THE PROGNOSIS

Severely ill coronavirus patients will generate such costly hospital bills that it could drive up insurance premiums by double digits for tens of millions of Americans next year.

That’s according to Peter Lee, director of California’s individual insurance marketplace, whose actuaries have estimated that medical care stemming from the virus could generate between $29 billion and $216 billion in hospital costs nationally for patients on employer-sponsored or individual market coverage, depending on the number of people ultimately infected.

The report out of California — which, like a half-dozen other states, is allowing people special permission to sign up for Affordable Care Act plans during the pandemic — underscores yet another economic ripple effect of the virus: It will spur large new health-care costs that many Americans will eventually feel.

While the vast majority of coronavirus patients will experience only mild symptoms, a subset of the infected will develop pneumonia or other respiratory trouble, requiring a hospital stay where they can have access to oxygen or a ventilator. 

Actuaries for Covered California, the state's ACA marketplace, estimated that patients hospitalized because of coronavirus would stay an average of 12 days, generating an average bill of $72,000. 

A majority of these patients will be over age 65, so the federal Medicare program will pay their bills, which are typically around half or two-thirds of what commercial insurers pay. Low-income people on Medicaid will have coverage, too.

But the outlook is troubling for other Americans. If they are insured, they’ll mostly be covered after meeting their annual deductible, but they’ll still cause a boost in health-care spending that will make future premiums more expensive for everyone else. 

And uninsured patients who require hospitalization will incur tens of thousands of dollars in costs. 

Covered California estimate calculated total costs to the system based on three scenarios. There's the scenario in which coronavirus has “low” impact, in which 400,000 people are hospitalized in the U.S.; “medium” impact where 1.2 million are hospitalized; and “high” impact where 3 million people are hospitalized. 

In any of these scenarios, insurers will face large, unexpected bills that could prompt widespread premium spikes next year.

“It’s a phenomenally large implication,” Lee told me. 

California’s $72,000 estimate for a hospital stay for coronavirus is considerably larger than what other analysts have projected. Kaiser Family Foundation researchers found the average employer-sponsored plan pays an average of $20,292 for hospital admission of a patient with pneumonia and major complications. The average cost ranged from $11,533 to $24,178, depending on the area of the country.

But this much is clear: The coronavirus outbreak, which killed 100 people in the United State in a single day yesterday, will further strain a U.S. health-care system whose patients are already plagued by perpetually rising costs and inefficiencies all around. 

The Washington Examiner’s Philip Klein:

CNN reporter Jeremy Diamond:

Yet the pandemic has also offered Obamacare advocates a chance to tout the law’s successes on its 10th anniversary yesterday. 

“We couldn’t need it more in terms of this pandemic,” House Speaker Nancy Pelosi (D-Calif.) said on a call yesterday hosted by the Democrat-connected group Protect Our Care. “As we prayerfully go into this further discussion on the coronavirus challenge, thank God for the Patient Protection and Affordable Care Act.” 

Advocates were forced to dramatically scale back their plans to celebrate the ACA’s decade of existence on March 23. President Obama released a video message instead of delivering an address at American University, which was canceled. 

Congressional Democrats still seized the opportunity to tout the law’s expansion of coverage to around 20 million Americans through the individual marketplaces and Medicaid expansion and its requirements for plans to cover essential services — including hospital visits and vaccinations, services that are particularly relevant during this pandemic.

They resurrected their frequent pre-coronavirus messaging about the Trump administration’s constant bombardment of the law, most specifically its position that the entire measure is unconstitutional and should be struck down by the courts. Pelosi asked the administration to reverse its position on the ACA and to instead encourage the states still resisting Medicaid expansion to accept it.

Chris Lu, deputy secretary of labor under Obama:

Larry Levitt, a senior vice president with the Kaiser Family Foundation:

And they called on the administration to further promote the law during the pandemic, by opening up HealthCare.gov for a special enrollment period. 

Sign-ups are typically allowed only in the final two months of the year, but Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington (which all run their own marketplaces) have all temporarily reopened sign-ups. Enrollment was already open in California and the District of Columbia for other reasons, but both jurisdictions have said they’ll keep it open longer.

Rep. Lauren Underwood (D-Ill.), who worked at the Department of Health and Human Services as the ACA was being passed, said it’s “really important we leverage all existing authorities to ensure the American people have access to the care and coverage they need.”

“We just haven’t seen any move toward that end from the administration,” she said.

AHH, OOF and OUCH

AHH: Senate leaders and the Trump administration appeared near a bipartisan deal last night on a massive stimulus package to bolster the economy with $2 trillion amid the coronavirus fallout. 

“After a day of partisan rancor and posturing on Capitol Hill, the outlook grew markedly more positive later in the afternoon, when offers and counteroffers were exchanged,” our colleagues Erica Werner, Paul Kane, Rachael Bade and Mike DeBonis report. “Senate Minority Leader Charles E. Schumer (D-N.Y.) convened Democrats on a conference call and told them he was hopeful about striking a deal by the end of the day.”

Hours of negotiations halted just before midnight. Schumer and Treasury Secretary Steve Mnuchin were optimistic a deal would be announced today. Schumer told reporters Mnuchin “called the president, we told him we were very, very close to an agreement; he seemed very happy with that and wanted us to try to — get us to get it done tomorrow.”

Trump tweeted this last night:

If lawmakers and administration officials settle on a deal, they’re hoping the package will move through the chambers quickly, although questions remained about how the House would address the legislation, since they’re out of session and probably not likely to return all together to vote. 

What will be included in the legislation? It’s set to include direct payments of $1,200 to many Americans adults and $500 to children; roughly $850 billion in loan and assistance programs for businesses, states and cities; and spending increases for the unemployment insurance program, as well as hospitals and health-care providers reeling from the crisis. 

Our colleagues add: “The fiery developments reflected rising tensions among lawmakers over the nation’s predicament and what’s happening in the Senate itself; Sen. Rand Paul (R-Ky.) announced Sunday that he has covid-19, and four other GOP senators are quarantined. Sen. Amy Klobuchar (D-Minn.) disclosed Monday that her husband, too, is infected with the virus.”
 

— Klobuchar said her husband, John Bessler, got the test results yesterday.

“I just wanted to reiterate that one of the hardest things about this disease is he’s in the hospital — he’s been there a few days — and I can’t even be by his side,” Klobuchar said on a previously scheduled conference call. “I think many families in America are now experiencing this and things that are much, much worse.”

She said the doctor advised her not to get tested — and noted she’s been away from her husband for the past two weeks and is “outside the 14-day period for getting sick.” 

“As everyone is aware, there are test shortages for people who need them everywhere and I don’t qualify to get one under any standard,” she wrote in a post on Medium. 

— Paul, the first senator to announce he was diagnosed with the coronavirus, continued to work at the Capitol for six days as the results of his test were pending, our colleagues Seung Min Kim, Michael Scherer and Paul Kane report. He cast votes on the Senate floor, met with other GOP senators, played golf at a private club in Northern Virginia and worked out in a senators-only gym at the Capitol Hill complex. 

“Paul was defiant that he did nothing wrong, despite bipartisan criticism for his behavior and even sharper private furor among senators and aides because he had potentially exposed them to a virus whose debilitating effect on the nation’s health and economy lawmakers were working so ferociously to combat,” they add. 

— As the coronavirus continues to spread to members of Congress and their loved ones, many are wondering why lawmakers aren’t vote allowed to vote remotely.

The idea is gaining traction with a number of lawmakers. On Monday, nearly 70 House Democrats sent a letter to their leadership to push for remote voting, Politico’s Sarah Ferris reports.

“On Sunday, President Trump said he’d support remote voting. Top House Democrats have privately floated it,” our colleague Amber Phillips writes. “In the Senate, there’s a new bipartisan proposal to vote remotely for up to 30 days. Senate Minority Leader Charles E. Schumer (D-N.Y.) has endorsed the idea for an emergency.” 

“The technology exists. We’re just going to have to find a way to do it,” Klobuchar said Monday. “… I think at some point it’s going to become inevitable.”

— The pandemic could now define the battle for Congress, in more dramatic ways than the impeachment storm, which now feels far in the rear view. 

“Democratic campaign officials say the dual threats to public health and the economy have upended an election they worried — and Republicans hoped — would focus on Trump’s impeachment,” Politico’s Sarah Ferris and Ally Mutnick report. “Campaigning has all but ceased in the traditional sense: Fundraising is down, and campaign officials on both sides say they’re being more careful about when and how to attack their opponents.”

Now it’s all about the coronavirus. Rep. Tom O’Halleran (D-Ariz.) said it’s “always about, ‘What meeting are you going to on the virus?’ or, ‘What are you going to do on the virus bill?’ ”

Rep. Cheri Bustos (D-Ill.), who heads the House Democratic campaign arm, said she’s urging vulnerable members to follow federal health guidelines, which also means no public gatherings. 

“Nobody knows how long this is going to last,” Bustos told reporters. “And here’s the thing, it’s not like coronavirus hits Dems and not Republicans.”

OOF: Trump said he may soon loosen coronavirus containment guidelines for social distancing, despite dire warnings from public health experts, our Post colleagues Philip Rucker, Jeff Stein, Josh Dawsey and Ashley Parker report. 

“America will again and soon be open for business — very soon,” Trump said at the daily White House news conference. “We cannot let the cure be worse than the problem itself.”

“The consensus among experts — including infectious disease expert Anthony S. Fauci and other senior officials on Trump’s coronavirus task force — is that restaurants, bars, schools, offices and other gathering places should remain closed for many more weeks to mitigate the outbreak, the worst effects of which are yet to be felt in the United States,” our colleagues write. “But Trump has been chafing against that notion and impatient to get American life back to normal.”

Fauci and other experts have warned administration officials that a weakening of social distancing guidelines prematurely could mean overwhelmed hospitals and impeded efforts to curb the spread of illness. 

The Post's Sarah Kaplan: 

— In an editorial last week, the Wall Street Journal’s editorial board argued that “federal and state officials need to start adjusting their anti-virus strategy now to avoid an economic recession that will dwarf the harm from 2008-2009.” 

“The vast social-distancing project of the last 10 days or so has been necessary and has done much good. Warnings about large gatherings of more than 10 people and limiting access to nursing homes will save lives,” the board wrote. “ … Yet the costs of this national shutdown are growing by the hour, and we don’t mean federal spending. We mean a tsunami of economic destruction that will cause tens of millions to lose their jobs as commerce and production simply cease. Many large companies can withstand a few weeks without revenue but that isn’t true of millions of small and mid-sized firms.”

OUCH: The new mysterious, deadly coronavirus is sneaky and difficult to defeat. It’s not alive, but it’s frighteningly good at hijacking our cells and replicating millions of versions of itself to wreak havoc. 

The virus is “little more than a packet of genetic material surrounded by a spiky protein shell one-thousandth the width of an eyelash, and leads such a zombielike existence that it’s barely considered a living organism,” our Post colleagues Sarah Kaplan, William Wan and Joel Achenbach report. “ … As researchers race to develop drugs and vaccines for the disease that has already sickened 350,000 and killed more than 15,000 people, and counting, this is a scientific portrait of what they are up against.” 

The new coronavirus, SARS-CoV-2, stays in the upper respiratory tract. It can lodge itself deep within lungs. 

Johns Hopkins University virologist Andrew Pekosz compared such viruses to particularly destructive burglars, our colleagues write. “They break into your home, eat your food and use your furniture and have 10,000 babies. ‘And then they leave the place trashed,’ he said.”

— Former vice president Joe Biden addressed the nation about the spreading pandemic in a new makeshift television studio in his Wilmington, Del., home. 

It’s part of a new effort, our Post colleague Matt Viser reports, and Biden has said he is hoping to make a similar address almost daily, with his comments streamed online. 

In his address yesterday, he criticized the president’s response. “Trump keeps saying that he’s a wartime president. Well, start to act like one. … Donald Trump is not to blame for the coronavirus, but he does bear responsibility for our response,” he said. “I, along with every American, hope he steps up and starts to get this right.”

The new effort is a “recognition that, while they lack the power of the presidency and the megaphone that comes from the White House briefing room, the campaign needs to try something to stand out,” Matt writes.

Where has Biden been lately? According to Matt, he has “spent the last week at home making calls to lawmakers and meeting with advisers, but has kept a relatively low public profile. Some have criticized his absence over the past week amid a national crisis. His campaign announced 10 days ago that Biden himself has not taken the test for the coronavirus because he has no symptoms and hasn’t come into contact with anyone who has tested positive.” 

— Biden and Trump have “allowed their campaigns to launch deeply personal offensives against the other in recent days as they confront a likely general election clash before a nation grappling with a viral pandemic,” our colleagues Matt, Michael Scherer and Josh Dawsey report. “The faceoff comes as much of the presidential campaign has been either put on hold or shifted online as the contenders retool for an new era of economic crisis and social distancing. Fundraisers have been postponed, rallies have been canceled, and new technologies are under consideration.”
 

— A few of the latest headlines and developments to catch up on this morning: 

Officials warn about a grim week ahead: 

  • U.S. Surgeon General Jerome Adams warned: “This week, it’s going to get bad.”
  • U.S. states reported more than 100 deaths yesterday, bringing the nation’s total death toll past 500.
  • A team of British ear, nose and throat doctors say it's possible losing sense of smell may be a hidden symptom of the novel coronavirus, our colleague Michael Brice-Saddler reports.

The impact of the president’s remarks: 

  • Trump touted an unproven coronavirus treatment. Now, supplies of two anti-malarial drugs are nearly exhausted in the United States, our colleague Chris Rowland reports. The drugs are being used by some for coronavirus treatment, but they “lack definitive evidence as effective treatment or approval from the Food and Drug Administration.”
  • The president tweeted over the weekend calling the compounds a possible “game-changer.” “But his own lieutenants, the heads of the Food and Drug Administration and the National Institute of Allergy and Infectious Diseases, have been hesitant,” Stat News’s Matthew Harper reports.

The response from states: 

  • Maryland Gov. Larry Hogan ordered the closure of all “non-essential” businesses in the state. But what is an essential business in Maryland, D.C. or Virginia? From The Post’s Jenna Portnoy.
  • Michigan, Ohio, Louisiana and Oregon are the latest states to announce stay-at-home orders. Massachusetts also ordered nonessential businesses to close, and Virginia’s governor said schools would be closed for the remainder of the academic year.
  • In New York, hospitals have reported a steady increase in the number of patients needing intensive care. The state “continues to lead the country in confirmed covid-19 cases, and the numbers are expected to accelerate rapidly in the coming days and weeks,” our colleagues Shayna Jacobs and Lenny Bernstein report.
  • According to a new Monmouth University poll, half of Americans say the president has done a good job handling the crisis, compared with 72 percent who say their state's governor has done a good job.

SUGAR RUSH