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The Health 202

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

How the pandemic may fundamentally change the health-care system

The Health 202

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

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Welcome to Friday's Health 202, where today we have a special spotlight on the pandemic two years in. Send us news, tips and ways you think the coronavirus has changed American life at rachel.roubein@washpost.com.

🚨 The federal government is about to be funded. The Senate sent the long-term spending bill to President Biden's desk last night after months of intense negotiations. 

Two years since the WHO declared a pandemic, what health-care system changes are here to stay?

Exactly two years ago, the World Health Organization declared the coronavirus a pandemic and much of American life began grinding to a halt. 

That’s when the health-care system, which has never been known for its quickness, sped up. The industry was forced to adapt, delivering virtual care and services outside of hospitals on the fly. Yet, the years-long pandemic has exposed decades-old cracks in the system, and galvanized efforts to fix them.

Today, as coronavirus cases plummet and President Biden says Americans can begin resuming their normal lives, we explore how the pandemic could fundamentally alter the health-care system for good. What changes are here to stay — and what barriers are standing in the way?

A telehealth boom

What happened: Telehealth services skyrocketed as doctors’ offices limited in-person visits amid the pandemic. The official declaration of a public health emergency eased long-standing restrictions on these virtual services, vastly expanding Medicare coverage. 

But will it stick? Some of these changes go away whenever the Biden administration decides not to renew the public health emergency (PHE). The government funding bill passed yesterday extends key services roughly five months after the PHE ends, such as letting those on Medicare access telehealth services even if they live outside a rural area.

But some lobbyists and lawmakers are pushing hard to make such changes permanent. Though the issue is bipartisan and popular, it could be challenging to pass unless the measures are attached to a must-pass piece of legislation. 

  • “Even just talking to colleagues, I used to have to spend three or four minutes while they were trying desperately not to stare at their phone and explain to them what telehealth was … remote patient monitoring, originating sites, and all this wonky stuff,” said Sen. Brian Schatz (D-Hawaii), a longtime proponent of telehealth.
  • “Now I can go up to them and say, ‘So telehealth is great, right?’ And they say, ‘yes, it is.’ ”
A new spotlight on in-home care

What happened: The infectious virus tore through nursing homes, where often fragile residents share rooms and depend on caregivers for daily tasks. Ultimately, nearly 152,000 residents died from covid-19.

The devastation has sparked a rethinking of where older adults live and how they get the services they need — particularly inside their own homes. 

  • “That is clearly what people prefer,” said Gail Wilensky, an economist at Project HOPE who directed the Medicare and Medicaid programs under President George H.W. Bush. “The challenge is whether or not it’s economically feasible to have that happen.”

More money, please: Finding in-home care — and paying for it — is still a struggle for many Americans. Meanwhile, many states have lengthy waitlists for such services under Medicaid.

Experts say an infusion of federal funds is needed to give seniors and those with disabilities more options for care outside of nursing homes and assisted-living facilities. 

For instance, Biden’s massive social spending bill included tens of billions of dollars for such services. But the effort has languished on Capitol Hill, making it unclear when and whether additional investments will come. 

A reckoning on racial disparities

What happened: Hispanic, Black, and American Indian and Alaska Native people are about twice as likely to die from covid-19 than White people. That’s according to age-adjusted data from a recent Kaiser Family Foundation report

In short, the coronavirus exposed the glaring inequities in the health-care system. 

  • “The first thing to deal with any problem is awareness,” said Georges Benjamin, the executive director of the American Public Health Association. “Nobody can say that they’re not aware of it anymore, that it doesn’t exist.”

But will change come? Health experts say they hope the country has reached a tipping point in the last two years. And yet, any real systemic change will likely take time. But, Benjamin said, it can start with increasing the number of practitioners from diverse communities, making office practices more welcoming and understanding biases. 

  • We need to, as a matter of course, ask ourselves who’s advantaged and who’s disadvantaged” when crafting new initiatives, like drive-through testing sites, Benjamin said. “And then how do we create systems so that the people that are disadvantaged have the same opportunity.”

Coronavirus

A snapshot of American life two years into the pandemic

We’re looking back to see how the covid-19 global pandemic has impacted nearly every aspect of American life. 

It affected our language. 

  • Bubble: The most exclusive invite of the pandemic, we created small groups with others to combat loneliness and stymie the spread of the virus.
  • Zoom fatigue: Nearly all social interactions — from work meetings to family holidays to happy hours — became digital at the onset of the pandemic, and millions of people began experiencing video-call-induced exhaustion.
  • Six feet: The amount of social distance necessary to reduce the transmission of covid-19, and also, the length of a moose — which we now know because some health advisories got creative with examples of how far we should stay apart.

It made us ask new questions.

Is there outdoor dining? 

  • Nearly 60 percent of casual dining establishments expanded outdoor dining options since the covid-19 outbreak began, according to the National Restaurant Association. Be it rain, shine, sleet or snow, Americans took advantage of the alternative for a moment of normalcy.

To mask or not to mask?

  • We’ve sewn our own, strapped on two at a time and donned medical-grade face coverings as the virus has surged and waned, but today, states are dropping the requirement and adopting more flexible standards based on community transmission rates rather than universal mandates.
  • In fact 98 percent of Americans live in areas where covid-19 transmission rates are low enough that people can ditch their masks indoors, the Centers for Disease Control and Prevention said Thursday

As well as changed our relationships.

They laughed, they cried, they killed monsters: How friendships thrived in video games during the pandemic (By Heather Kelly l The Washington Post)

What’s sexy in a pandemic? Caution. (By Lisa Bonos l The Washington Post)

How relationships between teachers and students are being tested in covid-19 crisis (By Valerie Strauss l The Washington Post)

And the past two years were so difficult, for so many people. 

And it caused so many Americans to experience loss. 

Agency alert

Back to today's news … Federal government allows program to pay those with an addiction for staying clean

A legal opinion from the Department of Health and Human Services greenlit the use of a harm reduction technique proposed by a Boston-based company to compensate those with an addiction for staying clean, The Post’s Lenny Bernstein reports. 

The strategy: Known as “contingency management,” the idea is supported by decades of research showing that repeated small payments for meeting goals in the recovery process can help people remain sober. Health care and rehabilitation facilities have scarcely used the technique due to a federal anti-kickback statute that prohibits financial incentives for patients to generate health-care business. 

The new program approval only applies to DynamiCare Health. Yet, harm reduction advocates told Lenny that the decision “is a breakthrough” that could pave the way for others who want to offer similar incentives down the road. 

  • DynamiCare Health said it will send incremental payments over 24 weeks to clients who agree to weekly drug testing and produce clean results, which could amount to as much as $599.

Billions of dollars in alleged fraud discovered among federal covid-19 programs

The Justice Department said Thursday it had uncovered more than $8 billion in alleged fraud tied to federal coronavirus aid programs, our colleague Tony Romm reports. 

  • The schemes included federal loans for fake businesses, transnational crime syndicates who stole people’s identities to collect unemployment benefits and fake Medicare claims for government reimbursement for faulty coronavirus tests.

The big picture: Officials said the true figure is probably much higher, and expect that it will continue to grow as additional aid is reviewed. DOJ officials said Kevin Chambers, currently an associate deputy attorney general, would serve as the agency’s new director for covid-19 fraud enforcement.

On the Hill

First in The Health 202: Democrats pressure Biden administration to enforce free contraceptive requirement

Members of the Democratic Women’s Caucus sent a letter to secretaries Xavier Becerra, Martin J. Walsh and Janet L. Yellen — who lead the Departments of Health and Human Services, Labor and Treasury, respectively — asking that their agencies crack down on insurers who are noncompliant with the Affordable Care Act’s contraceptive coverage requirement. 

Key context: Before the ACA was passed, contraceptives accounted for a much larger share of women’s out-of-pocket health costs. But now, the statute requires most health coverage plans to cover the costs of at least one form of each birth control method approved by the Food and Drug Administration

  • Yet: Patients say their insurers routinely refuse to cover certain contraceptives, impose administrative hurdles like prior authorizations or require cost-sharing, all of which violate current guidelines, the letter states.

The letter, signed by 118 members of Congress, requests that agencies use their resources to respond to reported violations of the requirement and launch outreach campaigns to raise awareness about patients rights to $0-cost-sharing birth control under ACA. 

In other health news

  • Nearly 1 in 10 Americans owe significant medical debt, with Black adults, people living with disabilities and poor or near-poor adults the most likely to have outstanding health charges, according to a new analysis of government data released yesterday by the Kaiser Family Foundation.
  • Americans will continue to be required to wear masks on airplanes, trains and in public transit hubs through April 18 at the recommendation of the CDC, the Transportation Security Administration said Thursday.
  • HELP Committee leaders Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.) introduced legislation to establish the Advanced Research Projects Authority for Health, which would be an independent entity within the structure of the National Institutes of Health to support cutting-edge biomedical research.
  • On the Hill: The Senate voted 49 to 50 against an amendment proposed by Sen. Mike Lee (R-Utah), which if passed would have prohibited federal funding for coronavirus vaccine mandates.

Quote of the week

Sugar rush

Thanks for reading! See y'all Monday.

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