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Healthcare in politics, week 7
Healthcare has been hot button a political issue for decades, with fights over Medicare going back to the mid-60s. The issue has been especially fractious over the last decade with the implementation of the Affordable Care Act, which passed without a single Republican voting for it.
It's with that backdrop that we now find ourselves in the midst of what HHS declared on January 31, 2020 to be a public health emergency. COVID-19 has upended the healthcare system in ways that nobody could have foreseen; thanks, in part, to CMS waiving telehealth regulations in April, combined with the necessity of using virtual care to see a doctor, that sector has been explosive growth in just a few months.
As this is an election year, the delineations between what the two sides believe in, and their vision for how healthcare should work, will be made clear. That is what will be discussed at the Healthcare in Politics salon, hosted by Vator, HP and UCSF Healthhub, on October 7. Every week until then we will be doing a roundup of some of the biggest healthcare news and what Trump, Biden and the biggest healthcare agencies are up to:
A new analysis released by the Centers for Disease Control and Prevention (CDC) found that people of color are being disproportionately hurt by coronavirus, with 76 out of 79 COVID-19 hot spots between February and June hitting those communities.
Disparities among Hispanic populations were found in 59 of those counties, or approximately three quarters them, with roughly 3.5 million Hispanic residents. Approximately 2 million black persons reside in 22 hotspot counties, where black residents were disproportionately affected.
The states with the highest disparities among Hispanic people were North Carolina, Oregon, South Carolina, Arkansas, Utah, Florida and Tennessee had the highest numbers of counties with disparities among Hispanics, while Michigan and South Carolina had the highest numbers of counties with disparities among Black people.
"Developing culturally responsive, targeted interventions in partnership with trusted leaders and community-based organizations within communities of color might reduce disparities in COVID-19 incidence. Increasing the proportion of cases for which race/ethnicity data are collected and reported can help inform efforts in the short-term to better understand patterns of incidence and mortality," the CDC wrote.
"Existing health inequities amplified by COVID-19 highlight the need for continued investment in communities of color to address social determinants of health and structural racism that affect health beyond this pandemic. Long-term efforts should focus on addressing societal factors that contribute to broader health disparities across communities of color."
The CDC noted that another 126 counties were also considered hot spots, but those did not have enough racial data of COVID-19 cases to include in the analysis.
Republican Senator Bill Cassidy of Louisiana tested positive for Covid-19, making him the second sitting Senator, after Kentucky's Rand Paul, to contract the disease. He has announced plans to quarantine for 14 days following the diagnosis.
"I am strictly following the direction of our medical experts and strongly encourage others to do the same," Cassidy said in a statement.
A number of members of the House of Representatives have also come down with the disease, including Republicans Rodney Davis of Illinois, Louie Gohmert of Texas, Morgan Griffith of Virginia, Mario Diaz-Balart of Florida and Mike Kelly of Pennsylvania, along with Democratic Representatives Joe Cunningham of South Carolina and Ben McAdams of Utah.
Masks have been required on the House floor since July, while the Senate has not implemented any mask requirements.
The Supreme Court will hear arguments in a case challenging the constitutionality of the Affordable Care Act on November 10, one week after Election Day. The case, which was brought by Republican attorneys general, alleges that the legislation’s individual mandate provision was made unconstitutional when all penalties were removed under President Trump’s 2017 tax overhaul.
In 2012, the Supreme Court upheld the ACA, finding that the individual mandate was a tax. The Republicans are now arguing that if the court strikes down the individual mandate provision, the entirety of the sprawling legislation must also be scrapped. President Trump is on the side of getting rid of the law altogether.
The court was originally going to hear the case in October, but has now moved it so that it will no longer influence the election.
If the court rules in favor of the Republicans, tens of millions of Americans could lose their health insurance.
The percentage of those people who are dying from COVID-19 has been falling in most states over the past few weeks and months.
In Arizona, for example, the percentage of people who tested positive for the coronavirus by the end of May was 5 percent, but that number is now cut in half. In California, the number went from 4 percent in May to 1.6 percent. In Minnesota, the death rate went from 7.5 percent in April to 2.7 percent.
In New York, Governor Cuomo announced that hospitalizations dropped below 500 for the first time, to the lowest number since March 16, and the number of ICU patients dropped to 119, the lowest number since March 15. The rate of positive tests was below 1 percent for the fourteenth straight day.
The reasons for these declines include a better understanding of how to treat the disease, and the fact that those who are getting it now tend to be younger, and are at less risk of dying.
However, the news is not all positive: in Massachusetts, the death rate is still above 7 percent and New Jersey's death rate is 8.4 percent. Florida recently passed 10,000 total deaths. Since the beginning of August, the state has been averaging 150 coronavirus deaths per day, which would make it the highest cause of death, more than cancer and heart disease, which each kill about 125 people per day on average.
Health officials are also concerned that a falling death rate will provide a false sense of security; even if COVID does not kill a patient, it can still cause significant damage to the heart, lungs and other organs.
"We have focused a lot on mortality, and one of the things I have really seen going back on the wards over and over again is that morbidity, the disease from this, is pretty bad. Even if they survive, the number of people who have long-term health effects that can really be disabling is being ignored by the media," Celine Gounder, a clinical researcher at New York University’s Grossman School of Medicine, told the Hill.
West Virginia's attorney Patrick Morrisey general filed separate lawsuits against Walmart and CVS, alleging that the companies helped create the opioid epidemic in the state by filling suspicious orders of opioids that were of unusual size and frequency and then distributing those drugs to retail pharmacies, rather than stopping those order.
Walmart and CVS are also accused of ordering additional pills from other distributors to fulfill demand.
These companies "reaped billions of dollars in revenues while causing immense harm to the State of West Virginia and its residents," it says in the lawsuits.
“We must hold everyone accountable for the roles they played in the opioid epidemic and continue to push toward solutions that go after the root cause of the problem,” Morrisey said in a statement.
Similar lawsuits were filed by West Virginia against Rite-Aid and Walgreens in June.
"We believe the State of West Virginia’s complaint against us is misguided. Opioids are made and marketed by drug manufacturers, not pharmacies. We dispense opioid prescriptions written by a licensed physician for a legitimate medical need," a CVS spokesman told the Hill.
"We intend to defend the company against the allegations in the complaint."
(Image source: beefmagazine.com)
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