Even if Biden moves at breakneck speed to replace outgoing Commissioner Stephen Hahn, it could be weeks after Biden is in the White House before his pick could get to work.
This article was published on Sunday, November 8, 2020 in Kaiser Health News.
President-elect Joe Biden made COVID-19 a linchpin of his campaign, criticizing President Donald Trump’s leadership on everything from masks and packed campaign rallies to vaccines.
That was the easy part. Biden now has the urgent job of filling top health care positions in his administration to help restore public trust in science-driven institutions Trump repeatedly undermined, and oversee the rollout of several coronavirus vaccines to a skeptical public who fear they were rushed for political expediency.
At the top of that list is a new commissioner of the Food and Drug Administration, an agency where Biden faces immense pressure to move faster than any other modern president as the pandemic rages and COVID deaths are expected to surge through the winter. That agency and its beleaguered personnel will be relied on to give the green light to vaccines and therapeutics to fight the COVID pandemic.
Biden is expected to swiftly announce his choices to lead the FDA and the Centers for Disease Control and Prevention, given their importance in informing the federal government’s COVID strategy, according to interviews with Biden advisers, former agency officials and Democrats with knowledge of the transition team’s inner workings. But how soon they’ll be able to begin work after Biden’s Jan. 20 inauguration is unclear.
The CDC director does not need Senate confirmation, avoiding a hurdle that could slow that process. That is not the case for the FDA commissioner, who now appears increasingly likely to face a Republican-controlled Senate that may not be as keen as Democrats to swiftly clear Biden’s nominees. As a result, even if Biden moves at breakneck speed to replace outgoing Commissioner Stephen Hahn, it could be weeks after Biden is in the White House before his pick could get to work.
In the meantime, the FDA will face critical decisions about vaccines needed to help put the nation on its path out of the pandemic. Biden will have to rely on a temporary head of the FDA to steer the 17,000-employee agency during one of the most challenging times in its history.
“It’s not ideal timing, for sure,” a former FDA official said. “It’s a huge job.”
The transition of power will occur at one of the most high-profile times for the FDA, as it vets multiple coronavirus vaccine candidates that could reach the public before the inauguration. The Trump administration could oversee emergency authorizations of initial vaccines from two front-runners, Pfizer and Moderna, that would be prioritized for health care workers and other groups at higher risk of severe COVID complications. But other companies’ vaccines that could be available for many more Americans — such as teachers, adults at lower risk of severe health consequences if they get sick, and children — are all but certain to fall under Biden’s FDA for review because the data on safety and efficacy isn’t expected until next year.
FDA’s credibility in vetting the safety and benefits of COVID products has been in question for months, fueled by Hahn’s inaccurate statements about certain treatments for sick patients. Further, infighting between officials there and political appointees at the White House and the Department of Health and Human Services persisted even in the weeks leading up to the election, with HHS Secretary Alex Azar openly plotting Hahn’s removal because of disagreements over vaccine standards, Politico reported in October.
In September, eight senior FDA officials who have served in multiple administrations took the extraordinary step of publishing an op-ed in USA Today stating they would work with agency leadership “to maintain FDA’s steadfast commitment to ensuring our decisions will continue to be guided by the best science.”
“Protecting the FDA’s independence is essential if we are to do the best possible job of protecting public health and saving lives,” the officials wrote.
“Trust has eroded so significantly in these institutions that have undermined public confidence, especially on vaccines,” a Biden adviser said of the FDA and CDC. “Change in leadership is critical.”
Getting new people into the federal government — where Biden is charged with filling roughly 4,000 jobs held by political appointees — is a mammoth slog on its own, let alone while moving to take over the U.S. pandemic response. Former President Barack Obama set the record for presidential appointments in the first 100 days, securing Senate confirmation for 69 appointees. The FDA commissioner wasn’t among them — Dr. Margaret Hamburg was not nominated until March 2009 and became commissioner that May. A similar timeline held for Trump’s first FDA commissioner, Dr. Scott Gottlieb, who began in May 2017.
“It is a difficult period because you’re going to have a lot of folks who need to get into place,” said Max Stier, CEO of the Partnership for Public Service, which advises presidential candidates and their teams installing new administrations. “The track record has not been good on getting people in quickly.”
At the outset of the Biden administration, it’s expected there will be a fair number of “acting” agency heads rather than Senate-confirmed appointees, Stier said. Biden has said he’ll trust the government’s scientists on COVID vaccines. Former FDA officials said in interviews that if there’s an acting official in charge when a specific vaccine is under review, it should not make a difference because the agency’s longtime scientists conduct the necessary scientific evaluations.
Where it could make a difference is in messaging and accountability, not just to the new president but to the public: The traditionally lower profile and temporary nature of an acting FDA commissioner is at odds with the highly visible role the commissioner is expected to play during a public health emergency, particularly in convincing people that vaccines are safe.
“An agency needs a face, and it’s hard for an ‘acting’ to be the face of the agency,” a former senior agency official said. “The work could be done, but the communication is always better if there’s an FDA commissioner who’s willing to take responsibility.”
The messaging role has taken on extraordinary importance since public confidence in a coronavirus vaccine has eroded significantly. A September Pew Research Center poll found that only 51% of U.S. adults would definitely or probably get a vaccine to prevent COVID-19 if it were available, a drop of 21 percentage points since May.
“Things can only be better,” said Michael Carome, director of the health research group at Public Citizen, a left-leaning group that advocates for consumer interests. “I think an acting commissioner under a Biden administration will be far more trusted than the current FDA commissioner, who has been kowtowed by the White House.”
FDA staffing policy outlines who should be the agency’s acting head in the event there isn’t a permanent commissioner. The most recent version, from 2016, says the position is delegated to the deputy commissioner for foods and veterinary medicine, a title that has since been recast as deputy commissioner for food policy and response. The job is currently held by Frank Yiannas, a longtime food safety expert who joined the agency in 2018 after the retirement of Stephen Ostroff, a veteran FDA scientist who served as acting commissioner twice. The FDA did not respond to questions about whether it had a new staffing policy.
Some administrations, however, have ignored that policy. The Trump administration, for example, briefly installed senior HHS official Brett Giroir, a political appointee, as acting FDA commissioner, a move criticized by Democrats in Congress.
But critical decisions await the new appointee.
The earliest officials would know whether COVID vaccines from Johnson & Johnson and AstraZeneca work is January or February, said Moncef Slaoui, the top scientific adviser for Operation Warp Speed, which is funding multiple coronavirus vaccines and treatments. Other efficacy trials won’t be completed until spring, he said in October.
Safety will take even longer to assess — Johnson & Johnson’s and AstraZeneca’s late-stage clinical trials were already paused earlier this year for safety reasons —and companies will seek emergency authorization or FDA approval only once both metrics are known.
After four years of politicization of the science agency, a Biden adviser said, most important was having a “trusted, credible voice to restore trust in a vaccine.”
Party control of the Senate may not be determined until January — thanks to what preliminary returns suggest will be runoffs for both Senate seats in Georgia.
This article was published on Saturday, November 7, 2020 in Kaiser Health News.
Former Vice President Joe Biden secured the 270 electoral votes needed to capture the White House on Saturday, major news organizations projected, after election officials in a handful of swing states spent days in round-the-clock counting of millions of mail-in ballots and early votes.
The Democrat’s victory came after the latest tallies showed him taking an insurmountable lead in Pennsylvania, a state both Biden and President Donald Trump had long identified as vital to their election efforts. Trump has signaled he will fight the election results in several states, filing a number of lawsuits and seeking recounts.
“America, I’m honored that you have chosen me to lead our great country,” Biden tweeted shortly after the news organizations called the race. “The work ahead of us will be hard, but I promise you this: I will be a President for all Americans — whether you voted for me or not.”
The Democratic celebration was tempered because it appeared the party would have a hard time taking back the Senate majority it lost in 2014. If that bears out, it will likely keep Biden and Democratic lawmakers from enacting many of the plans they campaigned on, including major changes in health care.
Party control of the Senate may not be determined until January — thanks to what preliminary returns suggest will be runoffs for both Senate seats in Georgia. No candidate for either seat reached the required 50% threshold.
Without a Democratic majority in the Senate, Biden will likely face strong Republican opposition to many of his top health agenda items — including lowering the eligibility age for Medicare to 60, expanding financial assistance for health insurance under the Affordable Care Act, and creating a “public option” government health plan.
However, his administration would be a bulwark to defend the ACA against Republican attacks, although the Supreme Court case challenging the health law — which will be heard next week — presents a major wild card for its future.
Health care was a key element of Biden’s campaign, especially improving the federal response to the coronavirus pandemic. He championed the use of face masks and blasted the Trump administration for shifting to states much of the responsibility for fighting the virus and helping hospitals. He was regularly mocked by the president for wearing a mask, working and campaigning from home, and not having an in-person Democratic convention.
Even before the latest vote tallies were released late Saturday morning, Biden had begun moving toward setting up his administration. On Thursday his transition team unveiled a website, BuildBackBetter.com, although it was only one page. And the former vice president held a meeting Thursday with health and economic advisers on the coronavirus.
In a speech to supporters in Delaware Saturday night, the president-elect pledged again to make the pandemic his top concern, saying that until COVID-19 is under control, the country “cannot repair the economy, restore our vitality or relish life’s most precious moments, hugging our grandchildren, our children, our birthdays, weddings, graduations, all the moments that matter most to us.”
He announced that on Monday he would name “a group of leading scientists and experts as transition advisors” to help develop a blueprint “built on bedrock science” to combat the virus.
The electoral outcome is not the one Democrats were hoping for — or, to some extent, expecting, based on preelection polling. Andy Slavitt, who ran the Centers for Medicare & Medicaid Services during the Obama administration, noted that frustration in a tweet Wednesday. “A large disappointment is that many hoped for a significant repudiation of Trump & his indifference to human life, human suffering, his corruption, and goal of getting rid of the ACA. No matter the final total it will be hard to make that claim,” Slavitt said.
Still up in the air is how willing a Republican-led Senate will be to provide further relief to individuals, businesses and states hit hard by the pandemic, and whether they will participate in previously bipartisan efforts to curtail “surprise” out-of-network medical bills and get a handle on prescription drug prices.
The largely unpublicized effort follows a Department of Defense announcement in September that it has partnered with AstraZeneca to recruit volunteers.
This article was published on Friday, November 6, 2020 in Kaiser Health News.
The Department of Veterans Affairs is recruiting 8,000 volunteers for the Phase 3 clinical trials of at least four COVID-19 vaccine candidates at 20 federal medical facilities across the U.S., according to officials with the VA and Operation Warp Speed, the Trump administration’s initiative to fast-track a coronavirus vaccine.
The largely unpublicized effort follows a Department of Defense announcement in September that it has partnered with AstraZeneca to recruit volunteers at five of its medical facilities, which are separate from the VA system.
DOD is also is in talks with developers of other vaccine candidates, although officials won’t say which ones.
Both federal departments have long experience in medical research and diverse populations — a crucial component of effective clinical trials, said J. Stephen Morrison, senior vice president and director of global health policy at the Center for Strategic and International Studies, a bipartisan think tank in Washington, D.C.
Since active troops are essential to national security, and veterans are extremely vulnerable to COVID-19, both departments have a vested interest in supporting the development of safe, effective vaccines, Morrison said.
“On the DOD active servicemen and -women side, it’s a question of making sure they’re ready, they are protected,” Morrison said. “With VA, their population, all elderly and infirm with underlying conditions, they could really be suffering if we don’t get a vaccine.”
According to a VA website, of its 20 medical centers involved, 17 would be part of the Johnson & Johnson vaccine trial, while the three others are recruiting — or have completed recruitment — for advanced-stage trials for Moderna, AstraZeneca and Pfizer vaccines.
Dr. Matthew Hepburn, head of vaccine development at Operation Warp Speed, said the VA effort lets veterans contribute to the overall well-being of the country.
“This is another way they can continue to serve in this way, fighting the pandemic as a volunteer,” Hepburn said during a discussion of vaccine and therapeutics development hosted by the Heritage Foundation on Oct. 27.
It’s not unusual for the military to participate in multicenter trials for treatments of ailments as diverse as cancer and trauma. Historically, many vaccines have been tested first by the military.
In the general population, clinicians often have difficulty recruiting African Americans and other minorities for medical research, and “the military provides a rich opportunity to find volunteers for those groups,” said retired Rear Adm. Thomas Cullison, a doctor and former deputy surgeon general for the Navy.
Military health facilities are held to the same standards as private research facilities, he said.
No service members will be required to participate in the COVID vaccine trials. All volunteers will be paid by the developer.
Support for routine vaccinations runs high in the military, but some have expressed concerns about new vaccines and mandatory inoculations, especially for anthrax. In a 2002 federal study, 85% of those who received that vaccine reported an adverse reaction, with just under half noticing minor redness at the injection site. But nearly a quarter of the side effects reported were more systemic, including fevers, chills, fatigue and joint pain.
That survey of a small group of National Guard and Reserve members found that, while 73% said they believe immunizations are effective, two-thirds said they did not support the mandatory anthrax program and 6 in 10 said they were not satisfied with the information they were given on the vaccines.
To quell concerns over the military’s role in supporting COVID vaccine development, the Pentagon has reiterated that troops or their dependents interested in participating in the research must provide voluntary written consent, and they will be allowed to take part only if they will be in the same location for the length of the research, expected to last at least two years.
In addition, active-duty members such as new recruits and boot camp participants will not be allowed to volunteer because they are “considered vulnerable from an ethical and regulatory standpoint,” an official said.
At the VA, officials are seeking to recruit healthy veterans from 18 to 65 years old who are not pregnant and may be at risk for exposure. As with trials conducted in civilian facilities, participants will be paid by the developer, VA spokesperson Christina Noel said.
Also, VA nurses and caseworkers also are being asked to identify their sickest, highest-risk patients to determine who should be at the top of the list once a vaccine is approved, according to a VA nurse and other health officials who asked not to be identified because they were not authorized to speak with the press.
The U.S. military has a long history of contributing to research on vaccines, including a key role in developing inoculations against yellow fever and adenovirus, and the Walter Reed Army Institute of Research is developing its own vaccine against the coronavirus.
Some segments of the population remain skeptical of federal medical experiments. A survey by AP-NORC in May found that Black people are particularly reluctant to get the coronavirus vaccine. Many have concerns about federal research in part because of associations with the infamous Tuskegee Institute syphilis experiments, in which U.S. Public Health Service officials intentionally withheld a cure from Black men infected with the disease.
But Morrison, of the Center for Strategic and International Studies, said the Defense Department and VA are a “natural fit” for the COVID vaccine trials.
“DOD has lots of expertise. They know how to vaccinate; they know how to reach communities. They have a whole science infrastructure and research-and-development infrastructure. And when you are thinking what the mission of VA is, [VA] sees this is part of their mission,” Morrison said.
The Defense Department announced its agreement with AstraZeneca in September, shortly before the drugmaker’s vaccine trial was put on hold to study a serious medical condition that one participant reported. That research was approved by the Food and Drug Administration to begin again Oct. 23. The military plans to restart its efforts to recruit 3,000 volunteers.
The Pentagon has also signed an agreement with another vaccine developer, the head of the Defense Health Agency, Army Lt. Gen. Ronald Place, told reporters Oct. 8. He wouldn’t provide the company’s name.
Democratic Sens. Elizabeth Warren of Massachusetts and Mazie Hirono of Hawaii have called, unsuccessfully, for the Senate Armed Services Committee to investigate what they say is a lack of Pentagon transparency on its role in vaccine development and distribution.
The Defense Department has awarded more than $6 billion in Operation Warp Speed contracts through an intermediary, Advanced Technology International, and the two senators want more information about those contracts.
“There may well be a valuable role for DoD officials in [Operation Warp Speed] — particularly given the department’s logistical capacity,” they wrote to the committee chair and ranking member. “But it is important that Congress conduct appropriate oversight of, and understand, DoD’s activities in this area.”
Neither department has disclosed the financial arrangements they have made with developers to support the vaccine research.
While Montana's public mask mandate has been in place since July, enforcement had been left to local governments that largely lack the resources or the political will to do so.
This article was published on Friday, November 6, 2020 in Kaiser Health News.
In Montana’s conservative Flathead County, prosecutors and local leaders were turning a blind eye to businesses that flouted state mask and social distancing mandates, even as the area’s COVID infections climbed to their highest levels.
When asked during an Oct. 7 press call from Montana’s capital city whether the state would step in, Gov. Steve Bullock said it was up to the locals to enforce the directives.
“I’ve never met anyone in Flathead County, especially Flathead government, that has asked me to take over their government,” Bullock said with a laugh. “It can’t all be solved from Helena.”
Just two weeks later, the Democratic governor, who was also running for the U.S. Senate, pivoted. He announced the state was taking five Flathead businesses to court for violating COVID-related mandates, asking a judge to order them to comply or close their doors.
While the state’s public mask mandate has been in place since July, enforcement had been left to local governments that largely lack the resources or the political will to do so. It’s an issue seen across the nation as public health decisions to curb the coronavirus are resisted by local leaders, business owners and individuals who are sick of pandemic rules — or too broke to continue them — or who question the state’s authority to issue them in the first place.
Yet rising caseloads have forced an evolution in the efforts to persuade people to mask up. When appealing to people’s better nature and sense of community didn’t work, Montana officials began a steady escalation: adding in guilt, then public shaming, and now attempts to punish. Still, there’s little evidence that minds are being changed, and a new Republican governor-elect, Greg Gianforte, will take over in January after campaigning more on “personal responsibility” than on state-issued mandates.
In June, Montana tried the soft approach with state public service announcements, including a video with a cowboy lassoing a calf, a hunter walking through a field and a child smiling in her mom’s arms.
“Montanans are independent. We’re also responsible, protective and committed to our families and communities,” the voiceover says before the scene cuts to a gray-haired couple wearing masks. “That’s why we’ve done so well against COVID-19.”
The ad aired June 11, a day that Montana reported 10 confirmed cases of COVID-19. As the state gradually reopened in the summer, cases began to climb, with the daily peak reaching 200 cases in July.
In the fall came the guilt trips: Hospital administrators joined the governor’s weekly press call on Sept. 30 through video conferencing and talked about overstretched resources and staffers who were exhausted by people choosing not to follow health guidelines. The new COVID case count the day of that September press conference was 423.
Meanwhile, Bullock rebuffed a White House Coronavirus Task Force recommendation to implement fines for mask noncompliance that month. Government regulation alone wouldn’t stop the virus, he said, adding, “We do things the Montana way here.”
Still, cases increased.
At the beginning of October, Bullock tried public shaming. He called out counties, including Flathead, for not enforcing mandates.
Then, after rising COVID cases put Montana among the states with the nation’s highest rates of new infections per capita, the state shifted from guiding voice to plaintiff on Oct. 22, a day after the state reported 924 new cases.
“We know how quickly this virus spreads and, as Montanans, we should always put the health of our own employees, friends and neighbors first,” Bullock said. “If businesses come into compliance, we’ll gladly drop the enforcements.”
So far, state officials have said those measures are reserved for the most egregious repeat offenders and are not a new standard.
Across the state, local officials and tribal nations are watching how far this new level of enforcement will stretch. Some have said they don’t have the means to drive enforcement alone.
Bullock has said financial aid is available for counties to educate businesses that don’t follow coronavirus health standards and, if needed, to file complaints about virus-related violations. As of Nov. 2, seven counties had followed up on that offer.
But some county health officials say more help is needed.
“We’ve done all the education we can,” said Clay Vincent of the Hill County Health Department. “We can collect all the complaints in the world, we can talk to people, we can yell at people in businesses. But then it has to go to the county attorney’s office for any type of enforcement after that, and that’s where it has stopped.”
In that county of roughly 16,000 on the Canadian border, some businesses have posted signs proclaiming the right not to wear a mask. Vincent said those stores are in the minority but noted they offer essential services like gas and food.
Health department investigations filed with the county attorney haven’t prompted enforcement of the mask mandate, Vincent said. So health officials are considering their own signs, announcing the establishment is refusing to comply with state rules to protect its employees and customers. Vincent hopes such public shaming leads to change. The county attorney’s office declined to comment and directed all questions back to the health department.
Across Montana, some businesses continue to skirt COVID rules. Last month, as Bullock announced the Flathead County court cases, he urged people to report other businesses that violate COVID restrictions via the state health department’s consumer complaint website. Within four days, more than 1,000 complaints poured in from 40 of Montana’s 56 counties.
Bullock has said the state will track the most egregious repeat offenders, though no thresholds are set for what would trigger state enforcement. Meanwhile, the site turns the complaints over to county health departments.
Tribal nations have the power to invoke emergency rules on reservations, but enforcement is another issue, even as Native Americans in Montana face disproportionately high rates of COVID hospitalizations and deaths. Some have taken steps to isolate their communities, such as Blackfeet Nation leaders’ decision to close their border with Glacier National Park. But that’s not so easy on some reservations. For instance, the Flathead Reservation overlaps four counties, and members of the Confederated Salish and Kootenai Tribes are in the minority.
“It’s unfortunate, because we as the Flathead Nation don’t have that ultimate authority in enforcement,” said Tribal Council Chair Shelly Fyant. “So we’re trying to appeal to people’s hearts from a cultural perspective.”
The tribal nation has focused its efforts on a campaign to use music, art and videos to sway people to wear a mask for the protection of those vulnerable to a risky COVID infection, especially elders.
Flathead County Attorney Travis Ahner said he hasn’t sought injunctions against businesses yet because he hasn’t seen proof that a store’s lack of mask use led to COVID cases. The mask mandate is intended to reduce spread, however, not penalize those who cause cases after the fact.
The Flathead County District Court denied the state’s request for temporary restraining orders ahead of court hearings for the businesses that allegedly overlooked mask mandates. Ahner said that shows state enforcement isn’t as simple as the governor saying he made a rule and everyone needs to follow it. Legal experts across the nation have said states have the authority to take public health emergency actions.
Some of the Flathead cases are scheduled for hearings this month. Whitefish, a destination ski town in Flathead County, didn’t want to wait and see whether the state or county would force businesses into line. The city council approved a temporary order tightening COVID restrictions over the Halloween weekend to prevent superspreader events. That created a way for the city to issue fines of up to $500 for businesses out of compliance.
“This has been pushed into our laps,” said city council member Steve Qunell. “It’s our turn to take leadership on this.”
But the city has yet to pass long-term rules to keep that power as it continues to weigh how to take on what much of the state hasn’t figured out.
Justice Amy Coney Barrett is considered likely to vote not only to uphold restrictions on abortion, but also, possibly, even to overturn the existing national right to abortion under the Supreme Court’s landmark rulings.
This article was published on Thursday, November 5, 2020 in Kaiser Health News.
Abortion opponents were among those most excited by the addition of Justice Amy Coney Barrett to the Supreme Court. And they had good reason to be.
As a law professor and circuit court judge, Barrett made it clear she is no fan of abortion rights. She is considered likely to vote not only to uphold restrictions on the procedure, but also, possibly, even to overturn the existing national right to abortion under the Supreme Court’s landmark rulings in Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey.
Her first opportunity to weigh in could come soon. A Mississippi ban on abortions after 15 weeks — impermissible under existing court precedents — is awaiting review by the justices, who could decide as early as this week to take up the case.
That’s the headline. But many overlook other things that could flow from a new abortion jurisprudence — such as erasing the right to birth control that the court recognized in a 1965 case, Griswold v. Connecticut. During her confirmation hearings, Barrett specifically refused to say whether she felt Griswold was correctly decided.
That was a flashing red warning light for Nancy Northup, president of the Center for Reproductive Rights, a legal advocacy group that argues cases on abortion and contraception. Roe, said Northup, is part of a century of jurisprudence based on the idea that the Constitution protects the liberty of individuals. “It began with cases about how one educates one’s children, and includes same-sex marriage, contraception and abortion,” she said. “You can’t just take Roe out and not unravel the whole fabric.”
Yet from what Barrett has said and written about the Constitution, continued Northup, “it’s clear she doesn’t believe it protects the right to personal liberty.”
Abortion rights advocates worry that the court could go beyond overturning Roe and Casey. If those precedents are overturned, abortion decisions would return to the states. But the court could go a step further and recognize “fetal personhood,” the idea that a fetus is a person with full constitutional rights from the moment of fertilization. That would create a constitutional bar to abortion, among other things, meaning even the most liberal states could not allow the procedure.
Personhood amendments were on the ballot in several states about a decade ago. They were rejected by voters even in conservative states like Mississippi after opponents argued that recognizing life at fertilization would outlaw not just abortion, without exceptions, but also things like in vitro fertilization and many forms of contraception, including some birth control pills, “morning after” pills, and intrauterine devices (IUDs) that some think could cause very early abortions by preventing a fertilized egg from implanting in the uterus. (More recent scientific evidence suggests nearly all those methods actually prevent ovulation, not implantation.)
But an abortion law passed in Georgia in 2019 not only includes a ban on abortion at the point a heartbeat can be detected — often before a woman is aware she is pregnant — but also has a fetal personhood provision. Georgia is appealing a federal district court ruling that struck down the law as a violation of Roe.
Proponents of these personhood provisions are cautiously optimistic. “It looks like there will be a court more friendly to a challenge to Roe,” said Les Riley, interim president of the Personhood Alliance, the group pushing the concept. “But to some extent we’ve been down this road before.”
Previous courts since the early 1990s that were thought poised to overturn Roe did not.
And even if the court were to uphold a law like the Mississippi ban it is considering now, he said, “all that’s saying is they agree that states can regulate or ban abortion at 15 weeks. What we want to do is have the factual reality that life begins at conception recognized in law.”
Mary Ziegler, a law professor at Florida State University who has written two books on the abortion battle, said the court wouldn’t have to recognize fetal personhood to threaten many forms of contraception.
States could effectively ban contraception by arguing that some contraceptives act as abortifacients, she said. The court has already opened the door to this argument. In the 2014 Hobby Lobby case, it allowed some companies to decline to offer birth control coverage otherwise required by the Affordable Care Act to their employees. The owners of the companies that brought the suit said they believe some contraceptives are a form of abortion, and the court said the requirement violated their religious freedom. The court used a similar reasoning in a 2020 case exempting the Roman Catholic order Little Sisters of the Poor from even having to sign a paper that would officially exempt them from the ACA contraceptive mandate.
Medical groups and the federal government don’t consider any form of contraception approved by the Food and Drug Administration an abortion equivalent, because the standard medical definition of the start of pregnancy is when a fertilized egg implants in the uterus, not when sperm and egg first unite. Yet the court has not always followed science on the issue.
Still, Ziegler said, “personhood has always been the endgame” for abortion foes, not simply overturning Roe, which would let each state decide whether to outlaw abortion. “Allowing states to leave abortion legal has never been the endgame,” she said.
Interestingly, however, Riley of the Personhood Alliance said that while he hopes his side will win eventually, he is not necessarily hoping that win will come from the Supreme Court.
“We think the strategy has been misguided for years,” he said. “Right now, five justices can overturn anything. That’s not the system of government our founders had in mind.”
Rather, he said, his organization is working more at the state and local level “to lay the groundwork of people’s hearts being changed.”
California’s annual health insurance enrollment season for individuals and families kicks off this week against a dramatic backdrop: the hotly contested presidential election; a pandemic raging out of control in much of the U.S.; and, on Nov. 10, a Supreme Court hearing of a case that could end the Affordable Care Act and strand millions without coverage.
The massive unemployment caused by the pandemic has already stripped employer-based health insurance from millions nationwide and induced severe financial anxiety as families struggle to pay rent and buy food.
One question hovering over enrollment for 2021 health plans is whether the large-scale loss of medical coverage will generate a surge of sign-ups, or if more pressing financial worries for many people will push insurance lower down their priority list.
“People have so many things to deal with: They’ve lost jobs, they’ve lost a lot of income, and in California they’re also facing fires. I don’t think health insurance has been top of mind for people,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization.
But Peter Lee, executive director of Covered California, the state’s ACA marketplace, is confident it will match the 40% increase in new sign-ups it had for 2020 coverage.
“It is clear that COVID is on Californians’ minds,” he says. “You cannot have COVID on your mind without also having coverage on your mind.”
A Supreme Court decision on the future of the ACA probably won’t come until well into next year, and it is unlikely to affect your 2021 coverage. “So people should feel confident in looking for a health plan,” says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund.
If you are 65 or older, you probably qualify for Medicare, the federal program for seniors, which is entirely separate from the ACA exchanges and broader individual market. Open enrollment for the private Medicare Advantage plans and Part D drug plans is also underway and ends Dec. 7. Insurance agents can usually help you with Medicare, and you can get advice by calling 1-800-434-0222.
If you are under 65, live in the Golden State and want to buy insurance for you and your family, start with Covered California. It’s the only place you can get federal and state assistance to cover some or all of your premiums.
The enrollment period for Covered California, and for the individual market outside the exchange, started Nov. 1 and runs through Jan. 31. In states whose exchanges are operated by the federal government, the enrollment window shuts Dec. 15.
If you lost coverage and need it for the month of December this year, you can still get it through Covered California if you sign up by Nov. 30. For regular annual coverage that starts Jan. 1, you must sign up by Dec. 15. If you miss that deadline, you can still get coverage starting Feb. 1 if you enroll by the final Jan. 31 deadline.
Many people leave money on the table because they aren’t aware of the financial assistance or think they earn too much to qualify. But you don’t need to be poor to get aid.
The federal subsidies, which are tax credits typically provided in the form of reduced monthly premiums, are available to individuals with annual income up to about $51,000 and a family of four with income up to nearly $105,000.
California has supplemented the federal aid with state-funded assistance that extends further into the middle class: up to around $76,500 for an individual and $157,000 for a family of four.
If you log on to Covered California’s website, www.coveredca.com, you can check how much financial help you qualify for and compare health plans. Or, an insurance agent or certified enroller can do the legwork work for you — at no charge. You can find one on the website. You can also call Covered California directly at 800-300-1506.
If your income is below 138% of the federal poverty level, you will probably qualify for Medi-Cal, the government insurance program for people of limited means. The Covered California website — or an enroller — will let you know if you do and walk you through signing up. You can also contact your county’s Medi-Cal office. If you don’t qualify for Medi-Cal, your children might, because the income threshold is higher for them.
If you are looking for exchange-sponsored coverage, click the “shop and compare” tab on the Covered California website, which takes you to a screen that asks your age, income, ZIP code and family size and shows the health plans available, their premiums and your aid amount.
The website also provides quality ratings of the participating health plans. And you can check for plans that have your doctors in their networks — though, as the website warns, that information is not always up to date.
Comparison shopping on the website is straightforward, because at each of the four levels of coverage — bronze, silver, gold and platinum — benefits are uniform from insurer to insurer. So once you’ve decided which metal tier is best for you, you only need to think about the price and whether your providers are in the network.
If you have a Covered California health plan already, shop around rather than automatically renew the one you’re in. “The best deal last year is not necessarily the best deal this year,” says Anthony Wright, executive director of Health Access California.
Anthem Blue Cross, for example, will hike rates by a statewide average of 6%, and the Oscar Health Plan of California by 7.6%, while Blue Shield of California will cut rates by an average of 2.4% and the L.A. Care Health Plan by 4.6%.
If you switch to the lowest-cost plan in your current metal tier, you could reduce your premium by as much as 7.4%, according to Covered California.
Keep in mind that the lowest premium, a bronze plan, is not necessarily the wisest — or cheapest — choice.
Tom Freker, a Huntington Beach insurance agent, counsels people not to buy bronze, because its higher deductibles and coinsurance rates could cost more than a higher-premium plan if you fall ill or have a serious accident.
Freker recommends you enroll in Covered California rather than the off-exchange market, even if you don’t initially qualify for aid. That’s because if your income drops and you report it to the exchange, you might then qualify and get a break on premiums for the rest of the year or a tax credit the following April, he says.
If your income rises during the year you also should report it, so your monthly premium subsidy is reduced, helping you avoid a potentially hefty tax bill come April.
Your initial aid amount, if you qualify, will be based on your projected 2021 income. In this period of pandemic-driven furloughs, slashed hours and job loss, that might be difficult to predict.
Maria Weston, a massage therapist in Long Beach, said her income has fluctuated week to week since the pandemic started and is down about 50% overall.
Her priority for 2021 was to find a less expensive option, so she switched to a cheaper silver plan last month (current enrollees were allowed to make their health plan choices starting Oct. 1).
Weston’s new health plan will save her nearly $1,700 a year on premiums. “I could put that in my retirement account — or eat,” she says. “One of the two.”
Due to critical shortages, staff agencies have deployed tens of thousands of traveling health workers nationally since March outbreaks in the Northeast.
This article was published on Wednesday, November 4, 2020 in Kaiser Health News.
David Joel Perea called from Maine, Vermont, Minnesota and, ultimately, Nevada, always with the same request: “Mom, can you send tamales?” Dominga Perea would ship them overnight.
That’s how she knew where her 35-year-old son was.
The traveling nurse had “a tremendous work ethic,” routinely putting in 80 hours a week, said his brother, Daniel.
But when Perea took a job at Lakeside Health & Wellness Suites — a Reno nursing home that has received dozens of safety citations since 2017 from the Centers for Medicare & Medicaid Services — Dominga was “scared silly.”
During Perea’s stint, nearly one-fifth of Lakeside’s residents were infected with COVID-19, according to state health records. Lakeside’s “top priority is the safety of those who live and work in our facility,” a spokesperson said.
When her son didn’t respond to her text on April 6, Dominga knew something was wrong. Perea had COVID-19. He died days later.
As COVID-19 surges across the country, health care systems continue to suffer critical shortages, especially among non-physician staff such as nurses, X-ray technicians and respiratory therapists.
To replenish their ranks, facilities have relied on “travelers” like Perea. Staff agencies have deployed tens of thousands nationally since March outbreaks in the Northeast.
Rural hospitals have relied largely on traveling nurses to fill staffing shortages that existed even before the pandemic, said Tim Blasl, president of the North Dakota Hospital Association. “They find staff for you, but it’s really expensive labor,” he said. “Our hospitals are willing to invest so the people of North Dakota get care.”
The arrangement presents risks for travelers and their patients. Personnel ping-ponging between overwhelmed cities and underserved towns could introduce infections. As contractors, travelers sometimes feel tensions their full-time colleagues do not. Frequently employed by staffing agencies based thousands of miles away, they can find themselves working in crisis without advocates or adequate safety equipment.
In 2020, the upsides of their jobs — freedom and flexibility — have been dwarfed by treacherous conditions. Now the ranks of travelers are thinning: The work is exhausting, bruising and dangerous. Thousands of front-line health workers have gotten the virus and hundreds have died, according to reporting by KHN and The Guardian.
On April 17, Lois Twum, a 23-year-old traveling nurse from New Orleans, was one of four passengers on a flight to New York’s John F. Kennedy Airport.
When the self-described “adventure-seeking adrenaline junkie” arrived for her first shift at Columbia University’s Irving Medical Center, she said, she was assigned four patients on a COVID-19 unit. (Intensive care nurses typically care for two or three patients.) As these “constantly crashing” patients required resuscitations and intubations, “there was practically no one to help,” Twum said, because “everyone’s patient was critical.” The hospital did not respond to requests for comment on the workplace conditions and treatment of travelers.
Meanwhile, as hospital employees got sick, quit or were furloughed amid budget cuts, travelers picked up the slack. They were redeployed, Twum said, assigned more patients as well as the sickest ones.
“It was like we were airdropped into Iraq,” Twum said. “Travelers, we got the worst of it.”
On social media and in email groups, recruiters for travelers circulate photos of sun-splashed skylines or coastlines emblazoned with dollar signs, boasting salaries two or three times those of staff nurses. They promise signing bonuses, relocation bonuses and referral bonuses. They make small talk, ask about travelers’ families and suggest restaurants in new cities.
But when it comes to navigating workplace issues, “these people can just disappear on you,” said Anna Skinner, a respiratory therapist who has traveled for over a decade. “They are not your friends.”
Caught between the hospitals where they report for duty and remote staffing agencies, their worker protections are blurred.
For instance, under the Occupational Safety and Health Act, providing protective equipment is the agency’s responsibility — but the travelers who spoke with KHN said agencies rarely distribute any.
Perea’s family said they believe David did not have adequate PPE. His employer said it was the nursing home’s responsibility to provide it. “It is up to each of our clients to provide PPE to our staff while they are working assignments through MAS,” said Sara Moore, a spokesperson for Perea’s agency, MAS Medical Staffing.
Sometimes travelers are assigned to emergency rooms or intensive care units with which they have little experience. Skinner, a pediatric specialist, said she landed in adult ICUs when deployed to the University of Miami Health System in April. She received an hour of orientation, she said, but “nothing could have prepared me for what I had to deal with.”
Over five weeks, she said, she intubated one patient after another; suctioned the blood pouring into patients’ lungs and out of their noses and mouths; and dealt with families who were aghast, angry and afraid. Under the stress, Skinner said, she couldn’t sleep and lost weight. The hospital did not respond to requests for comment on workplace conditions for travelers.
Travelers often face “incredibly onerous” hurdles to the overtime, sick leave or workers’ compensation they are entitled to under the Fair Labor Standards Act, said Nathan Piller, a lawyer at Schneider Wallace Cottrell Konecky, an employment and business litigation firm.
Even the number of hours they can count on working is out of their control, Skinner said. Contracts reviewed by KHN authorize travelers to work a set number of hours, but only a fraction of those hours are guaranteed, and must be approved by on-site managers. The guaranteed hours may be compensated at rates hovering around minimum wage, and may require working holidays, which are not uniformly recognized.
The terms can be “modified from time to time during employment,” according to the contracts.
In 2018, AMN Healthcare, one of the country’s largest travel nursing agencies, agreed to a $20 million settlement for wage violations involving nearly 9,000 travelers. Violations “appear fairly commonplace across the industry,” said Piller, who worked on the settlement.
Travelers, Skinner said, are left to advocate for themselves to managers they might have just met — and “complaining just isn’t an option.”
KHN reviewed travel nursing contracts issued by Aya Healthcare, a large staffing agency, and found that any disputes — wrongful termination claims; claims of discrimination, harassment or retaliation; wage claims; and claims for violation of federal, state or other laws or regulations — must be settled out of court, in arbitration.
Officials at the Service Employees International Union, the American Nurses Association and National Nurses United said their constituents have been suspended or fired from traveling worker agencies for speaking to the news media, posting on social media or otherwise voicing concerns about unfair practices.
Matthew Wall, a longtime traveling nurse, knows this all too well. In July, two days into his assignment at Piedmont Henry Hospital in Stockbridge, Georgia, Wall said, he reported to hospital administrators “undeniably unsafe” conditions for himself and patients, including inadequate PPE, long hours and high patient-to-staff ratios.
Instead of addressing his concerns, Wall said, the hospital — which is under investigation by the federal government for workplace safety issues after another traveling nurse died of COVID-19 in mid-March — canceled his contract. “Travelers are treated like dog chow,” Wall said. “The second you become a liability, they dispose of you.”
“We continue to closely follow Centers for Disease Control and Prevention guidelines paired with our best practices in patient care and safety for all,” said John Manasso, a hospital spokesperson, who declined to comment on Wall’s case.
Some see an impossible choice. “We all know, if not for us, these patients would have no one,” Twum said, “but watching each other get sick left and right, it makes you wonder, is this worth my life?”
Skinner, for her part, took a job as a staff nurse in Aspen, Colorado. After his current contract in New Orleans ends, Wall is planning a break from nursing.
Dominga Perea finally received a text back the night of April 6: “Don’t panic, Mama, I have the COVID.
“Pray for me.”
She saw David over FaceTime on Easter. “He struggled even eating mashed potatoes” she said, “because he couldn’t breathe.” The next morning he went on a ventilator and never woke up.
Months later, Lakeside hadn’t filled Perea’s position. “Ideal candidate must be a caring individual dedicated to providing high quality care,” the job listing read, and “able to react to emergency situations appropriately when required.”
KHN Mountain States editor Matt Volz contributed to this report.
As COVID-19 cases surge in the U.S., one Texas veterinarian has been quietly tracking the spread of the disease — not in people, but in their pets.
Since June, Dr. Sarah Hamer and her team at Texas A&M University have tested hundreds of animals from area households where humans contracted COVID-19. They’ve swabbed dogs and cats, sure, but also pet hamsters and guinea pigs, looking for signs of infection. “We’re open to all of it,” said Hamer, a professor of epidemiology, who has found at least 19 cases of infection.
One pet that tested positive was Phoenix, a 7-year-old part-Siamese cat owned by Kaitlyn Romoser, who works in a university lab. Romoser, 23, was confirmed to have COVID-19 twice, once in March and again in September. The second time she was much sicker, she said, and Phoenix was her constant companion.
“If I would have known animals were just getting it everywhere, I would have tried to distance myself, but he will not distance himself from me,” Romoser said. “He sleeps in my bed with me. There was absolutely no social distancing.”
Across the country, veterinarians and other researchers are scouring the animal kingdom for signs of the virus that causes COVID-19. At least 2,000 animals in the U.S. have been tested for the coronavirus since the pandemic began, according to federal records. Cats and dogs that were exposed to sick owners represent most of the animals tested and 80% of the positive cases found.
But scientists have cast a wide net investigating other animals that could be at risk. In states from California to Florida, researchers have tested species ranging from farmed minks and zoo cats to unexpected critters like dolphins, armadillos and anteaters.
The U.S. Department of Agriculture keeps an official tally of confirmed animal COVID cases that stands at several dozen. But that list is a vast undercount of actual infections. In Utah and Wisconsin, for instance, more than 14,000 minks died in recent weeks after contracting COVID infections initially spread by humans.
So far, there’s limited evidence that animals are transmitting the virus to people. Veterinarians emphasize that pet owners appear to be in no danger from their furry companions and should continue to love and care for them. But scientists say continued testing is one way to remain vigilant in the face of a previously unknown pathogen.
“We just know that coronaviruses, as a family, infect a lot of species, mostly mammals,” said Dr. Peter Rabinowitz, a professor of environmental and occupational health sciences and the director of the University of Washington Center for One Health Research in Seattle. “It makes sense to take a species-spanning approach and look at a wide spectrum.”
Much of the testing has been rooted in scientific curiosity. Since the pandemic began, a major puzzle has been how the virus, which likely originated in bats, spread to humans. A leading theory is that it jumped to an intermediate species, still unknown, and then to people.
In April, a 4-year-old Malayan tiger at the Bronx Zoo tested positive for COVID-19 in a first-of-its-kind case after seven big cats showed signs of respiratory illness. The tiger, Nadia, contracted the virus from a caretaker, federal health officials said. Four other tigers and three African lions were also confirmed to be infected.
In Washington state, the site of the first U.S. outbreak in humans, scientists rushed to design a COVID test for animals in March, said Charlie Powell, a spokesperson for the Washington State University College of Veterinary Medicine. “We knew with warm-blooded animals, housed together, there’s going to be some cross-infection,” he said. Tests for animals use different reagent compounds than those used for tests in people, so they don’t deplete the human supply, Powell added.
Since spring, the Washington Animal Disease Diagnostic Laboratory has tested nearly 80 animals, including 38 dogs, 29 cats, two ferrets, a camel and two tamanduas, a type of anteater. The lab also tested six minks from the outbreak in Utah, five of which accounted for the lab’s only positive tests.
All told, nearly 1,400 animals have been tested for COVID-19 through the National Animal Health Laboratory Network or private labs, said Lyndsay Cole, a spokesperson for the USDA’s Animal and Plant Health Inspection Service. More than 400 animals have been tested through the National Veterinary Services Laboratories. At least 250 more have been tested through academic research projects.
The vast majority of the tests have been in household cats and dogs with suspicious respiratory symptoms. In June, the USDA reported that a dog in New York was the first pet dog to test positive for the coronavirus after falling ill and struggling to breathe. The dog, a 7-year-old German shepherd named Buddy, later died. Officials determined he’d contracted the virus from his owner.
Neither the Centers for Disease Control and Prevention nor the USDA recommends routine testing for house pets or other animals — but that hasn’t stopped owners from asking, said Dr. Douglas Kratt, president of the American Veterinary Medical Association.
“The questions have become a little more consistent at my practice,” he said. “People do want to know about COVID-19 and their pets. Can their pet pick it up at a clinic or boarding or in doggie day care?”
The answer, so far, is that humans are the primary source of infection in pets. In September, a small, unpublished study from the University of Guelph in Canada found that companion cats and dogs appeared to be infected by their sick owners, judging by antibodies to the coronavirus detected in their blood.
In Texas, Hamer started testing animals from households where someone had contracted COVID-19 to learn more about transmission pathways. “Right now, we’re very much trying to describe what’s happening in nature,” she said.
So far, most of the animals — including Phoenix, Romoser’s cat — have shown no signs of illness or disease. That’s true so far for many species of animals tested for COVID-19, veterinarians said. Most nonhuman creatures appear to weather COVID infection with mild symptoms like sniffles and lethargy, if any.
Still, owners should apply best practices for avoiding COVID infection to pets, too, Kratt said. Don’t let pets come into contact with unfamiliar animals, he suggested. Owners should wash their hands frequently and avoid nuzzling and other very close contact, if possible.
Cats appear to be more susceptible to COVID-19 than dogs, researchers said. And minks, which are farmed in the U.S. and elsewhere for their fur, appear quite vulnerable.
In the meantime, the list of creatures tested for COVID-19 — whether for illness or science — is growing. In Florida, 22 animals had been tested as of early October, including three wild dolphins, two civets, two clouded leopards, a gorilla, an orangutan, an alpaca and a bush baby, state officials said.
In California, 29 animals had been tested by the end of September, including a meerkat, a monkey and a coatimundi, a member of the raccoon family.
In Seattle, a plan to test orcas, or killer whales, in Puget Sound was called off at the last minute after a member of the scientific team was exposed to COVID-19 and had to quarantine, said Dr. Joe Gaydos, a senior wildlife veterinarian and science director for the SeaDoc Society, a conservation program at the University of California-Davis. The group missed its September window to locate the animals and obtain breath and fecal samples for analysis.
No one thinks marine animals will play a big role in the pandemic decimating the human population, Gaydos said. But testing many creatures on both land and sea is vital.
“We don’t know what this virus is going to do or can do,” Gaydos said.
At stake is whether the federal government will play a stronger role in financing and setting the ground rules for health care coverage or cede more authority to states and the private sector.
This article was published on Wednesday, November 4, 2020 in Kaiser Health News.
Update: This story was updated Nov. 4 at 7:30 a.m. ET to add more details about vote tallies from states.
With the winner of the presidency and party control of the Senate still unclear the morning after Election Day, the future of the nation’s health system remains uncertain. At stake is whether the federal government will play a stronger role in financing and setting the ground rules for health care coverage or cede more authority to states and the private sector.
Should President Donald Trump win and Republicans retain control of the Senate, Trump still may not be able to make sweeping changes through legislation as long as the House is still controlled by Democrats. But — thanks to rules set up by the Senate GOP — the ability to continue to stack the federal courts with conservative jurists who are likely to uphold Trump’s expansive use of executive power could effectively remake the government’s relationship with the health care system even without signed legislation.
The president has also pledged to continue his efforts to get rid of the Affordable Care Act, and if the Supreme Court overturns the sweeping law as part of a challenge it will hear next week, the Republicans’ promise to protect people with preexisting medical conditions will be put to the test. In a second term, the administration would also likely push to continue to revamp Medicaid with its efforts to institute work requirements for adult enrollees and provide more flexibility for states to change the contours of the program.
If former Vice President Joe Biden wins and Democrats gain a Senate majority, it would represent the first time the party has controlled the White House and both houses of Congress since 2010 — the year the ACA was passed. A top priority will be dealing with the COVID-19 pandemic and the economic fallout. Biden made that a keystone of his campaign, promising to implement policies based on advice from medical and scientific advisers and provide more directives and aid to the states.
But also high on his agenda will be addressing parts of the ACA that haven’t worked as well as its authors hoped. He pledged to add a government-run “public option,” which would be an alternative to private insurance plans on the marketplaces, and to lower the eligibility age for Medicare to 60.
While Democrats will continue to control the House, the final makeup of the Senate is still to be determined. And even if the Democrats win the Senate, they are not expected to come away with a majority that would allow them to pass legislation without support from at least some GOP senators, unless they change the Senate’s rules. That could lower expectations of what the Democrats can accomplish — and may lead to some tensions among members.
But who controls Washington, D.C., is only part of the election’s impact on health policy. Several key health issues are on the ballot both directly and indirectly in many states. Here are a few:
Abortion
In Colorado, a measure that would have banned abortions after 22 weeks of pregnancy — except to save the life of the pregnant person — failed, according to The Associated Press. Colorado is one of seven states that don’t prohibit abortions at some point in pregnancy. It is also home to one of the few clinics in the nation that perform abortions in the third trimester, often for severe medical complications. The clinic draws patients from around the nation, so residents of other states would have been affected if the Colorado amendment passed.
In Louisiana, however, voters easily approved an amendment to the state constitution to say that nothing in the document protects the right to, or requires the funding of, abortion. That would make it easier for the state to outlaw abortion if the Supreme Court overturns Roe v. Wade, which makes state abortion bans unconstitutional.
Medicaid
The fate of the Medicaid program for people with low incomes is not on the ballot directly anywhere this election. (Voters approved expansions of the program in Missouri and Oklahoma earlier this year.) But the program will be affected not only by who controls the presidency and Congress, but also by who controls the legislatures in states that have not expanded the program under the Affordable Care Act. North Carolina is a key swing state where a change in majority in the legislature could turn the expansion tide.
Drug Policy
In six states, voters are deciding the legality of marijuana in one form or another. Montana, Arizona and New Jersey were deciding whether to join the 11 states that allow recreational use of the drug. Mississippi and Nebraska voters were choosing whether to legalize medical marijuana, and South Dakota became the first state to vote on legalizing both recreational and medical pot in the same election.
Magic mushrooms are on two ballots. A measure in Oregon to allow the use of psilocybin-producing mushrooms for medicinal purposes passed, and a District of Columbia proposal to decriminalize the hallucinogenic fungi was leading.
Also approved was a separate ballot question in Oregon to decriminalize possession of small amounts of hard drugs, including heroin, cocaine and methamphetamine, and mandate establishing addiction recovery centers, using some tax proceeds from marijuana sales to establish those centers.
California
As usual, voters in California faced a lengthy list of health-related ballot measures.
For the second time in two years, the state’s profitable kidney dialysis industry was challenged at the ballot box. A union-sponsored initiative would have required dialysis companies to employ a doctor at every clinic and submit infection reports to the state. But the industry spent $105 million against the measure. The measure failed, according to AP.
Voters were also asked to decide, again, whether to fund stem cell research through the California Institute for Regenerative Medicine via Proposition 14. Voters first approved funding for the agency in 2004, and since then, billions have been spent with few cures to show for it. The measure was winning in early returns.
California has been at the forefront of the fight over the so-called gig economy, and this year’s ballot included a proposal pushed by ride-hailing companies like Uber and Lyft that would let them continue to treat drivers as independent contractors instead of employees. Under Proposition 22, the companies would not have to provide direct health benefits to drivers but would have to give those who qualify a stipend they could use toward a premium for health insurance purchased through the state’s individual marketplace, Covered California. The measure was approved.
Finally, voters in the Golden State were asked whether to impose higher property taxes on commercial property owners with land and property holdings valued at $3 million or more, which could help provide new revenue earmarked for economically struggling cities and counties hit hard by COVID-19, as well as K-12 schools and community colleges. Community clinics, California nurses and Planned Parenthood jumped into the thorny political battle over Proposition 15 — taking on powerful business groups — eyeing revenue to help rebuild California’s underfunded public health system. The measure was too close to call in early returns.
Democrats in California, who control all statewide elected offices and hold a supermajority in the legislature, have been positioning for a Biden win, and some were already penning ambitious health care legislation for next year. Should Biden win, they said they plan to crack down on hospital consolidation and end surprise emergency room bills, and some were quietly discussing liberal initiatives such as pursuing a single-payer health care system and expanding Medicaid to cover more unauthorized immigrants.
JoNel Aleccia, Rachel Bluth, Angela Hart, Matt Volz and Samantha Young contributed to this story.
Older adults in all kinds of circumstances are similarly deliberating what to do as days and nights turn chilly and coronavirus cases rise across the country.
This article was published on Tuesday, November 3, 2020 in Kaiser Health News.
Over the past month, Dr. Richard Besdine and his wife have been discussing whether to see family and friends indoors this fall and winter.
He thinks they should, so long as people have been taking strict precautions during the coronavirus pandemic.
She’s not convinced it’s safe, given the heightened risk of viral transmission in indoor spaces.
Both are well positioned to weigh in on the question. Besdine, 80, was the longtime director of the division of geriatrics and palliative medicine at Brown University’s Alpert Medical School. His wife, Terrie Wetle, 73, also an aging specialist, was the founding dean of Brown’s School of Public Health.
“We differ, but I respect her hesitancy, so we don’t argue,” Besdine said.
Older adults in all kinds of circumstances — those living alone and those who are partnered, those in good health and those who are not — are similarly deliberating what to do as days and nights turn chilly and coronavirus cases rise across the country.
Some are forming “bubbles” or “pods”: small groups that agree on pandemic precautions and will see one another in person in the months ahead. Others are planning to go it alone.
Judith Rosenmeier, 84, of Boston, a widow who’s survived three bouts of breast cancer, doesn’t intend to invite friends to her apartment or visit them in theirs.
“My oncologist said when all this started, ‘You really have to stay home more than other people because the treatments you’ve had have destroyed a lot of your immune defenses,’” she said.
Since mid-March, Rosenmeier has been outside only three times: once, in September, to go to the eye doctor and twice since to walk with a few friends. After living in Denmark for most of her adult life, she doesn’t have a lot of close contacts. Her son lives in Edinburgh, Scotland.
“There’s a good chance I’ll be alone on Thanksgiving and on Christmas, but I’ll survive,” she said.
A friend who lives nearby, Joan Doucette, 82, is determined to maintain in-person social contacts. With her husband, Harry Fisher, 84, she’s formed a “pod” with two other couples in her nine-unit apartment building. All are members of Beacon Hill Village, an organization that provides various services to seniors aging in place. Doucette sees her pod almost every day.
“We’re always running up and down the stairs or elevator and bringing each other cookies or soup,” she said. “I don’t think I would have survived this pandemic without that companionship.”
About once a week, the couples have dinner together and “we don’t wear masks,” said Jerry Fielder, 74, who moved to Boston two years ago with his partner, Daniel, 73. But he said he feels safe because “we know where everyone goes and what they do: We’re all on the same page. We go out for walks every day, all of us. Otherwise, we’re very careful.”
Eleanor Weiss, 86, and her husband are also members of the group. “I wear a mask, I socially distance myself, but I don’t isolate myself,” Weiss said. This winter, she said, she’ll see “a few close friends” and three daughters who live in the Boston area.
One daughter is hosting Thanksgiving at her house, and everyone will get tested for the coronavirus beforehand. “We’re all careful. We don’t hug and kiss. We do the elbow thing,” Weiss said.
In Chicago, Arthur Koff, 85, and his wife, Norma, 69, don’t yet have plans for Thanksgiving or Christmas. “It’s up in the air depending on what’s happening with the virus,” he said. The couple has a wide circle of friends.
“I think it’s going to be a very hard winter,” said Koff, who has diabetes and blood cancer. He doesn’t plan to go to restaurants but hopes to meet some friends he trusts inside their homes or apartments when the weather turns bad.
Julie Freestone, 75, and her husband, Rudi Raab, 74, are “pretty fanatic” about staying safe during the pandemic. The couple invited six friends over for “Thanksgiving in October” earlier this month — outside, in their backyard in Richmond, California.
“Instead of a seating chart, this year I had a plating chart and I plated everything in advance,” Freestone said. “I asked everybody to tell me what they wanted — White or dark meat? Brussels sprouts or broccoli?”
This winter, Freestone isn’t planning to see people inside, but she’ll visit with people in groups, virtually. One is her monthly women’s group, which has been getting together over Zoom. “In some ways, I feel we’ve reached a new level of intimacy because people are struggling with so many issues — and we’re all talking about that,” she said.
“I think you need to redefine bubbles,” said Freestone, who’s on the board of Ashby Village, a Berkeley, California-based organization for seniors aging in place that’s hosting lots of virtual groups. “It should be something you feel a part of, but it doesn’t have to be people who come into your house.”
In the Minneapolis-St. Paul area in Minnesota, two psychologists — Leni de Mik, 79, and Brenda Hartman, 65 — are calling attention to what they call SILOS, an acronym for “single individuals left out of social circles,” and their need for dependable social contact this winter and fall.
They recommend that older adults in this situation reach out to others with similar interests — people they may have met at church or in book clubs or art classes, for instance — and try to form a group. Similarly, they recommend that families or friends invite a single older friend into their pods or bubbles.
“Look around at who’s in your community. Who used to come to your house that you haven’t seen? Reach out,” de Mik recommended.
Both psychologists are single and live alone. De Mik’s pod will include two friends who are “super careful outside,” as she is. Hartman’s will include her sister, 67, and her father, 89, who also live alone. Because her daughter works in an elementary school, she’ll see her only outside. Also, she’ll be walking regularly with two friends over the winter.
“COVID brings life and death right up in front of us,” Hartman said, “and when that happens, we have the opportunity to make crucial choices — the opportunity to take care of each other.”
Consumer Resources
Public health experts advise that thorough and frequent hand-washing, wearing masks in public meeting in small groups and maintaining at least 6 feet of social distancing can help prevent the transmission of the coronavirus. The federal Centers for Disease Control and Prevention has more detailed advice on its website, including these pages: