions (51%), debt (47%) and “do-it-yourself” retirement plans (45%).

Nearly 70% surveyed said most workers do not have the financial skills to manage money in retirement, which helps explain why 65% said they see pensions as better than 401k plans for providing retirement security. About three-fourths said that “all workers should have access to a pension plan so they can be independent and self-reliant in retirement.”

Expand Social Security?

In terms of retirement policy, the research indicates that Americans are highly supportive of Social Security(79%), and that it should remain a priority of the nation no matter the state of budget deficits. Nearly half (49%) surveyed were in strong agreement.

Most surveyed (60%) support the idea of increasing the amount that workers and employers contribute to Social Security to ensure it will be around for future generations. And half support expanding Social Security, with 25% saying it should be expanded for all Americans and 25% saying it should be expanded except for wealthier households.

The Washington, D.C.-based National Institute on Retirement Security is a non-profit, non-partisan organization established to contribute to informed policymaking by fostering a deep understanding of the value of retirement security to employees, employers and the economy as a whole. NIRS membership includes financial services firms, employee benefit plans, trade associations, and other retirement service providers.

GOP Working to Block Biden’s Health Care Pick; Dems Unfazed

GOP working to block Biden's health care pick; Dems unfazed

Source: Associated Press, by Ricardo Alonso-Zaldivar

President Joe Biden’s pick for health secretary, Xavier Becerra, told senators Tuesday that tackling the coronavirus pandemic will be his first priority if confirmed, but he also pledged to work to expand health insurance coverage, curb prescription drug costs and reduce racial and ethnic disparities in medical care.

“The COVID pandemic has killed 500,000 Americans,” Becerra told the Senate health committee. “To meet this moment, we need strong federal leadership.” A former congressman from the Los Angeles area, he currently serves as California’s attorney general.

Becerra cited Biden’s goals of 100 million vaccine shots in his first 100 days, increasing access to testing, ramped up DNA mapping of the virus to track worrisome mutations and reopening schools and businesses.

On health insurance, he pledged to work to expand the Obama-era Affordable Care Act, although in the past he’s supported a government-run health care system.

The Californian faces two days of contentious hearings. Republicans are portraying Becerra as unfit, but Democrats are unfazed, accusing the GOP of playing politics despite the coronavirus pandemic.

Becerra will be grilled by two panels. Following the health committee, he’ll be questioned Wednesday by the Finance Committee, which will vote on sending his nomination to the Senate floor. If confirmed, he’d be the first Latino to head the Department of Health and Human Services, a $1.4 trillion agency with a broad portfolio that includes health insurance programs, drug safety and approvals, advanced medical research and the welfare of children.

Ranking Republican Sen. Richard Burr of North Carolina on Tuesday left no doubt Becerra faces a tough road to win GOP support.

“I’m not sold yet,” Burr said, looking at the nominee. “I’m not sure that you have the necessary experience or skill to do this job at this moment.” In his opening statement, Burr questioned whether Becerra respects the role private companies, and particularly pharmaceutical firms, play in delivering innovation that benefits patients.

Becerra, 63, represented Hispanic neighborhoods of Los Angeles in the U.S. House for more than 20 years before becoming his state’s chief law enforcement officer, succeeding Vice President Kamala Harris after she won election to the Senate. His politics are liberal but his style is low-key and oriented toward problem solving. As a congressman he played a behind-the-scenes role steering President Barack Obama’s health care law through Democratic divisions in the House.

Republican opposition has grown louder ahead of his nomination hearings. On Monday, Sens. John Kennedy of Louisiana and Tom Cotton of Arkansas released a letter in which they asked Biden to withdraw the nomination, calling Becerra “unfit for any position of public trust.” Senate Minority Leader Mitch McConnell, R-Ky., has called him “famously partisan.” And the political group Heritage Action for America launched a cable and digital ad campaign against Becerra.

Republicans say Becerra is a radical supporter of socialized medicine, abortion and curbs on religious liberty and that he has no medical experience.

Democrats are shrugging it off.

Republicans are “just flailing around,” Finance Committee Chairman Ron Wyden of Oregon said Monday. “They’ve done their best to try to find something that could stick in terms of their opposition, but there’s no ‘there’ there.”

At a White House briefing, spokeswoman Jen Psaki said Becerra is part of the team that Biden needs to execute his COVID-19 response plan.

The pandemic was a focus of questioning at the Health, Education, Labor and Pensions hearing on Tuesday. Senators of both parties want to know about the administration’s timetable for a return to near-normalcy, the progress of the vaccination campaign, the outlook for reopening schools, and the threat from more aggressive virus mutations.

Becerra spent part of the hearing pushing Biden’s $1.9 trillion COVID-19 relief plan, which is on track to pass the House but faces major political and procedural challenges in the Senate.

In many ways, Becerra was California’s early face of opposition to the Trump administration. He was appointed by Gov. Jerry Brown to replace Harris and took over as attorney general in early 2017 as Trump became president.

Over four years, he filed 124 lawsuits, challenging the Trump administration on immigration, environmental and health care policies. His litigiousness and vocal resistance to Trump’s policies could allow Republicans to paint him as an overly partisan figure. California took pride in viewing itself as the resistance to Trump, and Becerra embodied that ethos.

Democrats say he’s not outside the mainstream of their party, which strongly supports women’s access to abortion, and where single-payer government-run health care for all remains a popular policy position, even if Biden has made clear he doesn’t support it.

Lack of medical experience doesn’t disqualify a nominee for HHS secretary, although it can be a plus. Recent secretaries have included one doctor but also a pharmaceutical executive, a White House budget director and three governors.

Biden’s pandemic response is being coordinated from the White House. While Becerra would be an important player, the administration’s decision-making structure is already in place. Becerra is expected to play a central role in broader health care policy issues, such as expanding insurance coverage and trying to curb prescription drug costs.

New Vaccine Delivery System Launches In Parts Of California, Including Riverside County

Newsom touts new Southern California vaccine pop-ups as counties transition  to Blue Shield network – Daily NewsSource: Los Angeles Daily News, by Janie Har, Amy Taxin and Kathleen Ronayne

California’s new system of delivering, tracking and scheduling coronavirus vaccines is being rolled out in select counties — including Riverside County — a first step in Gov. Gavin Newsom’s plan to smooth out what has been a confusing and disjointed rollout hampered by limited national supply.

Newsom announced last month that his administration had tapped insurer Blue Shield to design and manage a centralized system to get doses out quickly and equitably. He said the state also needs robust data to ensure vaccines are distributed equitably and reach low-income communities, largely Latino and Black, disproportionately affected by the pandemic.

An initial list provided by the state showed 10 counties in the inland sections of central and Southern California chosen to be the first to make the transition to the Blue Shield system this week, although one county said Friday it would shift later. While the counties understand the goals, there’s confusion about what changes will occur.

Counties in the initial group include Riverside, Fresno, Kern, Kings, Imperial, Madera, Merced, San Joaquin and Stanislaus. Starting March 3, another group that includes Los Angeles, which has 10 million of California’s nearly 40 million residents, will be added. San Francisco is among the counties being added in mid-March, though the dates and counties in each group are subject to change.

As of Sunday, Riverside County had yet to receive confirmation or further details from Blue Shield or the state regarding the new delivery system, according to Brooke Federico, the county’s spokeswoman.

However, Federico said the county has dealt with “extremely” limited quantities of vaccine, coupled with an “extreme” demand. Riverside County has worked to administer its vaccines to groups such as seniors, farmworkers, healthcare workers and educators within days of receiving them, she said.

“We continue to want to see additional vaccines available for our Riverside County residents,” Federico said.

Brynn Carrigan, Kern County’s director of public health, said she was told that starting Sunday everyone must make appointments through the state’s vaccine sign-up system, called My Turn. In neighboring Fresno County, a spokeswoman for St. Agnes Medical Center said it had no plans to switch its scheduling system.

“It’s scary to give up control of a system that we’ve spent a lot of time on, that’s working really well right now,” Carrigan said. “Our hope is there’s not a lot of hiccups and this goes smoothly.”

Darrel Ng, vaccine spokesman for the state’s public health agency, declined to answer questions about what to expect during the transition. But he said the state and Blue Shield “have worked tirelessly to plan and implement phased changes to more efficiently and equitably administer vaccines.” He said they will share more information next week.

Blue Shield spokesman Matthew Yi also declined to provide more detail, saying in a statement Saturday they are working “closely with state public health officials, local health jurisdictions, healthcare providers and others” to overcome the pandemic.

California has used stadiums, arenas, fairgrounds — even Dodgers Stadium and Disneyland — to build a large capacity to administer shots, but much has gone unused because of the limited availability of vaccines. Residents were frustrated when the state first started vaccinating the general population in January, with 58 counties and individual hospital systems setting their own rules for who could make an appointment and how.

While state officials have been clear on what they want the new system to accomplish, they have provided little information on how counties and other providers are expected to get there. And officials are upfront that they don’t have answers yet to critical questions, including how they will measure equity, what the monthly equity target is or even the complete network of providers.

What is sure is that counties will not be allowed to add any more vaccine providers, because the state through Blue Shield will decide who administers shots.

Yolanda Richardson, the state official in charge of implementing the change, faced a barrage of questions and concerns at a community advisory committee meeting last week. She said the state has the expertise and the relationships to figure it out.

“This is too critical and too important for us to let this get out of our hands,” Richardson said.

Joe Prado, community health division manager in Fresno County, said his team had a good talk with Blue Shield representatives and does not get the sense the insurer will hijack the county’s system. But there will be new management metrics in place, including the county’s ability to administer doses within a week, which Prado says will be easier once they get the anticipated three-week notice for how many shots to expect.

“Right now, without any direction or a plan from Blue Shield, nothing will change on Sunday,” he said.

The fast-tracked, no-bid $15 million contract charges Blue Shield with creating a “statewide vaccine network” to ensure the rapid delivery of vaccines.

Among the requirements: Rural Californians should be able to reach a vaccine site within 60 minutes and urban residents within 30 minutes. Homebound people must receive the vaccine at their residences. The state must be able to administer 3 million vaccines per week by March 1, dependent on supply. Now it is doing about 1.4 million.

Blue Shield must work with the state to develop an algorithm to determine how vaccines are allocated and set incentive payments and performance aimed at getting providers to give doses out more quickly and to the right populations. The state also will set goals for what percentage of vaccines go to people in low-income or otherwise disadvantaged areas.

Some counties and providers wonder how Blue Shield and the health care network Kaiser Permanente, which has also been tapped to help out, will cultivate the trusted relationships needed to vaccinate the underserved populations Newsom hopes to reach.

St. John’s Well Child & Family Center, a community health center whose clinics serve Black and Latino residents in south and central Los Angeles, plans to open three new vaccination sites and start inoculating worshippers at churches.

“It seems like we’ve got our groove on now, the counties are getting vaccine, particularly in the bigger counties, they’re getting it into the low-income communities of color,” CEO Jim Mangia said. However, he said “the incredible power that a non-elected body” like Blue Shield has over vaccine distribution is disconcerting.

Kaiser announced Saturday that it would ramp up its distribution of vaccines to seniors starting this week. CEO Greg Adams said California officials had increased the health care giant’s allotment to more accurately match its large share of the state’s health care market.

Kaiser is starting to schedule appointments several weeks out and beginning to offer inoculation appointments to members who are 65 and older.

Carrigan said there are currently more than 90 vaccination providers in her county of 900,000 people, and her office doesn’t have a say which ones will remain under Blue Shield.

The county has been using spreadsheets to keep track of vaccinations and will continue to do so for people who already have appointments and for those who have received first doses and are awaiting a second, she said.

“We feel like in Kern County we have this system dialed in. We’re ready. We just need more supply,” she said. “So making changes without a lot of explanation, without a lot of details, is a little bit scary for us, to be frank.”

Biden Is Changing PPP Rules. For 2 Weeks, Only Businesses With Fewer Than 20 Employees Can Claim Pandemic Relief Loans.

Biden is changing PPP rules. For 2 weeks, only businesses with fewer than  20 employees can claim pandemic relief loans. | Business Insider IndiaSource: Business Insider, by Kate Duffy and ReutersPresident Joe Biden is set to change the main US coronavirus aid program for small businesses on Monday to try to reach smaller, minority-owned businesses and sole proprietors left behind in previous rounds of aid.

Biden administration officials said that for two weeks starting on Wednesday, the Small Business Administration would accept applications for forgivable Paycheck Protection Program loans from only firms with fewer than 20 employees, to ensure that they are not crowded out by larger firms.

Experts have said that demand for the loans is slowing as firms reopen.

When the program was launched in April, its initial $349 billion ran out in two weeks. Congress approved another $320 billion in May, but the program expired in August with about $130 billion in unused funds.

The program was relaunched in January with $284 billion in new funds from a coronavirus aid bill enacted at the end of December. A Biden administration official said that about $150 billion of PPP money was still available.

But administration officials said many minority-owned and very small businesses in low-income areas had not been able to receive aid.

The changes are designed to make it easier for businesses with no employees — sole proprietors, independent contractors, and self-employed people such as house cleaners and personal care providers — that previously could not qualify because of business cost deductions.

The Small Business Administration is set to revise the rules to match the approach used to allow small farmers and ranchers to receive aid.

The officials said the program would also set aside $1 billion for businesses without employees in low- and moderate-income areas, mostly owned by women and people of color.

The SBA plans to provide new guidance making it clear that legal US residents who are not citizens, such as green-card holders, cannot be excluded from the program. The Biden administration said it would eliminate exclusions that prohibit a business owner who is delinquent on student loans from participating in the program.

Business owners with non-fraud felony arrests or convictions in the previous year are excluded from the program, but Biden administration officials said they would adopt bipartisan Senate proposals to remove this restriction, unless the applicant is currently incarcerated.

New California Single-Payer Bill Intensifies Newsom’s Political Peril

New Single-Payer Bill Intensifies Newsom's Political Peril | Kaiser Health  News

Source: Kaiser Health News, by Angela Hart and Rachel Bluth

A group of Democratic state lawmakers introduced legislation Friday to create a single-payer health care system to cover all Californians, immediately defining the biggest health policy debate of the year and putting enormous political pressure on Gov. Gavin Newsom.

The Democratic governor faces the increasingly likely prospect of a Republican-driven recall election later this year. The single-payer bill adds to his political peril from the left if he doesn’t express support, and from the right if he does.

State Assembly member Ash Kalra, author of AB 1400, said the coronavirus pandemic has exposed a broken health care system that has left millions without reliable and affordable health coverage. His bill would address those gaps in the system, he said, effectively eliminating private health insurance by shifting responsibility for administering and financing health coverage to the state government.

The new system, called CalCare, would expand coverage to nearly 3 million uninsured Californians and provide rich benefits, including dental care, generous prescription drug coverage and long-term care, according to the bill language, which was obtained by California Healthline before the measure was introduced.

The move, however, faces monumental financial and legal barriers, and would likely require new taxes. While the measure does not assign a price tag to the overhaul, a separate single-payer bill that failed in 2017 would have cost an estimated $400 billion each year.

“People are dying and suffering. They’re going bankrupt and starting GoFundMe pages just in order to survive in the wealthiest state in the wealthiest nation on earth,” said Kalra, a liberal Democrat from San Jose. “We now have a Democratic White House, and forward-thinking Democrats like Xavier Becerra going to Washington who can be incredibly helpful.”

Nearly 20 other Assembly Democrats signed on to the legislation, which is among the first state-based single-payer proposals to be introduced under the Biden administration. Massachusetts lawmakers this year introduced similar legislation, and other states are considering it.

Sponsored by the California Nurses Association, a powerful union and political force in Sacramento, the single-payer bill is expected to ignite a fierce health care fight among liberal and moderate Democratic lawmakers, and draw intense opposition from deep-pocketed health industry groups, including insurers, doctors and hospitals.

“Eliminating private health coverage in California will always be unworkable for a number of reasons. It would cost $400 billion a year, which we can’t afford,” said Ned Wigglesworth, spokesperson for Californians Against the Costly Disruption of our Healthcare, which includes major private health insurers and the state doctor and hospital lobbying groups, which also opposed the 2017 single-payer bill.

“Shifting to an entirely government-based health system would be especially harmful and disruptive now, as California’s health care community is focused on meeting the acute health care needs of our state during a pandemic,” Wigglesworth added.

Assembly member Jim Wood (D-Santa Rosa), who as chair of the Assembly Health Committee controls which health policy legislation gets a hearing, cast doubt on the feasibility of single-payer late last year, saying the state should instead build on the Affordable Care Act. Supporters fear his potential opposition could block the bill.

California’s proposal, if approved, could test the Biden administration’s willingness to grant states freedom to enact sweeping health care reforms such as a single-payer system. Becerra, California’s attorney general, has expressed unwavering support for single-payer and would be positioned to weigh in on the plan should he be confirmed as President Joe Biden’s Health and Human Services secretary. Becerra’s Senate confirmation hearings start Tuesday.

“The president himself doesn’t necessarily have to support single-payer on a national level to allow states to move forward,” Kalra said.

The introduction of a single-payer proposal this year forces Newsom into a delicate position. The first-term governor, who said he supported the creation of a state-based single-payer health care system when he ran for governor in 2018, has since distanced himself, expressing doubt that California can embark on such a massive transformation on its own.

Newsom’s office did not respond to a request for comment.

Newsom, once seen as a rising Democratic Party star, faces a burgeoning recall effort driven by state and national Republicans. The embattled governor is under fire for a clumsy and confusing vaccine rollout; backlogs and fraud at the state’s unemployment agency; and violating his own public health rules when he dined maskless last year at the ritzy French Laundry restaurant. Democrats have also criticized the governor for his pandemic response, including his inability to reach a legislative deal to open schools to in-person instruction.

With the March 17 deadline looming for the recall to qualify for the ballot, Newsom will undoubtedly be asked to weigh in on the single-payer proposal.

“It’s not a factor in this calculation,” said Stephanie Roberson, lead lobbyist with the California Nurses Association, which campaigned for Newsom during his gubernatorial run. “Our concern is people are dying and losing their health care. We’re sorry if this parallels some untimely political event for the governor.”

Last year, Newsom convened a commission to study the possibility of a single-payer system and other ways to cover more Californians. But the pandemic stalled its progress and the commission hasn’t met since August.

The exorbitant cost of developing a new system is a major hurdle. In 2017, the last time California lawmakers floated a single-payer proposal, a state legislative analysis pegged the projected cost at $400 billion a year. Assembly Speaker Anthony Rendon shelved the proposal, calling it “woefully incomplete,” in part because it was unveiled without a financing mechanism.

Kalra, who has not identified a way to pay for the massive transformation and said he’s unsure whether it would require higher taxes, will undoubtedly face similar skepticism over how to fund it.

His bill calls for CalCare to cover comprehensive health services far beyond what’s required under the Affordable Care Act, including traditional medical services, dental care, prescription drug coverage, long-term care, and mental health and substance use treatment.

It would also end all out-of-pocket patient costs — including premiums, copays and deductibles — and ban health care providers participating in CalCare from operating in the private marketplace. CalCare’s governing board would determine health care prices and set rules for providers.

While single-payer would require a significant initial investment, Kalra argued, the state might be able to reroute federal dollars for Medicare, Medicaid and other programs into CalCare. The system would also eventually cost less, he said, because it would simplify health care financing, end for-profit care and cut out private middlemen.

“Look, we’re already paying more than $400 billion a year for our current system,” Kalra said. “We currently have the most expensive health care system in the world, and our outcomes certainly don’t get us what we pay for.”

The latest estimates, based on federal data, show health care spending in California is about $450 billion a year, according to Gerald Kominski, a professor of health policy and management at the UCLA Fielding School of Public Health.

But switching to single-payer isn’t as simple as transferring those expenses to a new system, he said. Somehow, the money that employers and employees contribute to private health insurance plans needs to be funneled into a unified system.

“The mechanism you use to do that is almost certainly some form of taxation,” Kominski said. “It’s literally impossible for a single-payer system to move forward without capturing those current expenditures. They’re too substantial.”

While the proposal would not ban all private health insurance, it would allow only for coverage that supplements CalCare. The aim is to enroll all Californians, eliminating the need for private health coverage, said Carmen Comsti, a regulatory policy specialist with the California Nurses Association who is also on the state’s single-payer commission.

But that could present enormous challenges. Nearly 6 million Californians are enrolled in private health coverage regulated by the federal government. Enrolling them in CalCare could require a change in federal regulatory law, and would likely require changes to the state constitution — which, in addition to passing tax increases, could force single-payer backers to obtain voter approval.

‘The Problem Is Tomorrow’s Variants’: Renowned Bay Area Epidemiologist Predicts Prolonged Pandemic

Image result for ‘The Problem Is Tomorrow’s Variants’: Renowned Bay Area Epidemiologist Predicts Prolonged Pandemic images

Source: San Francisco Chronicle, by Aidin Vaziri

It will take years, not months, to gain the upper hand in the coronavirus pandemic — and it will require thinking well beyond our borders, says Dr. Larry Brilliant.

The 76-year-old Bay Area epidemiologist, who has worked to eradicate smallpox, polio and co-founded the Seva Foundation in Berkeley to combat blindness, has a unique perspective on the subject.

For years, Brilliant warned of a pandemic on the scale of the one we are living through. He even served as the senior technical adviser on the 2011 motion picture “Contagion,” filmed partly at the San Francisco 49ers old stadium, Candlestick Park — during which time he presciently predicted that epidemiologists would become rock stars and stadiums would become mass vaccination sites.

As the CEO of Pandefense Advisory, Brilliant has assisted in the global response to the coronavirus crisis over the past year. He has a broader view of the pandemic than most public health leaders and scientists, having invested his life’s work in anticipation of this very moment.

He is encouraged by dropping case counts, the rapid development and rollout of innovative new vaccines, the new science-driven leadership in the White House. But Brilliant is not here to reassure anyone that this will all be over soon.

“I think there’s a lot of good happening,” he said, speaking to The Chronicle by phone from his home in Mill Valley in a rare interview Friday. “I would prefer to think that things will get better, but the scientist in me worries we’re too perilously close to things going the other way.”

Brilliant, who moved to San Francisco in 1967 from his native Detroit, clearly remembers how he felt the moment he realized, in January 2020, that his predictions were about to come true. He was in a meeting with top epidemiologists and public health policy experts from around the world at the Flood Building in San Francisco when an alarming call came in. The Thai Health Ministry had identified a case of the novel coronavirus at one of its airports.

“Those of us who had been through MERS and SARS, we looked at each other and said, ‘This is going to really bad,’” Brilliant said. “We knew then that this was going to happen.”

As the first leader of Google’s philanthropy division, Brilliant is connected with tech leaders and public health officials worldwide. But in the former administration, he found his efforts stymied, and he was forced to watch from the sidelines as every opportunity to get the pandemic under control was ignored, dismissed and disparaged.

He feels renewed optimism with President Biden in charge, especially with a new federal COVID-19 response team that includes Andy Slavitt, the former acting chief of Medicare and Medicaid under the Obama administration; Vivek Murthy, the former U.S. surgeon general; and David Kessler, the former commissioner of the Food and Drug Administration.

“I think it’s going to be a very different attitude,” Brilliant said, praising Biden’s swift action in securing enough vaccine to deliver doses to every American by the end of the summer.

“We’ve got enough vaccine on order to vaccinate every man, woman and child in the United States,” he said. “We also have enough vaccine to help the rest of the world, which is important.”

He cautioned, however, that it will take a global effort to truly make an impact, especially to head off increasingly aggressive variants of the virus that could elude testing and vaccines.

Even if the United States gets most people vaccinated, it won’t be enough, he said: “Until everybody in the world is safe, no one is safe.”

The virus does not recognize borders, and variants such as those discovered in the U.K., Brazil and South Africa will continue to emerge until everyone is vaccinated, he predicted.

Brilliant, a longtime Grateful Dead doctor, laments that half the country still believes in an America First policy, and that kind of nationalism will create an “uphill battle” in the quest to wipe out the pandemic.

While he is confident that the vaccines in production now will be suitable to combat the variants in circulation, that picture could rapidly change.

“Today’s vaccines are good enough to stop today’s variants,” Brilliant said. “The problem is tomorrow’s variants. We’re just on the cusp.”

He thinks that the global picture of the pandemic is much more dire than the numbers show. There have been more than 100 million cases of COVID-19 reported since the start of the pandemic, according to data collected by Johns Hopkins University. Brilliant predicts the actual number of cases will top a billion, “without question.”

As government leaders rush to reopen the economy and schools while the pandemic continues to rage Brilliant urges caution.

“People are beginning to think, ‘Well, I can go hug my granddaughter,” he said, noting he rarely ventures out of the home he shares with his wife, Girija Brilliant. “The psychological letdowns people will have are going to be tremendous.”

He said the three surges we experienced last year may not have been surges at all but a portent of what is to come globally.

“There’s a nonzero probability that we’ll look back and all those three bumps will all together just be the first wave, and what’s coming next could be worse,” he said. “I think the future is really complicated.”

Brilliant, who said Thursday that he was set to receive his second vaccine dose with his wife on Valentine’s Day, said people should continue to follow public health protocols for now, including masking, physical distancing and staying home except for essential outings. He said not enough is known about the vaccines to be sure that even after people receive their shots, they will be unable to spread the virus.

“As a country, we’re still not vigilant enough,” he said. “When you meet the people who have long COVID, and a year after, they still wake up some night unable to breathe, they still have swollen toes, they still have difficulty focusing. … If I can use a technical medical definition, this is really a s—ty disease.”

Analysis: 30% Of Providers Not Complying With CMS’ New Rule On Price Transparency

Image result for Analysis: 30% Of Providers Not Complying With CMS’ New Rule On Price Transparency images

Source: Fierce Healthcare, by Robert King

Approximately 30% of hospitals are not complying with a new rule that requires them to post payer-negotiated rates, with a lack of resources the main reason, a new analysis found.

The analysis of more than 1,000 providers across 27 states completed by consulting firm Guidehouse found larger health systems were more likely to comply with the rule that went into effect Jan. 1.

The Centers for Medicare & Medicaid Services (CMS) rule requires hospitals to post prices in one of two ways: a machine-readable file containing all standard charges for the facility’s items and services or a consumer-friendly file that lists 300 shoppable services. A hospital can use a patient price estimator tool to comply with the requirement.

The analysis found 30% of hospitals weren’t complying with either method.

The reasons for noncompliance ranged from a lack of resources due to COVID-19 or other issues, a lack of understanding about the rule and waiting to see what their competitors do.

“Larger hospitals and health systems were most likely to be compliant and are using existing tools (i.e., MyChart) to meet the requirements via the consumer-friendly shoppable services file,” the analysis said.

Guidehouse found 60% of the providers chose to comply with the rule via the consumer-friendly file, and 48% used the machine-readable file.

The analysis, released Tuesday, also found major inconsistencies with how hospitals are complying with the machine-readable file.

“There is a general lack of consistency in format and content, making it difficult for anyone (e.g. CMS, providers, payers) to scan, consolidate and derive insights without significant data transformation and enhancements,” the analysis said.

Guidehouse noted that its analysis also underscored the “herculean task” CMS faces in evaluating compliance with the rule. CMS can fine hospitals $300 a day for each day they are not in compliance.

The firm believes more providers will comply with the rule as resource constraints, especially those related to the COVID-19 pandemic, lessen and with more clarity on how to comply.

“However, having a strategic plan to mitigate risks and capitalize on the benefits of appropriate compliance is key,” the analysis said.

The Number Of MA Plans Offering Supplemental Benefits Continues To Rise, Study Finds

Medicare Advantage

Source: Fierce Healthcare, by Paige Minemyer

The number of Medicare Advantage plans that offer supplemental benefits continues to grow, according to new data from the Better Medicare Alliance.

The analysis, conducted by Milliman, found the number of plans offering such benefits increased across 36 out of 41 categories from 2020 to plan year 2021. That includes increases across 15 of 17 traditional supplemental benefit categories, four of five new expanded categories and 17 of 19 supplemental benefits for the chronically ill categories.

For example, 57% of plans now offer a meal benefit, and 46% will cover members’ transport to and from doctors’ visits.

The most common benefits offered, according to the report, include vision (offered by 96% of plans), hearing (93%), fitness (92%) and dental care (87%).

“This analysis provides unique insight into the ways that Medicare Advantage continues to innovate and enhance benefit offerings, even in the face of the extraordinary circumstances presented by the COVID-19 pandemic,” said Allyson Schwartz, CEO of the Better Medicare Alliance, in a statement.

“The growth of extra benefits and lower out-of-pocket available to seniors, including those particularly targeted to individuals with chronic conditions, demonstrates the value that Medicare Advantage continues to deliver for millions of beneficiaries,” Schwartz said.

For benefits targeting chronic conditions specifically, diabetics were the most targeted patient population, the study found. In the 2021 plan year, 293 Medicare Advantage plans offered lower cost sharing and/or additional benefits targeting members with diabetes, reaching close to 1.5 million people.

The number of plans offering supplemental benefits for members with behavioral health diagnoses also grew significantly in 2021, according to the analysis, growing from just five plans in 2020 to 135 plans.

In addition, benefits targeting chronic obstructive pulmonary disorder and congestive heart failure were also common, the study found.

Last Updated 02/24/2021

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