Democratic and Republican House members appeared as far apart as ever Tuesday on the issue of the best way to achieve universal healthcare coverage in the U.S.

"Republicans are serious on this committee about trying to solve the healthcare problems we have in America, but bigger government and government-run healthcare is not the solution to the problem," said Rep. James Comer (R-Ky.), ranking member of the House Oversight and Reform Committee, which held a hearing on "Examining Pathways to Universal Health Coverage."

For a large number of Democratic committee members, however, government-run healthcare -- such as through a "Medicare for All" program -- was exactly the answer. "For my colleagues on this committee, you have a choice in front of you today," said Rep. Cori Bush (D-Mo.). "It's a choice to save lives or a choice to let people die ... I came to Congress because 'Medicare for All,' it's not a choice for me. It's a moral imperative."

Contrary Presentations of Facts

Viewers trying to figure out what the facts were on the issue would have been hard-pressed to do so. Would a government-run system cost more money? Absolutely, according to committee member Rep. Andrew Clyde (R-Ga.). He cited an Urban Institute report saying that a single-payer healthcare plan that would cover all residents -- including undocumented immigrants -- would cost the federal government $34 trillion over 10 years.

No, it wouldn't cost more money -- instead, it would save money, according to committee chair Rep. Carolyn Maloney (D-N.Y.). "I would like to submit for the record a study from the University of California San Francisco, which analyzed 22 single-payer proposals and found that every single one would result in long-term financial savings," she said. "If my Republican colleagues were really worried about inflation, they would support policies that bring down healthcare costs, instead of voting 60 times against the Affordable Care Act healthcare plan that has expanded healthcare to 30 million Americans."

One thing that committee members and witnesses agreed on: the current system is not working very well. "The U.S. system is completely broken," said Jeffrey Sachs, PhD, director of the Columbia University Center for Sustainable Development. "We are spending a fortune -- unlike every other country -- and we're getting worse outcomes. This is what needs to be understood beyond the ideology, beyond the anecdotes."

"There's no question Americans remain frustrated with the current healthcare system," said Grace-Marie Turner, president of the Galen Institute, a right-leaning think tank in Paeonian Springs, Virginia. "But the more government gets involved, the more that we see the health sector is forced to comply with countless rules and regulations rather than innovating to respond to more choices of more affordable care and coverage for patients ... 'Medicare for All' would take us further toward government control of our health sector, with fewer choices."

Patient Stories

The committee heard from a panel of witnesses who described their challenges in getting healthcare. One was ALS activist Ady Barkan, JD. Three years ago, "I had to decide whether to get a tracheostomy ... to compensate for my failing diaphragm," Barkan said. "But I didn't know how I would be able to pay for the care that would allow me to stay alive. My insurance had already denied me a ventilator, stating that it was experimental. And then 2 weeks after that, they rejected access to an FDA-approved ALS drug."

Barkan's insurer also initially denied him home care, but "we eventually secured 24-hour home care after suing my health insurance company in federal court," he added. "Home care has been life-changing, allowing me to participate in my family's life in ways I thought were no longer possible for me."

"It is time for America to guarantee comprehensive, affordable healthcare for all. The best way to do that is by enacting 'Medicare for All,'" he concluded.

But Chris Briggs, public affairs counsel to the Independent Institute, an Oakland, California-based right-leaning think tank, had a different opinion of government-run healthcare. Prior to the Affordable Care Act, "the private marketplace consistently and reliably had offered us a wide variety of inexpensive plans that covered specialist care, even out of state," said Briggs, who lives in Northern Virginia and buys his own health insurance. However, "after the ACA went into effect, [whatever] that was left were increasingly costly plans with fewer benefits, including fewer doctors and fewer hospitals ... We were and still are to this day basically restricted to medical facilities within a short radius of our zip code."

This became an issue after his young daughter was diagnosed with leukemia, and Briggs and his wife wanted her to be treated at Johns Hopkins; their insurer said it would not cover that. "The situation was made all the more painful by swelling premiums, as well as by skyrocketing deductibles," he said. "Maximum out-of-pocket expenses can go as high as $16,500, as it has been for my family."

"Bad ideas don't get better just because you make them bigger," said Briggs. "We must prohibit the government -- that is to say, all of you -- from further interfering in the acquisition by private citizens of their preferred medical care. And we do that by repealing the ACA and placing back into the hands of Americans real, actuarially sound, automatically renewable insurance products created to meet individual needs."

Effects on Vulnerable Populations

Uché Blackstock, MD, an emergency physician in New York City, discussed her experience working in communities where many patients were uninsured or underinsured. "Lack of access to healthcare is one of the primary social determinants of health," she said.

"I can never forget the 40-year-old Black man with a history of high blood pressure, who came into my ER unconscious on a stretcher after he collapsed at home in front of his family," Blackstock continued. "The paramedics were performing CPR on him. The CT scan of his head showed a brain bleed, a complication of untreated high blood pressure. He had been unable to afford to pay out of pocket for his blood pressure medication since he lost a job a year prior, and as a result, his health insurance ... Now is the time to protect our most vulnerable and underserved communities and identify a pathway to ensuring universal healthcare for all Americans."

But Turner suggested a different approach. "Rather than dramatically expanding the role of government through new or expanded taxpayer-supported programs, I believe we need targeted approaches to address the specific needs of those who are uninsured or underinsured, especially focusing on those in marginalized communities," she said. "'Medicare for All' would restrict access to new medicines and treatments, lead to dramatic increases in federal spending, and really turn back the clock on innovations in personalized care."

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. 

Hospitals are calling for a renewal of COVID-19 as a public health emergency. [ Beckers Health Review-Kelly Gooch] 

In a March 28 letter to HHS Secretary Xavier Becerra, national healthcare associations cited ongoing concerns about vulnerable populations, including children younger than 5 and the immunocompromised, who cannot be vaccinated, as well as the potential for additional surges. The groups also cited challenges hospitals continue to face.

"Our members continue to face challenges related to workforce shortages and staff burnout, continuing disruptions in the supply chain leading to shortages of supplies and a need for further clinical guidance regarding the symptoms of and best course of treatment for long COVID-19 patients," the letter said. "In addition, our hospitals and health systems are increasingly caring for patients with a variety of health needs for which care had to be delayed due to the pandemic."

The letter urged HHS to renew the COVID-19 public health emergency because the groups said it provides flexibility and resources to hospitals to respond to COVID-19, while best serving patients. The current public health emergency is set to expire April 15. 

The letter is signed by America's Essential Hospitals; the American Hospital Association; the Association of American Medical Colleges; the Catholic Health Association of the United States; the Children's Hospital Association; the Federation of American Hospitals; the National Association for Behavioral Healthcare; Premier healthcare alliance; and Vizient.

In February, more than 70 House Republican lawmakers signed a letter calling for an end to the public health emergency.

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The use of abdominal organs from COVID-19-positive donors for transplant was safe, a small study showed. [MedPage Today Molly Walker]

No rejection occurred among four recipients who received liver, kidney, or pancreas transplants from four COVID-positive donors, and none of the recipients acquired a COVID infection, reported Emily Eichenberger, MD, of Duke University in Durham, North Carolina, at a special COVID-focused pre-meeting of the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).

"While limited, our experience to date supports the use of abdominal organs from COVID-19 positive donors as safe and effective, even those actively infected, or with lung disease caused by COVID-19," Eichenberger said in a statement.

In the protocol implemented by her medical center, organ type, duration and severity of COVID, signs of hypercoagulable illness, and quality of organs were taken into account, as was the urgency of the transplant.

She explained that transplants were allowed from COVID-positive donors, provided the organs were good quality, though lung and intestine transplants had to go through more enhanced criteria, such as whether the donor tested positive for COVID fewer than 20 days prior to death. This was consistent with CDC infection control practices, she noted.

Among the four recipients examined, a total of six abdominal organ transplants were performed. Of the donors, one died from COVID complications, including pulmonary emboli, one died from a brain abscess likely triggered by COVID infection, and the other two had "mild to moderate" infection and died of other causes (a stroke and a drug overdose). Two donors were unvaccinated, while two had unknown vaccination status.

At a median follow-up of 46 days, all six organs had stable graft function. One heart-liver transplant recipient required an "urgent heart re-transplantation," Eichenberger said, which was completed using an asymptomatic COVID-positive donor.

She noted that her medical center has performed 20 successful abdominal organ transplants in total.

Jury Still Out on Omicron Infectious Period?

In another presentation at this special ECCMID pre-conference on COVID, a researcher argued that there is not enough evidence to say definitively that the Omicron variant has a shorter infectious period than other variants.

Using samples of culturable virus as a proxy for infectiousness, research has yet to prove that the period of infectiousness for Omicron is shorter, said Marjolein Irwin-Knoester, MD, of University Medical Center Groningen in The Netherlands.

She pointed to diverging recommendations for isolation following exposure across countries, ranging from 4 days in Norway and Denmark, up to 10 days in Germany and France. Ten days is the isolation period recommended by the WHO, she added.

"The decisions being made by different countries around the world to shorten the period of isolation for Omicron infections are partly based on evidence from modeling, but also take account of the fact that Omicron is causing less severe disease, and fewer hospitalizations and deaths," Irwin-Knoester noted. "From the evidence so far, I am not convinced that a person is likely to be infectious for a shorter period of time with Omicron as they would have been with previous variants."

She recommended an isolation period of 7 days, with 5 days as an "acceptable balance" between risk of infectiousness and what communities are likely to tolerate, but pointed out that this does not apply to everyone. Immunocompromised patients, especially transplant recipients and hematology patients, can shed infectious virus for months, and in that case, cycle threshold values should be used. Those with "continuing airway symptoms" like coughing and sneezing should also likely isolate for up to 10 to 14 days, she advised.

 is deputy managing editor and covers infectious diseases for MedPage Today. 

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Half of all states and nearly three quarters of all counties experienced more deaths than births in their populations between July 1, 2020, and June 30, 2021, according to U.S. Census Bureau population estimates released today.

Natural change is a measure of the relationship between births and deaths.

Natural increase happens when there are more births than deaths. Natural decrease means there were more people dying than babies born in a particular population.

Areas with large aging populations often experience natural decrease and shrinking populations in the absence of migration. 

Although more stats experienced natural decrease in 2021, patterns at the state level may mask trends in lower levels of geography.

While widespread, natural decrease was more common in some regions in 2021:

• Seven out of nine states (78%) in the Northeast had more deaths than births, making this the region with the most widespread natural decrease in 2021.
• The West had the lowest share of states with natural decrease — three out of 13 (23%).
• More states in the South had natural decrease than increase (65%); the reverse was true in the Midwest, where 33% of states had more deaths than births.

 Full article here> 

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A Senate committee signed off Tuesday on a plan its sponsor says will help diversify the healthcare workforce in Illinois.[Health News Illinois 3.23.2022]

The bill, sponsored by Sen. Mattie Hunter, D-Chicago, creates a framework for student loan repayment and scholarship programs that prioritize those from underserved communities entering the healthcare field.

“This bill also supports recruitment and retention of a healthcare workforce that better reflects, represents and understands the patients that they are serving and community-based providers that serve a high proportion of Medicaid and uninsured patients,” Hunter said.

Funds for the programs are subject to appropriation.

Amber Kirchhoff, director of state public policy and governmental affairs at the Illinois Primary Health Care Association, told lawmakers the proposal is similar to an existing student loan repayment program that provides loans in exchange for those who work in underserved communities.

The committee also approved a plan by Sen. Mike Simmons, D-Chicago, to create a division of men’s health within the Department of Public Health, which would raise awareness of health issues specific to men, including prostate and testicular cancer and heart disease.

Simmons told colleagues the agency is tasked with designating a worker to look after men’s health, but the position has been unfilled.

 “Ultimately, I think this will help us to increase life expectancy for men,” Simmons said.

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Joel Segal joins panel to discuss homelessness, nationally, and proposes ideas and solutions that are working now.  He is the national campaign director for Bring America Home which is a program with the National Coalition for the Homeless. 

Mr. Segal has a extensive experience in policy making and with homeless programs. 

·        Co-authored the first bill ever introduced in the U.S. Congress to end involuntary homelessness, the Bring America Home Act, in 2004.

·        Senior legislative assistant in Congress working on universal health care, homelessness, global HIV/AIDS, and ending poverty. He was the staff director of Rep. Conyers' Congressional Universal Health Care Task Force and the Out of Poverty Caucus.

·        Founder and leader of America's 2000 Universal Health Care and Global HIV/AIDS civil society advocacy movements.

·        He led efforts in Congress to reduce resident physician work hours. He co-authored unprecedented federal legislation which both the AMA and the ACGME adopted.

·        In addition, Segal led efforts in Congress to prevent the closing of the Detroit Medical Center, the largest Trauma 1 Public Hospital in Detroit, from going bankrupt by forging a bipartisan coalition of Democrats and Republicans. As a result, $40 million was allocated from the George W. Bush Administration to keep the hospital open.

·        He also was the co-author of the Katrina Relief Act and led efforts in Congress to pass the bill by working closely with the staff of then-House Majority Leader Nancy Pelosi.  

Join the virtual program 'Homelessness is  Public Health and Healthcare Issue' on March 25, 2022. More details and to register here. 

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Gov. J.B. Pritzker on Friday announced a children’s behavioral health initiative to oversee coordination across state agencies with the aim of making specialized support and resources more easily available to children and families. (Chicago Tribune 3.18.2022,Photo Antonio Perez, Chicago Tribune)

The initiative will evaluate and redesign the system of children’s health in the state, from school social workers and counselors to outpatient treatments and residential care centers, Pritzker said at a news conference at Lawrence Hall, a Ravenswood center that provides care for abused and neglected youths and their families.

The initiative will produce a “transformation blueprint” for better support of children in need by the end of this year, Pritzker said.

Children needing mental health services or support for an intellectual or developmental disability often run into a system that is “inefficient, confusing and difficult to navigate,” Pritzker said.

“If a kid needs help, it should be as straightforward as possible for them to get it,” Pritzker said. “As a result of this work, Illinois families will be better able to access holistic, wraparound support for children in need.”

Pritzker tapped Dana Weiner, a child welfare expert from the University of Chicago’s Chapin Hall, which researches best ways to improve children’s health services, to direct the initiative. Weiner’s work prioritizes evidence-based research to produce policies and services that best meet children’s needs.

Weiner will work with the leaders from six state agencies, including the Department of Children and Family Services, the Department of Public Health and the Department of Healthcare and Family Services, to streamline services. The heads of those agencies, as well as lawmakers and community service providers, joined Pritzker on Friday to announce the initiative.

Families presently needing support and services for their children lack “consistent, transparent solutions to the challenges they face,” Weiner said.

“This uncertainty can threaten the healthy development of children and the integrity and stability of families,” Weiner said. “What we need is an intentional, coordinated strategy to get families the help they need for children who are struggling.”

The announcement comes as a Cook County Juvenile Court judge has ordered DCFS Director Marc Smith to be held in contempt of court seven times since January for failing to place troubled youth in appropriate placements quickly.

State Sen. Karina Villa, a West Chicago Democrat, said working as a school social worker and seeing the desperation in parents’ eyes as their children were put on months long waitlists for therapy, counseling and other services, or turned away altogether is what made her run for office.

“A few years after getting inaugurated, I stand here with all of you, and I stand here saying the hope is here,” Villa said. “We are ready, we know what the issues are with mental health, we know that there needs to be changes. And the future depends on it, our students’ lives, our children’s lives, our families’ lives, our community lives, the lives of the communities of color that have been disproportionately impacted by so much in regards to COVID.

“We know that the time is now.”

cspaulding@chicagotribune.com

Download this article here>  

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AHA releases infographic with keys to prioritizing the mental health of mothers and families. 

Download the infographic here. 

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As part of the Maternal and Infant Health Initiative, the Centers for Medicare & Medicaid Services (CMS) is pleased to announce the Improving Maternal Health by Reducing Low-Risk Cesarean Delivery (LRCD) Learning Collaborative, which will use two strategies to offer technical assistance to states and their partners: (1) a webinar series and (2) an affinity group.

For more details and to register for the webinars, visit this page. 

Cesarean deliveries place birthing individuals and infants at higher risk for adverse outcomes. Reducing the rate of cesarean births for individuals at low risk from a vaginal birth provides an opportunity to improve both maternal and infant health. Nationally, the Medicaid LRCD rate was 25.9 percent in 2020, with marked disparities by race (30.6 percent among Black birthing persons and 24.7 percent among White birthing persons). As the largest single payer of pregnancy-related services, state Medicaid and CHIP agencies have an important role to play in reducing the number of LRCD births, reducing disparities, and improving health equity.

The learning collaborative will begin with a webinar series open to all state Medicaid and CHIP agencies and stakeholders demonstrating the potential impact of LRCD on maternal and infant health, describing disparities in the populations who have LRCDs, and outlining the approaches Medicaid and CHIP agencies may put in place to reduce the number of LRCD births. 

See full details here.

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    WASHINGTON – U.S. Senate Majority Whip Dick Durbin (D-IL), a member of the Senate Appropriations Committee, and U.S. Senator Tammy Duckworth (D-IL) secured $211 million through Congressionally-directed spending for Illinois projects in the Fiscal Year 2022 (FY22) Omnibus appropriations bill. The bill passed the Senate and now heads to the President’s desk to be signed into law.