Tuesday Tidbits

Congress

Tuesday Tidbits

David Ermer–AHRQ, Congress, COVID-19, COVID-19 vaccine, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The FEHBlog spent two hours this morning listening to the oral argument in the latest Affordable Care Act (“ACA”) constitutionality case to reach the U.S. Supreme Court, California v. Texas (No. 19-840). This activity resulted in the FEHBlog learning a new word hortatory and receiving confirmation that his hunch is correct, to wit, There is no chance that the Supreme Court will disrupt the ACA status quo as a result of this case. Indeed the Supreme Court clearly took the case to preserve, not disrupt, the status quo. If you are interested, Amy Howe from the SCOTUSblog has written a legal analysis of the oral argument.

Following up on yesterday’s good news about Pfizer’s COVID-19 vaccine, the Wall Street Journal informs us that

In Kalamazoo, Mich., Pfizer has turned a stretch of land the size of a football field into a staging ground outfitted with 350 large freezers, ready to take delivery of millions of doses of Covid-19 vaccine before they can be shipped around the world.

To make sure its Covid-19 vaccine doses arrive at hospitals and clinics frozen and potent, Pfizer created its own container to ship them.
The temperature-controlled container can store between 1,000 and 5,000 doses for 10 days at minus 70 degrees Celsius before requiring re-icing.

From that site, and another in Puurs, Belgium, the pharmaceutical giant said it wants to deliver up to 100 million doses this year and another 1.3 billion in 2021.

One person needs two doses of the vaccine in order to be protected, again assuming that the phase III study of the vaccine remains on its currently successful course.

The Journal further reports that

U.S. health officials on Monday authorized use of the first treatment for people with earlier-stage Covid-19 who aren’t hospitalized, filling a gap in treatment.

The U.S. Food and Drug Administration said Eli Lilly LLY 2.97% & Co.’s antibody drug should be used for patients ages 12 and up with mild to moderate Covid-19, based on a study showing it helped improve symptoms and kept many patients out of the hospital.

The drug is named bamlanivimab [and it is infused into the patient]. Lilly said it will begin shipping the drug immediately to AmerisourceBergen Corp. ABC 3.59% , a national drug distributor, to distribute it as directed by a federal allocation program [which is described in this HHS announcement issued today].

The Journal also discusses ongoing U.S. problems with COVID-19 testing

The U.S. is running more Covid-19 tests each day than at any other point during the pandemic, but the increased testing doesn’t fully explain recent case surges across the nation, data show. Altogether, testing data suggest Covid-19 diagnostic tests are still severely underused in the U.S. And inconsistencies in data collection and reporting systems are hampering efforts to understand and contain the virus’s spread as the holidays approach, public health and testing executives say.

Because the FEHBP covers a large cadre of senior citizens, it is worth pointing out this AHRQ funded report finding that

Healthcare costs for seniors who needed emergency services after a fall averaged $26,143 in the year following the event, according to an AHRQ-funded study published in The Journal of the American Geriatrics Society. Those costs significantly exceeded the average $8,642 in healthcare costs in the year prior to the event

In civil service news,

Federal employees would not receive an across-the-board increase in pay next year under provisions outlined in a series of fiscal year 2021 funding bills released by the Senate Appropriations Committee Nov. 10. Unlike FY2021 funding passed in the House earlier this year — which simply did not include any provision addressing federal pay — the Senate bill actively sets 2021 pay levels at the same rate as 2020. That difference would override any planned pay increase out of the White House, which was set at 1 percent in President Donald Trump’s February budget proposal.

The Senate is pushing through these measures in order to create a baseline for negotiating an omnibus continuing resolution with the House, which has completed its appropriations bills work, before the current continuing resolution expires on December 11.

  • Federal News Network reports on the Biden Administration’s transition team. Of note,

Kiran Ahuja, a former chief of staff at the agency, will lead the OPM team. Ahuja served at OPM during the aftermath of the agency’s cybersecurity breaches. Prior to her OPM service, she led the Obama administration’s White House Initiative on Asian Americans and Pacific Islanders. Today, she’s the CEO of Philanthropy Northwest, a non-profit organization. The rest of the team is filled with OPM alums who served at the agency as senior advisors during the Obama administration.

Weekend Update

David Ermer–Congress, COVID-19, OPM, SCOTUS, U.S. Healthcare–

The House and the Senate are resuming some Committee work this coming week. The Senate may be conducting floor votes but the House will not resume floor voting until next week. Wednesday November 11 is a federal holiday for Veterans’ Day.

Tuesday morning will feature the oral argument in the latest Affordable Care Act constitutionality case, California v. Texas (No. 19-840). The argument will proceed as follows beginning at 10 am:

  • 30 minutes for California, et al.,
  • 10 minutes for the U.S. House of Representatives,
  • 20 minutes for the Solicitor General, and
  • 20 minutes for Texas, et al. 

Of course, the FEHBlog will be listening to the oral argument and he will report his observations on Tuesday. The FEHBlog enjoys the live audio version of the Supreme Court’s oral arguments because the Justices ask questions in order of seniority following the Chief Justice. If you want to listen in too, here’s a link to C-SPAN website which will send you a reminder if you share your email address.

The Centers for Medicare and Medicaid Services did fix their broken link to the 2021 Medicare premium and cost-sharing changes fact sheet over the weekend. Here’s an active link for your information.

Of course, the Federal Benefits Open Season begins tomorrow and runs through December 14. Good luck to all.

Kaiser Permanente released its third quarter 2020 financial results last Friday.

“Although the pandemic continues to have an impact on Kaiser Permanente, during the third quarter we safely resumed in-person preventive and elective care, started to address the backlog of deferred procedures that were put on hold due to COVID-19, and continued to leverage and grow virtual care for members’ safety and convenience,” said executive vice president and chief financial officer Kathy Lancaster.

NPR Shots offers a useful overview of COVID-19 cases and deaths similar to the CDC and it offers a preview of the Biden Administration’s approach to the pandemic.

On Monday, I will name a group of leading scientists and experts as transition advisers to help take the Biden-Harris COVID plan and convert it into an action blueprint that starts on Jan. 20, 2021,” Mr Biden said last night in a public address.

A Biden spokesperson told NBC’s Meet The Press Sunday that the coronavirus task force will be led by former Surgeon General Dr. Vivek Murthy and Dr. David Kessler, who led the Food and Drug Administration during the 1990s.

“We have to function as one nation. That means having a national plan,” Dr. Murthy, a key adviser to the Biden campaign, told NPR recently.

Weekend update

David Ermer–ACA, Congress, COVID-19, Telehealth–

In view of the impending national election on Tuesday, Congress is out of session for the next two weeks except for one Committee hearing on November 10.

On the COVID-19 front –

  • The Wall Street Journal reports about research and medical efforts to address the health problems of so-called COVID-19 long haulers.

Nearly a year into the global coronavirus pandemic, scientists, doctors and patients are beginning to unlock a puzzling phenomenon: For many patients, including young ones who never required hospitalization, Covid-19 has a devastating second act.

Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss.

What is surprising to doctors is that many such cases involve people whose original cases weren’t the most serious, undermining the assumption that patients with mild Covid-19 recover within two weeks. Doctors call the condition “post-acute Covid” or “chronic Covid,” and sufferers often refer to themselves as “long haulers” or “long-Covid” patients.

According to the article, the estimated numbers of long haulers varies “widely.” Nevertheless, [w]ith more than 46 million cases world-wide, even the lower estimates would translate into millions living with long-term, sometimes disabling conditions, increasing the urgency to study this patient population, researchers said. What they find could have implications for how clinicians define recovery and what therapies they prescribe, doctors said.” What’s more, “[o]ther viral outbreaks, including the original SARS, MERS, Ebola, H1N1 and the Spanish flu, have been associated with long-term symptoms.”

  • Last Friday, ” the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Defense (DOD) jointly announced a $12.7 million contract with InBios International Inc., of Seattle, to expand domestic production capacity for two rapid point-of-care tests for SARS-CoV-2, the virus that causes COVID-19. The first, called the SCoV-2 Ag Detect Kit, detects current infections by identifying antigens – genetic material – of the virus in a nose swab sample. The second test, called the SCoV-2 Detect IgM/IgG Kit, detects antibodies for the virus in a finger prick of blood, indicating whether the person had a previous COVID-19 infection. The contract enables InBios to ramp up production of either or both tests to 400,000 units per week – 20 times the facility’s current output – by May 2021, significantly expanding the nation’s testing capacity.

Fierce Healthcare informs us

According to UnitedHealth Group’s fifth annual UnitedHealthcare Consumer Sentiment Survey, which examines Americans’ opinions about multiple areas of healthcare, a survey-record 56% said it is likely they would use virtual care for medical services.  More than a quarter of respondents (26%) said they would prefer a virtual relationship with a primary care physician, the survey found. And when comparison shopping for care, 55% of respondents said they had used the internet or mobile apps to comparison shop for healthcare during the past year, with 1 in 4 patients saying that online or mobile resources were their first option for evaluating health issues.

Follow up on a couple of stories that the FEHBlog has been following:

  • Health Payer Intelligence discusses various angles on the payer transparency rule that the ACA regulators issued last week. That rule is applicable to the FEHBP.
  • A friend of the FEHBlog related that the federal government has noticed an appeal to the D.C. Circuit of District Judge James Boasberg’s September 2, 2020, decision preliminarily enjoining certain provisions of the Trump Administration’s revised ACA Section 1557 rule that adversely affected transgendered people. The government’s 60 day period to notice such an interlocutory appeal would have expired tomorrow.

Weekend update

David Ermer–AHRQ, Congress, COVID-19, Mental health care, Telehealth, U.S. Healthcare–
Lincoln Memorial in the Fall

The House of Representatives is on the campaign trail. The Senate will join them tomorrow after a confirmation vote on Judge Amy Coney Barrett’s nomination to the Supreme Court. Her nomination narrowly cleared a cloture vote at the Senate today. If you want to understand why the Supreme Court will not strike down the Affordable Care Act this term even with Judge Barrett on its illustrious bench, click here.

There is only one Congressional hearing this week — a Senate Commerce Committee hearing on Wednesday morning, October 28, about the federal internet liability shield. The witnesses will be the CEOs from Twitter, Alphabet/Google, and Facebook, large companies that currently benefit from this shield. Congress returns to its legislative business on November 16 following the Presidential and Congressional election on November 3.

Today, the Department of Health and Human Services shared news on how States and the District of Columbia will use the rapid COVID-19 BinaxNOW tests that the federal government purchased on their behalves. “HHS also provided all CLIA-certified nursing homes over 11 million rapid, point-of-care tests. The tests include the following FDA-authorized antigen diagnostic tests: Abbott BinaxNOW and either a Quidel Sofia 2 or Becton, Dickinson and Company (BD) Veritor™ Plus System instrument(s).”

The Washington Post’s Lily website offers an interview with a 14 year young lady, Anika Chebrolu, who was awarded a $25,000 prize “for her discovery: a compound that can bind to the coronavirus [COVID-19-, inhibiting its ability to infect people. She beat out nine other finalists — whose own projects ranged from a robotic glove to a device that detects invisible particles in water — to be named America’s top young scientist.” Ms. Chebrolu modestly explains that “my effort to find a spike protein binder isn’t unique in its methodology, and it may appear to be a drop in the ocean, but it adds to all these efforts and therefore is quite substantial.” Congratulations.

It’s also worth pointing out this Healthcare Dive article informing us that

Medical device funding hit a new high in the third quarter, growing 63% year on year to top $5 billion for the first time in CB Insights’ dataset. Investments in robotic surgery startups was a major driver of the increase. The analysts listed the progress of neuromodulation devices and Medtronic’s deals in diabetes and neurosurgery as other medical device highlights of the quarter.

The Mayo Clinic explains that “Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions.”

The International Modulation Society further explains that

Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.

Neuromodulation devices and treatments are life changing. They affect every area of the body and treat nearly every disease or symptom from headaches to tremors to spinal cord damage to urinary incontinence. With such a broad therapeutic scope, and significant ongoing improvements in biotechnology, it is not surprising that neuromodulation is poised as a major growth industry for the next decade.

Most frequently, people think of neuromodulation in the context of chronic pain relief, the most common indication. However, there are a plethora of neuromodulation applications, such as deep brain stimulation (DBS) treatment for Parkinson’s disease, sacral nerve stimulation for pelvic disorders and incontinence, and spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease).

Cochlear implants to treat deafness, for example, are intermodulation devices.

The FEHBlog noticed on Twitter today that the HHS Agency for Healthcare Quality and Research has made available in the Apple Store and Google Play an app to help patients to develop questions for the doctor visits.

On the healthcare survey and report front

The top 12 reasons for using telehealth, according to the 2020 survey, are listed below, with the 2019 ranking and percentages in parentheses:

  1. Convenience, 51 percent (1, 64 percent)
  2. Safety, 46 percent (12, 13 percent)
  3. Speed – ability to receive care quickly, 44 percent (2, 53 percent)
  4. Quality care, 30 percent (6, 25 percent)
  5. Condition covered by telehealth visit, 28 percent (7, 22 percent)
  6. Ease of access to health information, 27 percent (3, 34 percent)
  7. Convenient communication channels, 26 percent (4, 33 percent)
  8. Lower overall cost, 23 percent (5, 30 percent)
  9. Difficult to travel to medical office, 21 percent (7, 20 percent)
  10. Recommendation, 19 percent (7, 20 percent)
  11. Reputation, 19 percent (11, 14 percent)
  12. Past experience, 17 percent (9, 19 percent).
  • Health Payer Intelligence reports that

Around a third of Millennials [ages 24 – 39] have a behavioral health condition, emphasizing a greater need for behavioral healthcare options and coverage as well as a new approach to millennial member engagement, the latest Blue Cross Blue Shield Association (BCBSA) report revealed. * * * Not only do Millennials have a high percentage of behavioral health conditions but their rate of developing a behaioral health condition is rising by double digits. Over five years from 2014 through 2018, the prevalence of major depression rose by 43 percent, ADHD rose by 39 percentage percent, and psychotic disorders rose by 26 percent among Millennials.”

Midweek update

David Ermer–Congress, COVID-19 vaccine, Telehealth–
Photo by Manasvita S on Unsplash

The Hill brings us up to date on the status of bipartisan negotiations over a COVID-19 relief bill. At least the negotiated bill may be teed up for the lame duck session of Congress next month.

On Monday, Healthcare Dive reported the CVS Health is hiring 10,000 pharmacy technicians to administer vaccinations and today, and today

the U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health (ASH), issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) authorizing qualified pharmacy technicians and State-authorized pharmacy interns to administer childhood vaccines, COVID-19 vaccines when made available, and COVID-19 tests, all subject to several requirements. This guidance clarifies that the pharmacy intern must be authorized by the State or board of pharmacy in the State in which the practical pharmacy internship occurs, but this authorization need not take the form of a license from, or registration with, the State board of pharmacy.

Smart move, CVS.

On Monday, NCQA released the results of its Spring 2020 telehealth questionnaire. Check it out.

On the opioid front, the Wall Street Journal reports today that

Purdue Pharma LP agreed to plead guilty to three felonies related to its marketing and distribution of powerful painkiller OxyContin, as part of an $8.34 billion settlement that caps yearslong federal investigations into tactics the government said helped fuel the opioid crisis.

The Justice Department unveiled the settlement Wednesday, alongside a deal with Purdue’s owners, members of the Sackler family. The price tag for Purdue, however, is largely symbolic: The bankrupt company’s assets fall well short of $8 billion. It will pay the federal government $225 million, and much of the rest of the fines will be waived to allow more money to flow to states, counties and tribes that accuse Purdue of sparking widespread opioid addiction and deaths.

The Sacklers, meanwhile, resolved civil charges for a separate $225 million, but prosecutors made clear criminal investigations into the family continue.

Tuesday Tidbits

David Ermer–Congress, COVID-19, OPM, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

The Hill reports “progress but not breakthroughs” as yet in the negotiation to achieve bipartisan agreement on a pre-election COVID-19 relief bill. The Speaker has agreed to continue negotiations past the 48 hour deadline that she set over the week. So both sides have set and withdrawn deadlines. That may be the clearest sign that progress is being made.

Federal News Network takes a deeper dive into last week’s FEHBP Open Season announcement from OPM. To recap “non-postal FEHBP participants will pay in 2021.

  • Self-only coverage: $4.67 more per biweekly pay period,
  • Self-plus-one coverage: $10.90 more per biweekly pay period,
  • Family coverage: $10.94 more per biweekly pay period.

It is interesting that the two other than self only options increased at the same level. This illustrates the small family size in the FEHBP. Furthermore,

[OPM Acting Director for Healthcare and Insurance Laurie] Bodenheimer described the premium rates OPM announced Wednesday as a “snapshot in time.” “These numbers are based on premiums for next year, along with what plans people are enrolled in right now,” she said. “It’s well known that during the open season people do choose different plans and coverage based on benefits or premiums or whatever is important to them. The end result is often that the overall premium increase is less than what we’re announcing today.”

That, my friend, is the benefit of FEHBP competition. The FEHBP/FEDVIP/FSAFeds Open Season runs from November 9 through December 14.

The open season for the Affordable Care Act’s marketplace begins on November 1. HHS released yesterday

a report showing the trend of lower premiums and increased issuer participation for HealthCare.gov will continue for 2021 year. The average premium for the second lowest cost silver plan (also called the benchmark plan) dropped by 2% for the 2021 coverage year and, when looking at states that are using HealthCare.gov in both 2020 and 2021, 22 more issuers will offer coverage in 2021, for a total of 181 issuers delivering more choice and competition for consumers.

The FEHBlog is happy to see that marketplace continues to mature and improve without the individual mandate.

On the COVID 19 front —

  • Healthcare Dive reports “About 20% of hospital executives surveyed by Kaufman Hall recently said they were ‘extremely concerned’ about their financial viability until an effective vaccine or treatment is available.”
  • A friend of the FEHBlog pointed out this helpful New York Times COVID-19 vaccination tracker.
  • NIH Director Dr. Francis Collins reports in his Director’s Blog that “findings [from two new studies] show that people who survive a COVID-19 infection continue to produce protective antibodies against key parts of the virus for at least three to four months after developing their first symptoms. In contrast, some other antibody types decline more quickly. The findings offer hope that people infected with the virus will have some lasting antibody protection against re-infection, though for how long still remains to be determined.”
  • NPR informs us that “Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.” That has been the FEHBlog’s operating assumption. The principal researcher remarks that “”I do think this is good news, “but it does not make the coronavirus a benign illness.” No doubt about that.

Monday Roundup

David Ermer–Congress, COVID-19, U.S. Healthcare–
Photo by Sven Read on Unsplash

The Wall Street Journal reports that Speaker Pelosi and Treasury Secretary Mnuchin continue to negotiate over another COVID-19 relief bill. “On Monday afternoon’s call with Democrats, Mrs. Pelosi said the two sides were still discussing how much money to provide state and local governments, child-care facilities and how to structure a national plan for testing and contact tracing of the virus.” The negotiations need to conclude soon if Congress is to have time to consider and pass the compromise bill before the national election which is two weeks from tomorrow.

Healthcare Dive offers a helpful overview of last week’s HLTH conference. Of note:

A slew of government agencies, including the Centers for Disease Control and Prevention, HHS and Operation Warp Speed, are working together to generate a vaccine distribution plan in tandem with private sector partners.

Plans for distribution are ongoing but shift as the frontrunners in the vaccine race do, experts say. Different vaccines require different processes. For example, there may be additional costs to store a coronavirus vaccine at cold temperatures, or because some of the candidates require two doses.

“All those things we’re working through to try and understand,” Alan Lotvin, president of CVS’ pharmacy benefit management arm Caremark, said Monday. “It’s going to be different for every vaccine.”

Walgreens, for example, is in regular conversations with five manufacturers in the last stages of clinical tests, the federal government and other retail partners to coordinate a distribution strategy, Gourlay said.

And CMS plans to release a rule before the end of the month for how Medicare will cover an eventual COVID-19 vaccine without cost-sharing, Verma said.

The Healthcare Dive article also discusses back to work technology presented at HLTH. In that regard, HR Daily advisor offers advice on how employers and managers can offer mental health guidance to their remote employees. For example,

Knowing that isolation is a big challenge, companies should look for ways to help their staff feel connected. “Working at home can prove challenging under the best of circumstances,” says Jeanne Hurlbert, PhD, President of Hurlbert Consulting. “Forming virtual work teams can help combat those challenges.”

“Teams can connect by phone or, ideally, through video conferencing, once or twice a day—and this can help to increase productivity. That allows them to provide instrumental support to each other,” Hurlbert adds. “And if your employees remain in the workplace, the same principles hold. The bonus? Our research shows that workers with more coworker connections enjoy higher job satisfaction.”

A friend of the FEHBlog shared this National Institutes of Health press release about “a groundbreaking study that will aim to address gaps in reaching communities most heavily affected by the opioid epidemic with proven, evidence-based interventions for opioid use disorder (OUD),” which as we have seen remains a national public health emergency.”

An estimated 1.6 million people had OUD in 2019; of these, only 18.1% received medication treatment for opioid misuse. To address this gap, in May 2019, the NIH announced plans to invest more than $350 million to support the multi-year HEALing Communities Study, a multi-site research study that will test the impact of an integrated set of evidence-based practices on reducing opioid-related overdose deaths by 40% in three years in communities hard-hit by the opioid crisis.

Study research sites include the University of Kentucky, Lexington; Boston Medical Center; Columbia University, New York City; and Ohio State University, Columbus. The study will track communities as they work to increase the number of individuals receiving medication-based treatment for OUD, increase treatment retention beyond six months, provide recovery support services, expand the distribution of naloxone, a medication to reverse opioid overdose, and reduce high-risk opioid prescribing.

Interesting.

Weekend update

David Ermer–Congress, COVID-19 vaccine, SCOTUS, U.S. Healthcare–

Note: The third time is charm. The correct version of OPM’s 2021 Non-Postal Nationwide / FFS Plan Premium chart is now linked to Friday’s note. Thanks readers.

To compensate for this inconvenience, the FEHBlog has attached his treasured actual maximum FEHB government contribution chart 2016-2021. If a plan’s premium is below the maximum government contribution, prescribed by 5 USC Sec. 8906, then plan annual premium increase is covered by the government contribution increase. If, however, the plan’s premium is above the maximum government contribution, the “shield” typically vanishes. As a result, the “above the max” plan’s annual premium changes are quite visible to the member. The maximum government contribution helps tamp down premium increases in this competitive program. The purpose of the chart is to illustrate the fact that the CPI-U is a useful proxy for maximum government contribution changes.

Onto the Weekend Update

The Senate is open for voting and committee work this week. On Thursday morning, the Senate Judiciary Committee will vote on Judge Amy Coney Barrett’s Supreme Court nomination. The House remains on the campaign trail although, according to the Hill, the Speaker has warned the Administration that she will stop negotiating a pre-election COVID-19 relief bill unless a compromise is reached early this week. Turnabout is fair play.

On the COVID-19 vaccine front —

Alex Gorsky, chief executive of Johnson & Johnson, remains upbeat about the possibility of a COVID-19 vaccine arriving as early as this year, despite the health care giant suspending a late-stage clinical trial for one of its own candidates after a patient fell ill this week. “If you just look at the sheer number of compounds that are in development right now, there is a very good probability that late this year or early next year, we will have options for vaccines.”

  • The Department of Health and Human Services announced on Friday that “agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term care facilities (LTCF) nationwide with no out-of-pocket costs.” “The pandemic has inflicted a devastating toll on America’s nursing home residents,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “That’s why the Trump Administration has taken unprecedented action to protect them in every possible way. This effort will ensure they are at the front of the line for the COVID vaccine and will bring their grueling trial to a close as swiftly as possible.”

On Saturday, according to CNN, the President signed into law a Congressionally approved bill that converts the national suicide hotlines ten digit number 1-800-273-8255 (TALK) to a three digit number 988. The Federal Communications Commission has ordered voice service providers to make the new three digit number available to subscribers by July 16, 2022.

The Centers for Medicare and Medicaid Services released the result of a Medicare beneficiary survey on the impact of COVID-19. It’s a survey of interest to FEHB plans because there is a large cadre of Medicare prime annuitants enrolled in their plans.

21% of Medicare beneficiaries report forgoing non-coronavirus disease 2019 (COVID-19) care due to the pandemic, and nearly all – 98% – of beneficiaries have taken preventative measures to keep themselves safe from the virus.

According to the survey, the most common type of forgone care because of the pandemic was dental care (43%), followed by regular check-up (36%), treatment for ongoing condition (36%), and diagnostic or medical screening test (32%). The most common reason cited for forgoing care was not wanting to risk being at a medical facility (45%).

“An infographic with a snapshot of the survey results is here.  A link to the public use file detailing the survey results is here.”

On the other side of the aging spectrum the Wall Street Journal reports on millennials agreeing to marry in part so that one partner can access the other partner’s employer sponsored health insurance. This has been happening for a long time. What’s interesting to the FEHBlog is that employer sponsored plans, not ACA marketplace plans , are viewed as the life raft.

Weekend update

David Ermer–Congress, COVID-19, Federal employment benefits, Medicare, U.S. Healthcare–
Thanks to ACK15 for sharing their work on Unsplash.

Congress does not plan to hold votes this week. The Senate Judiciary Committee begins Judge Amy Coney Barrett’s Supreme Court nomination confirmation hearing tomorrow.

Fox Business brings us up to date on the COVID-19 relief bill negotiations, and Federal News Network outlines new federal employment bills to watch.

This week the HLTH conference will virtually occur. Healthcare Dive describes five conference highlights.

On the afternoon of Tuesday October 13, the HCP-LAN will hold its virtual summit meeting. The FEHBlog has enjoyed these summits and, in contrast to HLTH, there’s no charge to attend. “The 2020 LAN Virtual Summit will center around how value-based payment models and the larger health care system have adapted to become more responsive and resilient in the wake of the public health emergency.”

On Thursday October 15, the Medicare Open Season begins. This is time when Medicare beneficiaries can enroll in or switch Medicare Advantage and Part D plans. The Open Season end on December 7.

Hopefully this week also will spotlight OPM’s 2020 Open Season announcement.

In recent news —

  • Health Payer Intelligence discusses a PriceWaterhouseCoopers report on strategies that health plans are implementing to control prescription benefit costs.
  • The Wall Street Journal considers “Lessons for the Next Pandemic—Act Very, Very Quickly / Scientists and public-health leaders are working on new ways to find infections before they spread; smarter lung scans and screening blood samples.” It’s never too early to start evaluating and planning.
  • The Federal Times reports on the virtual ceremony held to honor the federal employees who received the 2020 SAMMIE awards. SAMMIE is short for Samuel J. Heyman Service to America Medals. Congratulations SAMMIE winners.
  • NPR reports that

When developing a vaccine, scientists have a few strategies to try. They can take a piece or component of the bacteria and use that to trigger an immune response in a person. They can kill the pathogen and use its corpse as the vaccine. Or they can take a live pathogen and weaken it in the lab.

The latter are called “live, attenuated vaccines,” and over the past century, scientists have noticed something peculiar about these vaccines: They seem to offer some protection, not just from the targeted disease, but also against many different diseases, including respiratory infections.

COVID-19, of course, is a respiratory infection.

The nasal flu vaccine, in contrast to the injection, is a “live, attenuate vaccine.” However, it is only available to certain age groups. The Centers For Disease Control explains “The nasal spray flu vaccine is approved for use in healthy non-pregnant individuals, 2 years through 49 years old. People with certain medical conditions should not receive the nasal spray flu vaccine.” Of course, this is a conversation to hold with your doctor if you are eligible for the nasal flu vaccine.

Tuesday Tidbits

David Ermer–Congress, COVID-19, SCOTUS–

The Wall Street Journal reported this afternoon that the President has “endorsed the U.S. Food and Drug Administration’s [“FDA”] plans for assessing whether a Covid-19 vaccine should be given to the public, making it likely that a shot won’t be cleared until after the election, people familiar with the matter said.” Here is a link to that FDA guidance which was issued today. The FEHBlog also has confidence in the FDA.

The Journal also reports that the President has called off further COVID-19 relief bill negotiations between the Speaker of the House and the Treasury Secretary until after the November 3 election which is four weeks away.

Mr. Trump said he had instructed Senate Majority Leader Mitch McConnell (R., Ky.) to focus his efforts on confirming his Supreme Court nominee Amy Coney Barrett, whose Judiciary committee hearings start Monday, rather than the stimulus effort.

Mr. McConnell said that he agreed with Mr. Trump’s decision.

“I think his view was that they were not going to produce a result and that we needed to concentrate on what’s achievable,” he told reporters.

In other inside the Beltway news, the FEHBlog this morning listened to the oral argument before the U.S. Supreme Court in the ERISA preemption case involving an Arkansas law governing prescription benefit manager pricing practices. Rutledge v. PCMA (No. 18-540) — the recording of the argument is available here.

At issue is a U.S. Court of Appeals decision holding that ERISA preempted this Arkansas law. The counsel for the State of Arkansas, supported by the U.S. Solicitor General, argued that ERISA does not preempt a state law that regulates health care pricing. However, the counsel for PCMA countered, successfully in the FEHBlog’s view that the Arkansas law was not merely a pricing requirement. Rather it was loaded with administrative requirements. If the Supreme Court were to reverse the Eight Circuit, then there are forty states at last count that would be able to impose their pricing and procedural requirement on employer-sponsored health plans, which outcome likely would wind up encompassing the FEHBP.

PCMA’s counsel described that outcome as an administrative nightmare for ERISA plans. He directed the Court’s attention to the amicus brief filed by a nationwide employer based in Arkansas, J.B. Hunt.

For example, if an over-the-road truck driver for J.B. Hunt maintains two separate residences in Arkansas and California, which state PBM law applies? Many Arkansas communities straddle border states (e.g., West Memphis, Texarkana, Ft. Smith, Rogers). What if a J.B. Hunt employee resides in a border state but fills prescriptions across the border in Arkansas— or vice-versa? What if a Minnesota-based over-the- road truck driver needs to fill a prescription while passing through Arkansas, and now the Plan has to process and pay the claim under two different sets of laws?

ERISA and FEHBA state law preemption are in place to permit uniform nationwide administration of these employer sponsored plans. The Supreme Court will issue a decision before the end of June 2021.