with Alexandra Ellerbeck

It’s been a challenging year for the nation’s 911 system — including ambulances, which in some parts of the country have been providing care they can’t get paid for.

But now the industry’s lobbying may pay off. Senate leaders are moving on a measure to boost payments to ambulance service providers, slipping it into the massive coronavirus relief bill moving through Congress.

The measure would let Medicare pay companies for ambulance services rendered to patients never taken to a hospital.

Current rules generally only allow ambulance service providers to be reimbursed if they take the patient to the closest hospital or clinic.

Yet transporting patients to hospitals hasn’t always been possible during the pandemic. Some states and localities have ordered ambulances to deliver care in patients’ homes — if possible — so as to leave hospital facilities free and available for coronavirus patients.

As coronavirus hospitalizations surged in January, Los Angeles County ordered ambulance crews not to take patients who can’t be resuscitated after cardiac arrest to hospitals. In New Rochelle, N.Y., ambulance services were told to treat patients in place whenever possible.

Tristan North, vice president of government affairs at the American Ambulance Association, said easing the payment rules is essential for ambulance service providers in the hardest-hit areas of the country.

“If you’re in an area hit hard by covid, those are the areas most likely to have a protocol or directive requiring the service provider not to transport to the closest hospital,” North said.

Some ambulance services say 30 to 40 percent of their emergency calls now results in treatment-in-place instead of transport.

That’s according to a letter sent by AAA and other emergency responder associations to Senate leaders last month, asking them to address the issue by passing legislation from Sens. Bill Cassidy (R-La.) and Catherine Cortez Masto (D-Nev.).

The bill — whose text is included in the draft Senate relief package but not in the House version — lets Medicare pay ambulance providers even if the patients aren’t transported to a health-care facility. The authority would last as long as the nation is under a public health emergency.

“Without reimbursement, the situation is not sustainable,” the associations wrote. “Communities risk losing the very emergency medical providers and suppliers they have relied upon to help reduce hospital surge and decrease the infection rate.”

Cortez Masto said she's glad the provision will be included in the relief package. “Our ambulance organizations and first responders are working heroically to keep low-risk patients out of the hospital during the coronavirus pandemic, and they deserve to be properly paid for these efforts,” she said in a statement provided to The Health 202.

Cassidy didn't respond to an inquiry about the legislation being included in the relief package. He has criticized the relief bill, charging that its many elements — not all of which are connected to the pandemic — reflect “the interest of the Democratic constituencies that elected the president.”

Ambulance providers argue they’ve been mostly ignored by lawmakers up until now.

Over the last year, Congress has approved billions of dollars in aid for hospitals and other parts of the health-care system. But ambulance and emergency responders have received only a small fraction of that funding, my colleague William Wan reported.

Ambulance operators told William their workers are exhausted and their managers are increasingly struggling to keep operations afloat in the face of a series of financial blows.

“Even before the pandemic, the nation’s 911 system was strained,” William wrote. “Across the country, 911 calls are answered by a patchwork of nonprofit, for-profit, hospital-affiliated, fire department and municipal-run services.”

“As some ambulance services go out of business, others from neighboring counties will have to cover those areas,” he added. “To cut costs, some may keep fewer ambulances in the field. Both scenarios would result in longer wait times. Rural areas, which already struggle with wait times and coverage, could be especially hit hard.

President Biden is lobbying Democrats this week to pass the relief package.

The president, who can’t spare a single vote in the Senate, is trying to unify Democrats behind his $1.9 trillion measure, as the Senate prepares to move forward on it this week. Several moderates have raised concerns about the structure of unemployment insurance benefits and aid for state and local governments.

“The White House and congressional Democrats are staring down a March 14 deadline when enhanced unemployment benefits will expire unless the relief legislation is signed into law first,” Erica Werner and Jeff Stein report. “The House passed the bill on Saturday, allowing just two weeks to get it through the Senate, where it’s likely to undergo some changes, and then back to the House for final passage.”

“The president’s focus this week and in coming weeks, until it’s passed, is on the American Rescue Plan,” White House press secretary Jen Psaki said Monday. “It’s absolutely critical Congress act, and we certainly hope they do that as quickly as possible.”

Breaking: President Biden will today announce that Merck will help make Johnson & Johnson’s single-shot coronavirus vaccine.

The fierce competitors are striking an unusual pact that could sharply boost the supply of the newly authorized vaccine, senior administration officials told Laurie McGinley and Christopher Rowland.

The officials said they began scouring the country for additional manufacturing capacity after they realized Johnson & Johnson had fallen behind in vaccine production. They soon sought to broker a deal with Merck, one of the world’s largest vaccine makers, which had tried and failed to develop its own coronavirus vaccine.

“Under the arrangement, Merck will dedicate two facilities in the United States to Johnson & Johnson’s shots,” Laurie and Chris write. “One will provide ‘fill-finish’ services, the last stage of the production process during which the vaccine substance is placed in vials and packaged for distribution. The other will make the vaccine itself, and has the potential to vastly increase supply, perhaps even doubling what Johnson & Johnson could make on its own.”

Ahh, oof and ouch

AHH: The Senate parliamentarian says COBRA subsidies can stay in the relief package.

There had been some question about whether the subsidies for laid-off workers could be included in a budget reconciliation bill, which can generally include only things that directly affect federal spending (we wrote about that issue here).

Yesterday, parliamentarian Elizabeth MacDonough found that a provision allowing the federal government to subsidize COBRA premiums at 85 percent is eligible for the simple-majority process Democrats are using to push the measure through without any GOP votes.

Senate Finance Committee Chairman Ron Wyden (D-Ore.) issued a statement praising the decision.

“I am pleased this important provision will remain in the critical relief bill before the Senate this week,” Wyden said. “Workers who have been laid off need affordable health care for their families now more than ever, and helping people pay their COBRA premiums will make that a reality for millions.”

OOF: Fauci is calling for the U.S. to stick with its two-shot strategy for the Pfizer and Moderna vaccines.

“The government’s top infectious-disease expert on Monday reiterated that the United States will stick to a plan to inoculate tens of millions of Americans with two doses of coronavirus vaccine, as calls mount to protect more people by letting them get one shot now,” The Post’s Dan Diamond reports.

“There’s risks on either side,” Anthony S. Fauci told The Post, warning that a single-dose strategy could leave people less protected and create public confusion. Fauci said he spoke with health officials in the United Kingdom, who have opted to delay second doses to maximize the number of people with at least partial protection from the first shot. “We both agreed that both of our approaches were quite reasonable,” he said.

Two Democratic senators are asking the administration to more quickly deploy all doses of the Pfizer and Moderna vaccines instead of holding back half for a second shot – with the understanding that people should still get a second shot within the recommneded time frame.

“Based on conversations with health officials, we believe this approach is worthy of serious consideration,” Sens. Chris Van Hollen (D-Md.) and Martin Heinrich (D-N.M.) wrote to Jeff Zients, the White House coronavirus coordinator, in a letter shared with The Post.

Van Hollen and Heinrich cite data recently published in the New England Journal of Medicine that shows that a single dose of the Pfizer vaccine was 74 percent effective against hospitalization and 72 percent effective against coronavirus-related death between days 14-20 after one dose.

OUCH: A California surgeon called into a Zoom court hearing from the operating room.

Scott Green, a plastic surgeon, was wearing scrubs, gloves and a surgical cap when he called into a court hearing to contest a traffic violation, The Post’s Katie Shepherd reports. “As they waited for the judge to arrive for a hearing that was live-streamed on YouTube under state laws, Green could be seen handling surgical tools. At one point, an apparently unconscious patient on a table briefly appeared in the frame,” she writes.

“It kind of looks like you’re in an operating room right now,” the Sacramento Superior Court clerk said, in a live-streamed video of the hearing recorded by the Sacramento Bee.

“I am, sir,” Green confirmed. “Yes, I’m in an operating room right now. I’m available for trial. Go right ahead.”

Green reassured the court that he could multitask given that another surgeon was helping him, but the judge was unconvinced. “I don’t think that’s appropriate,” Sacramento Superior Court Commissioner Gary Link said. The judge then asked the court clerk to come up with a different date for the trial.

Vaccine latest

The Trump administration used hospital aid to bankroll Operation Warp Speed contracts.

Four former administration officials told Stat News that the Department of Health and Human Services quietly took around $10 billion from a fund meant to help hospitals and health care providers affected by covid-19 and used the money to pay for contracts with vaccine developers.

“The Department of Health and Human Services appears to have used a financial maneuver that allowed officials to spend the money without telling Congress, and the agency got permission from its top lawyer to do so,” Rachel Cohrs reports. "Now, the Biden administration is refusing to say whether the outlay means there will be less money available for hospitals, physicians, nursing homes, and other providers.

Congress set aside that money to help health care providers pay for pandemic-related expenses, but former White House budget office director Russ Vought, one of the key officials involved in the deliberations, defended the decision. “He told STAT the expenditure was necessary to support the successful development and purchase of Covid-19 vaccines and therapeutics,” Rachel writes.

The New Orleans archdiocese is urging Catholics to avoid the new Johnson & Johnson vaccine.

The archdiocese issued a statement calling the vaccine “morally compromised” because it uses cells that were originally derived from tissue from an aborted fetus in the 1970s. The cells are clones and not the original fetal tissue, Religion News Service’s Jack Jenkins reports.

Although the Moderna and Pfizer vaccines were developed using lab testing on cell lines derived from an aborted fetus, they do not use these lines in the manufacturing process, making “the connection to abortion … extremely remote,” according to the diocese.

In his Christmas message, Pope Francis urged leaders to prioritize making the coronavirus vaccine available to all and put first "the most vulnerable." (Reuters)

“The decision has the potential to impact vaccine distribution. Several houses of worship — including Catholic churches — currently serve as vaccination centers, as do many faith-affiliated organizations,” Jack writes.

The Vatican and the U.S. Conference of Catholic Bishops have not issued any statements discouraging the use of the Johnson & Johnson vaccine. The Vatican in December issued guidelines saying that it was morally acceptable for Catholics to receive vaccines that used cell lines derived from aborted fetuses in their research and production if other vaccines were not available. The Vatican has made the Pfizer-BioNTech vaccine available to citizens of the city-state.

More in coronavirus news

  • New coronavirus cases have started to tick upward after weeks of decline. Some health experts worry that new, more contagious coronavirus variants may be driving the uptick, The Post’s William Wan and Angela Fritz report.
     
  • Johnson & Johnson’s single-shot vaccine is easier to store and use, making it an ideal candidate in many ways to send to harder-to-reach communities, The Post’s Isaac Stanley-Becker reports. But decisions to send it to these communities could drive perceptions of a two-tiered vaccine system in which marginalized communities are getting a less-effective vaccine.
     
  • Germans have coined 1,200 words to talk about the coronavirus, The Post’s Luisa Beck reports. Among the new words are: Mindestabstandsregelung (minimum-distance regulation) for social distancing and Ausgangsbeschränk­ung (going-out restriction) to describe lockdowns at the start of the pandemic.
Donald Trump and his wife, Melania, received coronavirus vaccinations in January.

After Trump told people to “go get your shot” during a speech at the Conservative Political Action Conference on Sunday, the New York Times asked a former adviser whether the president had been vaccinated. The adviser told the Times that he had. 

“The secret approach by Mr. Trump came as a number of his supporters have expressed resistance to the vaccine, and as other officials have tried setting an example by getting the shot in public,” the Times’s Maggie Haberman reports. “President Biden, Vice President Kamala Harris and former Vice President Mike Pence received vaccine shots in front of television cameras.”

While Trump often touted his administration’s role in pushing for the production of vaccines, he did little to publicly encourage people to get inoculated while he was in office.

Elsewhere in health care

Diaper banks can’t keep up with skyrocketing demand.

As the pandemic has caused millions of Americans to lose their jobs and upended services like publicly funded day care, demand for diapers has surged. Diaper banks are struggling to keep up.

“In 2020, the National Diaper Bank Network distributed more than 100 million diapers to 220 diaper banks across the country, a 67 percent spike year-over-year,” The Post’s Hannah Denham reports.

“Diaper need can have significant health implications, because keeping babies and toddlers in diapers too long — or washing and reusing disposable ones — can lead to painful rashes, urinary tract infections and emergency room trips. A Yale University study found that it is a major indicator of maternal stress and depression, which can affect a child’s development and increase the likelihood of multigenerational poverty,” she writes.

The Biden administration’s plan to roll back Medicaid work requirements faces a temporary challenge.

“Just weeks before President Biden took office, the Trump administration urged states in a Jan. 4 letter to sign agreements that would preserve work requirements in the program for nine months before they could be undone by the federal government,” the Wall Street Journal’s Stephanie Armour reports.

Work requirements generally require people to work or participate in education or job training to get safety net health insurance. Democrats say that the requirements go against Medicaid’s purpose as a guarantees benefit for low-income and disabled people.

A Health and Human Services spokesperson told the Journal that at least 17 states signed the agreements, including Georgia, Tennessee and Arkansas. Republican leaders say that they are examining whether the agreements could provide grounds to challenge efforts by the Biden administration to undo the work requirements.

Biden signed executive orders last month directing government agencies to re-examine Trump era health-care policies, including waivers that let states change the Medicaid program.

The Biden administration will provide a modest amount of money to community groups that help people sign up for Obamacare plans.

“The $2.3 million, announced Monday by the Centers for Medicare and Medicaid Services (CMS), is being delivered after some of the groups, known as navigators, complained they had little money left after a regular enrollment season ended late last year,” The Post’s Amy Goldstein reports.

The money could help navigators after the Biden administration ordered HealthCare.gov, the federal online insurance marketplace for the Affordable Care Act, to reopen for a special enrollment in an effort to bolster coverage during the pandemic. But some experts say that the additional money may not be enough. 

Sugar rush