Tagged Cost and Quality

Newsom Likes To ‘Go Big’ But Doesn’t Always Deliver

Gavin Newsom knew it was a political gamble when, as the newly elected mayor of San Francisco, he promised to eradicate chronic homelessness.

“I recognize that I’m setting myself up. I’m not naive to that,” he told his hometown newspaper in 2003 as he embarked on a campaign to sell his controversial plan. It hinged on slashing welfare payments for homeless people and redirecting those funds to acquire single-room occupancy hotels, converting them into long-term housing with health and social services.

“I don’t want to over-promise, but I also don’t want to under-deliver,” he said.

Over-promise he did, and the venture ultimately failed. But that pledge by Newsom — who at the time was a young, politically connected wine shop owner relatively new to public office — previewed a brand of political leadership on full display today as the first-term governor confronts an unprecedented public health emergency that has decimated the state’s economy and killed more than 4,280 Californians.

The COVID-19 pandemic has catapulted the 52-year-old Democrat into greater national prominence, winning him praise and voter support for taking decisive action to control the spread of infection in the absence of strong federal leadership.

But it has also exposed his penchant for making ambitious, showy announcements — often broadcast to a national audience — that aren’t necessarily ready for prime time. His plans regularly lack detail and, in some cases, follow-through.

“This governor wants to get a lot done even if all the details aren’t quite there yet. It’s uniquely his approach,” said Democratic strategist Dana Williamson, longtime adviser to former Gov. Jerry Brown. “He isn’t afraid to go big. The upside is establishing yourself as a real leader and, in the case of COVID, saving lives. But the downside is it doesn’t always work out quite perfectly.”

Newsom has a long history of pushing big ideas before they become popular, including legalizing gay marriage and recreational marijuana use, halting death penalty executions and expanding free health care for undocumented immigrants. Since his entry into public life, he has cultivated the image of a political risk-taker willing to buck the Democratic Party establishment. And although he has demurred, there is widespread speculation that Newsom has presidential ambitions.

Since the start of the pandemic, Newsom has been praised by public health experts and Democratic strategists for making politically courageous decisions such as enacting the nation’s first statewide stay-at-home order, preventing widespread sickness and death. He has dramatically expanded hospital capacity while seeking to attack major problems as they erupt, from dire shortages of protective gear for hospital workers to inadequate testing in rural towns and poor, inner-city neighborhoods.

But as the crisis wears on, the list of Newsom’s unfulfilled promises is growing:

  • On April 7, he told MSNBC host Rachel Maddow that he had inked a deal securing “upwards” of 200 million protective masks per month, enough to “supply the needs of the state of California — potentially the needs of other Western states.” But nearly two months later, just 61 million surgical masks have arrived in California, while no higher-caliber N95 masks have been delivered, according to Brian Ferguson, spokesperson for the state Office of Emergency Services — despite Newsom’s promise that the deal included at least 150 million N95s. The $1 billion effort has been riddled with flaws, and the state so far has taken back nearly $250 million from the Chinese contractor, BYD Ltd. Co.
  • Later that month, Newsom announced a deal with Motel 6 that would provide thousands of rooms for homeless people in need of shelter. At least 5,025 Motel 6 rooms at 47 sites would open their doors to homeless people, “effective immediately,” should counties opt in, he said. But to date, just 628 Motel 6 rooms are open to homeless people at six sites.
  • Newsom also said in April that California must dramatically expand COVID-19 testing before it reopens to at least 60,000 — ideally 80,000 — tests per day. But the state still has not consistently reached 60,000 tests per day, even as it has allowed most counties to ease their stay-at-home restrictions.

In other cases, the governor has artfully avoided making specific promises. For instance, he has called the safety of nursing home patients and staff members a “top priority” without detailing plans, allowing him to dodge criticism even as more than half the deaths in California have occurred in long-term care facilities, according to state data.

Yet so far Newsom is showing strong support from Californians. Nearly 70% of likely voters say he’s doing a good job of handling the pandemic, according to a new poll released Wednesday by the Public Policy Institute of California. His overall approval rating has climbed by double digits since February, rising from 52% to 64%.

But his support could erode if the public begins to notice that his promises — and lofty rhetoric — do not match reality, said Mark Baldassare, president and CEO of the institute.

“People can be forgiving and give the governor the benefit of the doubt, but that can turn from positive to negative very quickly,” Baldassare said. “The risk is public opinion can shift very quickly if people get a sense that it’s not going well or according to expectations.”

Although Newsom himself has acknowledged criticism that the state is falling short on some fronts, his chief spokesperson Nathan Click defended the governor’s approach.

“When it’s your life or livelihood on the line, wouldn’t you want leaders who are moving aggressively to help people on every possible front?” Click said in a statement. “He’s not afraid to swing for the fences — especially in a time of massive need.”

Daniel Zingale, Newsom’s former chief adviser, who retired earlier this year, argued that the governor’s handling of the pandemic has saved countless lives while bolstering the social safety net for those at greatest risk of contracting the coronavirus.

“When you have a crisis like this that is unprecedented, there is no real playbook,” Zingale said. “I think Gavin Newsom was made for this moment. This is a situation where you want a governor who is high-energy, deeply earnest and prone to action rather than inaction.”

***

Newsom’s political career dates back to the late 1990s, when he was appointed to San Francisco’s parking and traffic commission by its then-mayor, Willie Brown. Soon thereafter, Brown tapped Newsom to fill an open seat on the San Francisco Board of Supervisors. Running as the incumbent in 1998, Newsom was elected that year to his first full term on the board.

During his early years in public life, he honed his approach to politics — aggressively seeking national media attention for first-in-the-country social and economic policies. In 2004, the year he took office as mayor, Newsom granted same-sex couples marriage licenses before it was legal, and in 2006 he signed into law the nation’s first universal health care program, which covered all city residents regardless of their immigration status or ability to pay.

Newsom, in his 2013 book “Citizenville,” described his leadership approach as “Ready, fire, aim.”

“I’m as proud of some of my failures in business and politics as I am of my successes,” he wrote. “Failure isn’t something to be embarrassed about; it’s just proof that you’re pushing your limits, trying new things, daring to innovate.”

Newsom believes strongly in setting “audacious goals,” even if he risks over-promising or alienating supporters, said Peter Ragone, who was press secretary for part of Newsom’s mayoral tenure.

“Gavin has always believed that if you show people you’re thinking big and trying hard, they will take that over timidity, even if you might fail,” said Ragone, who remains a close, informal adviser to Newsom and also advises New York City Mayor Bill de Blasio. “He wasn’t able to completely eradicate homelessness, but the voters were OK with that because they saw he was trying. Success doesn’t have to be an absolute policy triumph.”

***

Now Newsom is facing the biggest challenge of his political career, with several high-profile crises slamming California at once: A global public health emergency. Widespread civil unrest sparked by the killing of an African American man in Minnesota, George Floyd, at the hands of a white police officer, Derek Chauvin. Rising unemployment that could reach 30%. And another potentially devastating wildfire season.

The coronavirus pandemic, in particular, could have long-lasting consequences for Newsom’s future, said Dr. Leonard Marcus, co-director of the National Preparedness Leadership Initiative, a joint program of the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School of Government.

“The politics of crisis leadership are high-consequence,” Marcus said. “For every political leader, a crisis like this is going to make or break their career.”

George Chin, 80, lived in a nursing home in Woodland, California, until April 22, when he died of COVID-19, according to his family. Chin died six days after he first complained of shortness of breath and spiked a high fever. (Courtesy of Simon Chin)

Davis resident Simon Chin has grown disillusioned with Newsom since the start of the crisis.

Chin’s father, 80-year-old George Chin, lived in Stollwood Convalescent Hospital in nearby Woodland. Chin regularly tuned into Newsom’s public briefings on the crisis to hear the governor say he was committed to preventing infections in nursing homes and protecting staff members and residents.

But infections in senior care homes continued to rise. And although Newsom has called for universal testing of residents and staffers, the state hasn’t provided the resources to make that happen, said Jason Belden, emergency preparedness director for the California Association of Health Facilities, which represents California’s roughly 1,200 state-regulated nursing homes.

State Health and Human Services Secretary Mark Ghaly said it’s the responsibility of nursing homes, not the state, to test.

“It’s not what we’re doing, and it’s, in our view, not feasible,” Ghaly said in an interview, noting that across the state, there are about 119,000 nursing home beds and about 90,000 staff members.

Newsom’s rhetoric at times has given the public a false sense of hope, said Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine.

“When it comes to vulnerable older adults in California, all this governor has been doing is saying he’s going to act, he’s going to help them, but he hasn’t actually taken action,” Wasserman said. “People are dying because of it.”

Newsom’s reassuring statements during his public briefings made Chin feel like the state was doing more to prevent widespread infections, he said.

But Chin’s father died of COVID-19 on April 22. State records show 15 residents — roughly half of the nursing home’s capacity — died of the disease.

“We had no idea that there were such big problems in skilled nursing facilities based on what the governor was saying,” Chin said. “By the time we found out, it was too late.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Por qué los recortes en salud perjudican siempre a los californianos más vulnerables

Shirley Madden, de 83 años, depende de un cuidador y de sus dos hijas para seguir viviendo en casa, y no en una residencia.

Sus hijas, Carrie, de 55 años, y Kristy Madden, de 60, usan sillas de ruedas y necesitan un segundo cuidador que las ayude en su vida diaria.

Pero ese apoyo crítico para el cuidado, además de otros beneficios de atención médica para millones de californianos, podrían reducirse para ayudar a cubrir el enorme déficit presupuestario provocado por el coronavirus.

El gobernador de California, Gavin Newsom, ha propuesto recortes presupuestarios drásticos a los programas de salud pública, incluyendo Medi-Cal, el programa de Medicaid de California para personas de bajos ingresos, cuando se espera un aumento de inscripciones debido a la pérdida récord de empleos por culpa de la pandemia.

Los expertos temen que estos recortes puedan poner en peligro los miles de millones de dólares en fondos federales de emergencia para la salud asignados a California.

“Entiendo que hay una pandemia y que la situación es mala y que todo el mundo sufre”, dijo Carrie Madden de Chatsworth, California. Carrie y su hermana padecen distrofia muscular y su madre ha sobrevivido a un ataque al corazón mientras lucha contra la demencia.

Los temores de Madden se ven agravados por la crisis de COVID-19, que ha afectado con más fuerza a los mayores y a quienes tienen enfermedades crónicas. No quiere que su madre, su hermana o ella misma terminen en una residencia o en cualquier centro de cuidados a largo plazo, que son los lugares con más brotes.

“Este es el enfoque equivocado”, señaló. “Hará que las personas discapacitadas terminen en residencias para mayores”.

En todo el país, los estados consideran recortes a Medicaid para equilibrar sus presupuestos. En parte porque la salud suele ser la mayor parte del gasto estatal, después de la educación.

También proyectan que más gente se inscribirá en el programa de salud pública, a medida que el número de estadounidenses desempleados alcance niveles astronómicos. Más de 20 millones de estadounidenses solicitaron el subsidio de desempleo en abril, elevando la tasa de personas sin trabajo al 14,7%, la peor desde la Gran Depresión de la década de 1930.

Nueva York aprobó recortes a Medicaid que entrarán en vigor cuando termine la emergencia federal, mientras que Georgia ha dado instrucciones a todas sus agencias para reducir el gasto en un 14%.

En California, donde casi 2,9 millones de personas han solicitado el desempleo en los últimos dos meses, Newsom describió los recortes propuestos como “prudentes” y “estratégicos”, un giro enorme a los grandes planes que dio a conocer a principios de este año para ampliar la atención médica a algunos de los residentes más necesitados.

Para hacer frente a un déficit estimado de $54 mil millones en el presupuesto estatal 2020-21, Newsom propone un recorte de $205 millones —una reducción del 7% en las horas de los cuidadores— al programa de Servicios de Apoyo en el Hogar del que dependen los Maddens.

El programa, financiado principalmente por Medi-Cal, paga a los cuidadores para dar de comer a las personas que necesitan ayuda para vivir de forma independiente, lavar su ropa, bañarlos, administrarles tratamientos médicos y mantener su hogar limpio.

La lista de los otros recortes es larga: reducirá o eliminará programas que permiten a los mayores de bajos ingresos y a los discapacitados vivir en su propio hogar, como la atención médica diurna y el apoyo de los trabajadores sociales.

Propone facilitar al estado el cobro del pago póstumo de los fallecidos, mayores de 55 años, y afiliados a Medi-Cal, por una amplia gama de gastos médicos a través del controvertido “Programa de Recuperación de Bienes“. Sugiere que se reinstauren requisitos de ingresos más estrictos para que algunas personas mayores y las que tengan discapacidades puedan tener derecho a Medi-Cal gratuito.

Y ha pedido a los legisladores que eliminen $54,7 millones en beneficios “opcionales” de Medi-Cal, como la atención de podología para adultos, gafas, terapia del habla y exámenes de audición; beneficios que los mismos legisladores restauraron recientemente después de recortarlos durante la última recesión.

“No son beneficios opcionales para una persona que ha sufrido un derrame cerebral o necesita dientes para comer”, explicó Tricia Berke Vinson, una abogada de la Sociedad de Ayuda Legal del condado de San Mateo.

“Entiendo que estamos en una crisis presupuestaria”, añadió. “Pero no creo que se pueda equilibrar a costa de adultos mayores y enfermos”.

Médicos, dentistas y otros proveedores de atención de salud que tratan a pacientes de Medi-Cal también podrían perder $1,200 millones en pagos suplementarios que se derivan de la Propuesta 56, un impuesto sobre el tabaco que los votantes aprobaron en 2016.

La propuesta del gobernador demócrata incluye un “detonante” automático para eliminar los recortes si el estado obtiene más dólares federales para la crisis de la COVID, trasladando la responsabilidad al Congreso para negociar otro paquete de estímulo.

No se sabe si los legisladores aceptarán los enormes recortes a Medi-Cal que el gobernador ha propuesto. Por ejemplo, el plan del Senado estatal preserva la financiación de Medi-Cal y supone que el Congreso aprobará otro proyecto de ley de estímulo.

Ambas cámaras de la legislatura deben llegar a un acuerdo y presentar su versión del presupuesto al gobernador antes del 15 de junio.

“Salvar estos programas es salvar vidas y ahorrar dinero”, indicó el legisador Jim Wood (demócrata de Santa Rosa), presidente del Comité de Salud de la Asamblea. “Corten estos programas y los costos aumentarán y se perderán vidas”.

Tanto los expertos como algunos legisladores temen que el enfoque de Newsom pueda poner en peligro los miles de millones de dólares, en fondos federales de emergencia para la salud, que ya están asignados a California.

Los estados que abandonan a los inscritos en Medicaid, o reducen sus beneficios, corren el riesgo de perder los pagos federales de salud adicionales autorizados por el Congreso esta primavera, expresó Edwin Park, experto en Medicaid y profesor de la Escuela McCourt de Política Pública de la Universidad de Georgetown.

“El gobierno federal ha dicho que no se puede reducir la elegibilidad ni cancelar o recortar los beneficios”, dijo Park, y señaló que los legisladores de Nueva York retrasaron los recortes de Medicaid del estado hasta después de que terminara la emergencia federal, para asegurarse de que recibirán la ayuda federal ahora.

Los Centros de Servicios de Medicare y Medicaid no respondieron a las solicitudes de comentarios. La guía publicada en su sitio web sugiere que los estados deben mantener intactos los programas de Medicaid.

Se espera que California reciba $5.1 mil millones en fondos federales adicionales para Medi-Cal hasta el 30 de junio de 2021, según el presupuesto que Newsom hizo público a mediados de mayo.

La administración Newsom no cree que los recortes presupuestarios de Medi-Cal le cuesten al estado el dinero federal adicional ya aprobado por el Congreso.

“Nunca hay una garantía hasta que hablemos con el gobierno federal. Así que hasta entonces, es difícil decir qué se va a hacer a nivel federal”, dijo Yang Lee, analista del Departamento de Finanzas del estado.

La administración Newsom calcula que unos dos millones de californianos se inscribirán en Medi-Cal para julio como resultado de la pandemia, lo que eleva la inscripción en el programa a 14.5 millones, más de un tercio de todos los californianos.

La administración estima $3,100 millones en gastos adicionales para cubrir a los nuevos inscritos. La Legislative Analyst’s Office cree que esa cifra representa un exceso de $750 millones, en parte porque los nuevos inscritos serán principalmente personas más jóvenes y saludables que no necesitan tanta atención como los mayores de bajos ingresos y las personas con discapacidades.

Para muchos de los inscritos, las propuestas de Newsom recortarían múltiples beneficios.

Cynde Soto, de 63 años, dijo que se sintió como si “alguien me hubiera dado un puñetazo en el estómago” cuando supo que el plan del gobernador recortaría el presupuesto de los Servicios de Apoyo en el Hogar. Esta residente de Long Beach, que es tetrapléjica,  teme que los recortes del estado la obliguen a ir a una residencia de mayores. Además, teme perder la atención dental y de visión de Medi-Cal si se aprueban los otros recortes de Newsom.

“Es una pesadilla. No sé qué voy a hacer”, comentó Soto. “¿Por qué siempre somos los primeros a los que golpean?”.

Related Topics

California Cost and Quality Insurance Medi-Cal Noticias En Español States

‘An Arm And A Leg’: The $7,000 COVID Test And Other Lessons From SEASON-19


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Host Dan Weissmann spoke with three people who have very different reflections on what the COVID-19 pandemic is costing us.

  • A doctor and advocate in Brooklyn looked back on the wave of black and brown patients that filled her clinic in March.
  • A nurse practitioner in Texas shared how new tech is — and isn’t — helping the older patients she cares for.
  • One of the country’s top insurance nerds conceded that her initial policy ideas to keep people from getting stuck with expensive bills for COVID tests were wrong.

Here’s the season recap: A new abnormal. A shortage of hugs. And the $7,000 COVID test.

You can help guide the next steps for this show.  Please take five minutes for our listener survey.

Thank you in advance!


“SEASON-19” of “An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

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Related Topics

Cost and Quality Health Care Costs Multimedia

‘Why Do We Always Get Hit First?’ Proposed Budget Cuts Target Vulnerable Californians

Shirley Madden, 83, relies on a caregiver and her two grown daughters to remain living at home — and not in a nursing home.

Her daughters, 55-year-old Carrie and 60-year-old Kristy Madden, both use wheelchairs and need a second caregiver to help them navigate their own daily lives.

But that critical caregiving support, along with other health care benefits for millions of Californians, could be scaled back to help plug a massive budget deficit triggered by the coronavirus.

California Gov. Gavin Newsom has proposed sweeping budget cuts to safety-net health care programs ― including Medi-Cal, California’s Medicaid program for low-income people ― just as enrollment is projected to spike because of record job losses related to the pandemic.

Health care experts also fear the cuts could jeopardize billions of dollars in emergency federal health funding allotted to California.

“I understand there’s a pandemic and it’s really bad and everybody is hurting,” said Carrie Madden of Chatsworth, California. Carrie and her sister have muscular dystrophy and their mother is a heart attack survivor who struggles with dementia.

Madden’s fears are compounded by the COVID-19 crisis, which has hit older people and those with chronic health conditions the hardest. She doesn’t want her mother, her sister or herself to end up in a nursing home or other long-term care facility — the settings with the most outbreaks of COVID-19.

“This is the wrong approach,” she said. “This will make disabled people end up in nursing homes.”

States across the country are eyeing Medicaid cuts to balance their budgets, in part because health care is usually the biggest portion of state spending, after education. They also project that more people will sign up for the public health care program, as the number of unemployed Americans hits astronomical heights. More than 20 million Americans filed for unemployment in April, raising the unemployment rate at least to 14.7%, the worst since the Great Depression of the 1930s.

New York approved Medicaid cuts that will take effect after the federal emergency ends, while Georgia has instructed all its agencies to reduce spending by 14%.

In California, where almost 2.9 million people have filed for unemployment in the past two months, Newsom described the proposed budget cuts as “prudent” and “strategic,” a huge pivot from the grand plans he unveiled earlier this year to expand health care to some of the neediest residents.

To address an estimated $54 billion deficit in the 2020-21 state budget, Newsom proposes a $205 million cut — or a 7% reduction in caregiver hours — to the In-Home Supportive Services program the Maddens rely on. The program, primarily funded by Medi-Cal, pays caregivers to make meals for people who need help to live independently, do their laundry, bathe them, administer medical treatments and keep their home clean.

The list of his other proposed cuts is lengthy: He would scale back or eliminate other programs intended to keep low-income seniors and people with disabilities in their own homes, such as adult day health care and support from social workers. He proposes to make it easier for the state to collect posthumous payback from deceased Medi-Cal enrollees 55 and older for a broad range of medical costs through the controversial “Estate Recovery Program.” He suggests reinstituting stricter income requirements for some older people and those with disabilities to qualify for free Medi-Cal.

And he is calling on lawmakers to remove $54.7 million in “optional” Medi-Cal benefits, such as adult podiatry care, eyeglasses, speech therapy and hearing exams — benefits that lawmakers recently restored after they were cut during the last recession.

“These don’t feel optional to people if they have had a stroke or need teeth to eat their food,” said Tricia Berke Vinson, an attorney with the Legal Aid Society of San Mateo County.

“I understand we are in a budget crisis,” she added. “I just don’t think it can be balanced on the old and the sick.”

Physicians, dentists and other health care providers who treat Medi-Cal patients also stand to lose $1.2 billion in supplemental Medi-Cal payments that flow from Proposition 56, a tobacco tax that voters approved in 2016.

The Democratic governor’s proposal includes an automatic “trigger” to restore the cuts if the state gets more federal COVID relief dollars, shifting the responsibility to Congress to negotiate another stimulus package.

Whether lawmakers will make the sweeping Medi-Cal cuts the governor has proposed is uncertain. For example, the state Senate plan preserves Medi-Cal funding and assumes Congress will pass another stimulus bill.

Both houses of the legislature must come to an agreement and present their version of the budget to the governor for consideration by June 15.

“Save these programs and you save lives and money,” said Assembly member Jim Wood (D-Santa Rosa), chair of the Assembly Health Committee. “Cut these programs and costs will increase and lives will be lost.”

Health care experts and some lawmakers also fear Newsom’s approach could jeopardize billions of dollars in emergency federal health funding already allotted to California.

States that drop Medicaid enrollees or reduce benefits risk losing out on additional federal health payments authorized by Congress this spring, said Edwin Park, an expert on Medicaid and a professor at Georgetown University McCourt School of Public Policy.

“The federal government has said you can’t cut eligibility or disenroll or cut benefits,” Park said. He noted that New York lawmakers delayed their state Medicaid cuts until after the federal emergency ends to ensure they still receive the added federal help now.

The Centers for Medicare & Medicaid Services did not respond to requests for comment. Guidance posted on its website suggests states must keep Medicaid programs intact.

California is expected to receive $5.1 billion in additional federal funding for Medi-Cal through June 30, 2021, according to the proposed budget Newsom released in mid-May.

The Newsom administration is not convinced its Medi-Cal budget cuts will cost the state the additional federal money already approved by Congress.

“There’s never a guarantee until we have that conversation with the federal government. So until then, it’s hard for us to tell what the fed’s going to do,” said Yang Lee, an analyst at the state Department of Finance.

Newsom’s administration predicts about 2 million Californians will sign up for Medi-Cal by July as a result of the pandemic, bringing the program’s enrollment to 14.5 million, more than one-third of all Californians.

The administration anticipates $3.1 billion in added costs to cover the new enrollees. The Legislative Analyst’s Office believes that figure is $750 million too high, in part because new sign-ups will primarily be younger and healthier individuals who do not need as much care as low-income seniors and people with disabilities.

For many current enrollees, Newsom’s proposals would cut into multiple benefits.

Cynde Soto, 63, said it felt like “someone had punched me in the gut” when she heard about the governor’s plan to cut the In-Home Supportive Services budget. As a quadriplegic, the Long Beach resident worries state cutbacks could force her into a nursing home. On top of that, she fears she might lose her Medi-Cal dental and vision care if Newsom’s other cuts are approved.

“I’ve had nightmares about it. I don’t know what I’m going to do,” Soto said. “Why do we always get hit first?”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Related Topics

California Cost and Quality Insurance Medi-Cal Medicaid States

Must-Reads Of The Week

The Big News

It was a short work week for those still able to work, but there was a considerable amount of health care news. That hasn’t changed.

The story that probably got the most attention was that the death toll in the United States from COVID-19 passed 100,000 people. It can be hard to get a handle on what that means. The Washington Post looked at the people who count the deaths and track the deaths.

There will be more. The Texas Tribune noted how the coronavirus was a threat to people living in homeless shelters. Nursing homes continue to be a major hot spot in this pandemic. Same goes for areas where poorer people live.

The Reopening

But another source of infections just might be the crowds of people who think all danger has passed and it’s time to frolic in close proximity with others.

You probably saw the photos and video of the crowds Memorial Day weekend in the pool at Lake of the Ozarks, Missouri, or on the boardwalk of Ocean City, Maryland. Missouri health officials pondered how to somehow place the partiers in self-quarantine, but that is unlikely. Cities, states and counties may also play fast and loose with the metrics that indicate when it is safe. The Centers for Disease Control and Prevention quietly removed a recommendation to limit singing in churches. (Singing has been shown to propel saliva particles.) So on it goes.

Disneyland is likely to open in July. Las Vegas casinos also announced their reopening and issued rules. Players can’t touch cards and slot machines will be fewer and farther apart.

Things That Don’t Change

Meanwhile, health care providers continue to find ways to make consumers pay more. The federal government’s Department of Health and Human Services said it will watch for “upcoding” of medical procedures — billing for a more expensive procedure.

We are already seeing it. KHN reporter Phil Galewitz wrote about a large bill for what was supposed to be a free COVID test. (This was not a fluke. We’ve already heard of other similar cases and will be writing about them.)

Drugmakers are also a source of concern. Critics note that the development of remdesivir, a possible COVID treatment, was heavily subsidized by the government, yet Gilead Sciences will be able to place whatever price tag it wants on the drug. Not that what was available went to the right places, The Washington Post reported.

And Stat did an excellent analysis of how there was a lot less to President Donald Trump’s announcement Tuesday about lower insulin prices for seniors. Stat also reported how executives of Moderna, a drug company that reported it was having success with a COVID vaccine, cashed out as the share price soared. The shares have since fallen as investors took another look at the hype.

And NPR noted a White House staffer with some interesting health care investments.

Toolkits

All of us are looking for ways to measure the epidemic, to quantify it, to find patterns that either agitate or reassure. Here are a few classics and newer ones that I and the staff at KHN found this week.

ProPublica created a quite amazing tool that tracks the companies that won federal contracts related to COVID-19. It helped them develop several very interesting stories about some of those contractors. (Related stories: The federal government’s efforts to get Americans tested for the virus are still failing in myriad ways.)

Stuff You Should Know

For the past couple of weeks, you could hear discussion of “herd immunity” protecting us from the coronavirus bubbling up in conversations on cable TV news shows, on Twitter and among neighbors still observing social distancing. It’s the notion that if enough people are immune from a disease, the few who are not are protected. It’s the basic concept that makes measles shots so important; it protects the young children and vulnerable people who can’t be immunized. It’s why we want a coronavirus vaccine so quickly.

So The Upshot at The New York Times looked at the possibility of herd immunity in a series of tight graphics. Their conclusion: “Even in some of the hardest-hit cities in the world, the studies suggest, the vast majority of people still remain vulnerable to the virus.”

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‘An Arm And A Leg’: Tips For Surviving COVID With Your Financial Health Intact


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In early April, Katelyn was in a financial bind. At home and sick with COVID-19, she hadn’t been paid in weeks. And her bills were due.

“My landlord is kinda beating down my door right now,” she said in a voicemail to the podcast hotline: (724) 276-6534; that’s 724 ARM N LEG.

Weeks later, Katelyn got back in touch: She had made it through with her financial health intact, thanks to a combination of playing hardball with one company and knowing how to play nice with others.

Katelyn works in collections for a financial institution, so she knew how to ask for help. Even so, she didn’t find the process easy. She came out of the ordeal with hard-won tips for all of us, and a heck of a story.

Here are two other resources from the episode: our favorite TikTok mom shares tips for dealing with medical bills and collection agencies, and Hello Landlord. It’s a free online tool that automatically generates letters you can send to your landlord, asserting your legal rights. (Right now, those rights may include some federal protections against evictions.)


“SEASON-19” of “An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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El Congreso dijo que los tests de COVID-19 debían ser gratuitos, pero ¿quién paga?

Los hospitales de todo el país tienen miedo de enviar cientos de miles de facturas relacionadas con las pruebas para COVID-19, porque el Congreso ordenó que no hubiera copagos ni costos de bolsillo para los pacientes.

Pero muchos empleadores con planes de salud autofinanciados parecen creer que están exentos de estas reglas.

Cuando los kits de pruebas aún eran escasos, el Centro Médico de la Universidad de Vanderbilt (VUMC) en Nashville, Tennessee, puso en acción sus laboratorios clínicos. Se hizo cargo de casi todas las pruebas en gran parte de Tennessee.

Otros sistemas de salud ni siquiera intentaron competir, aunque las pruebas debían estar cubiertas por los seguros.

A fines de marzo, el Congreso aprobó dos leyes, el Families First Coronavirus Response Act y el CARES Act, que esencialmente establecieron no solo que las pruebas para COVID tenían que estar cubiertas, sino que los pacientes no debían pagar un centavo. Sin embargo, VUMC ha descubierto que con frecuencia ese no es el caso.

“Cerca de la mitad de estos pacientes potencialmente tienen algún costo de bolsillo, ya sea por las pruebas o por servicios complementarios”, dijo Cecelia Moore, directora financiera de VUMC.

VUMC está reteniendo las facturas de estos pacientes, en lugar de enfrentar una reacción violenta por la facturación sorpresa durante la pandemia, explicó Moore.

El problema se reduce a una interpretación de si la nueva legislación federal aplica a los planes de salud ofrecidos por los empleadores más grandes.

Esas compañías, que cientos o miles de empleados, generalmente usan su propio dinero para pagar reclamos, como una forma de reducir los costos. Una encuesta realizada por la Kaiser Family Foundation (KFF) revela que la mayoría de los estadounidenses con cobertura de salud están en este tipo de planes.

Por ejemplo, BlueCross BlueShield of Tennessee puede ser la aseguradora que figura en la tarjeta del empleado, pero solo administra los pagos: el empleador paga los reclamos. Estos planes a menudo se denominan autofinanciados o autoasegurados, y puede que esto no esté claro para los empleados bajo estos planes.

Según múltiples fuentes, muchas de las compañías con estos planes están operando como si estuvieran exentas de las nuevas reglas federales.

“Pareciera que la ley puede haber dejado a estos empleadores fuera de ciertos detalles”, dijo Mike Thompson, CEO de la National Alliance of Healthcare Purchaser Coalitions.

Esta alianza representa a empleadores con planes de salud autofinanciados. Dijo que algunos no renuncian a los copagos y otras facturas, aunque la mayoría solo factura por la prueba para COVID-19 en sí y no por la visita al médico o la prueba para descartar la gripe.

“Muchos de ellos han optado por cubrir el primer dólar, pero de diferentes maneras. Es posible que hayan incluido o no los tratamientos relacionados”, dijo Thompson, quien admite que hay mucha confusión.

Otras asociaciones que representan planes de salud financiados por el empleador, incluido el Business Group on Health, dijeron que sus miembros generalmente siguen el espíritu de la ley.

Pero los expertos en políticas de salud no ven espacio para la interpretación.

“No importa si es un plan autofinanciado o cubierto totalmente por la aseguradora, si es de un pequeño empleador o de un gran empleador, o si lo compras por tu cuenta en el mercado”, dijo Karen Pollitz, analista senior de KFF. “Todo seguro privado debe cubrir el 100% del costo de las pruebas para COVID-19”.

Pollitz dijo que le molesta que los empleadores estén tratando de argumentar lo contrario.

Aun así, está sucediendo, y no solo en Tennessee.

Duke Health en Carolina del Norte confirma que no está facturando reclamos relacionados con las pruebas o el tratamiento de COVID, citando una falta de claridad sobre lo que el paciente tiene que pagar.

En California, el Centro Médico UCSF también está retrasando la facturación, y el Centro Médico UCLA está presionando a los planes de salud para que paguen su parte.

“UCLA Health no factura a los pacientes por las pruebas para COVID-19, incluso si el plan de salud no paga por error”, dijo el vocero Enrique Rivero en un comunicado por escrito. “Nosotros notificamos a las aseguradoras de su error y solicitamos que vuelvan a procesar los reclamos de conformidad con las pautas de la Ley CARES”.

La NYU Langone Health y la Clínica Cleveland dijeron que no facturarán a los pacientes ningún costo compartido por las pruebas, incluso si eso significa que tienen que pagar el costo.

El problema se extiende más allá de los centros médicos académicos.

Envision Health, una empresa con sede en Nashville que opera con personal propio cientos de salas de emergencia en todo el país, está reteniendo 200,000 facturas relacionadas con las pruebas para COVID-19 debido a la confusión sobre quién cubre los costos compartidos.

Por lo que, muchas facturas médicas que serían “sorpresa” todavía están esperando ser enviadas. Solo en Vanderbilt, el centro médico ha retenido más de $6 millones en facturación desde mediados de marzo.

“Seguramente sorprenderemos, pero no en este momento”, dijo Heather Dunn, vicepresidenta de servicios de ingresos de VUMC.

Dado el creciente desdén por las facturas médicas sorpresa, Dunn espera una reacción violenta de los pacientes vulnerables.

“Mi mayor temor es por los pacientes que ya tienen COVID o enfrentan problemas después, o han perdido su trabajo. No les diría: ‘su aseguradora ha transferido este copago de $50’”, dijo.

A veces, el paciente también se queda con un gran deducible, que puede sumar cientos de dólares.

Dunn dijo que no puede retrasar la facturación para siempre y que el hecho de que las pruebas sean gratuitas para los pacientes no significa que no tengan costo.

Por Blake Farmer

Esta historia es parte de una asociación que incluye WPLN, NPR y Kaiser Health News.

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Congress Said COVID-19 Tests Should Be Free — But Who’s Paying?

Hospitals around the country are afraid to send out hundreds of thousands of bills related to COVID-19 testing. That’s because Congress mandated there would be no copays and no out-of-pocket costs for patients. But many employers with self-funded health plans seem to believe they’re exempt from the rules.

When testing kits were still scarce, Vanderbilt University Medical Center in Nashville, Tennessee, fired up its clinical labs. It almost single-handedly took over testing in much of Tennessee. Other health systems didn’t even try to compete, although the tests were supposed to be covered by insurance.

In late March, Congress passed two laws, the Families First Coronavirus Response Act and the CARES Act, that essentially stated that not only does testing have to be covered, but patients shouldn’t have to pay a dime. Yet VUMC has found that’s frequently not the case.

“As many as half of those patients potentially have some out-of-pocket [cost], either for the tests or for companion services with the test,” VUMC Chief Financial Officer Cecelia Moore said.

VUMC is holding back bills for these patients, Moore said, rather than face a backlash of anger at surprise billing during the pandemic.

The issue comes down to an interpretation of whether the new federal legislation applies to health plans offered by larger employers. Those companies, which usually have at least a few hundred employees, often use their own money to pay claims as a way to drive down costs. A survey by the Kaiser Family Foundation finds a majority of Americans with health coverage are in this type of plan. (Kaiser Health News is an editorially independent program of the foundation.)

So BlueCross BlueShield of Tennessee may be on an employee’s insurance card, but the insurer is just managing the payments. The employer’s money pays the claims; these plans are often called self-funded or self-insured, and it may not be clear to employees that they are in such a plan.

According to multiple sources, many of the companies with those plans are operating as if they’re exempt from the new federal rules.

“In this case, it appears that the law may have left self-insured employers out of certain elements,” said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.

The National Alliance represents employers with self-funded health plans. He said some are not waiving copays and other bills. Most are, he said, though sometimes only bills for the COVID-19 test itself and not for the doctor’s visit or the test to rule out the flu.

“Many of them have opted to cover on a first-dollar basis, but in different ways. They may or may not have included the related treatment elements,” Thompson said. He acknowledges the distinction would be lost on patients. “I get why it’s causing confusion.”

Other associations representing employer-funded health plans, including the Business Group on Health, said their members are generally following the spirit of the law.

Health policy experts don’t see any room for interpretation.

“It doesn’t matter if it’s a self-funded plan or a fully insured plan, if you get it from a small employer or a large employer, if you buy it on your own in the marketplace,” said Karen Pollitz, a senior fellow with KFF. “All private insurance has to cover 100% of the cost of COVID-19 testing.”

Pollitz said she is miffed that employers are trying to argue otherwise.

Still, it’s happening, and not only in Tennessee.

Duke Health in North Carolina confirms it’s not billing claims related to COVID testing or treatment, citing a lack of clarity in what the patient is responsible for paying. In California, UCSF Medical Center is also holding off on billing, and UCLA Medical Center is pressing health plans to pay their part.

“UCLA Health does not bill COVID-19 patients for testing even if their health plan erroneously does not pay,” spokesperson Enrique Rivero said in a written statement. “Our practice is to notify insurers of their error and request that they reprocess claims consistent with CARES Act guidelines.”

NYU Langone Health and Cleveland Clinic said they won’t bill patients any cost sharing for testing, even if that means they have to bear the cost.

The issue extends beyond academic medical centers. Envision Health, a Nashville-based firm that staffs and operates hundreds of emergency rooms around the country, is holding back 200,000 bills related to COVID-19 testing because of confusion about coverage of cost sharing.

So, many would-be surprise medical bills are still waiting to be sent out. At Vanderbilt alone, the medical center has held back more than $6 million in billing since mid-March.

“I know I’m supposed to be shaking everybody down, but we’re not right now,” said Heather Dunn, VUMC’s vice president of revenue cycle services.

Given the growing disdain for surprise medical bills, she expects a backlash from vulnerable patients.

“My greatest fear is [for] patients who are already suffering from the COVID virus or issues after or have lost their job. I’m hesitant to also say, ‘Your insurance company has passed along this $50 copay,’” she said.

Sometimes, the patient is also left with a large deductible to pay, in the hundreds of dollars.

Dunn said that she can’t delay billing forever and that just because the tests are supposed to be free to patients doesn’t mean they have no cost.

This story is part of a partnership that includes WPLN, NPR and Kaiser Health News.

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