Payers, Providers And States Likely Have More Time Until COVID-19 Health Emergency Ends

Payers, providers, states have more time until COVID emergency ends

Source: Fierce Healthcare, by Robert King

The healthcare industry likely has until this fall to face the end of the COVID-19 public health emergency (PHE) as a key deadline came and went with no notice Monday.


The Department of Health and Human Services (HHS) promised to give states a 60-day notice when the PHE will end, giving a vital heads-up for when a slew of regulatory flexibilities that have been in place for more than two years will go away. The current PHE will run until July 16, and HHS did not provide any notice that it won’t be extended again for another 90 days.

The decision to not give a 60-day notice comes after an intense lobbying effort from healthcare providers that are worried about the flexibilities of the PHE going away amid a potential new surge of COVID-19.

“The risk from COVID-19 variants remains, and case rates are currently rising across the country,” said the letter from 16 health groups to HHS leadership dated May 10. “Throughout the pandemic, we have painfully learned that the rapid global spread of new variants has resulted in significantly increased transmission rates and infections in the U.S.”

Some health groups and state Medicaid officials have asked HHS Secretary Xavier Becerra to give them more than a 60-day notice of the PHE going away. A key reason is that states agreed to get a 6.2% increase in federal Medicaid matching funds in exchange for not dropping anyone off Medicaid for the duration of the PHE. Once the PHE ends, states will have up to 14 months to fully redetermine whether Medicaid beneficiaries are still eligible.

Becerra has shot down giving more notice, previously saying the PHE can only be extended for 90 days at a time. Becerra has also said that any decision on the PHE will be made via the science.


The PHE brought a series of major regulatory flexibilities that could go away once it expires, chief among them in telehealth. The Centers for Medicare & Medicaid Services temporarily removed barriers that include originating site requirements and audio-only restrictions for telehealth services, enabling providers to get reimbursement from Medicare for the new technology.

The flexibilities, however, only last through the PHE. Several bills introduced this session aim to offer to extend the telehealth flexibilities for several months past the PHE to determine what should be made permanent.

Trump v. Clinton: How They Line Up On Health

The Philadelphia Inquirer offers an analysis on the Candidate’s Position on health care. The following is a summary the article:

Health insurance

  • Clinton: Wants to improve the Affordable Care Act. She wants to reduce the cost of health insurance purchased on exchanges and provide a tax credit of up to $5,000 a family to offset out-of-pocket costs and premiums above 5% of household income. She would expand tax credits and cap the cost of premiums at 8.5% of family income. She calls for fixing the “family glitch” so families can access coverage in the exchanges when their employer’s family plan is not affordable. She would allow undocumented immigrants to buy insurance through the exchanges. In what is seen as a nod to Bernie Sanders’ supporters, she is affirming support for a public option that would allow people as young as 55 to buy health insurance through Medicare.
  • Trump: Opposes requiring people to buy health insurance. He wants to repeal the Affordable Care Act. He proposes to make coverage more affordable by allowing sales of health insurance across state lines and permitting people to deduct health insurance premium payments from their taxes. He would emphasize tax-deductible health savings accounts (HSA) where funds could accumulate if they are not used. He wants to require price transparency by health-care providers so that people can shop around for the best prices. He also wants would-be immigrants to certify that they can pay for their own health care.

Prescription drugs

  • Clinton: Wants to eliminate tax breaks that pharmaceutical companies get for direct-to-consumer advertising, and require those that benefit from federal research spending to reinvest profits into research. She would ban legal settlements in which pharma companies pay competitors so they will hold off on introducing generics and would allow consumers to import cheaper drugs from countries such as Canada. She supports allowing Medicare to negotiate lower drug prices and would cap out-of-pocket costs for people with chronic health problems.
  • Trump: Calls for a free market for prescription drugs, including allowing consumers to import them from countries that regulate prices. This practice is now illegal, though the law is not firmly enforced.


  • Clinton: Supports president Obama’s proposal to let states that sign up for Medicaid expansion to get a 100% match for the first three years. She would expand access to Medicaid and children’s health insurance.
  • Trump: Wants states to get federal Medicaid funding through block grants, which could mean fewer dollars for many states, but would give local officials more authority over expenditures.


  • Clinton: Has vowed to fight proposals to privatize or phase out Medicare, and would give Medicare the power to negotiate lower drug costs.
  • Trump: Is against abolishing Medicare.

Social Security

  • Clinton: Opposes privatizing Social Security, reducing annual cost-of-living adjustments, and raising the retirement age. Clinton would expand Social Security for some, such as widows and caregivers, and help to fund the benefit through a wealth tax.
  • Trump: Has voiced support for Social Security and called it “honoring a deal.” He has said that Republicans cannot win elections if they seek to change it substantially.

Veterans Administration

  • Clinton: Says she would ensure more timely benefits, block privatization efforts, and strengthen services for military families and employment programs for veterans.
  • Trump: Has vowed to reform the agency and make it more efficient in delivering service and employment assistance.


  • Clinton: Wants to protect access to safe and legal abortion.
  • Trump: Back in 1999, he told Meet the Press that, despite his personal dislike of abortion, “I’m very pro-choice.” More recently, he announced, “I am pro-life.” This year, Trump he said on MSNBC that if abortion were banned, women who violated the law would have to be punished. Soon after, his campaign released a statement saying that providers, not patients, should be held liable. His running mate, Indiana Gov. Mike Pence, has backed some of the nation’s toughest abortion restrictions.


  • Clinton: Her proposals include funding research to seek a cure; finding more affordable treatment, including capping prescription costs; urging all states to extend Medicaid coverage for people living with HIV; and increasing use of HIV prevention medication.
  • Trump: Has not issued a policy on HIV and AIDS, though some in the advocacy media say his goals of lowering prescription drug costs and increasing transparency about health care pricing could be beneficial.

Medical research funding

  • Clinton: Advocates increasing funding for Alzheimer’s research to $2 billion a year, paying for care-planning services through Medicare, and funding a federal program to help locate Alzheimer’s patients who wander.
  • Trump: Has called funding for Alzheimer’s research “a total top priority,” but he has not offered many specifics about policies he would pursue. He has alarmed the research community with scientifically unfounded statements about Ebola, autism, and climate change.


  • Clinton: Has called for a nationwide early-screening campaign. She wants to push all states to require health insurance coverage for autism services, help get adults on the autism spectrum connected to employment opportunities, and fund more research.
  • Trump: In tweets and during a presidential debate, Trump has linked autism to some vaccinations, a tie that has been widely debunked by international medical authorities and advocates, such as Autism Speaks, a group that Trump has supported.

Addiction and drugs

  • Clinton: Would increase funds for addiction treatment and prevention, and emphasize rehabilitation over prison for low-level and non-violent drug offenses. She wants more preventive services for adolescents, opioid antidotes for all first responders, and more training for drug prescribers.
  • Trump: In New Hampshire, Trump vowed to fight addiction on two fronts saying, “First, we have to support locally based and locally run clinics, and we have got to close the border. That’s where the drugs are coming from.”

Medical marijuana

  • Clinton: Supports the use of medical marijuana.
  • Trump:.Supports the use of medical marijuana.

Family and medical leave

  • Clinton: Advocates a paid family and medical leave of up to 12 weeks with at least a two-thirds wage replacement rate. She proposes paying for the plan with taxes on the wealthy.
  • Trump: He told Stuart Varney on Fox News last year, “Well, it’s something that’s being discussed. I think we have to keep our country very competitive, so you have to be careful of it.”

Federal funding of Planned Parenthood

Clinton: Supports federal funding of Planned Parenthood.
Trump: At a news conference on Super Tuesday, Trump said he would not give federal funds to Planned Parenthood because the organization performs abortions. But he praised the health care it provides, saying, “millions and millions of women – cervical cancer, breast cancer – are helped by Planned Parenthood.”

Employment-Based Health Coverage Holds Steady

Sixty-two percent of the non-elderly population had employment-based health overage in 2014, which is the same as in 2013, according to the Census Bureau. The percentage of non-elderly people in the United States with health insurance increased from 2013 (84.6%) to 2014 (88%). The percentage of uninsured when down from 2013 (15.4%) to 2014 (12%). Just over 32 million were uninsured in 2014, down from 41.1 million in 2013. The increase in health coverage among the entire non-elderly population came from growth among people buying health insurance directly from an insurance carrier (up from 8.8% in 2013 to 12.6% in 2014) and from enrollment in public programs (up from 19.3% in 2013 to 21.7% in 2014).

Employees Want Financial Guidance and Benefits

Forty-six percent of employees expect their financial situation to get better in the next year, and they’re turning to the workplace for financial education, according to a recent MetLife study. These financial concerns may be making employees more loyal, with 45% of employees planning to work for their current employer 12 months from now, compared to 41% last year. The study finds the following:

  • 47% of employees say that non-medical benefits can help limit their out-of-pocket medical expenses.
  • 52% of Millennials understand life insurance compared to 69% of Baby Boomers.
  • 38% of Millennials understand long term disability insurance compared to 57% of Baby Boomers.
  • 68% of Millennials prefer one-on-one consultations with a benefit expert, compared to 62% of Gen Xrs and 57% of Baby Boomers.
  • 44% of Millennials want their employer to help them solve their financial concerns compared to 20% of Baby Boomers
  • 75% of Millennials say employers have a responsibility for the financial well-being of employees.
  • 62% of employees are looking to their employer for more help in achieving financial security through employee benefits, compared to 49% in 2011.
  • 44% of employees feel in control of their finances.
  • 65% of Millennial employees don’t have a savings cushion of three months of salary.

The study finds that strong communication is a key driver of employee confidence when selecting benefits. The most effective resources are one-on-one consultation. Todd Katz, executive vice president, Group, Voluntary & Worksite Benefits, at MetLife said, “Employers looking to harness the power of one-on-one consultations can turn to outside experts such as brokers, consultants, and enrollment communications firms. For employers, this is an opportunity to evolve into a more consultative role and provide meaningful education and training for employees, while engendering loyalty. Helping employees understand the value of their benefits through engaging communications is critical for employee and for the workplace. If employees fully understand their benefit options, they’ll make better purchasing decisions and decrease their financial stress. To alleviate confusion about benefits, it’s critical that employers…enable their employees to make informed decisions about which benefits best suit their needs. This includes providing a variety of decision-support resources and offerings to help them make educated benefit decisions.”

Study: Effective wellness plans need culture of health, good communications

A corporate culture of health and a good communications strategy are needed for effective employee wellness programs, according to a study in the Journal of Occupational and Environmental Medicine. Researchers said creating a culture of health required a supportive environment and employee engagement. “In the companies we visited, healthy options were accessible and easy to adopt,” the authors wrote. Safety + Health magazine online (2/23)

The Dept. of Insurance Year in Review

The California Dept. of Insurance lists the following actions it took last year related to life insurance, health insurance, and workers comp:

  • Issued emergency regulations on the adequacy of health insurance medical provider networks.
  • Created a healthcare price and quality ratings comparison tool (California Healthcare Compare at
  • Issued emergency regulations strengthening requirements for health insurers to have enough doctors, hospitals, and clinics in their networks to ensure that consumers have timely access to health care. The regulations were approved on February 2, 2015.
  • In a major fraud case, pharmaceutical company Warner Chilcott agreed to pay $23.2 million for defrauding California insurers through drug marketing fraud. Jones insisted that Warner Chilcott agree to discontinue the unlawful promotion of pharmaceutical products identified in the whistle blower complaint and sold in California. Additionally, the Commissioner settled another insurer fraud case brought against Daiichi-Sanyo for $950,000 for making illegal kickbacks to healthcare providers.
  • Concluded a 15-year-old case involving Executive Life Insurance Company, which was placed into liquidation over 25 years ago by the department. French company Artemis S.A. agreed to pay $200 million for allegedly defrauding Executive Life in addition to $110 million it paid previously bringing the total recovery against all defendants to over $930 million.
  • In 2015, there were five national settlements with insurers as a result of investigations of their failure to use the Death Master File database to pay life insurance benefits. Insurers representing over 73% of the life insurance market have agreed to reform their practices and use the Death Master File database to identify deceased policyholders in order to pay benefits to their beneficiaries. Combined settlements have resulted in life insurers returning more than $1 billion in life insurance benefits to beneficiaries nationwide.
  • For fiscal year 2015/2016, the Department awarded $34.95 million in grants to district attorneys to combat workers compensation fraud and more than $21.95 million in grant funding to fight auto and organized auto fraud. As of November 30, Dept. of Insurance detectives arrested 745 people for insurance fraud this year.

It’s time for employees to review available benefits

As 2015 ends and 2016 begins, employees should review handbooks and ensure they are not missing out on valuable benefits, writes consumer advocate Dee Lee. Retirement benefits, savings plans, health and dental benefits, life and disability insurance, health and weight-loss programs, and flexible spending plans are among the benefits “worth real dollars” to employees, she writes. WBZ-TV (Boston) (12/28)

Enrollment Figures Show Robust Interest in Health and Dental Coverage through Covered California

Covered California is seeing very strong interest in the new optional dental coverage offered for adults through the health exchange. More than 33,000 people enrolled in family dental coverage since Covered California members began renewing their health insurance plans on Oct. 12. “We have been surprised by the extraordinarily high enrollment,” said Covered California executive director Peter V. Lee.As of Nov. 17, approximately 6,000 new enrollees purchased a family dental plan at the time of enrollment. In addition, more than 27,000 members had chosen to purchase a family dental plan at the time of renewal.

This year, Covered California makes it possible for consumers to purchase optional dental coverage for 2016 as an add-on to the health coverage they purchase through the exchange. Pediatric dental benefits for members under 19 years of age continue to be included with health coverage.

The family dental plan offers adults the option of receiving dental coverage outside of the general health plans at an additional cost. Unlike premiums for health coverage, premiums for dental coverage through a family dental plan are not subsidized through Covered California, but dental plans offered through the exchange are actively purchased and must be offered on a guaranteed issue basis — meaning the coverage is available to anyone who wants it regardless of any pre-existing dental health conditions. Open enrollment for health insurance coverage and for the new 2016 dental coverage for adults began on Nov. 1 and will continue through Jan. 31.

Covered California is offering dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans. There is no financial assistance available for the optional family dental plans, and there is no tax penalty for choosing not to enroll.

US Spends More on Health Care, But Has Worse Health

The United States spends more per-person on health care than do 12 other high-income nations. But the U.S. has the lowest life expectancy and some of the worst health outcomes, according to a Commonwealth Fund report. The study compares the U.S., Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

The U.S. spent an average of $9,086 per person annually in 2013 and had an average life expectancy of 79 years. Switzerland, the second-highest-spending country, spent $6,325 per person and had a life expectancy of 83 years. Mortality rates for cancer are among the lowest in the U.S., but rates of chronic conditions, obesity, and infant mortality are higher than in the other countries. Most of the data predates the major insurance provisions of the Affordable Care Act.

Health care consumed 17% of the United States’ gross domestic product (GDP) in 2013, about 50% more than any in other country. Despite being the only country in the study without universal health care coverage, government spending on health care in the U.S.—mainly for Medicare and Medicaid—was high as well, at $4,197 per person in 2013. The U.K., where all residents are covered by the National Health Service, spends $2,802 per person.

Health care spending per-person is highest in the U.S. because of greater use of medical technology and higher health care prices. The study finds the following:

  • People in the U.S. visit doctors an average of four times per year; only residents of Switzerland, New Zealand, and Sweden have fewer visits. Americans also go to the hospital relatively infrequently, with 126 visits per every 1,000 people, compared to 252 visits in Germany, where the rate is highest.
  • Americans get the most diagnostic imaging exams, including MRIs, CT scans, and PET exams. The average U.S. adult also takes more prescription drugs than do adults in all the other countries except New Zealand.
  • Prescription drugs are most expensive in the U.S., with prices twice as high as in the U.K., Australia, and Canada.
  • Prices for health services are considerably higher in the U.S. On average, heart bypass surgery costs $75,345 in the U.S., compared to $15,742 in the Netherlands.

Rates of cancer deaths are lower in the U.S. than in most other nations—164 for every 100,000 people, compared to 220 in Denmark, 196 in the Netherlands, and 193 in the U.K. Cancer deaths in the U.S. also declined faster from 1995 to 2007 than in the other countries.

Health care spending growth slowed in the U.S. and globally. Per capita health care spending growth in the U.S. has slowed in recent years, from 2.5% in 2003 to 2009 to 1.5% in 2009 to 2013. This slowdown occurred in other countries as well, with spending growth even turning negative in Denmark and the U.K.

The U.S. spends the least on social services. The U.S. spends only 9% of GDP on social services like disability benefits or employment programs. It is the only country studied where health care spending accounts for a greater share of GDP than social services spending. In contrast, France and Sweden spent 21% of GDP on social services.

New health care models like accountable-care organizations, which base provider pay on patient outcomes, could encourage higher-quality, lower-cost care. These models could also help bring about a shift toward greater spending on social services, as health care organizations are incentivized to think more broadly about what their patients need to be healthy

Americans Embrace Health and Fitness Technology

Sixty-three percent of consumers who use fitness or health monitoring technologies say it has changed their behavior significantly. Forty percent have shared their fitness or monitoring information with their doctor, according to a survey by the Deloitte Center for Health Solutions.

Twenty-two percent used technology to access, store, and transmit health records in the past year, up from 13% in 2013. Use was higher for those with major chronic conditions (32% compared to 19% in 2013). Sixteen percent who needed care went online for cost information, up from 11% in 2013. Technology use among Millennials increased the most (27% versus 17%). Further, 71% of all those surveyed have not gone online for cost information, but are very or somewhat likely to use a pricing tool in the future.
Twenty-five percent used a scorecard to compare the performance of doctors, hospitals, and health plans, up from 19% in 2013. The rate was highest in the youngest cohort, with 49% of Millennials who received care in the last year using a scorecard compared to 31% in 2013.

Greg Scott of Deloitte Consulting said, “Health care is becoming more digitized and consumer oriented. It’s not an overnight change, but more like how summer turns into fall – gradual yet very perceptible. The specter of a more customer-driven industry is causing many health companies to transform into retail-focused organizations, impacting everything from strategy and scale to operations and human capital…This is about more than a cool app; this is about making the…changes needed to better identify and engage a more empowered purchaser.”

Last Updated 05/25/2022

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