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News

State tops 250,000 COVID-19 cases, 6,000 deaths, renewing safety calls
Posted: Nov 8 2020

CRONKITE NEWS | By Josh Ortega | Nov 5, 2020

WASHINGTON – State officials repeated calls for Arizonans to take commonsense health measures, as the state passed two grim milestones this week in the fight against the COVID-19 pandemic.

The Arizona Department of Health Services reported that the state surpassed 6,000 coronavirus-related deaths Tuesday, one day before it reported that total cases had topped the quarter-million mark. By Thursday, the numbers stood at 6,087 dead and 252,768 people infected.

“The increased cases and percent positivity show that COVID-19 is still actively circulating in our communities,” said Dr. Cara Christ, the health department director. “Now is not the time to let our guard down.”

Her comments came in a video Thursday, released along with a report updating the state of the disease in Arizona. Christ said that while every county in the state meets “moderate” or lower rates of transmission that allow for reopening of schools and businesses, there is no denying the rise in the infection rate and percent positivity in many counties. 

“We have seen cases rise over the past month globally, nationally and locally,” she said. “The increase this fall was expected, with more Arizonans returning to school and reopening of many businesses.”

Christ said the solution is simple – residents need to follow measures that have worked well to bring the disease under control since summer, such as wearing masks, washing hands and avoiding large gatherings.

Health experts around the state agreed with Christ, but also suggested that more needs to be done, such as a statewide mask mandate, which Gov. Doug Ducey has shied away from so far.

“Now that the election is behind us, I’m hoping that we will see some slightly more aggressive intervention measures from the governor,” said Will Humble, executive director of the Arizona Public Health Association and former director of the state health department.

Humble said the main issue now is moving to prevent more cases rather than dwelling on the “grim” statistics of this week. He said that means boosting compliance and enforcement at bars, restaurants and nightclubs, as well as a statewide mask mandate “but, time will tell.”

Dan Derksen, associate vice president for health equity, outreach and interprofessional activities at the University of Arizona Health Sciences, said the state might have to consider measures such as the stay-at-home orders imposed this summer to protect the availability of hospital beds. 

Derksen said that while hospitals have become better about identifying and treating COVID-19 patients, mask-wearing still remains “the most effective tool” to reduce the spread of the virus.

“Compared to other states, Arizona is doing perhaps a little better, but we’re concerned about this trend in increases,” Derksen said.

The Centers for Disease Control and Prevention ranked Arizona 10th in the U.S. in recent weeks for total COVID-19 cases. 

Derksen said the evidence is “incredibly clear” that masks also reduce hospitalization and death rates, but that it has become politicized during this election season when “wearing a mask is somehow going against who you’re voting for.”

“That’s just kind of ridiculous when it comes to public health measures that are evidence-based and proven effective,” he said.

Holly Ward, communications director for the Arizona Hospital and Healthcare Association, said hospitals remain dedicated to helping, but that individuals need to do their part to prevent another surge in demand for hospital beds.

“We have seen how the proper use of facial coverings along with public health basics works to stop the spread of this virus,” Ward said in an email Tuesday. She said other important measures include hand-washing, staying home when sick and avoiding gatherings in large groups when you cannot socially distance.

Christ agreed that there are enough available hospital beds to handle COVID-19 patients and others – for now.

“Our hospitals currently report sufficient capacity in their inpatient and intensive care unit beds, but the number of beds in use has increased over the past few weeks,” she said.

Christ noted that Arizona enjoys one advantage in the fight against COVID19 over other states, where people will soon be heading indoors to avoid the cold: The climate allows Arizonans to stay outside and socially distance.

“We encourage everyone to move gatherings outside while following other COVID-19 precautions, she said.

Christ also said Thursday that the age group hit hardest by the recent surge in COVID-19 cases is 20 to 44-year-olds – particularly college students- with more than 3,700 infections reported last week, almost half of the total number of new cases reported in the state. While college-age individuals saw the highest rates, the most recent data this week shows cases rose among all age groups. 

Humble said experts know that COVID-19 “eats” on human behavior and can still spread easily through populations, regardless of whether they are in urban or rural areas.

“The more socially connected your network is in person, the more likely the virus is to spread,” he said.

Rural counties – such as Navajo, Apache, Yuma, Santa Cruz – have continued to see the highest rates of infection, according to AZDHS.

Humble said masks remain a “very effective intervention” tool for indoor gatherings that “doesn’t cost anything except political capital.” If people do not wear face coverings in public now, he said, it is more likely the state will end up with another hospital crisis and stay-at-home order in coming months.

“It doesn’t need to last forever,” Humble said of a mask requirement. “It just needs to be in place until we get wide distribution of the vaccine.”

 

 
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UArizona Health Sciences to Lead Statewide Outreach to Reduce Disparities in COVID-19 Research, Clinical Studies
Posted: Nov 4 2020

Early in the pandemic it became clear certain groups suffered more from COVID-19, the disease caused by the novel coronavirus SARS-CoV-2. In particular, African Americans, Hispanics/Latinos and Native Americans not only were diagnosed with COVID-19 in disproportionate numbers, but also were more likely to suffer serious health consequences or die from the disease. Their populations account for more than half of all reported U.S. cases, which now have surpassed 8 million.

Sairam Parthasarathy, MD, chief of the UArizona Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, leads the Arizona effort to reduce disparities in underrepresented communities in COVID-19 research and clinical trials. Sairam Parthasarathy, MD, chief of the UArizona Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, leads the Arizona effort to reduce disparities in underrepresented communities in COVID-19 research and clinical trials. 

In response, the National Institutes of Health, as part of an 11-state effort to address such health disparities, has awarded $12 million for outreach and engagement efforts in ethnic and racial minority communities disproportionately affected by COVID-19. This 11-state alliance created by the NIH is called the Community Engagement Alliance Against COVID-19 Disparities, or CEAL. Teams in Alabama, Arizona, California, Florida, Georgia, Louisiana, Michigan, Mississippi, North Carolina, Tennessee and Texas have received initial funding to create CEAL programs immediately.

“It was clear to us early in the pandemic the University of Arizona needed to reach out and assist communities across the state to help understand and fight COVID-19,” said University of Arizona President Robert C. Robbins, MD. “With this support from the NIH, we will be able to work closely with Arizona’s other public universities and other partners to look at why specific populations in the United States are suffering at a much greater rate from COVID-19. It also builds on a recent commitment by the Tohono O’odham Nation to give $1 million toward efforts to accelerate the work of University of Arizona researchers to create new and more efficient, effective and affordable COVID-19 tests.”

In Arizona, the CEAL program is being led by Sairam Parthasarathy, MD, the program’s lead principal investigator and chief of the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine in the UArizona College of Medicine – Tucson. Co-investigators for the UArizona Health Sciences effort include: Tracy Crane, PhD; Daniel Derksen, MD; Kacey Ernst, PhD, MPH; Fayez Ghishan, MD; Nirav Merchant and Francisco Moreno, MD.

“This collaborative effort, which seeks to help ease the burden on some of Arizona’s most vulnerable populations, also will increase their participation in the development of vaccines and clinical therapies to fight this dreadful disease,” said Michael D. Dake, MD, UArizona Health Sciences senior vice president. “The Arizona team’s collaborative outreach efforts can only make these potential remedies more effective in addressing the disparate health impact of COVID-19.”

Tracy Crane, PhD, RD, a UArizona assistant professor of nursing and public health and co-director, Behavioral Measurement and Interventions Shared Resource for the Cancer Prevention and Control Program, UArizona Cancer CenterTracy Crane, PhD, RD, a UArizona assistant professor of nursing and public health and co-director, Behavioral Measurement and Interventions Shared Resource for the Cancer Prevention and Control Program, UArizona Cancer Center

Splitting a $1 million, one-year subcontract award, the UArizona Health Sciences team – along with researchers from Arizona State University, Northern Arizona University and Mayo Clinic in Scottsdale – have formed the Arizona CEAL COVID Consortium, or AC3. As AC3 co-principal investigators, Sabrina Oesterle, PhD, leads the ASU effort, Samantha Sabo, DrPH, leads the NAU effort, Chyke Abadama Doubeni, MD, leads the Mayo Clinic effort and Floribella Redondo Martinez heads up the effort by the Arizona Community Health Workers Association. Their overarching goal is to conduct community-engaged research and outreach to increase COVID-19 awareness and education among communities disproportionately affected by COVID-19 and to reduce misinformation and mistrust.

“Community engagement is the cornerstone for performing highly relevant and impactful health disparities research,” Dr. Parthasarathy said. “ASU, Mayo, NAU and University of Arizona investigators under AC3 will work closely with community advisers to identify urgent unmet needs and rapidly develop and tailor existing infrastructures, such as AZCOVIDTXT, and a diverse workforce of community health workers.”

The AZCOVIDTXT initiative, which allows volunteers to relay household health information anonymously via a two-way text messaging service, was created this past spring by a team of UArizona researchers to better track COVID-19 and gather and disseminate information about available resources for those affected.

“With the AC3 CEAL initiative,” Dr. Crane said, “we will be able to better understand the needs of our underrepresented – or, in this case, overrepresented – communities to meet their needs via tailoring of AZCOVIDTXT, as well as utilizing community health workers through a toll-free health number that will link directly to the community health workers so people who don’t have a smart cellphone can receive the same help and information.”

The initiative also will involve mobile health units, such as those deployed in the Phoenix and Tucson areas by the UArizona Mel and Enid Zuckerman College of Public Health in outreach to Spanish-speaking communities, as well as additional outreach to rural and Native American communities throughout the state.

This multiprong approach, Dr. Parthasarathy said, aims to establish effective, culturally appropriate strategies to enhance participation of communities disproportionally affected by COVID-19 in research designed to advance the prevention and treatment of COVID-19 and reduce the burden of disease on the hardest-hit communities. They will do that, in part, by leveraging existing relationships with more than 30 Arizona community-based organizations and partners. These steps aim to help community organizations address misinformation, build trust and broaden awareness to reduce the overall impact of COVID-19. A key focus will be to promote and facilitate inclusion and participation of these ethnic and racial groups in vaccine and therapeutic clinical trials to prevent and treat the disease.

They also will promote nationally developed information resources and a clinical trial patient registry. Dr. Parthasarathy pointed out that even though half of all COVID-19 cases are among minority/ethnic groups, only a small proportion of participants who signed up for clinical trials are from these underrepresented communities. You can follow the AC3 initiative via Twitter here.

“One of our tasks,” Dr. Parthasarathy said, “is to enable greater awareness for coronavirus information available at the coronaviruspreventionnetwork.org website, which is the NIH COVID-19 Prevention Network that is orchestrating these clinical research studies related to vaccines and other therapeutic remedies. The site not only disseminates educational material and resources in multiple languages, but also establishes a COVID-19 volunteer registry for potential research participants.”

About the University of Arizona Health Sciences
The University of Arizona Health Sciences is the statewide leader in biomedical research and health professions training. UArizona Health Sciences includes the Colleges of Medicine (Tucson and Phoenix), Nursing, Pharmacy, and the Mel and Enid Zuckerman College of Public Health, with main campus locations in Tucson and the Phoenix Biomedical Campus in downtown Phoenix. From these vantage points, Health Sciences reaches across the state of Arizona, the greater Southwest and around the world to provide next-generation education, research and outreach. A major economic engine, Health Sciences employs nearly 5,000 people, has approximately 4,000 students and 900 faculty members, and garners $200 million in research grants and contracts annually.

 
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COVID in Arizona, 10-22-20: a summary by Daniel Derksen, MD
Posted: Oct 30 2020

» Download PDF

COVID-19 in AZ Report

 
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Mt. Graham moving closer to critical access hospital designation
Posted: Oct 26 2020

EASTERN ARIZONA COURIER | By Kim Smith editor@eacourier.com | Oct 23, 2020

Gila Valley residents could soon see expanded cardiology, wound care and inpatient dialysis services if things go as planned for Mt. Graham Regional Medical Center.

The hospital is taking the final steps necessary to be designated a critical access hospital, which would allow it to be reimbursed differently by Medicare and Medicaid.

A public meeting was held Thursday night to inform Gila Valley residents about the effort and as part of the application process.

Hospital CEO Roland Knox and Jill Bullock from the Arizona Center for Rural Health, which is helping the hospital during the process, spoke to roughly a dozen people at Graham County’s general services building.

Right now, the hospital is reimbursed a lump sum of money based on a diagnosis code and it doesn’t matter if the patient takes a few days longer to recover in the hospital than anticipated, Knox said.

If the hospital receives the critical access designation, the reimbursements will become cost-based, he said.

The additional funding would allow the hospital to expand services, including cardiology, Knox said.

More than 200 rural hospitals closed in the 1990s because the payment system wasn’t working, Bullock said. As a result, lawmakers passed the Medicare Rural Hospital Flexibility Program in 1997 to make changes to the payment system and improve the health and wellness of people living in rural communities.

There are 15 critical access hospitals in Arizona right now and both Mt. Graham Regional Medical Center and San Carlos Apache Healthcare Corporation are seeking the designation, Bullock said. Nationally, 22 percent of all hospitals have the designation.

In order to become a critical access hospital, the hospital must be located in a rural area 35 miles or more from another hospital and provide 24/7 emergency care, she said. The hospital must also have no more than 25 acute care and swing beds.

Knox explained that Mt. Graham will be losing 23 medical/surgical beds and one bed in obstetrics, but adding 10 observation beds if it receives the CAH designation.

However, the CEO stressed that over the last four years, the medical/surgery unit usually only had five or six patients a day anyway. The obstetrics unit averaged three patients a day.

If the hospital had designated observation beds over the last four years, it would’ve averaged five or six patients a day.

Overall, the hospital only has a 33 percent occupancy rate right now, Knox said. Once the hospital is designated a critical access hospital, the occupancy rate will be around 46 percent.

Besides the cost-based reimbursements from Medicare, another benefit to being a critical access hospital is getting access to educational resources, technical assistance and funding for special projects, Bullock said.

Over the next couple of months, the hospital and Arizona Center for Rural Health will finish up the application, sent it to the Arizona Department of Health Services and then on to the Centers for Medicare and Medicaid Services.

If all goes well, Knox said the hospital will get the designation by spring.

 
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Biden vs. Trump: ObamaCare, access to health care in rural US impacts voters' decisions
Posted: Oct 22 2020

By Stephanie Bennett | Fox News | October 22, 2020

Access to affordable and reliable health care is one of the hot topics of this election

ARIVACA, Ariz – Kathleen Wishnick left the hustle and bustle of Sacramento for a new life in the rural deserts of Arizona more than 15 years ago.

She said her family wanted a “place in the middle of nowhere” and they found it in the small town of Arivaca, which boasts a population of about 684 people.

The peaceful setting has its perks, Wishnick told Fox News, but when it comes to health care, access is almost nonexistent.

“The roads when it rains are iffy...sometimes ambulances can’t get in… people said to us, 'Well you won’t have any health services,' I said well it’s just a helicopter ride away, but when it happens to you, you tend to rethink that just a little bit,” she said.

Wishnick says the town does have a clinic, but it’s only open certain days a week and has just two doctors. For more advanced procedures or to see a specialist, it involves driving to the closest hospital about an hour away.

With only days until the 2020 presidential election, the topic of health care access, insurance and affordability is front and center in Wishnick’s mind — and she is not alone.

According to the Kaiser Family Foundation, about 2.8 million Arizonans live in areas that the federal government says has a health care shortage — ranking 9th in the country overall.

Dan Derksen, MD“I believe everyone in Arizona and across the United States should have access to care,” Dr. Daniel Derksen, associate vice president for health sciences at the University of Arizona and director of the Arizona Center for Rural Health, told Fox News. “We are certainly spending enough as a nation and spending enough as a state to cover every single person with the care that they need, so that they get it when they need it, such as during a COVID-19 pandemic.”

Derksen said the Affordable Care Act – or ObamaCare – which former Vice President Joe Biden wants to protect and expand, is a good thing and would be harmful to rural residents to lose.

“We need to make sure that coverage is built upon not torn away … we need to build on the gains made, not throw things away and especially during a time where people really need the health care and access,” he added. “The Affordable Care Act does protect individuals from being charged more or being denied coverage or dropped from coverage once they exceed a certain amount.”

He said that about 20 million Americans could lose their health care – and more than half a million Arizonians – if provisions in the health care act went away. 

President Trump, on the other hand, wants to scrap the Affordable Care Act and replace it with some sort of different plan. He’s spoken several times about lowering the cost of prescription medications.

According to Dr. Jane Orient, the executive director of the Association of American Physicians & Surgeons, the Affordable Care Act actually isn’t so affordable and has caused nothing but trouble for millions of Americans.

“I know so many people who have lost their insurance three, four, five times. They get another plan, it’s much more expensive, the deductible is so high they might as well be uninsured because they can’t afford to use it,” she said. “You can’t make something affordable by adding on all types of regulations and requirements and mandates; it’s just not affordable.”

Either way, both doctors can agree that the cost of health care is currently too high in the United States and needs to be reduced. They say everyone deserves equal access to quality care.

As for Wishnick, she says the little clinic in Arivaca works well for minor issues, but she worries about what will happen in times of emergencies.

“I would say it’s something that people think about a lot of the time, that’s one of the downsides when you move into a rural community; you don’t really think about those kinds of things,” she said.

 
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Election 2020: What Exactly Is Joe Biden's Healthcare Plan?
Posted: Oct 13 2020

MedScape Family Medicine | by Leigh Page | August 12, 2020

Physicians — like all Americans — are trying to size up Joe Biden's healthcare agenda, which the Democratic presidential nominee has outlined in speeches and on his official website.

Many healthcare professionals, patients, and voters of all political stripes think our current healthcare system is broken and in need of change, but they don't agree on how it should change. In Part I of this article, we take a look at Biden's proposals for changing the US healthcare system. Then, we include comments and analysis from physicians on both sides of the fence regarding the pros and cons of these proposed healthcare measures.

Part 1: An Overview of Biden's Proposed Healthcare Plan

Biden's proposed healthcare plan has many features. The main thrust is to expand access to healthcare and increase federal subsidies for health coverage.

If elected, “I’ll put your family first,” he said in a speech in June. “That will begin the dramatic expansion of health coverage and bold steps to lower healthcare costs.” He said he favored a plan that “lowers healthcare costs, gets us universal coverage quickly, when Americans desperately need it now.”

Below are Biden's major proposals. They are followed by Part 2, which assesses the proposals on the basis of comments by doctors from across the political spectrum.

Biden Says We Should Restore the ACA

At a debate of the Democrat presidential candidates in June 2019, Biden argued that the best way to expand coverage is "to build on what we did during the Obama administration," rather than create a whole new healthcare system, as many other Democratic candidates for president were proposing.

“I’m proud of the Affordable Care Act,” he said a year later in his June 2020 speech. "”n addition to helping people with preexisting conditions, this is the law that delivered vital coverage for 20 million Americans who did not have health insurance.”

At the heart of the ACA are the health insurance marketplaces, where people can buy individual insurance that is often federally subsidized. Buyers select coverage at different levels ― Gold, Silver, and Bronze. Those willing to pay higher premiums for a Gold plan don't have high deductibles, as they would with the Silver and Bronze plans.

Currently, federal subsidies are based on premiums on the Silver level, where premiums are lower but deductibles are higher than with the Gold plan. Biden would shift the subsidies to the Gold plan, where they would be more generous, because subsidies are pegged to the premiums.

In addition, Biden would remove the current limit on subsidies, under which only people with incomes less than 400% of the federal poverty level qualify for them. “Many families making more than 400% of the federal poverty level (about $50,000 for a single person and $100,000 for a family of four), and thus not qualifying for financial assistance, still struggle to afford health insurance,” the Biden for President website states.

Under the Biden plan, there would still be a limit on insurance payments as a percentage of income, but that percentage would drop, meaning that more people would qualify. Currently, the level is 9.86% or more of a person's income; Biden would lower that level to 8.5%.

“We’re going to lower premiums for people buying coverage on their own by guaranteeing that no American ever has to spend more than 8.5% of their income on health insurance, and that number would be lower for lower-income people,” Biden said in the June speech.

Add a Public Option, but Not Medicare for All

In the primary, Biden parted company from rivals who backed Medicare for All, a single-payer health system that would make the government pay for everyone's healthcare. “I understand the appeal of Medicare for All,” he said in a video released by his campaign. “But folks supporting it should be clear that it means getting rid of Obamacare, and I'm not for that.”

However, Biden embraced a “public option” that would allow people to buy into or be subsidized into "a Medicare-like" plan. It is unclear how similar the public option would be to regular Medicare coverage, but the Biden campaign has made it clear that it would not take funds from the Medicare trust fund, which is expected to start losing funds by 2026.

The more than 150 million Americans who have employer-sponsored insurance could keep it, but they could still buy into the public option if they wanted to. In addition, the public option would automatically enroll ― at no cost to them ― some 4.8 million low-income Americans who were excluded from the ACA's Medicaid expansion when many states chose to opt out of the Medicaid expansion.

In addition, the 37 states that participate in expanded Medicaid could switch coverage to the new public option, provided that they continue to pay their current share of the costs. (In June, Oklahoma became the 37th state to allow the expansion, following the results of a ballot measure.)

“We need a public option now more than ever, especially when more than 20 million people are unemployed,” Biden said in the June speech. “That public option will allow every American, regardless of their employment status, the choice to get a Medicare-like plan.”

Lower the Medicare Age

In spring 2020, Biden proposed lowering the age to qualify for Medicare from 65 to 60. This provision is not included among the official policies listed on the Biden for President website, but it has been cited by many, including the Biden-Sanders Unity Task Force.

This provision would bring almost 23 million people into Medicare, including 13.4 million from employer-sponsored coverage, according to one analysis. It's not clear whether these people would buy into Medicare or simply be covered. Their care would not be paid for by the Medicare Trust Fund but would use tax dollars instead.

Provide Relief in the Covid-19 Pandemic

Biden would cover the cost of COVID-19 testing and the cost of health coverage for people laid off during the pandemic.

“Testing unequivocally saves lives, and widespread testing is the key to opening our economy again,” Biden said in his June speech. “To fix the economy, we have to get control over the virus.”

Prescription Drug Reform

Biden would repeal a Bush-era exception that bars the Medicare program from negotiating prescription drug prices for the Part D prescription drug benefit. “There’s no justification for this except the power of prescription drug lobbying,” the Biden for President website states.

In addition Biden's prescription drug reform plan would do the following:

• Limit launch prices for drugs. The administration would establish an independent review board that would assess the value of new drugs and would have the power to set limits on their prices. Such drugs are “being abusively priced by manufacturers,” the Biden for President site says.

• Limit price increases to inflation. As a condition of participation in government programs, drug prices could not rise more than the general inflation rate. Biden would impose a tax penalty on drugmakers whose prices surpassed inflation.

• Allow consumers to buy prescription drugs from other countries. Biden would allow consumers to import prescription drugs from other countries, provided the US Department of Health and Human Services certifies that those drugs are safe.

• Stop tax breaks for pharma ads: Biden would drop drugmakers’ tax breaks for advertising, which amounted to $6 billion in 2016.

Stop Surprise Billing

Biden proposes to stop surprise billing, which occurs when patients receive care from a doctor or hospital that is not in their insurer's network. In these situations, patients can be surprised with very high bills because no payment limit has been negotiated by the insurer.

Twenty-eight states have enacted consumer protections to address surprise medical billing, but Congress has not passed such a measure. One proposed solution is to require payers to pay for out-of-network services on the basis of a benchmark, such as the average Medicare rate for that service in a specific geographic area.

Closely Monitor Healthcare Mergers

Biden would take a more active stance in enforcing antitrust laws against mergers in the healthcare industry.

“The concentration of market power in the hands of a few corporations is occurring throughout our health care system, and this lack of competition is driving up prices for consumers,” the Biden for President website states.

Overhaul Long-term Care

Biden’s latest plan calls for a $775 billion overhaul of the nation's caregiving infrastructure. Biden says he would help create new jobs, improve working conditions, and invest in new models of long-term care outside of traditional nursing homes.

Restore Funding for Planned Parenthood

Biden would reissue guidance barring states from refusing Medicaid funding for Planned Parenthood and other providers that refer for abortions or that provide related information, according to the Biden for President website. This action would reverse a Trump administration rule.

Boost Community Health Centers

Biden promises to double federal funding for community health centers, such as federally qualified health centers, that provide care to underserved populations.

Support Mental Health Parity

Biden says he supports mental health parity and would enforce the federal mental health parity law and expand funding for mental health services.

Part 2: Physicians’ Opinions on Biden's Healthcare Plans: Pro and Con

Biden’s plans to expand coverage are at the heart of his healthcare platform, and many see these as the most controversial part of his legislative agenda.

Biden's Medicare expansion is not Medicare for All, but it can be seen as “Medicare for all who want it.” Potentially, millions of people could enter Medicare or something like Medicare. If the Medicare eligibility age is dropped to 60, people could switch from their employer-sponsored plans, many of which have high deductibles. In addition, poor people who have no coverage because their states opted out of the Medicaid expansion would be included.

The possibility of such a mass movement to government-run healthcare alarms many people. “Biden's proposals look moderate, but it is basically Medicare for All in sheep’s clothing,” said Cesar De Leon, DO, a family physician in Naples, Florida, and past president of the county’s medical society.

Reimbursements for Doctors Could Fall

A shift of millions of people into Medicare would likely mean lower reimbursements for doctors. For example, the 13.4 million people aged 60 to 65 who would switch from employer-sponsored coverage to Medicare would be leaving some of the best-paying insurance plans, and their physicians would then be reimbursed at Medicare rates.

“Biden’s plan would lower payments to already cash-strapped doctors and hospitals, who have already seen a significant decrease in reimbursement over the past decade,” De Leon said. “He is trying to win the support of low-income voters by giving them lower healthcare prices, which doctors and hospitals would have to absorb.”

“Yes, the US healthcare system is dysfunctional,” De Leon added, “but the basic system needs to be fixed before it is expanded to new groups of people.”

The American Association of Neurological Surgeons/Congress of Neurological Surgeons warns against Biden’s proposed government-run system. “We support expanding health insurance coverage, but the expansion should build on the existing employer-based system,” said Katie O. Orrico, director of the group's Washington office. “We have consistently opposed a public option or Medicare for All.” 

“Shifting more Americans into government-sponsored healthcare will inevitably result in lower payments for physicians’ services,” Orrico added. “Reimbursement rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”

Prospect of Higher Taxes

Paying for ambitious reforms means raising taxes. Biden’s plan would not make the Medicare trust fund pay for the expansions and would to some extent rely on payments from new beneficiaries. However, many new beneficiaries, such as people older than 60 and the poor, would be covered by tax dollars.

Altogether, Biden's plan is expected to cost the federal government $800 billion over the next 10 years. To pay for it, Biden proposes reversing President Trump's tax cuts, which disproportionately helped high earners, and eliminating capital gains tax loopholes for the wealthy.

“Rather than tax the average American, the Democrats will try to redistribute wealth,” De Leon said.

“The elephant in the room is that taxes would have to be raised to pay for all these programs,” said Gary Price, MD, president of the Physicians Foundation. Because no one likes higher taxes, he says, architects of the Biden plan would try to find ways to save money, such as tamping down reimbursements for physicians, to try to avoid a public backlash against the reforms.

“Physicians’ great fear is that efforts to keep taxes from getting too high will result in cutting physician reimbursement,” he said.

Impact of COVID-19

Perhaps an even larger barrier to Biden’s health reforms comes from the COVID-19 crisis, which didn’t exist last year, when health reform was the central issue in the presidential primary that pitted Biden against Vermont Senator Bernie Sanders, the chief proponent of Medicare for All.

“The top two issues on voters’ minds right now are the pandemic and the economy,” said Daniel Derksen, MD, a family physician who is professor of public health policy at the University of Arizona in Tucson. “Any other concerns are pushed down the list.”

The COVID-19 crisis is forcing the federal government to spend trillions of dollars to help businesses and individuals who have lost income because of the crisis. Will there be enough money left over to fund an ambitious set of health reforms?

“It’s not a good time to start reforms,” warned Kevin Campbell, MD, a cardiologist in Raleigh, North Carolina. “Given the current pressures that COVID-19 has placed on physicians, healthcare systems, and hospitals, I don’t believe that we can achieve meaningful change in the near term.”

However, supporters of Biden’s reforms think that now, during the COVID-19 crisis, is precisely the right time to enact healthcare reform. When millions of Americans lost their jobs because of the pandemic, they also lost their insurance coverage.

“COVID-19 has made Biden’s healthcare agenda all the more relevant and necessary,” said Don Berwick, MD, who led the Center for Medicare & Medicaid Services (CMS) under President Obama. “The COVID-19 recession has made people more aware of how vulnerable their coverage is.”

Orrico at the neurosurgeons group acknowledges this point. “The COVID-19 pandemic has exposed some cracks in the US healthcare system,” she said. “Whether this will lead to new reforms is hard to say, but policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and healthcare costs due to the COVID-19 emergency.”

Many Physicians Want Major Reform

Although many doctors are skeptical of reform, others are impatient for reform to come and support Biden's agenda ― especially its goal to expand coverage.

“Joe Biden's goal is to get everyone covered,” said Alice Chen, MD, an internist who is a leader of Doctors for Biden, an independent group that is not part of the Biden campaign. “What brings Democrats together is that they are united in the belief that healthcare is a right.”

In January, the American College of Physicians (ACP) endorsed both Medicare for All and the public option. The US healthcare system “is ill and needs a bold new prescription,” the ACP stated.

The medical profession, once mostly Republican, now has more Democrats. In 2016, 35% of physicians identified themselves as Democrats, 27% as Republicans, and 36% as independents.

Many of the doctors behind reform appear to be younger physicians who are employed by large organizations. They are passionate about reforming the healthcare system, and as employees of large organizations, they would not be directly affected if reimbursements fell to Medicare levels ― although their institutions might subsequently have to adjust their salaries downward.

Chen, for example, is a young physician who says she has taken leave from her work as adjunct assistant clinical professor of medicine at the University of California, Los Angeles, to raise her young children.

She is the former executive director of Doctors for America, a movement of thousands of physicians and medical students “to bring their patients' experiences to policymakers.”

“Doctors feel that they are unseen and unheard, that they often feel frankly used by large health systems and by insurance companies,” Chen said. “Biden wants to hear from them.”

Many idealistic young physicians look to health system leaders like Berwick. “I believe this nation needs to get universal coverage as fast as we can, and Biden’s policies present a path to get there,” the former CMS director said. "”his would be done chiefly through Biden’s public option and his plans to expand coverage in states that have not adopted the ACA Medicaid expansion.”

But what about the potential effect of lowering reimbursement rates for doctors? “The exact rates will have to be worked out,” Berwick said, “but it’s not just about who pays physicians, it’s about how physicians get paid.” He thinks the current fee-for-service system needs to be replaced by a value-based payment system such as capitation, shared savings, and bundled payments.

The Biden-Sanders Task Force

Berwick was a member of the Biden-Sanders Unity Task Force, which brings together supporters of Biden and Sanders to create a shared platform for the Biden campaign.

Is the Nation Ready for Another Health Reform Battle?

Clearly, many Democrats are ready to reform the system, but is the nation ready? “Are American voters ready for another major, Democratic-led health reform initiative?” asked Patricia Salber, MD, an internist and healthcare consultant who runs a blog called The Doctor Weighs In.

“I’ve been around long enough to remember the fight over President Clinton’s health plan and then President Obama’s plan,” she said. Each time, she says, there seemed to be a great deal of momentum, and then there was a backlash. “If Biden is elected, I hope we don't have to go through the same thing all over again,” Salber said.

Derksen believes Biden’s proposed healthcare reforms could come close to rivaling President Obamas Affordable Care Act in ambition, cost, and controversy.

He shares Biden’s goal of extending coverage to all ― including paying the cost of covering low-income people. But the result is that “Biden's agenda is going to be a ‘heavy lift,’ as they say in Washington,” he said. “He has some very ambitious plans to expand access to care.”

Derksen speaks from experience. He helped draft part of the ACA as a health policy fellow in Capitol Hill in 2009. Then in 2011, he was in charge of setting up the ACA's insurance marketplace for the state of New Mexico.

Now Biden wants to begin a second wave of health reform. But Derksen thinks this second wave of reform could encounter opposition as formidable as those Obama faced.

“Assuming that Biden is elected, it would be tough to get this agenda passed ― even if he had solid Democratic majorities in both the House and Senate,” said Derksen,

According to polls by the Kaiser Family Foundation (KFF), 53% of Americans like the ACA, while 37% dislike it ― a split that has been relatively stable for the past 2 years, since the failed GOP effort to repeal the law.

In that KFF poll, the public option fared better ― 68% of Americans support the public option, including 42% of Republicans. These numbers help explain why the Biden campaign moved beyond its support of the ACA to embrace the public option as well.

Even when Democrats gain control of all the levers of power, as they did in 2009, they still have a very difficult time passing an ambitious healthcare reform bill. Derksen remembers how tough it was to get that massive bill through Congress.

The House bill’s public option might have prevailed in a reconciliation process between the two bills, but that process was cut short when Sen. Ted Kennedy died and Senate Democrats lost their filibuster-proof majority. The bill squeaked through as the Senate version, without the public option.

The ACA Has Survived

The ACA is much more complex piece of legislation than the public option.

“The ACA has survived for a decade, despite all efforts to dismantle it,” Salber said. “Biden wants to restore a law that the Republicans have been chipping away at. The Republicans eliminated the penalty for not having coverage. Think about it, a penalty of zero is not much of a deterrent.”

It was the loss of the ACA penalty in tax year 2019 that, paradoxically, formed the legal basis for the latest challenge of the ACA before the Supreme Court, in a suit brought by the Trump administration and 18 Republican state attorneys general.

The Supreme Court will make its ruling after the election, but Salber thinks the suit itself will boost both Biden and the ACA in the campaign. “I think most people are tired of all the attempts to repeal the ACA,” she said.

“The public now thinks of the US healthcare system as pathetically broken,” she added. “It used to be that Americans would say we have the best healthcare system in the world. I don’t hear that much anymore.”

Physicians who oppose the ACA hold exactly the opposite view. “Our healthcare system is in a shambles after the Obamacare fiasco,” Campbell said. “Even if Biden has a Democrat-controlled House and Senate, I still don’t think that there would be enough votes to pass sweeping changes to healthcare.”

Biden Could Choose Issues Other Than Expanding Access

There are plenty of proposals in the Biden healthcare plan that don't involve remaking the healthcare system.

These include making COVID-19 testing free, providing extra funding for community health centers, and stopping surprise billing. Proposals such as stepping up antitrust enforcement against mergers would involve administrative rather than Congressional action.

Some of these other proposals could be quite expensive, such as overhauling long-term care and paying for health insurance for laid-off workers. And another proposal ― limiting the prices of pharmaceuticals ― could be almost as contentious as expanding coverage.

“This proposal has been talked about for many years, but it has always met with strong resistance from drugmakers,” said Robert Pearl, MD, former CEO of the Permanente Medical Group and now a faculty member at Stanford School of Medicine and Graduate School of Business.

Pearl thinks the first item in Biden's drug plan ― to repeal a ban against Medicare negotiating drug prices with drugmakers ― would meet with Congressional resistance, owing to heavy lobbying and campaign contributions by the drug companies.

In addition, Pearl thinks Biden's plans to limit drug prices ― barring drugmakers from raising their prices above the general inflation rate and limiting the launch prices for many drugs ― enter uncharted legal waters and could end up in the courts.

Even Without Reform, Expect Lower Reimbursements

Although many doctors are concerned that Biden's healthcare reforms would reduce reimbursements, Pearl thinks reimbursements will decline even without reforms, owing in part to the COVID-19 pandemic.

Employer-based health insurance has been the bedrock of the US healthcare system, but Pearl says many employers have long wanted to get rid of this obligation. Increasingly, they are pushing costs onto the employee by raising deductibles and through premium sharing.

Now, with the pandemic, employers are struggling just to stay in business, and health insurance has truly become a financial burden, he says. In addition, states will be unable to balance their budgets and will try to reduce their Medicaid obligations.

“Before COVID-19 hit, healthcare spending was supposed to grow by 5% a year, but that won't happen for some time into the future,” Pearl said. “The COVID economic crisis is likely to continue for quite some time, forcing physicians to either accept much lower payments or find better ways to provide care.”

Like Berwick, Pearl believes healthcare will have to move to value-based payments. “Instead of producing more services, doctors will have to preserve resources, which is value-based healthcare,” he said. The primary form of value-based reimbursement, Pearl thinks, will be capitation, in which physicians agree to quality and service guarantees.

Even steadfast opponents of many of Biden's reforms foresee value-based payments taking off. “Certainly, there are ways to improve the current healthcare system, such as moving to value-based care,” said Orrico at the neurosurgeons group.

In short, a wide swath of observers agree that doctors are facing major changes in the payment and delivery of healthcare, regardless of whether Biden is elected and succeeds with his health agenda.

 
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COVID-19 cases in Arizona fall below 1,000 for 25th straight day
Posted: Oct 13 2020

BUSINESS NEWS | Oct 7, 2020 | CRONKITE NEWS

Confirmed COVID-19 cases in Arizona reached 226,734 on Tuesday, Oct. 13, an increase of 683 from the previous day, according to the Arizona Department of Health Services. The number marks the 25th straight day that new daily cases in Arizona were below 1,000.

The state has been effective over the last two month in combating the virus. While July saw an average increase of 3,075 new cases a day, Arizona averaged 877 new cases a day in August, averaged 552 new cases a day in September; and is averaging 606 new cases a day so far in October.

The number of deaths attributed to COVID-19 stands at 5,767 in Arizona after eight new reported  deaths since the previous day.

Rates of infection and death are down sharply from just a month ago and hospital bed availability has improved, which experts attribute to tighter restrictions on congregating and mask-wearing, among other changes.

But health experts all warn that now is not the time to relax.

“Just because the numbers are better, does not mean we can relax on the efforts that we’ve been putting forward,” said Holly Ward, spokeswoman for the Arizona Hospital and Healthcare Association.

Challenges to those practices could come soon, as improving infection rates have put eight of the state’s 15 counties in the “moderate” range for transmission and one in the “minimal” range – thresholds that let bars and restaurants start reopening.

Schools around the state are also finishing their second week of in-person classes for some students and teachers.

That has some health experts warning that state businesses and residents need to guard against easing up too much, too soon. A sudden easing of restrictions in May led to a spike in cases that made Arizona a national hot spot for COVID-19 infections.

“I think we’ve gone through several experiences now where we’ve let up on some of these things and opened a bit too quickly,” said Dr. Daniel Derksen, director of the University of Arizona Center for Rural Health. “People got relaxed and less careful about going to places like bars, the public congregating in large gatherings, or even large numbers of people not wearing masks.

“We have to continue to tend to the public health measures you see on the commercials and billboards, social distancing, wearing a mask, and being careful if you don’t have to be going out to a place where you’re exposed to the COVID-19 virus,” Derksen said.

That appears to have worked. The Arizona Department of Health Services reported that new infections fell from 386 cases per 100,000 residents for the week of June 28 to 64 cases per 100,000 people for the week of Aug. 9. The department also reported that deaths, hospitalizations and the percent of positive tests all fell during the same period.

“The numbers within the Arizona hospitals are improving,” Ward said. “We’re seeing our ICU bed usage, specifically for COVID patients down dramatically, and that’s a great thing.”

As of Thursday, 20% of intensive-care unit beds were available for use, according to state data. About 18% of those beds were being used by COVID-19 patients and 62% were being used by other patients. At one point in July, COVID-19 patients occupied 57% of ICU beds.

“Those numbers were in the 40% range back in June,” Ward said. “To give perspective, now that we’re down in ICU beds used for COVID patients, that’s a fantastic drop.”

COVID-19 numbers have improved enough that three states – New York, New Jersey and Connecticut – removed Arizona from the list of states whose residents have to quarantine.

Ward and others attributed the state’s ability to “flatten the curve” of infection rates to following Centers for Disease Control and Prevention guidelines, including social distancing, wearing face-coverings, and monitoring symptoms.

“Most definitely social distancing that has been implemented in serious form, many more people are wearing masks,” Ward said. “As soon as cities and towns had the authority to do so, they implemented mask mandates and the pause in large social gatherings or events – all of those things have contributed. Along with every single individual’s effort to try to slow the spread.”

Will Humble, executive director of the Arizona Public Health Association, said “one of the biggest reasons” for slowdown in infection rates was when local officials began mandating those rules.

“The governor finally allowed local jurisdictions to put in place face-covering ordinances, which have actually been really successful,” Humble said. “On June 24, the governor closed bars and nightclubs and that, together with the face-covering requirement, are the two biggest reasons why we’ve seen a decline in the number of new cases here in Arizona.”

The decrease means more parts of the state met benchmarks that let them enter the “moderate” transmission zone that allows some reopening, with Maricopa and Pima counties meeting the benchmarks Thursday. That means bars and nightclubs that serve food can open at 50% of capacity if unrelated customers stay 6 feet apart and employees are masked, among other requirements.

Humble worries about the dangers reopened businesses and schools could present if people do not take the restrictions seriously enough. He said that if the state hopes to continue mitigating the spread of the virus, it will be important to continue observing social distancing and following CDC guidelines – now more than ever.

“The people that will suffer first are those kids and parents that would like to be in school learning in-person this fall,” he said. “But if compliance is good, if the compliance system works, then I think there’s a chance that cases could level off. The key is going to be enforcement.”

Derksen called the total number of infections and deaths an “unfortunate milestone,” but added that “on the better side … we’ve seemed to have flattened that curve.”

Enforcement and continuing mitigation efforts will also be important as the state heads into its typical flu season, Derksen said.

“There are still areas that are of some concern, but it looks like the public health measures that have been put into place by the Arizona Department of Health Services and the governor’s office, towns and municipalities, are helping us along much better than the rise we saw in the summer,” Derksen said. “There’s still an awful lot of COVID-19 virus in the community. But we are getting better.”

COVID-19 is a serious disease that can be fatal in anyone, especially our elderly population and people with underlying health conditions. ADHS advises everyone to take precautions:

The best ways to prevent the spread of COVID-19:

• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.

• Wear a mask when you are in close proximity to other people.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Avoid close contact with people who are sick.

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then immediately throw the tissue in the trash.

• Clean and disinfect frequently touched objects and surfaces.

COVID-19 spreads through the air when an infected person coughs or sneezes. Symptoms are thought to appear within two to 14 days after exposure and consist of fever, cough, runny nose, and difficulty breathing. For people with mild illness, individuals are asked to stay home, drink plenty of fluids, and get rest. For people with more severe symptoms, such as shortness of breath, individuals are advised to seek healthcare.

ADHS activated its Health Emergency Operations Center on January 27th after the first case of travel-associated COVID-19 was confirmed in Arizona. The Health Emergency Operations Center remains open to coordinate the State’s response to the COVID-19 outbreak. For more information about the COVID-19 response in Arizona, go online to azhealth.gov/COVID19.

 
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Census: Number of Arizonans without health insurance rose again in 2019
Posted: Oct 13 2020

By Josh Ortega/Cronkite News | Sept. 24, 2020

WASHINGTON – The number of Arizonans without health insurance jumped to more than 800,000 last year, the third consecutive year of increases for the state, according to the latest data from the Census Bureau.

The number of uninsured also rose nationwide, but not as sharply as in Arizona. Nationally, the share of people without insurance rose from 8.9% in 2018 to 9.2% last year, the bureau said, while Arizona went from 10.6% to 11.3% in the same period.

And health experts in Arizona note that the latest numbers do not reflect the onset of the COVID-19 pandemic earlier this year, which likely makes for an even gloomier picture this year.

“Probably anything you look at that’s estimated, as far as our uninsured rate, is an undercount of where things are right now,” said Dr. Dan Derksen, associate vice president of health sciences at the University of Arizona.

Analysts attribute the rise to a number of factors, not the least of which is uncertainty about the availability of coverage under the Affordable Care Act after years of attack by the Trump administration.

Allen Gjersvig, director of outreach and enrollment services for Arizona Alliance for Community Health Centers, points to what he calls an “awareness and education problem” that has left some uninsured unaware that they might still qualify for affordable coverage under the ACA, or Obamacare.

Gjersvig said “the vast majority” of the 809,000 uninsured people in Arizona could qualify for a tax credit that covers most of their monthly premiums, which could end up being less than $100 per month out of pocket. Some could even qualify for the tax credit and a reduction in deductibles and co-pay that Gjersvig said could cut out-of-pocket expenses to “less than $1 per month.”

“Based on Kaiser Family Foundation for 2018 data, we estimate that 323,000 or more Arizonans are eligible for no-cost coverage (AHCCCS) or low-cost coverage from the health insurance marketplace,” Gjersvig said.

The number of uninsured has crept up steadily for the past three years, after sharp drops after 2014 when the state expanded eligibility for coverage under the Arizona Health Care Cost Containment System, the state’s Medicaid system.

Currently, families earning up to 138% of the federal poverty level can qualify for Medicaid coverage in Arizona. The federal poverty threshold varies according to family size, but in 2019 it was set at $25,926 for a family of two parents and two children under 18 – so a family of four making about $35,000 would meet the 138% threshold.

Derksen said another factor behind the loss in insurance is the fact that U.S. health care remains “needlessly” complicated, with information so “fragmented” between different places that it requires navigators to help people understand the system.

That is not the case in other developed countries, which deliver health care at a much lower cost per capita, Derksen said. He pointed to an article in the Journal of the American Medical Association that said wasteful spending on fraud, abuse and administrative costs contribute to almost $1 trillion of the $4 trillion that is spent annually on health care in the U.S.

One resource Gjersvig recommends to people looking for insurance coverage is the Cover ArizonaCoalition through Vitalyst, a coalition of resources throughout the state that helps people navigate the healthcare marketplace in Arizona.

He also touted two national grants that he said have helped his organization work with more than 180 locations across the state to have certified application counselors help consumers navigate the health insurance marketplace.

Arizona’s 11.3% uninsured rate last year tied with North Carolina for ninth-worst in the nation. Texas had the highest rate of uninsured residents, at 18.4%, while Massachusetts was lowest, with a 3% rate.

With a pandemic raging and an election nearing, health care remains one of the top priorities for many Americans, Derksen said. He encouraged voters to consider all health care options this fall.

“It doesn’t have to be a binary choice of Medicare-for-all vs. the private sector,” Derksen said. “Those aren’t the only two choices.”

Open enrollment for coverage through the federally facilitated ACA Marketplace starts Nov 1 and runs through Dec. 15.

 
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State passes 5,000 COVID-19 deaths, but overall numbers trending down
Posted: Oct 13 2020

By Joycelyn Cabrera/Cronkite News | Aug 29, 2020

WASHINGTON – Arizona passed 200,000 COVID-19 cases this week and the death toll from the disease topped 5,000 Saturday, but despite those somber milestones experts said the numbers are all moving in the right direction – for now.

Rates of infection and death are down sharply from just a month ago and hospital bed availability has improved, which experts attribute to tighter restrictions on congregating and mask-wearing, among other changes.

But they all warn that now is not the time to relax.

“Just because the numbers are better, does not mean we can relax on the efforts that we’ve been putting forward,” said Holly Ward, spokeswoman for the Arizona Hospital and Healthcare Association.

Challenges to those practices could come soon, as improving infection rates have put eight of the state’s 15 counties in the “moderate” range for transmission and one in the “minimal” range – thresholds that let bars and restaurants start reopening.

Schools around the state are also finishing their second week of in-person classes for some students and teachers.

That has some health experts warning that state businesses and residents need to guard against easing up too much, too soon. A sudden easing of restrictions in May led to a spike in cases that made Arizona a national hot spot for COVID-19 infections.

“I think we’ve gone through several experiences now where we’ve let up on some of these things and opened a bit too quickly,” said Dr. Daniel Derksen, director of the University of Arizona Center for Rural Health. “People got relaxed and less careful about going to places like bars, the public congregating in large gatherings, or even large numbers of people not wearing masks.

“We have to continue to tend to the public health measures you see on the commercials and billboards, social distancing, wearing a mask, and being careful if you don’t have to be going out to a place where you’re exposed to the COVID-19 virus,” Derksen said.

That appears to have worked. The Arizona Department of Health Services reported that new infections fell from 386 cases per 100,000 residents for the week of June 28 to 64 cases per 100,000 people for the week of Aug. 9. The department also reported that deaths, hospitalizations and the percent of positive tests all fell during the same period.

“The numbers within the Arizona hospitals are improving,” Ward said. “We’re seeing our ICU bed usage, specifically for COVID patients down dramatically, and that’s a great thing.”

As of Thursday, 20% of intensive-care unit beds were available for use, according to state data. About 18% of those beds were being used by COVID-19 patients and 62% were being used by other patients. At one point in July, COVID-19 patients occupied 57% of ICU beds.

“Those numbers were in the 40% range back in June,” Ward said. “To give perspective, now that we’re down in ICU beds used for COVID patients, that’s a fantastic drop.”

COVID-19 numbers have improved enough that three states – New York, New Jersey and Connecticut – removed Arizona from the list of states whose residents have to quarantine.

Ward and others attributed the state’s ability to “flatten the curve” of infection rates to following Centers for Disease Control and Prevention guidelines, including social distancing, wearing face-coverings, and monitoring symptoms.

“Most definitely social distancing that has been implemented in serious form, many more people are wearing masks,” Ward said. “As soon as cities and towns had the authority to do so, they implemented mask mandates and the pause in large social gatherings or events – all of those things have contributed. Along with every single individual’s effort to try to slow the spread.”

Will Humble, executive director of the Arizona Public Health Association, said “one of the biggest reasons” for slowdown in infection rates was when local officials began mandating those rules.

» Continued at link below:

 

 
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Job-Based Health Insurance Costs Are Up 4% This Year, 55% in Past Decade
Posted: Oct 12 2020

KAISER HEALTH NEWS | By Phil Galewitz | Oct 8, 2020

Health insurance costs for Americans who get their coverage through work continued a relentless march upward with average family premiums rising 4% to $21,342 this year, according to a study published Thursday.

The annual survey by KFF found workers on average are paying nearly $5,600 this year toward family coverage, up from about $4,000 in 2010 and $1,600 in 2000. (KHN is an editorially independent program of KFF.)

While health insurance costs rose a modest amount in 2020, as has been the trend in recent years, they soared 55% in the past decade — more than twice the pace of inflation and wages.

About 157 million Americans rely on employer-sponsored coverage — far more than any other type of coverage, including Medicare, Medicaid and individually purchased insurance on the Affordable Care Act exchanges. More than half of employers provide insurance to at least some workers.

“Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,” Drew Altman, KFF’s CEO, said in a statement. “Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.”

The survey was conducted from January to July as the coronavirus pandemic took hold and upended the nation’s economy. Many of the details of the employers’ plans that the researchers examined were set before the virus hit.

Since 2012, the cost of family coverage has increased 3% to 5% annually. It’s been more than 15 years since these costs were rising at double-digit rates.

Employers help shield workers from much of the cost of their health insurance premiums, though employees often feel the impact via higher deductibles, copayments and lower wages.

On average, workers pay 17% of the premium for single coverage and 27% for family coverage, the survey found. Workers at smaller companies pay 35% of the premium for family coverage, compared with 24% for larger companies, the survey found.

The average annual deductible for single coverage is now $1,644, up 25% in the past five years and 79% in the past decade.

Workers with coverage are exposed to higher costs when using the hospital since 65% have coinsurance, which means they are responsible for a fixed share of the charge, and 13% contribute a copayment, or fixed fee per visit or service. The average coinsurance for hospital admission is 20% and average copayment is $311 per hospital admission.

Workers are protected for catastrophic costs through limits set on their out-of-pocket spending in provider networks, although those amounts vary by employer: 11% face a maximum of less than $2,000, while 18% are in a plan with a maximum of $6,000 or more.

The study also noted that large employers have made it easier for workers to access care by adopting coverage for telemedicine in recent years. Nearly 9 in 10 companies that have 200 or more workers and offer insurance covered these medical appointments done via telephone or computer this year, up from fewer than 3 in 10 in 2015, according to the research. During the pandemic, telemedicine usage has increased markedly as people sought care from the safety of their home.

The KFF study is based on a telephone survey of 1,765 randomly selected nonfederal public and private employers with three or more workers from January to July.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 
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Tracking The Uninsured Rate In 2019 And 2020
Posted: Oct 12 2020

Federal data shows that the uninsured rate has been rising since 2016 and rose again in 2019. New analyses of the uninsured population in 2019 show that consumers were struggling with coverage affordability even before the COVID-19 pandemic. And recent surveys and mediareports suggest a deepening affordability crisis in 2020 as millions have been laid off from work or lost income. Enrollment in Medicaid and the Children’s Health Insurance Program is rising, and some state-based marketplaces have reported much higher enrollment throughout 2020. In the meantime, the federal government still has not authorized a broad special enrollment period through HealthCare.gov where anyone who is uninsured could enroll in marketplace coverage.

This post highlights some of the latest data on the uninsured rate in 2019 and 2020.

Who Was Uninsured In 2019?

The uninsured rate continued to rise in 2019. Two new analyses—one from the Centers for Disease Control and Prevention (CDC) and the other from the Congressional Budget Office (CBO)—discuss who was uninsured in 2019 and why. Consistent with a prior CDC analysis, an estimated 14.5 percent of non-elderly adults were uninsured in 2019. Men, young adults, Hispanic adults, and those in fair or poor health were more likely to be uninsured (compared to women, older adults, white adults, and those in better health, respectively).

CDC Analysis Delves Into Reasons For Uninsurance

But the latest CDC analysis went further to assess why adults were uninsured in 2019. The most common reason? Coverage was not affordable. Affordability was cited by an overwhelming 73.7 percent of respondents as their reason for being uninsured. Affordability challenges increased with age: 80.9 percent of those aged 50 to 64 cited affordability challenges, compared to 66.8 percent of those aged 18 to 29. Even so, young adults were more likely to be uninsured than older adults.

Beyond affordability, about one-quarter of respondents were uninsured because they were ineligible for coverage; this rate was higher among Hispanic adults relative to non-Hispanic white adults and higher among women relative to men. About one-fifth of uninsured adults reported not needing or wanting coverage: this rate was far higher for men and those in better health than for women and those in fair or poor health. Other reasons for being uninsured were that enrolling in coverage was too difficult or confusing, the individual could not find a plan that met their needs, or the individual applied for coverage but it had not yet gone into effect.

CBO Report Finds Many Uninsured Adults Eligible For, But Not Enrolled In, Job-Based Coverage

The CBO released a similar analysis on who went without health insurance and why. Low-income people were more likely than others to be uninsured in 2019, and employment status was not strongly linked to coverage in 2019. In fact, the vast majority of uninsured people had at least one full-time worker in their family in 2019. Of the estimated 29.8 million uninsured people in 2019, 67 percent (20 million) were eligible for subsidized coverage whether through Medicaid, the marketplace, or job-based coverage. Most of these individuals—31 percent (9.4 million people)—were eligible for but not enrolled in job-based coverage. Of the remaining 33 percent (9.8 million) who were not eligible for subsidized coverage, 13 percent were not lawfully present in the United States and thus ineligible, 11 percent were in the Medicaid coverage gap, and 9 percent had incomes too high to qualify for marketplace subsidies.

Consistent with the CDC analysis, the CBO found that many uninsured people do not enroll in coverage because of cost. About one-third of uninsured single adults would have to contribute more than 10 percent of their income towards health insurance. Others do not realize they qualify for subsidies or are deterred by the complexity of the enrollment process. Still others qualified for marketplace subsidies but could not afford to enroll in coverage; this was especially true for those whose income is over 250 percent of the federal poverty level. The public charge rule may also have discouraged recent immigrants from enrolling eligible children in Medicaid coverage because of the perceived impact on their ability to become a permanent legal resident.

The CBO also looked at the length of time that individuals remain uninsured. The vast majority of the uninsured—80 percent—went without coverage for one year or more, 11 percent were uninsured for 1 to 5 months, and another 9 percent were uninsured for 6 to 11 months. This suggests that many uninsured people are chronically uninsured for long stretches of time.

Significant Coverage Losses Ahead?

Although definitive data will not be available until 2021, numerous studies have estimated the effect of the 2020 recession on job-based coverage and the uninsured rate. Analyses have been conducted by Avalere Health, the Commonwealth Fund, the Economic Policy Institute, Families USA, the Kaiser Family Foundation, and the Urban Institute, among others. The Urban Institute even conducted a separate analysis of some of these studies to compare their assumptions and estimates.

Most of these studies suggest significant coverage losses already, as economic upheaval from the pandemic has led consumers to lose their job-based coverage or a family member’s job-based coverage. Covered California, for instance, reports record-high numbers of covered members and enrolled nearly 290,000 Californians since late March 2020.

Others, such as a Commonwealth Fund survey through early June 2020, did not show significant coverage changes relative to prior years (although it did show persistent affordability challenges). The CBO expects the number of uninsured people to increase to only about 31 million in 2020, with coverage losses mitigated by a range of factors, including the fact that the Affordable Care Act has enabled many would-be uninsured people to obtain Medicaid or marketplace coverage. And while nationwide enrollment through Medicaid and CHIP has grown by nearly 4 million people since March, observers believe that this growth is driven not by the newly uninsured but by a requirement that states freeze disenrollment during the public health crisis under the Families First Coronavirus Response Act.

Coverage losses may have been blunted so far for several reasons. Some employers, for instance, continue to provide coverage to laid-off and furloughed employees, but this trend may not last for long as the pandemic and recession continue. Media reports warn of looming cutoffs, especially as employers grapple with end-of-year coverage renewal deadlines. And many consumers who find their way to the individual market, including those eligible for premium tax credits, may not be able to afford even subsidized coverage. Some state-based marketplaces that allowed broad enrollment during COVID-19 found that consumers who selected a plan were unable to pay their first month’s premium, and Covered California reportsaffordability challenges (including for consumers who receive subsidies) even though the state offers supplemental subsidies for low- and middle-income consumers.

These challenges—for employers and individuals—are among the reasons why stakeholdershave urged Congress to further enhance federal funding for Medicaid programs, provide COBRA subsidies for employees, and require a broad special enrollment period through HealthCare.gov. Some of these priorities were in the revised Heroes Act passed by the U.S. House of Representatives in early October.

 
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Getting Health Care Was Already Tough In Rural Areas. The Pandemic Has Made It Worse
Posted: Oct 12 2020

SHOTS | Health News from NPR | By Will Stone | Oct 7, 2020

Even when there isn't a pandemic, finding the right doctor can be tough in rural eastern Ohio. Reid Davis, 21, and his mother Crystal live in Jefferson County, which hugs the Ohio River near West Virginia. Their home is surrounded by farms, hayfields and just a few neighbors.

"To the nearest hospital, you're talking about 50 minutes to an hour," Reid Davis says.

Davis' mother has rheumatoid arthritis, a severe autoimmune condition, for which she sees a specialist. That doctor prescribes an injectable medication and also works on her joints to ease inflammation and pain, he says.

But when the pandemic began, that doctor stopped seeing patients. Nearly six months went by, and only recently was Crystal Davis able to resume in-person visits.

In the meantime, her condition got worse.

"There have been days where she's just been unwilling to get out of bed because of pain," Davis says.

There were only a few other rheumatologists within a two-hour drive and none of them were accepting new patients at the time.

Even before the pandemic, the health care systems that serve rural Americans were in decline: rural hospitals were closing their doors, and the medical workforce was shrinking. This year, as the coronavirus outbreak has made its way from major cities to rural America, threats to the rural health care infrastructure have only increased.

A new nationwide poll shows that one in every four rural U.S households have been unable to get medical care for serious problems. Among those households that had trouble getting care, more than half reported that a family member experienced negative health consequences as a result.

The poll was conducted by NPR, the Harvard T.H. Chan School of Public School and the Robert Wood Johnson Foundation.

"The crisis is really widening the fractures that have already existed in rural communities," says Brock Slabach, senior vice president of the National Rural Health Association, based in Kansas.

New coronavirus infections in rural America are now at record levels, with 54% of rural counties in the "red zone," defined as places with an infection rate of 100 or more new cases per 100,000 residents.

Only 14% of the U.S. population lives in rural counties, but last week 20% of new cases and 23% of COVID-19-related deaths were in rural counties, according to an analysis by The Daily Yonder, an online newspaper that covers rural America.

Rural Americans contacted for the NPR poll — from Montana to Georgia to upstate New York — discussed problems getting treatment for many types of health problems, including the virus.

In the U.S., one of the biggest obstacles to getting health care is the simple fact of not having health coverage, and people living in rural areas are more likely to be uninsured compared to other Americans. Not having insurance can also mean higher out-of-pocket payments for treatments or medications, on top of other pandemic-related financial stresses.

But the poll also revealed many non-financial obstacles. In interviews with NPR, rural respondents talked about being forced to cancel surgeries and procedures, waiting months for appointments, putting mental health care on hold, or spending hours on the road in search of specialists. Some talked specifically about their struggles to get a coronavirus test. Because of these problems, many were experiencing increased pain, anxiety or financial hardship.

Over the past 15 years, 174 rural hospitals have closed in the U.S. and the pandemic may be accelerating the trend. So far, 15 rural hospitals have closed in 2020, casualties of the pandemic-related shutdowns that forced hospitals to cancel elective surgeries, an important source of their revenue. Because of the pandemic, some people also avoided going to the hospital, even for life-threatening emergencies. Among the rural hospitals that remain, more than half don't have an intensive care unit, according to Slabach.

"As the hotspots grow, where do these people go? A lot of them have serious illnesses," says Harvard professor Robert J. Blendon, a co-director for the NPR poll.

Unlike major metro areas where hospitals have lots of beds, many smaller hospitals in geographically isolated places are not equipped to handle COVID-19 patients and other emergencies at the same time, Blendon says.

"People are hundreds of miles away and many rural hospitals have been deciding, 'Can I take anybody else but COVID?' " he says.

Long waits mean pain, delayed surgeries, and dental problems

The poll looked closely at two especially vulnerable groups: rural households that include someone living with a chronic illness, and rural households that include someone at high risk for a serious case of COVID-19 (due to age or underlying health conditions). In both groups, about a third of the households reported problems getting medical care.

"It's really scary that there's a very large number of rural households at risk at this point, and we haven't figured out a better way to provide care for them," says Mary Gorski Findling, a researcher with Harvard's polling team.

"The rural health care workforce was already disproportionately small," says professor Carrie Henning-Smith, who studies rural health at the University of Minnesota.

The pandemic disrupted a root canal for Stephen McDonald, and he ended up losing the entire tooth, and incurring additional costs.

McDonald lives about 70 miles outside of Missoula, Mont., and was left stranded after many doctors and dentists temporarily shut down their offices in the spring. His dentist had begun the root canal, but had to call off the follow-up appointment.

With limited options in his area, McDonald had to make do with the temporary filling.

"During that period of waiting, my tooth cracked and the tooth was no longer salvageable," McDonald says.

Even to remove the cracked tooth proved difficult. A local dentist couldn't see him, so McDonald went to a different dentist an hour away.

But that dentist could only extract a portion of the cracked tooth.

"Because of the procedures they had to follow for COVID, they weren't able to extract the rest of the tooth, so I had to go to an oral surgeon," he says.

While many health care providers tried to cope by using telehealth, it doesn't cover urgent problems that require hands-on treatment. In addition, the NPR poll found that a third of rural households have serious problems connecting to the Internet.

Slabach says ensuring people have adequate broadband connections would help, but even that wouldn't be enough.

"Many of our rural citizens are older, poorer and sicker, and so they don't have iPads. They don't have the necessary means, perhaps, to communicate," Slabach says.

Cynthia Davis, who lives in central Missouri, says she had lots of trouble using telehealth.

"I've got a small phone so I had a three-inch screen to do these online video appointments," Davis says of her efforts to use telehealth. "That did not work well, and even the phone would not work half the time."

Along with obstacles to health care, many rural households are under immense financial pressure during the pandemic, according to the NPR poll. More than 40% reported they are facing serious financial problems.

For Black and Latino households, the economic toll is especially stark in rural America. More than 80% of those households are facing serious financial problems, compared to only 36% of white rural households.

More than 40% of rural families also said at least one person in their household had lost a job, been furloughed, or had wages or hours reduced. In addition, more than half of families also shared that they are having serious problems caring for their children.

Even as more clinics and doctors have resumed in-person appointments, some patients are encountering long wait times because there are not enough providers in rural areas to handle the backlog of patients.

In Arkansas, Elizabeth Booher says she scrambled to get her husband to the right doctors, when he started having severe abdominal pain in early August.

Until last week, she kept hearing that the earliest he could get surgery was late October.

"He's lost a ton of weight because he can't eat," Booher says. "I feel like this is being elongated because doctors have been closed, and now they're just trying to play catch up."

Brett Corbett of Glens Falls, N.Y., says that last spring all of his doctor's appointments were called off. Corbett is in recovery for substance use disorder.

"All my mental health appointments got cancelled across the board," Corbett says. "It's December before anyone can get a doctor's appointment around here."

Even with so much attention on the coronavirus, some living in rural America are barely able to find tests.

Sunshine Peebles, who lives an hour outside Syracuse, N.Y., worried she might have COVID-19 when she spiked a fever.

"There's a lot of people who have access to free testing, where I am in upstate New York, that's not an option," Peebles says.

Peebles can't afford health insurance and says money was tight because her family's small construction business was out of work because of the pandemic.

"I should have gone sooner. I just couldn't wait any longer. I had to go to an urgent care," she says.

She had to pay $150 out of pocket. Luckily, her test result came back negative, but she knows others in her community have encountered similar problems.

"I think it's a big dilemma for people who live in the more rural areas," she says.

 
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Native American tribes were already being wiped out. Then the 1918 flu hit.
Posted: Sep 28 2020

THE WASHINGTON POST | By Dana Hedgpeth | September 27, 2020 at 5:00 a.m. MDT

The letter delivered the worst news to Grace Nye.

Her daughter Cecilia, a Yakama tribal member from Toppenish, Wash., had died of the flu at the Chemawa Indian School, a government-run boarding facility for American Indians in Salem, Ore.

She was 16 and lived more than 200 miles away from her family.

The letter from the school was dated Oct. 29, 1918. It read:

My dear Mrs. Nye: 

During the scourge of Spanish Influenza from which your daughter Cecilia died I was so extremely busy that it was impossible for me to tell you the particulars in connection with the death of Cecilia.

This plague attacked this school on the 15th of October. It was brought here at first by new students coming in and it spread rapidly until we had about 250 cases. The entire school stopped its regular activities and devoted itself absolutely to the care and nursing of the sick. Out of the 250 cases we lost a comparatively few. Among the number was your daughter. 

Cecilia was one of thousands of American Indians who died of the 1918 flu, which swept the world and killed upward of 50 million people. Like the coronavirus, which has devastated Native American reservations and people, the 1918 pandemic was deadly. But no one is sure how deadly.

The flu can kill tens of millions of people. In 1918, that’s exactly what it did.

One National Institutes of Health study said at least 3,200 American Indians died of the 1918 flu. Another count puts it at more than 6,600. And one Navajo scholar said just her tribe alone lost roughly 3,400 tribal members — about 12 percent of its population at that time.

Alaska tribal villages were hit especially hard.

At the Inupiat village of the Brevig Mission, 72 of 80 residents died, according to NIH. One schoolteacher went to 10 remote Alaskan Native villages and wrote of how he found “three wiped out entirely; others average 85 percent deaths. … Total number of deaths reported 750, probably 25 percent this number frozen to death before help arrived.”

The teacher’s post, went on, “Over 300 children to be cared for, majority of whom are orphans.” 

“Virtually all of the factors that made Native Americans extremely vulnerable to the Spanish flu are still in place today," said Benjamin R. Brady, a public health professor at the University of Arizona who has studied the 1918 flu’s impact on American Indian communities. He cited poor housing, underlying health issues and lack of access to doctors and hospitals.

Even before the 1918 flu, American Indians had already suffered near decimation from the collapse of the buffalo in the West and widespread outbreaks of smallpox, yellow fever, tuberculosis and trachoma — a highly contagious eye infection that leads to blindness — plus horrific wars and being forcibly removed from their homelands.

The population of American Indians in the United States had already plunged from 10 million to about 320,000 in 1918, according to Mikaëla Adams, an associate professor of history at the University of Mississippi in Oxford who specializes in Native American research.

"They were in a period of crisis and then you’ve got a pandemic happening on top of it,” said Brenda Child, an Ojibwe from the Red Lake reservation in northern Minnesota who has studied the impact of the 1918 flu on her tribe.

The 15,000 American Indians shoved aside by Jamestown’s settlers

The flu spared almost no tribe, spreading from the Pacific Northwest to the Southwest, Midwest and Southeast.

One report from a federal commission on Indian affairs estimated that roughly 39,200 Native Americans were infected with the flu in an eight-month period from the fall of 1918 to the summer of 1919.

Men joining the military sometimes brought it back to their reservations. American Indians working on building railroads in the Southwest got sick. Ships and mail carriers brought the flu to very remote Alaskan villages.

Sometimes, a tribe’s “medicine man” tending to the sick on a reservation spread the disease. And kids attending underfunded and overcrowded boarding schools caught the flu.

At the Haskell Institute in Lawrence, Kan., one of the largest federal Indian boarding schools in the country, more than a third of the student body was hospitalized at one point in 1918 and 17 students died.

The Potawatomi brothers ran away from Haskell during the outbreak. Their father, Jesse Wapp, wrote to Haskell’s school officials and reported that one of the boys died of pneumonia. His father wrote, “I ain’t gone send Leo until he is well and the disease is over.

"I lost one boy and I hate to loose another.” 

At the Chemawa Indian School, where Cecilia went, Daisy Codding — a head nurse there — recorded 150 cases and 13 deaths.

The letter to Cecilia’s mother told of the conditions at the Chemawa school:

Absolutely everything possible was done in the way of medical care and nursing. The sick was never left alone for one minute, someone was administering to their needs and looking after them and I want you to feel that in this sickness that your daughter has had as good attention as she possibly could have had in any hospital or home. 

I have spared neither expense nor time nor trouble. Although I feel that we have done just as well as could be done. This disease which has taken thousands upon thousands throughout the country was no worse here than elsewhere. It was not due to Chemawa or its location. It was a general disease everywhere.

There were grim tales of loss and illness on many reservations.

Charles Dog with Horns, who was a Lakota and went to Rapid City Indian School, recalled in a 1971 oral history how he skipped going to school in 1918 because so many in his family were “in bed,” sick with the flu.

At one point, two boys from his tribe were “so bad” with fever and headache and “just about to die” that he went 15 miles from their home to a post office to call a village doctor. The doctor, he recalled, came “over in the sled” across a river and gave them medicine. He wasn’t sure what it was, but they lived.

In the Southwest, the Navajo reservation was hit particularly hard, much like it has been with the coronavirus pandemic.

“Small children and old people were the first victims," one trader with the Navajo wrote, "but the flu played no favorites and soon the death rate was just as high among the strong men and women.”

In his book “White Man’s Medicine,” Robert Trennert described the conditions at Pueblo Bonito on the Navajo reservation, where “corpses were left where they lay and the unopened Shiprock hospital became a morgue.” 

Tall Woman, a Navajo who caught the flu but survived, recalled how her father helped care for others in the tribe, gathering plants and making medicines to be taken. He “butchered horses during the epidemic so the meat could be boiled and used as broth; the fat was mixed in a healing paste,” according to a paper written by Brady.

Tall Woman’s father told her how “this kind of sickness, this epidemic, had nothing to do with any of our ceremonies, not even the small ones.” The best thing people could do, her father said, was to pray.

Navajo leaders said that 100 years ago, the tribe didn’t have enough resources to deal with such a widespread pandemic. But it has worked hard to try to get a handle on the high number of coronavirus cases that hit in early spring at the reservation, which spans three states. In the past week, the tribe has reported some days with no deaths.

"This is a monster that has plagued our people,” Navajo Nation President Jonathan Nez said of the coronavirus. “There have been monsters that have come to the Navajo Nation. This is one of those modern day monsters we’re fighting against. We do have the weapons to combat those and armor to help us get through this.

“That’s the mind-set we have here on Navajo," Nez said. "We’re overcomers. We’re resilient.” 

In 1918, at the Chemawa Indian School where Cecilia had contracted the flu and died, the letter ended this way, telling her grieving mother of how the school had recovered from the flu’s outbreak.

Now that the plague is over we have resumed our regular school work. All the students we have now are well and strong and getting along all right. 

Trusting that Cecilia’s body reached you in good shape and sympathizing with you, I am. 

Sincerely your friend, 

Harwood Hall - superintendent

 
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Millions of patients at risk for losing health center access, researchers say
Posted: Sep 21 2020

THE GW HATCHET | By Lia DeGroot Sep 20, 2020 11:32 PM

Researchers from the Milken Institute School of Public Health published a study earlier this month revealing that millions of Americans are at risk of losing access to community health centers because of a lack of funding.

The report, which is published annually using the Health Resources and Services Administration’s data on health centers, shows that visits to community health centers had dropped by about 20 percent by late August since before the pandemic and about one out of 14 centers have closed nationwide. Jessica Sharac, a research scientist in the Department of Health Policy Management, said community health centers provide services like dental care and transportation that people risk losing long-term access to.

Sharac said she worked with Geiger Gibson/RCHN Community Health Foundation to compile the report for 2019, and she and her team are using financial and demographic data from HRSA to track how the pandemic is affecting community health centers on a weekly basis.

She said HRSA is reporting how many centers have closed, the decline in weekly visits to centers and the percentage of staff that is unable to work due to safety concerns from the pandemic.

The report found that nearly 30 million Americans – many who are racial and ethnic minorities – received care at a federally funded health center in 2019.

Sharac said community health centers are missing large amounts of revenue because of a drop in patient visits and a lack of federal funding, which could lead to multiple closures. She added that the Affordable Care Act provided funding for community health centers, but centers could lose federal funding after the CARES Act’s funding runs out in November.

“The big problem really facing community health centers right now is financial uncertainty,” Sharac said. “Obviously with the decline in visits to community health centers because of people being afraid to go out to get health care and trying to stay indoors, they might not be able afford health care because they lost a job or similar things like that.”

Public health experts said community health center closures put uninsured community members at risk of losing their care in the long term.

Leila Barraza, an associate professor of public health at the University of Arizona, said many people haven’t been accessing the regular care they need from primary care doctors, including at community health centers, due to the COVID-19 pandemic. She said people with underlying medical conditions who are at a greater risk for contracting COVID-19 may have trouble accessing the health care they need if their community health center has closed and they don’t have another primary care doctor.

“People still need their primary care,” she said. “We know that people with underlying medical conditions are at higher risk of severe complications from COVID-19, so those underlying conditions, people still need care for those.”

Tara McCollum Plese, the chief external affairs officer for the Arizona Alliance for Community Health Centers, said health centers in Arizona have started to offer telemedicine options for patients who don’t want to come into the office, which she said can make reimbursements for doctors complicated because telemedicine costs less than in-person care.

The Medical Faculty Associates started offering virtual follow-up visits for patients who received care at the emergency department, which medical experts said can complicate the reimbursement process for health care providers.

“The funding issue is paramount because if you don’t have a good strong workforce, it is almost impossible to serve the people in that community,” Plese said.

She added that policymakers and public health officials should use data like the information compiled in Sharac’s report to guide their decisions about how they’ll fund community health centers moving forward.

“Those people with chronic diseases may find themselves concerned about not having seen their primary care provider in a certain period of time,” she said. “Especially if they’re diabetic or have asthma, this is really the time that this is most critical that they be able to touch base with their primary care providers.”

 

 
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ADHS Encourages People to Seek Care in an Emergency and to Maintain Routine Medical Care
Posted: Sep 17 2020

People Should Follow Guidelines to Prevent the Spread of COVID-19 and Influenza While Seeking Care

PHOENIX — Arizonans have dramatically reduced the spread of COVID-19 by wearing masks, distancing, washing hands thoroughly, and taking other steps to protect themselves and the community. But it’s also important to continue seeking routine medical care such as wellness visits to primary healthcare providers, cancer screenings, managing chronic health conditions, and keeping children up to date on routine vaccinations. 

The Arizona Department of Health Services (ADHS) has launched a public awareness campaign reminding Arizonans to look after their overall health, and also to call 911 and seek care during medical emergencies. 

“People who experience a medical emergency such as a suspected heart attack or stroke should not avoid calling 911 because of concerns of COVID-19 in hospitals,” said Governor Doug Ducey. “Our hospitals statewide have done a tremendous job in developing and implementing protocols to minimize the risk of COVID-19 spread in their facilities.”

Seeking care in the event of an emergency is critical because rapid treatment for certain conditions can dramatically improve a person’s chance of survival. Through July 2020, nearly 1,800 more Arizonans suffered a cardiac arrest compared to 2018, with 10% fewer people transported to the hospital and 10% more people dying from heart attacks. Arizonans should seek emergency care if they are suffering symptoms of a heart attack or stroke. 

Taking action at the first sign of these symptoms can dramatically improve the chances of recovery and could mean the difference between life and death. If anyone is experiencing life-threatening symptoms of a stroke, such as sudden weakness, numbness, or confusion, or symptoms of a heart attack, such as chest pain, shortness of breath, or nausea, call 911. In addition, it is not unusual for women to have additional symptoms, such as unexplained tiredness and vomiting.

“Arizonans have done a great job of helping to reduce the spread of COVID-19 by staying home and avoiding large gatherings. While we all must remain vigilant, now is not the time to skip routine medical care,” said Dr. Cara Christ, director of ADHS. “This is especially important for people with chronic health conditions such as diabetes and asthma who are at higher risk for serious complications from COVID-19 and the flu.” 

Arizonans are also encouraged to keep their children’s vaccinations up to date and to get an influenza shot this year. Through July, the number of childhood vaccine doses ordered by healthcare providers participating in the Vaccines for Children program is 21% less than an average year, indicating that many Arizona children may not be up to date on their childhood immunizations.  

“Immunizations are the most effective tool that we have to keep our children safe from diseases such as measles, pertussis, and dozens of other diseases that can cause serious illness, so parents need to ensure their children’s immunizations are current,” Dr. Christ said. “Everyone should also be vaccinated against influenza as soon as possible. We are entering influenza season in Arizona, and we still have community spread of COVID-19. The influenza vaccine is the most effective prevention tool we have against the virus and can lessen the severity if you do get influenza.”   

Arizonans should take the following precautions to mitigate the spread of COVID-19 and influenza: 

  • Stay home when you are sick.
  • Wear a mask every time you are in public, even if you do not feel sick.  
  • Physically distance by staying at least 6 feet away from others who are not in your household when you are in public. 
  • Avoid gatherings of more than 10 people. 
  • Arizonans at higher risk for severe illness should continue to stay at home and avoid crowded public spaces. People at higher risk for severe illness include adults 65 or older and people of any age who have serious underlying medical conditions. 
  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Cover your cough or sneeze with a tissue or your sleeve (not your hands) and immediately throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.

To find a flu vaccination clinic near you, please visit azhealth.gov/RollUpYourSleeve.    

 
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