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The Health 202: Biden wants more seniors to get care at home instead of in a nursing facility

with Alexandra Ellerbeck

President Biden wants to let more seniors and those with disabilities get care at home instead of having to live in a nursing facility.

The president is proposing to spend $400 billion on long-term care within the massive jobs package he rolled out yesterday. He made the opening pitch for his plan in Pittsburgh, calling it a once-in-a-generation opportunity to revamp the country’s infrastructure, reinvigorate the economy and tackle climate change, my colleague Reis Thebault reports.

“We have to move now, because I’m convinced that if we act now, in 50 years, people are going to look back and say this was the moment that America won the future,” Biden said.

There are indeed many problems surrounding long-term care in the United States.

The nation’s senior population is only growing. Most won’t have saved enough to afford regular assistance when they start needing it. And while research shows being cared for at home results in better outcomes for patients and costs less, millions of seniors still reside in nursing homes.

Yet Biden’s proposal wouldn’t solve one of the biggest underlying problems.

Most seniors don’t have long-term care insurance because Medicare largely doesn’t cover it, aside from the first 100 days of skilled nursing care following a hospitalization.

As a result, many seniors must spend their way to poverty before gaining access to long-term care via the Medicaid program. Medicaid, which in all but a dozen states covers people up to 138 percent of the federal poverty level, is the largest payer for community and home-based long-term care services used by seniors and those with disabilities. 

It’s a problem health policy experts and members of Congress have raised for years. Sen. Bernie Sanders (I-Vt.) has added long-term care to his most recent Medicare-for-all legislation. Other Democrats have worked on legislation to create a new insurance program for long-term care.

Matt Salo, executive director of the National Association of Medicaid Directors, argues that the best way to improve long-term care in the U.S. is to make it less reliant on Medicaid.

“By relying on Medicaid to solve the country’s needs, we are both explicitly and implicitly requiring anyone who needs help to impoverish themselves,” Salo said. “That’s not the hallmark of a humane system, and that needs to change.”

Demand for long-term care is ballooning.

Demand will grow as the nation’s senior population expands over the next decade, experts have warned.

And it will largely be middle-income seniors who find themselves in a financial bind, often without enough savings to pay for long-term care yet not poor enough to qualify for Medicaid.

A 2019 study published in Health Affairs found that even if middle-income seniors devote 100 percent of their annual income to assisted living costs, only 19 percent of the population would have any money left over for other expenses.

While Biden’s proposal won’t necessarily tackle that problem, it could accelerate some positive trends in long-term care.

There’s a growing desire for seniors to be cared for in their homes instead of being institutionalized. Some Medicaid programs already allow family members and friends to be paid for providing in-home care, but the $400 billion in funding Biden is proposing would expand on those programs.

The proposal released by the White House yesterday calls on Congress to put $400 billion toward “expanding access to quality, affordable home or community-based care for aging relatives and people with disabilities.”

Administration officials didn’t provide many details on how this would work, indicating that it would be up to Congress to flush out the details. 

But this seems to be the main thrust: States would be given the extra dollars through their regular Medicaid funding streams and could use the funds to improve pay and benefits for home care workers, as well as providing them with the chance to unionize and collectively bargain.

The approach jibes with research showing “people heal best in environments that are familiar to them,” said Vikram Bakhru, a doctor and chief operating officer at ConsejoSano, a tech company specializing in multicultural patient engagement for Medicaid plans.

“There’s a lot of evidence that suggest home-based care is the right answer,” Bakhru said. “We need to put our resources behind this goal of delivering better care in the home setting where patients will heal and recover faster.”

Ahh, oof and ouch

AHH: Today the Biden administration will unveil its first television ads encouraging Americans to get vaccinated.

The “We Can Do This” campaign will air nationwide and include multimillion-dollar ad buys for Black and Spanish-language media. The ads are part of a series of efforts by the administration to promote a pro-vaccine message, Dan Diamond reports.

The administration is also partnering with advocacy organizations, sports leagues and faith leaders to introduce a network of local leaders who will help encourage Americans to get the shot. Vice President Harris and Surgeon General Vivek Murthy will hold a virtual meeting this morning with members of the network, billed as the “Covid-19 Community Corps,” to kick off the new campaign.

“The network includes more than 275 member organizations, a diverse mix of advocacy organizations, sports leagues, faith leaders and other prominent voices,” Dan writes. “Participants include the American Medical Association, the NAACP, the National Association of Evangelicals and the NFL.”

The administration will spend more than $10 million on the TV ads in April.

OOF: Vaccines are on the way for kids, but it could take time.

“The euphoria from stunningly effective vaccines late last year has been tempered by the realization that more than a fifth of the U.S. population faces a wait,” The Post’s Carolyn Y. Johnson reports.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says older teens such as Evans will be the first to be offered vaccines, probably by the fall, Carolyn writes. Elementary-school-age children will probably have to wait until early 2022.

The initial trials of the vaccine were targeted at adults because they are at much higher risk from the virus, and because the safety profile of the vaccines was still unknown. Children are at low risk from the coronavirus, making up about 270 of the more than 549,000 coronavirus-related deaths in the United States. 

More recent trials involving kids are already underway and producing results. Pfizer and BioNTech announced Wednesday their vaccine is 100 percent effective in preventing symptomatic illness in 12- to 15-year-olds. Moderna is expected to release results from a similar trial by the summer. The companies, along with other major vaccine makers, are also working on trials for younger children.

OUCH: A batch of raw Johnson & Johnson vaccine was ruined in a mishap attributed to human error.

The vaccine was contaminated by ingredients from another vaccine at the Emergent manufacturing plant in Baltimore, federal officials confirmed on Wednesday, The Post’s Christopher Rowland and Laurie McGinley report.

The New York Times first reported the incident and said that 15 million doses had been ruined in an incident that federal officials attributed to human error.

Johnson & Johnson said in a statement that it is still on track to meet its commitment to deliver 20 million doses by Wednesday and another 24 million by the end of April. 

Federal officials said that none of the contaminated vaccine made it out of the plant and that they will review what went wrong. Emergent is a contract manufacturer for bulk vaccine substances for Johnson & Johnson and AstraZeneca.

More in coronavirus news

A Trump adviser pursued controversial virus supply deals after Trump ignored his warning over shortages.

President Trump’s former trade adviser Peter Navarro warned the president on March 1, 2020, to invest immediately in ingredients for drugs and supplies for fighting the coronavirus, according to a memo obtained by the House’s select subcommittee on the coronavirus outbreak.  “MOVE IN ‘TRUMP TIME,'" he warned. “There is NO downside risk to taking swift actions as an insurance policy against what may be a very serious public health emergency."

But after Trump ignored the early warning, Navarro “pursued his own ad hoc strategy that committed more than $1 billion in federal funds and has since prompted multiple probes, according to newly released documents from congressional investigators,” Dan reports.

  • Democrats have raised concerns over Navarro's involvement in a $765 million loan to Eastman Kodak to produce ingredients for generic drugs and in a $354 million sole-source contract to a start-up called Phlow for pharmaceutical ingredients. Neither company had previously manufactured drugs. 
  • Navarro also directed $96 million for powered respirators and filters to AirBoss Defense Group after communicating with retired Gen. Jack Keane, a Trump ally who was a paid AirBoss consultant.

Robert Kadlec, who served as the former assistant health secretary for preparedness and response under Trump, offered a mixed view of Navarro's efforts.

“Navarro’s like a shotgun. Some of it was on target, some of the buckshot caused collateral damage,” Kadlec said. “I think he was trying to do the right thing, but there can be a difference between the right thing and the correct thing.”

Drug policy developments

Ohio Gov. Mike DeWine is calling on Biden to push China on fentanyl.

DeWine (R) told The Post’s Olivier Knox that the Chinese production and export of the synthetic painkiller is leading to overdose deaths in the United States. The Republican governor said that Biden should view it as a “major foreign policy concern.”

“Fentanyl is our biggest drug problem. It’s being mixed into virtually everything,” the Republican governor said. “… And to a great extent, this fentanyl is coming out of China. Despite China’s statements that they’re working to stop it, it’s still coming out of China.”

Olivier writes: “The coronavirus that has killed more than 550,000 people in the United States hasn’t just pushed the fight against drugs like fentanyl from the front pages. It has also made the opioid crisis deadlier — enhancing strains like job loss while keeping people away from in-person treatment and support and increasing overdoses.”

New York has legalized recreational marijuana.

The program will reinvest 40 percent of tax revenue from cannabis into minority communities that have been disproportionately affected by the war on drugs, the New York Times’s Luis Ferré-Sadurní reports. The move comes after years of stalled attempts, which were held up by disagreements about how the tax revenue should be allocated.

People in New York will immediately be allowed to possess three ounces of pot for recreational purposes, but dispensaries won’t open for more than a year and will be highly regulated. New York will be the 15th state to legalize marijuana and will likely become one of the largest markets for the drug.

Elsewhere in healthcare

Former Trump testing czar Brett Giroir announced a new consulting job.

Giroir will join Leavitt Partners, the health care consulting group founded by Michael Leavitt, a former governor of Utah who served as secretary of health and human services under secretary of health and human services under President George W. Bush.

Giroir served as the assistant secretary for health under Trump and was put in charge of overseeing the country’s production and rollout of coronavirus tests. In a recent CNN interview, he acknowledged that the Trump administration made misleading statements about the availability of tests during the early weeks of the pandemic in the United States. “When we said there were millions of tests available, there weren’t, right?” Giroir told CNN.

CMS is pausing Medicare payments while Congress works to extend a moratorium on payment cuts.

The Centers for Medicare & Medicaid Services will temporarily hold Medicare claims with service dates from April 1 onward in an effort to ensure that they are not impacted by a 2 percent automatic cut to payment rates set to go into effect on that date, Fierce Healthcare's Robert King reports

The Senate voted last week to extend the moratorium on payment cuts and the House passed its own extension earlier this month. But the Senate version made major changes to the bill, including removing a provision that would have delayed further cuts to Medicare. Because of the changes, the bill will need to go back to the House. 

Sugar rush