How Will We Know When It’s Time to Reopen the Nation?

Times Square on Friday.

Source: The New York Times, by Aaron E. Carroll

Everyone wants to know when we are going to be able to leave our homes and reopen the United States. That’s the wrong way to frame it.

The better question is: “How will we know when to reopen the country?”

Any date that is currently being thrown around is just a guess. It’s pulled out of the air.

To this point, Americans have been reacting, often too late, and rarely with data. Most of us are engaging in social distancing because leaders have seen what’s happening in Europe or in New York; they want to avoid getting there; and we don’t have the testing available to know where coronavirus hot spots really are.

Since the virus appears to be everywhere, we have to shut everything down. That’s unlikely to be the way we’ll exit, though.

Some cities or states will recover sooner than others. It’s helpful to have criteria by which cities or states could determine they’re ready. A recent report by Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out some goal posts.

* Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.

Other cities and states fear that they will approach New York City’s state of crisis. They’re trying to increase the number of available beds and ventilators — as well as doctors, nurses and other health care providers — to make sure they aren’t overwhelmed in their capacity to provide care to all those who need it.

This is the most immediate bar, and the focus of most public health officials’ attention. At the moment, there’s no reason to believe any area is over a surge of cases, and analysts’ models predict many places won’t peak for weeks to come.

* A state needs to be able to test at least everyone who has symptoms.

Dr. Gottlieb and colleagues estimate that the nation would need to have the capacity to run 750,000 tests a week — this is after things have calmed down greatly. There are times we might need even more.

“The 750,000 number should be viewed as a reasonable expectation for when we haven’t been having any major pockets or regional outbreaks to manage,” said Mark McClellan, an author of the report and a professor of business, medicine and policy at Duke. “If more testing to help contain outbreaks and potential outbreaks is needed, which seems very plausible, especially early on, the number would need to be significantly larger. We’ll also have to do some surveillance of people without symptoms, especially in higher-risk settings.”

A national estimate means less in deciding whether a state can reopen than its local capabilities. A state would need to be sure it could test every single person who might be infected, and have the results in a timely manner. That would be the only way to achieve the next requirement.

* The state is able to conduct monitoring of confirmed cases and contacts.

A robust system of contact tracing and isolation is the only thing that can prevent an outbreak and a resulting lockdown from recurring. Every time an individual tests positive, the public health infrastructure needs to be able to determine whom that person has been in close contact with, find those people, and have them go into isolation or quarantine until it’s established they aren’t infected, too.

This will be a big challenge for most areas. Other countries have relied on cellphone tracking technology to determine whom people have been near. We don’t have anything like that ready, nor is it even clear we’d allow it. The United States also doesn’t have enough people working in public health in many areas to carry out this task.

Building that capacity will take significant time and money, and the country hasn’t even started.

* There must be a sustained reduction in cases for at least 14 days.

Because it can take up to two weeks for symptoms to emerge, any infections that have already happened can take that long to appear. If the number of cases in an area is dropping steadily for that much time, however, public health officials can be reasonably comfortable that suppression has been achieved, defined by every infected person infecting fewer than one other.

In suppression, cases will dwindle at an exponential fashion, just as they rose. It’s not possible to set a benchmark number for every state because the number of infections that will be manageable in any area depends on the local population and the public health system’s ability to handle sporadic cases.

“We wanted to suggest criteria that would allow locations to safely and thoughtfully begin to reopen, but what that looks like exactly will vary from state to state,” said Caitlin Rivers, another author of the report and an epidemiologist at the Johns Hopkins Center for Health Security. “We therefore included some flexibility for jurisdictions to tailor these criteria to their local context.”

These four criteria are a baseline. Other experts think we will need to add serological testing, which is different from the viral detection going on now. This type of testing looks for antibodies in the blood that our bodies created to fight the infection, not the infection itself. These tests can be much cheaper and faster than the ones we’re currently using to detect the virus in sick people.

Testing for antibodies will tell us how many people in a community have already been infected, as opposed to currently infected, and may also provide information about future immunity.

Gregg Gonsalves, a professor of epidemiology and law at Yale, said: “I’d feel better if we had serological testing, and could preferentially allow those who are antibody positive and no longer infectious to return to work first. The point is, though, that we are nowhere even near accomplishing any of these criteria. Opening up before then will be met with a resurgence of the virus.”

He added, “That’s the thing that keeps me up every night.”

Until we get a vaccine or effective drug treatments, focusing on these major criteria, and directing efforts toward them, should help us determine how we are progressing locally, and how we might achieve each goal.

It would also prevent us from offering false hope about when America can start reopening. Instead of guesses, people could have clear answers about when they might be able to go back to a closer-to-normal way of life.

Trump Administration Uses Wartime Powers To Be First In Line On Medical Supplies

Source: Kaiser Health News, by Christina Jewett and Lauren Weber

The Trump administration quietly invoked the Defense Production Act to force medical suppliers in Texas and Colorado to sell to it first — ahead of states, hospitals or foreign countries.

It took this action more than a week before it announced Thursday that it would use the little-known aspect of the law to force 3M to fill its contract to the U.S. first. Firms face fines or jail time if they don’t comply.

The Cold War-era law gives federal officials the power to edge out the competition and force contractors to provide supplies to them before filling orders for other customers.

While it’s unclear how many times the power has been used during the coronavirus pandemic, federal contracting records examined by Kaiser Health News show that federal authorities staked first rights to $137 million in medical supplies. The orders in late March flew under the radar, even as dog-eat-dog bidding wars raged among states and nations for desperately needed medical protective gear.

“It’s like ‘Lord of the Flies’ out there for states and hospitals as they bid against each other for critical medical supplies and equipment,” Sen. Chris Murphy (D-Conn.) said in a statement to KHN. “Plus, there’s no transparency about what the federal government is doing with the equipment that they purchase when they outbid states and hospitals.”

Without public awareness of what was taken on a federal-first basis — and who it was given to — the states are left in the dark after being told repeatedly to procure their own goods. The federal government, President Donald Trump has said, is not the states’ “shipping clerk.”

“It’s putting people into the free market where the invisible hand doesn’t care who it strangles,” said Arthur Caplan, director of the division of medical ethics at New York University School of Medicine.

Trump enacted the first-in-line power of the DPA for the Health and Human Services Department in an executive order on March 18 — and nine days later extended the power to the Department of Homeland Security, which includes the Federal Emergency Management Agency.

On Thursday at his White House press briefing, Trump announced he had invoked the DPA “against” 3M. His executive order states that the government “shall use any and all authority available under the Act to acquire … the number of N-95 respirators that the Administrator determines to be appropriate.”

“We hit 3M hard today after seeing what they were doing with their Masks. ‘P Act’ all the way,” the president tweeted. “Big surprise to many in government as to what they were doing – will have a big price to pay!”

While the administration had asked the company to stop exporting respirators to the Latin American and Canadian markets, 3M stated in a press release Friday there would be humanitarian implications, since the company supplies a critical amount of those countries’ N95 masks. 3M also warned such a move could create a potential trade war where other countries then refuse to sell N95s to the U.S., potentially resulting in fewer N95s in the United States.

When federal authorities use the DPA to seek a so-called rated order, it relieves companies from having to decide which state or hospital or foreign government gets the goods first, said Eric Crusius, a partner at the Washington, D.C., firm Holland & Knight and a contract law specialist. It makes things simple — the federal government’s order is filled first.

The defense law was cited in contracts for an estimated $54 million in medical supplies from Colorado-based Marathon Medical Corp., a medical supply distributor, and an estimated $84 million from Texas-based Retractable Technologies Inc., which makes retractable needles.

A woman who answered the phone at Marathon Medical declined to give her name and said the company policy is not to talk to the media. Officials for RTI, contacted by phone and email, did not respond by press time.

Contracts show that federal HHS officials also invoked their right to be first in line for an estimated $13.5 million in goods produced by New Jersey-based health care products manufacturer and supplier Becton, Dickinson and Co.

A modification to that contract signed March 23 says it applies to “medical and surgical instruments, equipment and supplies” and cites “delegation of authority” under the Defense Production Act “ordered by President Donald J. Trump in response to” the threat of the coronavirus. It’s not clear what product officials ordered from the company.

Becton, Dickinson and Co. told KHN on Thursday that the contract had been modified — again — so that the Defense Production Act was not invoked. Because there is a lag in federal contract disclosures, it’s possible that the contracts for Retractable Technologies and Marathon Medical also have been modified.

All three records name the contract-awarding agency as the HHS Office of the Assistant Secretary for Preparedness and Response and note: “Only the agency awarding the contract may place orders.”

When federal officials made a similar move in Massachusetts, it took state leaders by surprise. Marylou Sudders, who leads the state coronavirus command center, said an order of 400 masks from MSC Industrial Supply was canceled abruptly due to federal intervention, according to a report in The Boston Globe.

MSC spokesperson Paul Mason told KHN that the Defense Production Act compelled his company to put federal orders first.

That cancellation and a similar seizure of goods sowed so much distrust in Massachusetts that the New England Patriots sent a team plane to ship personal protective gear from China, according to The Boston Globe.

Officials from the White House and FEMA declined to directly answer questions about the use of the 1950 law to put the feds first in line for goods. HHS provided a statement saying the Defense Production Act is “an important tool that may be used when necessary to ensure needed supplies are available and going where they are most urgently needed. HHS and FEMA are and will continue working with the private sector and States to increase supply and allocate needed PPE.”

Top Democratic leaders and even a Republican governor were clamoring for a change in how the market was run in recent weeks, as health care workers warned against being sent out to the coronavirus front lines without proper supplies.

In a letter to the president Thursday, Senate Minority Leader Chuck Schumer called for strong federal intervention and leadership on the issue, citing the need for a military logistician to run such a response.

“While you continue to dismiss the Defense Production Act as not being needed, it is clear that the capacity of American industry has not yet been fully harnessed,” Schumer’s letter says.

Trump fired back with his own letter that evening, stating that Navy Rear Adm. John Polowczyk, currently serving as the leader of FEMA’s supply chain task force, was in charge of “purchasing, distributing, etc.”

“The Defense Production Act (DPA) has been consistently used by my team and me for the purchase of billions of dollars’ worth of equipment, medical supplies, ventilators, and other related items,” he wrote. “It has been powerful leverage, so powerful that companies generally do whatever we are asking, without even a formal notice.”

But if the government is going to take more control — which many health and government leaders have urged it to do — it should be transparent about its actions, said Dr. Atul Grover, executive vice president of the Association of American Medical Colleges. He said medical leaders have been whiplashed by their orders for protective gear falling through and speculated that they lost out to federal agencies.

Some institutions “fully expected to be able to purchase [personal protective equipment] from contractors who then turned around and said, ‘No, we’re going with another buyer instead,’” he said.

When asked about this phenomenon during Thursday’s national briefing, Trump said the governments could work it out.

“If you think there is bidding between federal government and state, let us know and we’ll drop out immediately,” Trump said. “There are 151 countries that have this problem, and they’re ordering, too. It’s really a mess.”

The Coronavirus Small Business Loan Program: What You Need To Know

Source: NPR, by Danielle Kurtzleben

Editor’s note: This article was published early Friday morning (Apr 3) and includes references to last week. However, there is important pertinent information relating to the Paycheck Protection Program, within the article.

Starting today, small businesses can apply for the nearly $350 billion in loans available through the economic rescue plan from Congress.

The loan program, known as the Paycheck Protection Program, is intended to support businesses so they can ride out the tough economic times and, most importantly, assist with either keeping current workers or rehire those who were laid off.

It’s sorely needed salve for all sorts of small establishments nationwide. Half of small businesses have less than 27 days’ worth of financial cushion, according to one 2016 report, and many have already suffered weeks of low or no income.

Below are some basics on how the program will work and what business owners can expect.

How much money can small businesses get?

They can get up to 2.5 times their total monthly payroll (with a maximum of $10 million). Importantly, as many businesses have already slashed jobs, companies will rely on payroll numbers from before the crisis. The Small Business Administration has set an interest rate of 1% on the loans, and repayment will be deferred for six months.

Congress has appropriated $349 billion toward this program. That may not be enough to meet demand, but it is possible Congress will decide to put more funds toward this program. (Read on to find out more about this.)

Who is eligible?

lot of businesses — those with fewer than 500 employees, including sole proprietorships and freelancers, as well as nonprofits.

The application requires much less information than a typical small business loan. A sample form put out by the SBA ahead of the program showed there were just two pages of questions on basic information, like payroll size and what the owner intends to use the money for.

Notably, these loans do not require personal guarantees or collateral, which administration officials are hoping will make for a speedy approval process.

The program is currently set to run through June 30.

Some banks won’t be ready immediately

Right now, around 1,800 banks are part of the SBA’s primary lending program. A senior administration official this week said thousands of additional financial institutions could also lend through this program.

But some won’t be ready on Friday. As of Thursday night, JPMorgan Chase’s website said it will “most likely not be able to start accepting applications on Friday.”

Reuters also reported this week that some major banks have been considering not participating in the program. That’s because they would be expected to hand out loans quickly — within days — which could open them up to legal risk.

In addition, some banks initially said that they might not want to participate because of unattractive loan terms laid out by the SBA. The Independent Community Bankers of America sent a letter this week to SBA Administrator Jovita Carranza and Treasury Secretary Steven Mnuchin laying out its concerns, one of which was the low 0.5% interest rate initially set by the SBA, even though the act said interest rates could be as high as 4%.

“Community bank lenders cannot ‘break even’ with such a low rate of interest, and for many it will not be economic or feasible to participate in the program,” wrote ICBA CEO and President Rebeca Romero Rainey.

At a Thursday White House press briefing, Mnuchin said the interest rates would now be set at 1%, citing some small banks’ concerns.

Can businesses really get money in one day?

Here’s what we do know: Friday is when the program opens. Administration officials have said they’re hopeful that businesses will be able to apply for and get their money within the same day. Whether that is feasible will quickly become clear once things get rolling. One day is a much quicker timeline than for standard SBA loans, which usually take five to 10 days to process.

In addition, some banks may not be ready to lend right away on Friday.

“This is an entirely new program, and that’s something that both banks and customers will have to get used to,” said James Ballentine, executive vice president of congressional relations and political affairs at the American Bankers Association. “There will be some banks that will be ready to go, and there will be others that will still learn how to do this and still be working on this for a few days.”

He added that the process may be quicker for businesses with strong ties to their banks already.

“Those customers that have these relationships with their banks, the banks have a lot of their information on file already, so some of those loans will be easier to turn around,” he said. “Others that may not have a banking relationship with their local bank or national bank. Certainly we’re encouraging them to go into that bank to get those loans and apply for them.”

Indeed, on Friday, Bank of America’s website said the program was open to “clients with a business lending and a business deposit relationship at Bank of America.”

The fact that some businesses might be able to get loans more quickly and easily, by virtue of their existing relationships, has raised some concern.

“The small businesses that [existing SBA lenders] serve are not the small businesses who need it most,” said Michael Roth, managing partner at Next Street, an advisory firm that works with local governments to boost small businesses. “They’re not the small businesses that need the cash within 30 days, within 90 days. And it’s just going to exacerbate the inequality that already exists.”

In particular, he said, he is concerned about availability of these loans to nonwhite-owned businesses and those in low-income neighborhoods.

Loans are forgivable if you keep employees

A business’ loan could be fully forgiven, but only if a business meets certain criteria.

First, to be forgiven, the money must be spent on payroll, rent, mortgage interest and utilities during the eight weeks after the loan is made. Any portion spent on anything else won’t be forgiven.

In addition, the SBA has said that at least three-quarters of the forgiven portion must be used for payroll, which can include benefits in addition to wages.

Many businesses may see their loans partially forgiven. The forgiven amount will be reduced if businesses cut their number of full-time workers, as well as if they cut their pay levels beyond a certain amount.

If a business owner has already laid off workers, they can rehire employees and still get forgiveness, as long as they rehire those workers by June 30.

Will there be enough loan money to meet demand?

It’s not clear. There is a very real possibility that $349 billion won’t meet the demand.

George Washington University Economics Professor Steven Hamilton walked through some back-of-the-envelope math on Twitter last week, noting that 2.5 times the total payroll of all businesses with fewer than 500 workers is $2.76 trillion (compared to the $349 billion in this Paycheck Protection plan). While of course not all small businesses may apply for the loans, it certainly shows that there is a possibility that the pot of money will be quickly exhausted.

“One of the things I’ve heard is this small business program is going to be so popular that we’re going to run out of our $350 billion,” Mnuchin told CNBC this week. “If that’s the case, I can assure you that will be top of the list for me to go back to Congress on. It has huge bipartisan support and we want to protect small business.”

Bill Gates Is Spending Billions To Produce 7 Potential Coronavirus Vaccines

Source: The Hill, by Joseph Guzman

Microsoft founder and billionaire philanthropist Bill Gates said his foundation is funding the construction of factories that will manufacture seven promising coronavirus vaccines.

In a clip released from Friday’s episode of The Daily Show, Gates said his foundation, the Bill and Melinda Gates Foundation, is moving forward with building manufacturing capacity for the seven vaccine candidates to save time, as the novel coronavirus continues to spread throughout the world.

“Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven just so we don’t waste time in serially saying ‘ok which vaccine works’ and then building the factory,” Gates told The Daily Show host Trevor Noah.

“It’ll be a few billion dollars we’ll waste on manufacturing for the constructs that don’t get picked because something else is better. But a few billion in this situation we’re in, where there’s trillions of dollars…being lost economically, it is worth it,” Gates said.

Gates said testing and building the manufacturing capacity at the same time is essential in developing a vaccine in the 18-month timeframe. He commented on the current social distancing and stay-at-home measures occurring across the country, saying we’ll have a lot of unusual measures in place until “we get the world vaccinated,” adding, “that’s a tall order, but it’s where we need to get to.”

On Tuesday, Gates called for a nationwide shutdown in an op-ed in the Washington Post, arguing the U.S. needs to enforce stricter lockdown measures in every state.

The number of coronavirus cases worldwide topped one million Thursday, and more than 55,000 deaths have been reported, according to Johns Hopkins University data. The U.S. leads the world in cases, with more than 245,000.

COVID-19’s Potential Double-Digit Hike on 2021 Premiums

Source: Softeon

According to a new report by Covered California, California’s marketplace, 2021 premium increases to individuals and employers from COVID-19 alone could range from 4 percent to more than 40 percent, if carriers must recoup 2020 costs and protect solvency.

COVID-19 has been an unprecedented situation with one-year projected costs in the national commercial market ranging from $34 billion to $251 billion. Patients hospitalized due to COVID-19 will stay in the hospital for 12 days on average and generate an average bill of $72,000, according to Covered California.

It is worth noting that, as reported by Healthcare Dive, other researchers have estimated lower costs. Researchers at the Kaiser Family Foundation estimate an average of $20,292 for a COVID-19 hospital stay.

Though most COVID-19 patients will be covered by Medicare, the uninsured and those with high deductibles may buckle under the weight of their bills. This uptick in healthcare spending will raise 2021 premiums across the entire risk pool.

Since carriers set 2020 commercial-population insurance rates in early to middle 2019, it is highly unlikely that they were prepared for such an unthinkable crisis.

If the full first-year costs of the epidemic had been priced into 2020’s premiums, premiums would have been 2 percent and 21 percent higher.

Covered California’s actuaries considered three scenarios of how COVID-19 could unravel:

  1. 1. A “low impact” scenario: 400,000 people are hospitalized
  2. 2. A “medium impact” scenario: 1.2 million people are hospitalized
  3. 3. A “high impact” scenario: 3 million people are hospitalized

In all three scenarios, carriers would have to grapple with bills they didn’t plan for in 2019 and could send premiums up in 2021.

Carriers are currently calculating 2021 rates and will submit them in May, finalizing them around July 1. Covered California officials say now is the time for the federal government to implement reinsurance policies, which would provide federal funding for portions of unforeseen COVID-19 costs for the individual and employer markets, along with Medicaid managed care programs. This would bring more certainty to beleaguered carriers, states and consumers.

Covered California also calls on the federal government to:

  1. 1. Increase the level of tax credits for those earning under 400 percent of the federal poverty level (FPL) and expand subsidies to those earning more than 400 percent FPL.
  2. 2. Establish a temporary program to limit the costs of COVID-19 for health insurers, self-insured employers and those they cover.
  3. 3. Establish a national special-enrollment period for the individual market.

Worried That $2 Trillion Law Wasn’t Enough, Trump And Congressional Leaders Converge On Need For New Coronavirus Economic Package

White House, leaders in Congress aim for new stimulus amid worry recent $2 trillion law wasn’t enough

Source: The Washington Post, by Erica Werner and Mike DeBonis

Congressional leaders and the White House are converging on the need for a new assistance package to try to contain the coronavirus pandemic’s economic devastation, fearful that a $2 trillion bailout law enacted last month will have only a limited effect.

House Democrats are eyeing a package of spending increases that would “easily” cost more than $1 trillion, Speaker Nancy Pelosi (D-Calif.) told lawmakers Monday, according to two officials on the conference call who spoke on the condition of anonymity to discuss it. Democrats are looking to extend unemployment aid and small-business assistance for additional months, as well as authorize another round of direct checks to taxpayers.

Trump has signaled support for some of the ideas that Democrats back, such as expanded help for small-business owners and new bailout checks for households. Republican leaders, meanwhile, have also called for more corporate aid and money to boost the overwhelmed health-care system.

The rushed effort comes as the economy’s fortunes appear tethered to political decisions in Washington. A surge of demand for new Small Business Administration loans has overwhelmed the agency’s system, but the Dow Jones industrial average rose 1,627 points, or 7.7 percent, on Monday amid Wall Street optimism that the pandemic’s domestic spread could be slowing.

Although there is some overlap in the political ideas, significant differences remain, and it’s unclear whether the sides will be able to reach a deal in the coming weeks.

Democrats are pushing for wider-ranging relief measures to help hospitals, health-care workers, farmers, first responders and education programs, among other things. A group of House Democrats led by Rep. Joe Neguse (Colo.) plans to roll out a proposal for $250 billion to assist smaller cities and communities they say have been shortchanged on assistance so far. A number of congressional Republicans have demanded an expansion of a new $349 billion small-business loan program, and Trump has also said that initiative needs more money.

In a sign that lawmakers might be preparing to cut a deal, Pelosi has backed away from some of her recent proposals that Republicans found most objectionable, including a multi-trillion-dollar infrastructure plan. And Senate Majority Leader Mitch McConnell (R-Ky.) has said he believes that Congress will have to act again to address health-care needs, among other things, opening the door to a pact. The two leaders spoke Thursday.

“All I can tell you is, I think we’re going to definitely need” another rescue bill, Senate Minority Leader Charles E. Schumer (D-N.Y.) told reporters Monday. “And I think it’s going to have to be big and bold because the problem is so huge.”

Their work to mobilize new legislation came amid growing signs that the economy is deteriorating much faster than expected and that the initial $2 trillion law is proving insufficient. Former Federal Reserve chair Janet L. Yellen told Pelosi and House Democrats on their conference call that the actual unemployment rate is probably 13 percent, not the 4.4 percent the Bureau of Labor Statistics reported Friday. And Yellen said the number of new jobless claims this week is likely to exceed last week’s 6.6 million, a record, according to Democrats on the call.

Households and businesses are confronting so much turmoil that the new assistance programs are overwhelmed. State unemployment offices have been bombarded with people seeking help.

And Bank of America said Monday that it had received 178,000 applications from firms seeking $32.9 billion in loans as companies clamor to qualify for the $349 billion Small Business Administration program.

Wells Fargo didn’t begin taking applications until Saturday and by Monday morning said it had reached the $10 billion cap it had set for loans under the program. To deal with the crushing demand, the Federal Reserve launched a system for banks to offload these assets so they could originate more loans.

This program is supposed to encourage small businesses to stop laying off employees, after 10 million workers sought unemployment claims late last month. The unemployment rate is expected to surge far beyond 10 percent this spring, and it could stay there into next year.

Goldman Sachs projected that the jump in new spending and sharp drop in tax revenue would push the federal budget deficit to $3.7 trillion in 2020, up from prior estimates of $1 trillion, which many experts said was already too high.

And in his annual letter, JPMorgan Chase chief executive Jamie Dimon predicted that the economic fallout from the pandemic would lead to a “bad recession” and create financial stress rivaling the 2008 crisis.

A new economic package would be the fourth piece of legislation focused on the coronavirus to move through Congress since early March and would aim to extend and bolster programs created in the $2 trillion Cares Act.

The office of Sen. Marco Rubio (R-Fla.) said over the weekend that the lending fund for small businesses — billed as the Paycheck Protection Program — will be depleted before it expires June 30, and “it is clear that Congress will need to appropriate additional money.”

Across the nation, state unemployment offices are staggering under the weight of an unprecedented number of claims, and lawmakers called for expanding the $260 billion program they created last month that offers unemployed workers an additional $600 weekly for four months on top of what their state programs provide.

In a letter to Democratic lawmakers Sunday, Pelosi said, “The acceleration of the coronavirus crisis demands that we continue to legislate.”

“We must double down on the down-payment we made in the Cares Act by passing a Cares 2 package, which will extend and expand this bipartisan legislation to meet the needs of the American people,” she said.

Pelosi and House Democrats last week rolled out a host of more ambitious — and controversial — measures, including new federal workplace safety standards for health-care providers and the infrastructure plan. But Pelosi later told CNBC that those ideas might have to wait.

“While I’m very much in favor of doing some of the things that we need to do to meet the needs — clean water, more broadband and the rest of that — that may have to be for a bill beyond this,” Pelosi said in an interview Friday. “Right now, I think that we have a good model — it was bipartisan, it was signed by the president, but it’s not enough.”

Trump has indicated openness to more money for any number of additional programs.

“If we do more, we’re going to do more. We’re going to try and get directly to people that are hit so hard,” Trump said Sunday. “But we’re going to take care of our workers. We’re going to take care of our citizens. We’re going to take care of our small businesses. We’re going to take care of our large businesses, the airplane industry, the airline industry, a lot of industries that we have that are in trouble.”

A senior administration official, speaking on the condition of anonymity Monday to describe internal deliberations, said the administration was focused on implementing the programs in the new law. Several of these are experiencing rocky rollouts as the Treasury Department and the Internal Revenue Service try to move quickly to push out loans to businesses and send checks of between $500 and $1,200 to individual Americans making $99,000 or less.

But the administration is not ruling out another piece of legislation building on existing programs.

“We clearly hear it from the Hill including [unemployment insurance], payments to individuals, how we do another small-business program, and then lots of conversations about things that were left out or groups of people that were left out,” this official said.

One of the gaps in the Cares Act that lawmakers are looking to fill deals with aid to local governments. While the bill reserved $150 billion for states and local jurisdictions with more than 500,000 residents, smaller cities, towns and counties are not directly eligible.

Neguse — in concert with Democratic Reps. Andy Levin (Mich.), Ben Ray Luján (N.M.) and Tom Malinowski (N.J.) — is proposing to earmark $250 billion for smaller jurisdictions in the next relief bill. Dozens of lawmakers of both parties previously signed letters calling for the fix.

“It does not matter what political affiliation you might have or whether you live in a big city or a small city, the virus at the end of the day is impacting all of us as Americans,” Neguse said Monday. “There are cities across our country, counties, that are going to be in very dire economic circumstances very soon if the Congress does not step up to the plate.”

Sen. Shelley Moore Capito (R-W.Va.), a senior member of the Senate Appropriations Committee, said Monday that lawmakers need to “see what’s working, what’s not working, anybody falling through the cracks.”

As thorny as the policy questions about what would be in the next bill is the question of how to pass it.

The House and Senate are out of session over coronavirus fears, and many lawmakers are not eager to return to the close quarters of the Capitol. But to pass legislation without lawmakers present, leadership in both chambers and of both parties would have to get unanimous agreement from all members of Congress, something that may be difficult to achieve.

Because one House member, Rep. Thomas Massie (R-Ky.), demanded a recorded vote on the Cares Act, leaders scrambled to bring more than half the chamber’s members back to ensure that the law could pass by voice vote. Aides of both parties, who spoke on the condition of anonymity to candidly describe internal thinking, said it is more unlikely that subsequent bills will be able to pass unanimously or on voice votes.

The Senate has tentatively scheduled votes for the week of April 20, and the House leadership has also targeted that week for potential votes. But aides say the legislative schedule is entirely dependent on the course of the pandemic and whether the two chambers and Trump can come together on workable legislation.

Newsom Is ‘Confident’ About The State’s Supply Of Ventilators, Hospital Beds

Source: Mercury News, by Maggie Angst and Emily Deruy

As the total number of coronavirus cases in California topped 16,000, Gov. Gavin Newsom said Monday he is confident the state is building up its number of ventilators, hospital beds and workforce to meet the demand of a still-to-come surge in patients that he projects won’t peak until May.

Newsom is so confident, in fact, that he announced the state was donating 500 ventilators to the Strategic National Stockpile to deploy in states that need them more, like New York, which has already received ventilators from Oregon, Washington and from China.

“We feel confident in our capacity to meet our needs as we support the needs of others,” Newsom said, adding that the ventilators are being “lent” and could be recalled if necessary down the road.

The generosity comes in the weeks after California — and other states — launched massive efforts to stockpile medical supplies and personal protective equipment to prepare before a surge of coronavirus patients overwhelmed the Golden State’s hospitals. California’s clout and partnerships with tech companies and other manufacturers have helped it amass supplies while its early adoption of stay-home orders has so far pushed back the expected crush of patients that New York and New Jersey are now experiencing.

“We can do certain things to punch above our weight,” Newsom said during a news conference inside the Sleep Train Arena, the former home of the NBA Sacramento Kings, one of more than a dozen facilities around the state being converted into overflow hospitals. “And we carry a big weight, but to the extent that other Americans need our support, our largesse, and to the extent that we have the resources, we’re going to be there for as many people as we possibly can.”

Even when supplies are available for purchase, the federal government sometimes intervenes and has them redistributed to areas of high need. For example, Kaiser was supposed receive a shipment of much-needed supplies before the federal government sent it elsewhere.

“Where the federal government finds they need to go to the supplier directly and take some of the resources, whether it belongs to us, it’s part of trying to make sure areas of the country in significant need receive resources, so that’s something that’s happening,”  Smita Rouillard, associate executive director of The Permanente Medical Group at Kaiser Permanente Northern California, confirmed in an interview Monday.

Despite Newsom’s reassurance, the U.S. reached a grim milestone on Monday, as the country’s coronavirus death toll passed 10,000, according to data from John Hopkins University.

As of Monday evening, California had recorded 16,309 positive COVID-19 tests — a 46% increase since Friday, and 387 deaths, according to data compiled by this news organization.

Santa Clara County public health officials reported that 1,224 people have tested positive and the county’s death toll has reached 42 — double what it was 10 days ago. Alameda County has recorded a total of 590 confirmed cases and 13 deaths, San Francisco has 583 cases and nine deaths, San Mateo County has 579 cases and 13 deaths and Contra Costa County has 417 cases and seven deaths.

But the Bay Area’s hospitals have still not experienced an anticipated surge in coronavirus patients, and it’s unclear when that might happen. Some of the forecasting models that the governor’s office rely on are now showing earlier dates for hospitalizations to peak in the Golden State, which don’t match what Newsom forecast on Monday.

For example, the University of Washington’s Institute for Health Metrics and Evaluation now anticipates that California will reach its peak use of resources — total beds, ICU beds and ventilators — on April 14. That’s almost two weeks earlier than what it forecast a week ago, based on a larger sampling of data and lower ratios of hospital admissions to deaths.

The good news: Given the state’s current resources, that model predicts that California will have a surplus of all the necessary resources to meet the surge in coronavirus patients.

Newsom and his team of health professionals repeated on Monday they are still preparing for the state to reach its capacity of permanent hospital beds — 50,000 — in mid-May.

His office did not immediately respond to questions on Monday about the discrepancies between the state’s timeline and the new University of Washington projections.

John E. Swartzberg, a professor of infectious diseases at the University of California Berkeley, said his “best guess” was that the Bay Area will see peaks in hospital patients in about two and a half weeks — or toward the end of April. But he admitted, no one can be certain.

“This is like blind people feeling an elephant,” Swartzberg said in an email to this news organization. “Everyone feels a part and describes the elephant differently.

“There is nothing wrong with the modeling; the problem is the poor data that we feed it.”

During a news conference on Monday, Newsom said that the number of people hospitalized due to coronavirus had increased 4.9% overnight to 2,509 and the number of patients in ICU beds has increased by 4.3% to 1,085.

But so far, the state has room for more. There are 7,345 ICU beds in California, of which 1,498 are in the Bay Area, according to a recent analysis by Kaiser Health News.

Newsom has declared a goal of identifying 50,000 additional hospital beds to complement the 70,000 licensed beds that already exist. The state has asked hospitals to identify 30,000 beds that could be repurposed to serve a surge in COVID-19 patients and is working with partners to find another 20,000.

And the rush to add more medical equipment to face a surge is continuing. The state has increased its number of ventilators from about 7,600 to more than 11,000 in recent weeks. It has also secured 4,316 additional hospital beds — a fourth of the overall goal — by transforming the Kings’ former arena and the Santa Clara Convention Center into temporary medical facilities for acute patients and taking over Seton Hospital in Daly City.

7 Healthcare-Related Items You May Have Missed in the $2T Coronavirus Stimulus Package

7 healthcare-related items you may have missed in the $2T ...

Source: FierceHealthcare, by Robert King

An enormous $2 trillion economic stimulus package includes major requirements for insurers to cover diagnostics and services associated with COVID-19 and gives some flexibility to hospitals.

A major part of the legislation, which passed the Senate in the early hours of Thursday morning and is set to get through Congress by the end of this week, is $100 billion to hospitals to help them meet the COVID-19 pandemic.

But the bill, which includes massive unemployment assistance and help to businesses, includes several other healthcare provisions.

  1. 1. Requiring Medicare Part D and Medicare Advantage plans to allow for refills and fills for up to three months. The provision does give exceptions for cost and utilization management like step therapy or prior authorization and medication therapy management.
  2. 2. Extending healthcare programs through November. The bill includes a raft of extensions for healthcare programs that were expected to run out of money on May 23. For instance, the bill would extend a delay of reductions in payments to disproportionate share hospitals until Dec. 1. The legislation also extends funding to community health centers through Nov. 30. Funding for the series of programs was extended at the end of last year through May 22. The goal was to give Congress more time to address drug prices and surprise medical bills. But Congress has been blindsided by responding to the COVID-19 pandemic, so work on those bills is likely delayed.
  3. 3. Waiving site-neutral payment cuts, 50% rule for long-term care hospitals. For the duration of the emergency period, the bill would waive the 50% rule, which cuts payments for long-term care hospitals where fewer than 50% of their Medicare patients get a standard payment. It also waives the site-neutral payment cuts installed this year for long-term care facilities for the duration of the emergency.
  4. 4. Eliminating Medicare sequester and boosting Medicare payments for COVID-19 payments. This provision was in the original legislation released by Senate Republicans. It would pause for the rest of the year the 2% cut for Medicare under sequestration. It would also boost payments to providers by 20% for COVID-19 related cases.
  5. 5. Requiring payers to cover hospital-made tests. Major insurers have largely agreed to waive co-pays for COVID-19 tests, but the bill also requires insurers to cover tests developed by hospitals. Major hospital groups and academic medical centers have been working on developing their own tests in-house to get results much faster. The provision ensures that those tests will also be covered.
  6. 6. Publishing the cash price for diagnostic testing. During the emergency period, each provider of a diagnostic test must put the cash price for a COVID-19 diagnostic test online. The Department of Health and Human Services could fine the diagnostic test provider if they aren’t in compliant by as much as $300 per day that the violation occurs.
  7. 7. Requiring group and individual health plans to cover preventive services. The bill defines preventive services as immunization or any other item or service intended to “prevent or mitigate coronavirus disease.”

Pelosi Floats New Stimulus Plan: Rolling Back SALT Cap

Pelosi Floats New Stimulus Plan: Rolling Back SALT Cap - The New ...

Source: The New York Times, by Jim Tankersley and Emily Cochrane

As lawmakers prepare for another round of fiscal stimulus to address economic fallout from the coronavirus pandemic, Speaker Nancy Pelosi suggested the next package include a retroactive rollback of a tax change that hurt high earners in states like New York and California.

A full rollback of the limit on the state and local tax deduction, or SALT, would provide a quick cash infusion in the form of increased tax rebates to an estimated 13 million American households — nearly all of which earn at least $100,000 a year.

In an interview with The New York Times, Ms. Pelosi said the next phase of an economic rescue package should include additional measures to get more money directly to individuals — like the $1,200 direct payments for low- and middle-income taxpayers that were authorized in the $2 trillion bill that President Trump signed on Friday.

That could be achieved, she said, by having Congress “retroactively undo SALT,” a reference to a cap on the state and local tax deduction that Republicans included in their 2017 tax overhaul. That limit prevents households from deducting more than $10,000 a year in state and local tax expenses from their federal tax bills.

Henry Connelly, a spokesman for Ms. Pelosi, said on Monday evening that she was proposing something narrower than a full SALT rollback, and that any change would be “tailored to focus on middle-class earners and include limitations on the higher end.”

“We could reverse that for 2018 and 2019 so that people could refile their taxes” and receive more money back from the government, Ms. Pelosi said in the interview. “They’d have more disposable income, which is the lifeblood of our economy, a consumer economy that we are.”

In the 2018 midterm elections, Democrats wielded the SALT limits in House campaigns against Republicans in wealthy blue-state suburbs of cities like New York, Los Angeles and Chicago. Democrats voted last year to repeal the cap, but the effort died in the Republican-controlled Senate.

Republicans called the effort hypocritical, saying that it would primarily benefit wealthy households in high-tax states. Democrats had roundly denounced the 2017 law, which included rate cuts for businesses and individuals, as a handout to the rich. But the SALT deduction overwhelmingly benefits high earners.

“The ink is hardly dry on a $2 trillion-plus emergency package,” said Senator Patrick J. Toomey, Republican of Pennsylvania. “It’s far too soon to know whether and of what nature additional legislation is needed. If we determine that another measure is necessary, it should not be the vehicle for Speaker Pelosi’s partisan, parochial wish list.”

The congressional Joint Committee on Taxation estimated last year that a full repeal of the SALT limit for 2019 alone would reduce federal revenues by about $77 billion. Americans earning $1 million a year or more would collectively reap $40 billion of those benefits. Most of the rest would go to households earning $200,000 or more.

That is a contrast with the bill Mr. Trump signed on Friday, which began to phase out direct payments for households earning $150,000 or more.

Ms. Pelosi’s proposal represents “the way to get money into the hands of people who don’t benefit from the $1,200 checks because they make too much money,” said Kyle Pomerleau, a resident fellow at the conservative American Enterprise Institute. “It certainly gets money into hands. But I’m not sure it’s the correct hands.”

Many liberal economic policy analysts also oppose lifting the SALT cap, calling it regressive tax policy. Seth Hanlon, a senior fellow at the liberal Center for American Progress, said the same logic was also a reason not to lift the limit in the next economic rescue bill. That is particularly true because consumption data show that low- and middle-income Americans are more likely than higher earners to spend benefits from the government immediately and stimulate economic activity.

To continue with direct assistance, Mr. Hanlon said, “there are ways you could target it to truly middle-class people. The problem is, relatively few middle-class people claim SALT.”

The Tax Policy Center estimates that only 3 percent of households in the middle quintile of American taxpayers would receive any benefit at all from the SALT cap repeal.

“In and of itself,” Mr. Hanlon said, “it doesn’t strike me as the most effective way of targeting economic stimulus.”

Ford, GE to Produce 50,000 Ventilators in 100 days

Ford will produce 50,000 ventilators in the next 100 days to fight ...

Source: Reuters, by Nick Carey

Ford Motor Co said on Monday it will produce 50,000 ventilators over the next 100 days at a plant in Michigan in cooperation with General Electric’s healthcare unit, and can then build 30,000 per month as needed to treat patients afflicted with the coronavirus.

Ford said the simplified ventilator design, which is licensed by GE Healthcare from Florida-based Airon Corp and has been cleared by the Food and Drug Administration, can meet the needs of most COVID-19 patients and relies on air pressure without the need for electricity.

Officials in states hard hit by the pandemic have pleaded with the Trump administration and manufacturers to speed up production of ventilators to cope with a surge in patients struggling to breathe. Hospitals in New York already are using one ventilator to sustain two patients. New Orleans has a fraction of the ventilators it needs for a surge of COVID-19 patients, Louisiana officials said.

On Friday, President Donald Trump said he would invoke powers under the Defense Production Act to direct manufacturers, including Ford and General Motors Co, to produce ventilators.

On Monday, the head of the United Auto Workers and other officials compared the auto industry’s effort to build ventilators to Detroit’s conversion to bomber production during the World War Two.

Ford said it plans to begin production of ventilators at a plant in Ypsilanti, Michigan, deploying 500 United Auto Workers employees.

It said it plans to start production at the facility the week of April 20. That is roughly when New York officials expect the peak of COVID-19 cases to hit their state.

Ventilators built by Ford, GM and others could be used in other parts of the United States where the peak case loads are expected later.

GM said Sunday it plans to produce up to 10,000 ventilators a month by this summer at a plant in Kokomo, Indiana.

The Ypsilanti workers will be stationed at a safe distance apart and will be screened for symptoms of coronavirus infection before they enter the plant, Ford officials said.

“We’re using and deploying a whole host of technologies to keep workers safe,” said Adrian Price, director of global manufacturing core engineering for Ford. The safety procedures will be adapted from work Ford and the UAW have been doing to prepare for the automaker to reopen other U.S. factories, Price said.

Separately, GE and Ford engineers are working together to boost production at a GE plant in Madison, Wisconsin, of a GE ventilator, different from the model licensed from Airon.

GE expects to double ventilator output from the Wisconsin plant during the second quarter, Tom Westrick, GE Healthcare’s vice president for quality, said during a call with reporters on Monday.

Last Updated 04/08/2020

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