IHA Daily Briefing: Nov. 19

Friday, November 19, 2021
U.S. House Passes Sweeping Social Infrastructure Bill
FDA Expands Eligibility for COVID-19 Vaccine Boosters
Commonwealth Fund Releases Health Equity Scorecard
KFF: Majority of Uninsured Eligible for Coverage
IHA Vaccination Campaign in Vaccine Project Newsletter
State, National, Global COVID-19 Updates
Briefly Noted

U.S. House Passes Sweeping Social Infrastructure Bill
This morning, the U.S. House of Representatives passed President Biden’s $1.75 trillion social infrastructure package, the Build Back Better Act, by a vote of 220-213. The bill received no Republican votes, and only one Democrat opposed it. The bill now moves to the Senate for consideration.

An IHA summary of key healthcare provisions is here. Legislative text and a section-by-section summary of the Build Back Better Act is available on the House Rules Committee website. Among the provisions of interest to hospitals and health systems are:

  • Medicare Graduate Medical Education: The legislation would provide 4,000 new, Medicare-supported GME slots in FY 2025 and 2026, with 25% of the new slots directed to primary care specialties and 15% to psychiatry residencies. The slots would be distributed to eligible hospitals with 30% to teaching hospitals over their caps, 20% to teaching hospitals in rural areas, 20% to teaching hospitals in states with new medical schools or branch campuses, 20% to teaching hospitals located in or serving a health professional shortage area, and 10% to teaching hospitals in states in the lowest quartile of resident-to-population ratios.
  • Children’s Hospital Graduate Medical Education: The bill would provide $200 million in funding for the Children’s Hospital Graduate Medical Education program, which supports the training of pediatric primary care, specialty, and dental residents.
  • Health Workforce Programs: The bill would invest $2 billion in the National Health Service Corps, which provides scholarships and loan repayment to qualified healthcare providers in exchange for service in underserved areas. In addition, the legislation would provide $500 million for the Nurse Corps program.
  • Extension of ACA Expansions: As advocated by IHA and AHA, the legislation would extend the American Rescue Plan’s enhanced Marketplace tax credits for three additional years through 2025. The enhanced Marketplace tax credits increased financial assistance for consumers eligible for tax credits across all income levels and extended financial assistance to people with incomes above 400% of the federal poverty line.
  • Maternal Health: The legislation would provide 12 months of continuous Medicaid eligibility to postpartum individuals, as well as more than $1 billion in other maternal health investments. It also contains funding for initiatives to address morbidity and mortality including $110 million for addressing social determinants of maternal health; $50 million for perinatal quality collaboratives and $100 million for maternal health equity grants.
  • Community Violence and Trauma Intervention: The bill provides a $2.5 billion investment in the Centers for Disease Control and Prevention to support public health approaches to reducing community violence, including through hospital-based violence intervention programs.
  • Drug Pricing: The legislation directs the HHS Secretary to create a Drug Negotiation Program to help reduce spending and out-of-pocket costs for prescription drugs. Under the program, the secretary would negotiate a maximum price of high-cost Medicare Part B & D prescription drugs beginning in 2025.

The Build Back Better Act is expected to undergo changes in the Senate as Democratic leaders seek full support of its caucus and the chamber’s parliamentarian reviews the legislation for adherence to Senate rules governing the reconciliation process. As outlined in a recent letter to the Congressional delegation, IHA will continue to advocate for critical hospital and health system priorities in this legislation and other bills under consideration through the end of the year.

FDA Expands Eligibility for COVID-19 Vaccine Boosters
The U.S. Food and Drug Administration today amended the emergency use authorizations (EUAs) for both the Moderna and Pfizer-BioNTech COVID-19 vaccines authorizing use of a single booster dose for all individuals 18 years of age and older after completion of primary vaccination with any FDA-authorized or approved COVID-19 vaccine.

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices this afternoon also backed the expansion of Moderna and Pfizer-BioNTech COVID-19 vaccine boosters to all adults.

Following today’s FDA decision, the Illinois Dept. of Public Health is recommending anyone 18 years and older get a COVID-19 vaccine booster dose six months after receiving their second Moderna or Pfizer-BioNTech vaccine, or two months after receiving the one-dose Johnson & Johnson vaccine.

Prior to today’s FDA authorizations, a single booster dose of the Moderna and Pfizer-BioNTech COVID-19 vaccines was authorized for administration to individuals 65 years of age and older, individuals 18 through 64 years of age at high risk of severe COVID-19 and individuals 18 through 64 years of age with frequent institutional or occupational exposure to SARS-CoV-2.

Commonwealth Fund Releases Health Equity Scorecard
The Commonwealth Fund has released a new health equity scorecard, finding racial and ethnic health inequities in all 50 states and the District of Columbia — disparities that have been exacerbated by the COVID-19 pandemic.

Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance, a comprehensive examination of how healthcare systems are functioning for people of color in every state, uses 24 measures to evaluate each state on healthcare access, quality and service use, and health outcomes for Black, White, Latinx/Hispanic, American Indian/Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. Key findings include:

  • Both across states and within states, healthcare system performance varies widely by race and ethnicity.
  • Substantial health and healthcare disparities exist between white and Black, Latinx/Hispanic, and AIAN communities in nearly all states.
  • On health outcomes, in most states, Black and AIAN populations tend to fare worse than White, Latinx/ Hispanic, and AANHPI populations.
  • Large disparities in access to care between White and most nonwhite populations are apparent across states. Latinx/Hispanic people typically face the highest barriers to care, although they also tend to have better health outcomes than many other groups (despite variations by geographic region).
  • Across and within most states, White populations overall receive better care than Black, Latinx/Hispanic, AIAN and, often, ANNHPI individuals.

Illinois’ scorecard rankings are mixed:

  • For Black residents, 28th out of 38 states for overall health system performance; 35th out of 38 for health outcomes; 13th out of 40 for healthcare access; and 31st out of 40 for healthcare quality.
  • For Latinx residents, 13th out of 42 for overall health system performance; eighth out of 42 for health outcomes; 13th out of 48 for healthcare access; and 37th out of 48 for healthcare quality.
  • For White people, 22nd out of 51 for overall health system performance; 27th out of 51 for health outcomes; 18th out of 51 for healthcare access; and 27th out of 51 for healthcare quality.
  • For Asian Americans, Native Hawaiians and Pacific Islanders, 14th out of 23 for overall health system performance; 10th out of 24 for health outcomes; 15th out of 30 for healthcare access; and 27th out of 41 for healthcare quality.

The report authors suggest pursuing four broad policy goals to create an equitable, antiracist health system:

  • Ensuring affordable, comprehensive, and equitable health insurance coverage for all;
  • Strengthening primary care;
  • Lowering administrative burden for patients; and
  • Investing in social services.

They also say that since health inequities vary across states, there are also opportunities for state programs to tailor interventions that address the unique needs of their communities.

KFF: Majority of Uninsured Eligible for Coverage
A new Kaiser Family Foundation analysis shows that a majority – more than 6 in 10 – of the 27.4 million people who remained uninsured in 2020 already are eligible for financial assistance for coverage through Medicaid/Children’s Health Insurance Program (CHIP) or the Affordable Care Act Marketplace.

The eligible group includes more than 10 million people who qualify for subsidized plans in the Marketplace and 7 million who are eligible for Medicaid or CHIP.

Of the 7 million people who are uninsured and eligible for Medicaid or CHIP, 4.2 million are adults and 2.8 million are children; nearly two-thirds are people of color and nearly three out of four live in working families; and three quarters, or 5.2 million people, reside in Medicaid expansion states (including Illinois), which have more people living in them and have higher income eligibility for adults than non-expansion states.

The report suggests that policies in the Build Back Better Act and outreach for the current Affordable Care Act Marketplace open enrollment period could help reduce the number of uninsured who are eligible for coverage. Many people eligible for coverage remain uninsured due to lack of knowledge of coverage options, difficulty signing up, or other reasons.

IHA Vaccination Campaign in Vaccine Project Newsletter
IHA’s statewide public awareness campaign encouraging COVID-19 vaccination—There’s Unity In Immunity—was highlighted in this week’s Vaccine Project Newsletter, a digital publication on the pandemic by Medical Marketing and Media.

The newsletter focused on the current state of vaccination across the U.S., noting that “we’ve come a long way” in vaccinating Americans against COVID-19 over the past year. IHA’s campaign launched in April with its bold, unifying message to:

  • Address vaccine hesitancy, especially in the hardest-hit communities;
  • Build confidence in the vaccines by dispelling fears and misinformation; and
  • Share video messages from clinicians in different of regions of the state on the value and benefits of COVID-19 vaccines.

Social media outreach was the campaign’s core component. IHA also provided members with a toolkit, digital assets and resources. In addition to the consumer-facing campaign webpage, we developed a webpage for IHA members to access campaign assets.

IHA thanks members for their robust participation in the There’s Unity In Immunity campaign. Together, we had an impact on increasing vaccination and reducing COVID-19 infections across Illinois.

State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) today reported 5,720 new confirmed and probable COVID-19 cases, including 37 additional deaths. IDPH also reported 28,280 new confirmed and probable cases, including 150 additional deaths, since last Friday, Nov. 12, a 25% increase in the number of cases from the previous weekly total.

Currently, IDPH is reporting a total of 1,763,866 cases, including 26,227 deaths. In the past 24 hours, laboratories have reported 176,441, specimens for a total of 37,895,788. As of last night, 1,759 individuals in Illinois were reported to be in the hospital with COVID-19. Of those, 350 patients were in the ICU and 152 patients were on ventilators.

The preliminary seven-day statewide positivity for cases as a percent of total tests is 3.2%. The preliminary seven-day statewide test positivity is 3.8%. The latest daily case positivity rate is 3.2%.

The seven-day rolling average of vaccines administered daily in Illinois is 62,142 doses, with 69,949 doses administered in the past 24 hours. Of Illinois’ total population, approximately 67% has received at least one COVID-19 vaccine dose and almost 61% of Illinois’ total population is fully vaccinated according to data from the Centers for Disease Control and Prevention (CDC).

Today’s CDC figures showed more than 47.3 million confirmed and presumptive positive cases of COVID-19 in the U.S. (a daily increase of more than 107,000 cases; seven-day moving average of more than 88,000 cases), with 764,473 deaths (a daily increase of 1,301).

Today’s WHO Coronavirus Disease Dashboard showed more than 255.3 million COVID-19 cases globally (a daily increase of more than 448,000 cases), with more than 5.1 million deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 95.5 million cases and more than 2.3 million deaths.

Briefly Noted
A new report on “COVID-19 and the Rural Opioid Epidemic” in Illinois makes several recommendations to address the crisis: increase the availability of Medications for Opioid Use Disorder (MOUD) centers, including virtual treatment and remote counseling options; engage justice involved populations to reduce opioid use disorder; and sustain and dramatically expand harm reduction services into rural areas to prevent overdoses and the spread of infectious diseases. The report by SIU Medicine notes that while every area of the state faces opioid misuse, overdose deaths are a significant issue in rural counties. According to the Illinois Dept. of Public Health, nine of the 20 Illinois counties with the highest opioid fatality rate are in rural areas.

As part of their immunization campaigns to urge people to get their flu and COVID-19 vaccine shots, the Centers for Medicare & Medicaid Services has developed a Flu Vaccine Partner Toolkit (see also CMS’ Flu Vaccine Page) and the Centers for Disease Control and Prevention has COVID-19 Vaccine Toolkits and a Social Media Toolkit.

The Centers for Medicare & Medicaid Services (CMS) is reporting that in week two (Nov. 7-13) of the 2022 Affordable Care Act Marketplace open enrollment period, more than 850,000 people selected individual market plans in the 33 states (including Illinois) that use the HealthCare.gov platform. So far, a total of more than1.6 million people have selected individual market plans on HealthCare.gov.