California Hospitals Prepping For Grim COVID-19 Choices

Source: Modern Healthcare

California hospitals struggling with a skyrocketing coronavirus surge are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don’t have to make that choice.

The state avoided surging cases for months, but now the virus is raging out of control there and across the nation in the wake of Thanksgiving holiday gatherings that authorities say vastly spread infections. Only Arizona tops California in cases per resident.

The state this week ordered hospitals in the hardest-hit areas to delay many elective surgeries in order to free up space.

In Los Angeles County, Methodist Hospital of Southern California convened an in-house triage team that makes daily evaluations “about the severity of critically ill patients that allows us to distribute resources to those who need it the most,” chief strategy officer Cliff Daniels said.

The hospital isn’t rationing care “and we hope we don’t get there,” Daniels said.

However, guidelines posted on the hospital’s website warn: “If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources … may be allocated to another patient who is more likely to survive.”

Los Angeles County, the nation’s most populous with 10 million residents, is one of nearly two dozen in Southern California and the agricultural Central Valley that have essentially run out of intensive care unit beds for COVID-19 patients.

Health officials warned Wednesday that hospitalizations will continue for at least the next three weeks as people who ignored social distancing rules to gather for Christmas and New Year’s Eve fall ill.

Hospitals statewide with room have been told to accept patients from others that have exhausted their ICU beds but in fact most of the state is reporting struggling to provide ICU beds, with non-COVID-19 patients spilling into corridors, tents and cafeterias.

To the north, officials in Santa Clara County, with about 2 million residents, say 100 infected people a day are winding up in hospitals.

“And as awful as it is, it could get worse,” said Dr. Ahmad Kamal, the county’s director of Healthcare System Preparedness. “We haven’t had a situation where two people are out of breath and one person gets a ventilator. We could get there.”

California reported its second-highest number of daily coronavirus deaths Wednesday with 459 lives lost, bringing the death toll to 2,504 in the last week as more than a quarter-million new weekly cases portended a continued overwhelming crush.

Vaccinations being administered at what Gov. Gavin Newsom has said is too slow a pace will take weeks or months to slow the spread.

About 12% of people who test positive for COVID-19 eventually are likely to need hospital care, authorities have estimated.

“The numbers are extraordinary,” said Carmela Coyle, president and CEO of the California Hospital Association. “We’re not going to dodge this math. We need the state’s help.”

State officials also should override decisions by many county health officers that prevent recovering coronavirus patients from being released to skilled nursing facilities, despite fears that they could spread the virus, Coyle said.

“Focus on nothing other than saving lives for the next few weeks,” Coyle said.

L.A. County, which is recording more than 200 deaths a day, has seen a rate of new COVID-19 cases nearly double that of December, health officials said.

More than 8,000 people are hospitalized with COVID-19 — with a fifth of them in intensive care — and more than a third of adult hospital beds are occupied by virus patients, said Barbara Ferrer, the county public health director.

“This is a health crisis of epic proportions,” Ferrer said.

COVID-19 Still A Big Uncertainty For Insurers In 2021

Finance earnings stock ticker graph

Source: Nimbus-T PPE, by Nona Tepper

Given the continuation of the pandemic, health insurers are steeling themselves for a possible bumpy ride. Industry analysts said they expect 2021 to be a volatile year for insurers, although nothing can compare to the dramatic peaks and valleys in profits publicly traded companies reported in the first half of 2020.

Moody’s Investors Service forecasts mid- to single-digit earnings growth among insurers in 2021. “The need to control health costs has been a huge problem for the industry and for the country,” said Dean Ungar, vice president and senior credit officer at Moody’s. “The health insurers know that their future in a way depends on helping keep costs under control without government intervention and government meddling. The insurers are investing in things like value-based care and digital, remote monitoring.”

During the first two quarters of 2020, hospitals deferred elective procedures and health plan members put off routine doctor appointments. Those care deferrals are expected to continue at insurance giant UnitedHealth Group, John Rex, chief financial officer at the Minnetonka, Minn.-based health insurer, said at an investors conference in December.

Rex said he expects the deferral of care to continue into 2021, with the spike in COVID-19 cases this winter keeping members out of hospital waiting rooms, although not at the levels seen in 2020.

He said the missed preventive tests and procedures people delayed would result in more severe illness when they’re diagnosed, plus COVID-19 could also have long-term health effects on patients’ health that may be expensive for insurers.

UnitedHealth expects COVID-19 testing, treatment and other pandemic-related costs to reach $2 billion in 2021, with about 75% of that total coming from its insurance subsidiary UnitedHealthcare’s bottom line.

“Certain populations, particularly seniors, have deferred care,” Rex said. “Some have not seen a doctor at all in 2020, which impacts their health, and our ability to close gaps in care and properly document conditions that surely still exist. This could affect final risk scores in 2021.”

Some insurers expect a lower amount of traditional claims to offset the high costs of COVID-19 treatment. Mary Anne Jones, chief financial officer at Priority Health, said she expects the Grand Rapids, Mich.-based insurer’s finances in 2021 to mirror the third and fourth quarters of the previous years for the company, which is a subsidiary of Spectrum Health.

“Accidents aren’t happening like they had happened in the past,” Jones said. Sports-related injuries and contagious conditions beside COVID-19 are down because people are doing so much mask wearing and social distancing, which is offsetting the added costs of treating the coronavirus.

California Oks Expansion Of Who Can Get COVID-19 Vaccine To Avoid Doses Going To Waste

Nurse Cherry Costales prepares Pfizer-BioNTech COVID-19 vaccine at St. John's Well Child & Family Center in Los Angeles.

Source: Los Angeles Times, by Colleen Shalby

In an effort to avoid wasting COVID-19 vaccine and help speed up the vaccine rollout, the state is instructing local health departments and providers to expand vaccine prioritization to community healthcare workers, public health field staff, primary care clinics, specialty clinics, laboratory workers, dental clinics and pharmacy staff.

The state has also told officials that if a surplus remains even after all those eligible to receive the Pfizer-BioNTech and Moderna vaccine under expanded criteria have been granted access, they should move to Tier 1 of the next phase of distribution, which has not yet officially taken effect.

That group includes individuals who work in education, child care, emergency services, food and agriculture, as well as those 75 and older.

The announcement comes amid a slower than anticipated vaccine rollout throughout the state. The slowdown has been blamed on a variety of issues including the fact that some frontline workers have declined the vaccine and the state has lacked a regimented plan when it comes to leftover doses.

On Monday, Gov. Gavin Newsom said that distribution rules would be eased to prevent vaccine from going to waste.

“We want to see 100% of what’s received immediately administered in people’s arms, and so that’s a challenge,” he said during a briefing. “It’s a challenge across this country — it’s a challenge, for that matter, around the rest of the world. But that’s not an excuse.”

Last month, the state health department released guidance that said vaccine doses may be offered to people in lower priority groups when demand eases and doses are about to expire.

“Health Departments may temporarily adjust prioritization based on other resource constraints while continuing efforts to immunize higher priority groups as soon as feasible,” the guidelines state.

To date, a total of 586,379 vaccine doses have been administered throughout the state. A total of 2,052,025 doses, which includes the first and second dose, have been shipped to local health departments and facilities, CDPH said.

With Virus Surging, Biden To Speed Release Of COVID Vaccines

Source: Associated Press, by Ricardo Alonso-Zaldivar and Zeke Miller

With COVID-19 surging and vaccinations off to a slow start, President-elect Joe Biden will rapidly release most available vaccine doses to protect more people, his office said Friday, a reversal of Trump administration policies.

“The president-elect believes we must accelerate distribution of the vaccine while continuing to ensure the Americans who need it most get it as soon as possible,” spokesman T.J. Ducklo said in a statement. Biden “supports releasing available doses immediately, and believes the government should stop holding back vaccine supply so we can get more shots in Americans’ arms now.”

Biden’s plan is not about cutting two-dose vaccines in half, a strategy that top government scientists recommend against. Instead, it would accelerate shipment of first doses and use the levers of government power to provide required second doses in a timely manner.

The Trump administration has been holding back millions of doses of vaccine to guarantee that people can get a second shot, which provides maximum protection against COVID-19. It’s seen as a prudent approach, since both the Pfizer-BioNTech and Moderna vaccines require a second shot after the first vaccination.

Health and Human Services Secretary Alex Azar raised questions about Biden’s plan, telling a hospital forum on Friday that “we’re pushing the system as much as I as secretary believe is ethically and legally appropriate.”

But a recent scientific analysis in the journal Annals of Internal Medicine estimated that a “flexible” approach roughly analogous to what Biden is talking about could avert an additional 23% to 29% of COVID-19 cases when compared to the “fixed” strategy the Trump administration is following. That’s assuming a steady supply of vaccine.

After a glow of hope when the first vaccines were approved last month, the nation’s inoculation campaign has gotten off to a slow start. Of 21.4 million doses distributed, about 5.9 million have been administered, or just under 28%, according to the Centers for Disease Control and Prevention.

Biden has indicated his displeasure with the progress of vaccinations.

“I think the way it’s being done now has been very, very sad,” he said at his news conference Friday.

The Trump administration’s “Operation Warp Speed” has delivered vaccines to the states, he said, “but did not get them from those vials into people’s arms,” he continued. “And so it is a gigantic logistical concern of how we do that.”

Biden says he intends to speed up vaccinations by having the federal government deliver more vaccines and take a stronger role ensuring that they are being administered.

The American Hospital Association estimates that the nation would need to vaccinate 1.8 million people a day, every day, from Jan. 1 to May 31, to reach the goal of having widespread immunity by the summer. That’s also called “herd immunity” and would involve vaccinating at least 75% of the population.

Biden has set a goal of administering 100 million shots in the first 100 days of his administration. He’s previously said that he and Vice-President elect Kamala Harris have been talking with state and local leaders about meshing the efforts of governments at all levels. Among the specifics: opening up vaccination centers and sending mobile vaccine units to hard-to-reach communities.

The Biden transition office said its experts believe that pushing out available vaccine as fast as possible will not create problems for people needing their second dose. Biden will make broader use of a Cold War-era law to direct private industry to supply materials for vaccine production, should that become necessary, his office said. One-shot vaccines are moving through development.

Former Food and Drug Administration head Mark McClellan said he agrees with Biden’s decision, but the increased supply of vaccines has to be coupled with steps to get shots actually administered.

“We’re holding back more doses than we really need to,” McClellan said in an interview. But “this needs to be combined with steps to increase the administration of vaccines, or it won’t make much difference.” McClellan, who served under former Republican President George W. Bush, now leads a health policy center at Duke University.

But Azar, President Donald Trump’s health secretary, said if vaccine production doesn’t increase Biden’s approach could lead could lead to “fits and starts” in vaccination. “What we’ve set up is a system that manages the flow, to maximize the number of first doses, but knowing there will be a second dose available,” Azar said, defending the Trump administration’s decision.

Biden announced his plan after eight Democratic governors wrote the Trump administration on Friday urging it to do as much.

“The federal government currently has upwards of 50% of currently produced vaccines held back,” the governors wrote. “While some of these life-saving vaccines are sitting in Pfizer freezers, our nation is losing 2,661 Americans each day, according to the latest seven-day average. The failure to distribute these doses to states who request them is unconscionable and unacceptable. We demand that the federal government begin distributing these reserved doses to states immediately.”

The letter was signed by Govs. Gretchen Whitmer of Michigan, Gavin Newsom of California, Laura Kelly of Kansas, J.B. Pritzker of Illinois, Tim Walz of Minnesota, Andrew Cuomo of New York, Jay Inslee of Washington, and Tony Evers of Wisconsin.

With the winter wave of the pandemic pushing deaths to record levels, and hospitals overwhelmed in cities large and small, some have called on the government to authorize using just one dose of the Pfizer and Moderna vaccines. That would indeed confer a boost of immunity.

However, government scientists including Dr. Anthony Fauci have said the vaccines should continue to be used as prescribed under their emergency approval by the FDA. The two-shot regimen provides around 95% protection.

More than 365,000 Americans have died as a result of the pandemic, according to data from Johns Hopkins University. The seven-day average positivity rate for the nation has continued to rise since Christmas, and stood at 13.6% on Thursday, according to the COVID Tracking Project. That’s well above the 10% rate considered a marker of widespread contagion.

Biden spokesman Ducklo said the president-elect will share additional details next week.

Biden’s plan to change the vaccine distribution plan was first reported by CNN.

How COVID-19 Is Changing The Way HR Professionals Think About Employee Benefits

Stack of health insurance application forms with stethoscope on top

Source: Fierce Healthcare, by Paige Minemyer

COVID-19 is changing the way human resources professionals view employee benefits, a new survey shows.

Artemis Health, a data analytics company, polled 300 benefits leaders at firms with more than 5,000 employees and found that 78% reported employee health and well-being became a significantly higher priority over the course of 2020.

The number of professionals who identified improving employee health as a top goal doubled from 2019 to 2020, the survey found. Sixty-one percent of those surveyed named bettering health and well-being as their top goal in 2020, up from 36% the year prior.

“Employers increasingly recognize the role they play in an employee’s physical and mental well-being. During COVID-19, many benefits leaders are working with Artemis to measure the health impacts of the pandemic, such as stress, delayed care, and increased telemedicine usage,” said Grant Gordon, CEO and co-founder of Artemis Health, in a statement.

“Benefits analytics is a key tool for leaders looking to address gaps in employee benefits, improve employee well-being, and manage ever-increasing costs,” Gordon said.

The surveyed benefits professionals said they expect their focus on the issue to only grow in 2021.

Also as a result of the pandemic, the survey found that these professionals are increasingly motivated by improving the health of employees and less so by controlling costs. In 2020, 52% said improving health was their primary personal motivation, compared to 15% in 2019.

By contrast, just 5% said they were motivated by saving the company money, compared to 15% who said the same in 2019.

In addition, the survey found more benefits professionals feel they are “ahead of the curve” in planning for employees’ needs. Thirty percent of those surveyed said so, and 57% said they are keeping up with trends.

In 2019, 18% said they felt they were ahead of the curve on employee benefits.

Looking ahead, the survey found HR leaders are especially focused on mental well-being and the potential impacts on behavioral health as a result of the pandemic.

“During this turbulent time, more than ever, I need to figure out how to take care of our employees,” a director at a company with more than 50,000 workers said in the survey.

California Budget Reflects ‘Pandemic-Induced Reality,’ Governor Says

LOS ANGELES, CALIFORNIA - DECEMBER 14: Gov. Gavin Newsom holds up a vial of the Pfizer-BioNTech COVID-19 vaccine at Kaiser Permanente Los Angeles Medical Center on December 14, 2020 in Los Angeles, California. The first doses of the vaccine are being administered to frontline workers in hospitals across the country today. (Photo by Jae C. Hong-Pool/Getty Images)

Source: Kaiser Health News, by Angela Hart

The coronavirus pandemic doomed Gov. Gavin Newsom’s ambitious plans last year to combat homelessness, expand behavioral health services and create a state agency to control soaring health care costs.

But even as the pandemic continues to rage, California’s Democratic governor said Friday he plans to push forward with those goals in the coming year, due to a rosier budget forecast buoyed by higher tax revenue from wealthy Californians who have fared relatively well during the crisis.

Newsom’s $227.2 billion budget blueprint also prioritizes billions to safely reopen K-12 schools shuttered by the pandemic, $600 payments for nearly 4 million low-income Californians — in addition to federal stimulus payments — and coronavirus relief grants and tax credits for hard-hit small businesses.

However, his 2021-22 fiscal year spending plan does not include additional public health money for local health departments steering California’s pandemic response, which have been chronically underfunded. He vowed to support cities and counties by boosting state testing and contact tracing capacity, speeding vaccination efforts and funding state-run surge hospitals that take overflow patients.

Newsom said Friday his budget reflects a “pandemic-induced reality” with investments aimed at spurring California’s economic recovery by helping businesses and people living in poverty. Wealth and income disparities, he added, “must be addressed.”

But Democrats in control of the state legislature, county leaders and social justice groups say that will be difficult to achieve because Newsom’s spending plan does not sufficiently fund health and social safety-net programs.

And without additional public health money, local leaders worry California will not be able to adequately control the spread of the virus.

“County public health is drowning,” said Graham Knaus, executive director of the California State Association of Counties. “We are triaging right now between testing, contact tracing and vaccination, and it’s impacting the response to the pandemic.”

Newsom’s budget proposal is the first step in a months-long negotiation process with the Democratic-controlled legislature, which has until June 15 to adopt the state budget that takes effect July 1. Lawmakers have become increasingly frustrated with the governor’s response to the pandemic, including his unilateral spending decisions in response to the emergency. Newsom is also facing a burgeoning recall effort, backed by heavyweight Republicans such as former San Diego Mayor Kevin Faulconer, who is considering challenging Newsom in the 2022 California gubernatorial election.

Newsom said he expects to make some tough calls on spending even though the state anticipates a $15 billion budget surplus for the coming fiscal year, largely because a state fiscal analysis projected deficits in subsequent years.

“While we are enjoying the fruits of a lot of one-time energy and surplus, it’s not permanent and we have to be mindful of over-committing,” Newsom said, explaining why he didn’t include funding to expand Medicaid to more unauthorized immigrants.

Some lawmakers say they will nonetheless press Newsom to use higher-than-expected revenues — and perhaps seek new taxes — to expand health coverage to more Californians.

The following health care proposals factor heavily into Newsom’s 2021-22 budget proposal.

Covid Relief

Newsom committed $4.4 billion in his budget to vaccine distribution, increased testing, contact tracing and other short-term pandemic expenses. Because that spending is related to the public health emergency, the state expects at least 75% to be reimbursed by the federal government and insurance payments.

He also proposed $52 million to fund costs at state-run surge hospitals, including support staff. And he is asking lawmakers to sign off on a covid relief package that would provide funding before the start of the fiscal year in July. It would include $2 billion to help school districts reopen classrooms to in-person instruction beginning in February by paying for protective equipment, ventilation systems and adequate testing. It would also commit billions to economic recovery, such as stimulus payments for individuals, and grants and tax credits for struggling small businesses.

Newsom also wants to increase the budget for the Department of Industrial Relations by $23 million to fund up to 113 additional workplace inspectors at the California Division of Occupational Safety and Health to police health order violations at businesses and enforce workplace safety laws.

Transforming Medi-Cal

Spending for Medi-Cal, the state’s Medicaid program for low-income residents, is expected to grow in the coming year because of the economic impact of the pandemic — as is its enrollment. The program has roughly 13 million enrollees, or about one-third of the state population.

In the coming year, Newsom will also press forward with a major overhaul of Medi-Cal, through a project called CalAIM, to provide new benefits emphasizing mental health care and substance use treatment, and pay for some nontraditional costs such as housing assistance. The hope is the program would divert homeless and other vulnerable people away from expensive emergency room care and keep them out of jail.

State Medi-Cal officials estimate the program would cost $1.1 billion for the first year. The state is working with the federal Centers for Medicare & Medicaid Services to obtain approval for the program.

Newsom also wants to expand Medi-Cal benefits to cover over-the-counter cold medicine and blood glucose monitors for people with diabetes. His budget includes $95 million for a major expansion of telehealth services that would permanently provide higher payments for virtual doctor visits.

Controlling Health Care Costs

Newsom is proposing a new state agency, the Office of Health Care Affordability, which he said would help control health care costs. He budgeted $63 million over the next three years for the office, which would set health care cost targets for the health care industry — along with financial penalties for failing to meet future targets.

Powerful health industry groups said they are still assessing whether they will support the proposal. But some expressed concern last year when Newsom floated the idea. Doctors and hospitals routinely fight proposals in Sacramento that might limit their revenue.

Newsom acknowledged Friday the task would be “tough.”

Battling Homelessness and Food Insecurity

Newsom is proposing a one-time infusion of $1.75 billion to battle homelessness.

Of that, Newsom said, $750 million would help counties purchase hotels and transform them into permanent housing for chronically homeless people. Another $750 million would allow counties to purchase facilities to treat people with mental illness or substance use disorders. And $250 million would help counties purchase and renovate homes for low-income older people.

Newsom’s budget also includes $30 million to help overwhelmed food banks and emergency food assistance programs.

Lawmakers said they plan to negotiate for even more funding for homelessness and safety-net programs.

“We absolutely need to significantly increase our investment to address homelessness because the need is so intense,” said Assembly member David Chiu (D-San Francisco). “And I don’t think there’s a single legislator who isn’t incredibly concerned about the food insecurity we’re seeing: lines around the block for food banks in what should be the wealthiest state in the country.”

Expanding Health Coverage

Newsom did not include money in his proposed budget to expand Medi-Cal to unauthorized immigrants age 65 and older. He had previously promised to fund the proposal, estimated to cost $350 million per year once fully implemented, but he said Friday the state cannot afford to commit to ongoing costs with a projected budget deficit starting in fiscal year 2022-23. California already offers full Medicaid benefits for income-eligible unauthorized immigrants up to age 26.

Some lawmakers and health care advocates countered that providing health insurance for undocumented immigrants would save lives and reduce costs, especially during the pandemic, and vowed to continue to fight for the expansion.

“To say we are disappointed is describing it very lightly,” said Orville Thomas, a lobbyist with the California Immigrant Policy Center. “These are Californians dying and getting sick at disproportionate rates during covid.”

Dems Take The Senate: What Does It Mean For Health Care?

U.S. Senate Chamber, empty

Source: BenefitsPRO, by Alan Goforth

Victories by Democrats Raphael Warnock and John Ossoff in Georgia’s Senate runoffs Tuesday have changed the dynamics for health-care legislation. However, experts believe that small changes are more likely than major structural overhauls, according to the New York Times.

A series of tweaks bolstering the Affordable Care Act stand the best chance of passage. Legislators could make insurance subsidies more generous, get coverage to low-income Americans in states that haven’t expanded Medicaid and render moot a pending Supreme Court lawsuit that aims to overturn the entire law.

But structural overhauls such as Medicare for All, which would move all Americans to a government-run health plan, face a much tougher road. So would elements of Joe Biden’s health agenda, such as a public option, which would give Americans a choice between a new public plan and private insurance.

There are several areas of health policy where congressional aides and health policy experts could see Democrats focusing their efforts this year. Smaller policy reforms are expected to be easier, both legally and politically, while more ambitious policies may not easily slot into strict parliamentary rules — or the political preferences of enough Democratic lawmakers.

ACA expansion

Congress is most likely to act on a set of changes meant to expand the ACA and make health coverage less expensive for those who buy their own plans. One priority is raising the income ceiling for those who receives subsidies, which would expand the number of people who qualify for help. Another is rewriting formulas to peg the size of the subsidy to a more generous health insurance plan, a way to increase the amount of assistance.

Closing the Medicaid gap

In the 12 states that do not participate in the health law’s Medicaid expansion, millions of low-income Americans are left without affordable coverage options. Many Democrats are eager to change this but have so far been stymied by states’ decisions to decline the program. One option that has been floated is to extend the ACA’s tax credits to this population. They wouldn’t get to enroll in Medicaid, but they would have access to a highly subsidized private plan on the health law’s marketplace.

Reducing drug prices

Lowering drug prices has been a Democratic policy priority for many years, and one that Biden endorses, at least in general. Experts believed that certain drug pricing controls might be possible with reconciliation, since they have clear budgetary effects. But the politics of passage could be difficult with narrow majorities in both the House and Senate and such strong opposition from the drug industry.

Public option

Biden included a public health insurance option, available to all Americans, in his 2020 campaign platform. The slim majority in the Senate, however, may make it hard to move this type of plan forward.

Medicare for All

The obstacle to such a plan is more likely political than procedural. Currently, a majority of House Democrats back Medicare for all, but that would not be nearly enough votes to pass such a bill. An even smaller share of senators back the plan.

Newsom Recall Effort Gets $500K Boost From Orange County Firm

Newsom searches for messaging rhythm as coronavirus fatigue sets in

Source: Politico, by Jeremy B. White

A campaign to recall Gov. Gavin Newsom has received its first six-figure infusion, underscoring the effort’s potential.

Irvine-based consulting firm Prov 3:9, LLC contributed $500,000 to one of the committees seeking to put a recall election before California voters. The effort also received roughly $100,000 from Sequoia Capital partner Douglas Leone and his wife Patricia Perkins-Leone, who donated hundreds of thousands of dollars to President Donald Trump and allied Republican groups this last campaign cycle.

Why it matters: Statewide campaigns require lots of money, usually in the millions of dollars, and political observers have been closely watching to see if major donors step up for the recall effort. Now the first major sum has landed, bolstering the recall’s chances.

The background: The longshot recall effort has gathered steam in recent months as Newsom has faced criticism for his management of the pandemic. The governor’s decision to attend a top aide’s birthday celebration at the opulent French Laundry restaurant crystallized frustration with stringent restrictions and a sense that Newsom was not abiding by the rules.

Proponents got a major boost last month when a judge gave them three additional months to collect the roughly 1.5 million signatures they would need to certify a recall. Proponents have said they have some 800,000 signatures, but getting enough valid signatures would likely mean collecting close to 2 million given that a share of them are typically deemed invalid.

The California Republican Party has been promoting the effort, as has former Republican gubernatorial candidate John Cox. It has begun to gain national media attention, including the blessings of conservative media figures like former House Speaker Newt Gingrich and former Arkansas Gov. Mike Huckabee.

The 2003 recall of former Gov. Gray Davis succeeded in part because of former Rep. Darrell Issa pouring money into the effort. So far, the 2020 Newsom recall effort has only seen a smattering of smaller five-figure donations.

Donor info: Prov 3:9, LLC has very little public trace. The company filed paperwork with the state in 2018 listing Gordon Schaller as the California agent. Subsequent filings list Schaller, as well as Thomas Liu as the manager, with “consulting services” as the type of business.

The company’s address is for the White Nelson Diehl Evans CPA firm in Irvine, where Liu is listed as a partner.

“We have our beliefs in terms of the direction the state needs to go, and we felt that this effort was worthy of our contribution,” Liu said in an interview.

Schaller, a licensed Orange County attorney, did not immediately respond to a request for comment.

Prov 3:9 does not yet have a major donor filing on the Secretary of State’s website. Any donor contributing $10,000 or more is required to file with the office. The firm, Liu and Schaller also do not have records of past state contributions.

The company’s name could refer to Proverbs 3:9 in the Bible, which says to “Honor the Lord with your wealth, with the firstfruits of all your crops.”

What’s next: Half a million dollars is a substantial sum but still not enough to collect all of the remaining signatures needed. But the money could signal the recall’s seriousness to other prospective donors, potentially encouraging them to open their wallets.

FDA Says People Need Both Doses Of Coronavirus Vaccines

FDA says people need both doses of coronavirus vaccines - CNN

Source: CNN Health, by Maggie Fox

Anyone who receives the Moderna or Pfizer vaccine must get two full doses, two top US Food and Drug Administration officials said Monday.

They also dismissed other ideas for stretching the vaccine supply and said people who are speculating about the possibility of making do with just one dose or cutting doses in half are misinterpreting the data.

“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19,” FDA Commissioner Dr. Stephen Hahn and Dr. Peter Marks, who heads FDA’s vaccine division, said in a statement.

“These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19,” they added.

Operation Warp Speed’s top adviser, Moncef Slaoui, told CNN Sunday that the FDA would consider giving half-doses of Moderna’s Covid-19 vaccine to people 18 to 55 — which could make the vaccine available to twice as many people in this age group.

Slaoui said earlier data show that the vaccine appeared to elicit effective antibody responses among volunteers under age 55 who received either the full 100-microgram dose or a half dose. While an FDA briefing document last month also references these “comparable” immune responses from Moderna’s phase 2 study, the full data have not yet been published.

But Marks and Hahn said these findings covered only a very few people who were not followed for long to see if their immune responses held up over time.

“What we have seen is that the data in the firms’ submissions regarding the first dose is commonly being misinterpreted. In the phase 3 trials, 98% of participants in the Pfizer-BioNTech trial and 92% of participants in the Moderna trial received two doses of the vaccine at either a three- or four-week interval, respectively,” they wrote.

“Those participants who did not receive two vaccine doses at either a three-or four-week interval were generally only followed for a short period of time, such that we cannot conclude anything definitive about the depth or duration of protection after a single dose of vaccine from the single dose percentages reported by the companies.”

British officials have said they will allow more than 21 days between doses of Pfizer’s vaccines and would consider allowing people to get vaccinated with two different vaccines. Hahn and Marks dismissed these ideas for the US.

“The available data continue to support the use of two specified doses of each authorized vaccine at specified intervals. For the Pfizer/BioNTech COVID-19 vaccine, the interval is 21 days between the first and second dose. And for the Moderna COVID-19 vaccine, the interval is 28 days between the first and second dose,” they wrote.

It’s understandable that people may want to stretch the vaccine supply, they said. But it’s not advisable.

“If people do not truly know how protective a vaccine is, there is the potential for harm because they may assume that they are fully protected when they are not, and accordingly, alter their behavior to take unnecessary risks,” they said.

Dr. Paul Offit, an infectious disease specialist at the University of Pennsylvania, told CNN he thought cutting vaccine doses in half was a bad idea.

“There’s no data on efficacy of a half dose. If you use a half dose, you’re just making it up. You’re just hoping that you’re right,”added Offit, a member of the FDA’s Vaccines and Related Biological Products Advisory Committee. “Why would you dare to make up something when you don’t know whether or not it works?”

Dr. Arnold Monto, who was acting chair of the committee during the meetings last month to consider Moderna’s and Pfizer’s vaccine applications, told CNN Monday that cutting the dose would be out of the ordinary. “This would be a very unusual step, given the fact that this was not studied in Phase 3, but emergency use is also a very unusual step,” said Monto, a professor of epidemiology at the University of Michigan.

Medicare For All May Die In 2021

Medicare For All May Die In 2021

Source: Forbes, by Bruce Japsen

A closely divided Congress and a moderate Democrat in Joe Biden in the White House doesn’t bode well for a government-run single payer version of Medicare for All to emerge in 2021 despite the coming end of Donald Trump’s presidency.

As Democrats talk about ways to strengthen the Affordable Care Act and possibly expand Medicare to age 60, it seems far less likely anything will emerge to resurrect Medicare for All or a related single-payer version of healthcare reform even with key supporters of such health policy serving in high-ranking roles in the Biden administration.

Both vice president-elect Kamala Harris and Biden’s pick for U.S. Secretary of Health and Human Services – Xavier Becerra – were supporters of Medicare for All while they served in Congress and would seem to be in a position to push it on the legislative front.

But Democrats have a slim majority in the U.S. House of Representatives and at best may control the Senate by a single vote even if the party wins two U.S. Senate runoff elections next week in Georgia. Such slim control of Congress doesn’t bode well for any effort to greatly expand Medicare or add a Medicare-like public option as a health plan choice alongside commercial offerings on the ACA’s public exchanges, analysts say

“It is hard to see how the more ambitious parts of the Biden health agenda, can move through Congress without a Democratic majority in the Senate,” says Tricia Neuman, senior vice president at the Kaiser Family Foundation and executive director of the group’s program on Medicare policy. “Even if the Georgia election results in Democratic control of the Senate, it would still be a challenge with such a narrow margin.”

Further complicating any major Medicare expansion like the government-run single payer version of Medicare for All is that millions of seniors continue to flock to privatized Medicare Advantage. Biden is on record as supporting the private insurer’s role in administering Medicare benefits and offering coverage on the ACA’s exchanges.

And seniors like Medicare Advantage with enrollment doubling over the past decade to more than 24 million this year.

Practically every major health insurer selling Medicare Advantage expanded into new regions to offer more plans in 2021. CVS Health’s Aetna unit, Cigna, Humana and UnitedHealth Group were among the big health insurers offering more Medicare Advantage health benefit options in 2021 including richer benefit packages with lower co-payments.

Still, the New York Times reported a month ago Becerra would have powers to help expand coverage on a state by state basis via his waiver authority which “states can use to cover new groups or provide different types of health plans.”

“Without a Senate majority, it will be hard to advance some of the fundamental planks of the administration’s plans,” the Robert Wood Johnson Foundation’s Katherine Hempstead told the Times. “That’s where the waiver authority becomes important.”

Last Updated 01/13/2021

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