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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

CDC may start recommending N95 masks

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good Tuesday morning. We can only hope to have the courage of this dog, who was rescued after four months in the wilderness, braving wildfires, snowstorms and maybe even a standoff with a coyote. Send your stories of bravery to 

Below: Private insurers will soon pay for at-home rapid tests, and the nation's top health official directed Medicare to consider lowering current premiums for outpatient care. But first:

The Biden administration's masking guidance is in flux

The Centers for Disease Control and Prevention is weighing recommending better masks as the omicron variant surges across the country, The Post’s Lena H. Sun and your host scooped last night. 

The agency is considering updating its guidance to recommend Americans opt for masks health care workers traditionally wear — such as N95 or KN95 masks — if they can do so consistently, said an official close to the deliberations who was not authorized to speak publicly.

  • What the guidance is expected to say: If people can “tolerate wearing a KN95 or N95 mask all day, you should.” It’s also likely to say that the best mask is the one that’s worn consistently and correctly.
  • Before the pandemic, N95 masks were mostly used in health facilities and industrial settings, and some workers say they can be uncomfortable to wear all day.

Some public health experts had repeatedly pressed CDC to recommend the higher quality products instead of frequently used cloth masks. Those calls grew louder as the contagious omicron variant led to unprecedented case counts. The country is poised to surpass its record for coronavirus hospitalizations as soon as today, our colleagues report. 

  • “Omicron is very transmissible through shared air,” Julia Raifman, an assistant professor at Boston University School of Public Health, told Lena. “Mask policies that ensure people with covid and people around them are wearing high-quality masks do the most to reduce covid spread.”

Rick Bright, a previous adviser to Biden's transition team on covid

CDC's stance right now

In the past, CDC Director Rochelle Walensky has declined to fully endorse Americans wearing N95s rather than fabric mask. 

  • “If people want extra layers of protection, the KN95 or N95s do offer that,” Walensky said in a December interview on PBS NewsHour. “But what I also want to really emphasize is that you need to be able to keep them on for when you’re in those settings. Those KN95 and N95s are often not as comfortable.”

The agency currently recommends wearing masks that are snugly fit, have at least two layers of breathable fabric and a wire bridge around the nose. The guidance also says N95 masks should be prioritized for health care workers. Some argue that harkens back to the days when workers scrambled to find the product — and that there’s no longer a severe shortage of N95s.

  • “That note of trying to save N95s for health-care workers is just grossly out of date,” said Michael Osterholm, who leads the University of Minnesota’s Center for Infectious Disease Research and Policy and advised President Biden’s transition team on the coronavirus response.

Not all experts say N95s and K95s need to be worn all the time. 

  • “Context matters. If you're with a group of people who are fully vaccinated and boosted, your risk is low, your risk of a severe outcome is very low,” said Joseph G. Allen, an associate professor and director of the Healthy Buildings program at Harvard University’s T.H. Chan School of Public Health.
Taking action now

Even before the expected change, some state and local areas began doling out higher quality masks. 

  • In the Capitol, House staff will soon get 40 KN95 masks per month in their Washington offices, The Post’s Dan Diamond reported last week.
  • In Milwaukee, the health department recently started giving out a half-million free N95 masks at places like testing sites and public libraries, per local news reports. 
  • In Montgomery County, Md., the public school system is providing K9N5s to teachers, staff and students, The Post’s Allison Klein and Donna St. George report.

The Post's Lena H. Sun

White House prescriptions

Insurers will start covering at-home tests this week

Here’s what you need to know about these at-home tests, including where to get them, how they work and when to take them. (Video: The Washington Post)

Starting Saturday, private insurers will be required to cover eight at-home rapid tests a month per person, according to the administration’s plan announced yesterday.

  • The details: The Biden administration will incentivize health plans to cover the cost of tests upfront for people who get them at their insurer’s preferred pharmacy. If they go elsewhere, they’ll need to submit a claim for reimbursement. Insurers need to pay up to $12 per individual test, or the total cost of the test if less than $12.

But some critics say that won't do much in the short-term to address the fact that many consumers still cannot access tests. 

  • The Alliance of Community Health Plans called the guidance “ill-conceived” in a statement, saying it failed to address major barriers to testing, including “sold-out pharmacies” and “early signs of price-gouging.”

Agency alert

Could Medicare premiums decrease?

In an unprecedented move, the nation’s top health official is asking Medicare to consider lowering premiums for the part of the program that covers visits to the doctor and other care outside hospitals.

  • “It marked the first time the vast federal health insurance system for older Americans and those with disabilities has rethought the monthly amount patients pay after a change has gone into effect,” The Post's Amy Goldstein reports.

Behind the move: Health and Human Services Secretary Xavier Becerra told Medicare officials that the premiums should be reevaluated given a price drop in a controversial Alzheimer’s drug, known as Aduhelm, which Medicare is deciding whether to pay for.

  • The standard monthly premium for Medicare Part B is $170.10 in 2022, up from $148.50 last year.
  • The large hike was, in part, due to the projected cost of covering Aduhelm. But in December, the drug manufacturer Biogen cut Aduhelm's cost nearly in half, to $28,200 from its $56,000 initial price.
  • “With the 50% price drop of Aduhelm on January 1, there is a compelling basis for CMS to reexamine the previous recommendation,” Becerra said in a statement.

Officials at the Centers for Medicare & Medicaid Services (CMS) are expected to make a preliminary decision this week on whether or not Medicare will cover Aduhelm, which was approved last year by the Food and Drug Administration. 

Whatever Medicare decides could also have ripple effects on Medicaid. If Medicare opts to withhold or severely restrict coverage of Aduhelm, state Medicaid programs would be left holding the proverbial bag,” Stat’s Ed Silverman writes. That’s because Medicaid must cover treatments approved by the FDA. 

The National Association of Medicaid Directors warned that such a decision would create “immense fiscal pressure for states” if Medicaid was first in line to cover patients who are eligible for both Medicaid and Medicare. 

  • Some states are already looking for a way out. Oregon announced last month that it was asking the Biden administration to allow its state Medicaid program to avoid paying for medicines like Aduhelm that are approved through fast-track pathways.

On the Hill

Today's a big day for Biden's covid-19 officials. They'll testify on the Hill during a precarious moment for the Biden administration's pandemic response.

Here's who we'll hear from: CDC director Rochelle Walensky; National Institute of Allergy and Infectious Diseases director Anthony Fauci; acting FDA commissioner Janet Woodcock; and HHS assistant secretary for preparedness and response Dawn O'Connell.

They could face tough questions. Sen. Patty Murray (D-Wash.), the chair of the Senate HELP Committee, will express concerns about testing shortages, confusion over the CDC's guidance on isolation and quarantine, and challenges faced by schools and hospitals, according to a committee aide.


The U.S. is poised to break a record on coronavirus hospitalizations

On Monday, 141,385 people were hospitalized in the United States with covid-19, just short of a record set last Jan. 14. Hospitalizations that day totaled 142,273.

The nation could surpass the record as soon as today.

And then it could get even worse: Disease modelers expect total hospitalizations to hit the 275,000 to 300,000 range by the time the peak of this wave is reached, probably later this month, The Post’s Fenit Nirappil, Brittany Shammas, Dan Keating and Lenny Bernstein report.

  • The omicron variant appears to cause less severe illness overall, but the sheer number of cases threatens to overwhelm hospitals, even as fewer people are currently in intensive care units compared with January’s peak.
  • On Monday, there were 23,524 covid patients in ICUs nationwide, compared with a record last year of 29,591.

There are some limits to the hospitalization data: It can be hard to tell whether patients are hospitalized for covid-19 or for some other reason, and then happen to also test positive for the virus. (The distinction is also not always black and white, given that for patients admitted for other primary reasons, a coronavirus infection can make their situation worse). 

But it's clear that hospitals are in crisis: As of yesterday, Colorado, Oregon, Louisiana, Maryland and Virginia had declared public health emergencies or authorized crisis standards of care, which allow ambulances or hospitals to restrict treatments when they can’t meet demand.

State scan

California Gov. Gavin Newsom, a Democrat, is proposing an expansion of Medi-Cal, the state’s Medicaid program, to undocumented adults. If the provision in the governor’s budget proposal goes through, California would be the first state to provide health-care access for all residents regardless of legal status, The Sacramento Bee’s Nadia Lopez reports.

Sugar rush

Thanks for reading! See y'all tomorrow.