Category: From California Healthline.org

KHN Midwest correspondent Lauren Weber discussed COVID-19 surges in Wisconsin with Wisconsin Public Radio’s “Central Time” on Nov. 13.

• Click here to hear Weber on Wisconsin Public Radio

California Healthline correspondent Angela Hart and editor Emily Bazar discussed how the Supreme Court case about the Affordable Care Act could affect California with the CalMatters and Capital Public Radio’s “California State of Mind” podcast.

• Click here to hear Hart and Bazar on “California State of Mind”
• Read Hart’s “California Stands to Lose Big if US Supreme Court Cancels Obamacare“

KHN chief Washington correspondent Julie Rovner discussed open enrollment for ACA marketplace plans with Maine Public Radio’s “Maine Calling” on Monday.

• Click here to hear Rovner on Maine Public Radio

KHN Midwest correspondent Cara Anthony discussed protections against race-based hair discrimination with KTVU Fox 2 on Tuesday.

• Click here to watch Anthony on KTVU Fox 2
• Read Anthony’s “Black Hair Matters: How Going Natural Made Me Visible“

KHN senior correspondent Liz Szabo discussed COVID vaccine candidates with Newsy on Tuesday.

• Click here to watch Szabo on Newsy

The holidays are approaching just as COVID-19 case rates nationwide are increasing at a record-breaking pace, leading to dire warnings from public health experts.

The Centers for Disease Control and Prevention has issued cautions and updated guidelines related to family gatherings. Dr. Anthony Fauci, a White House coronavirus adviser and director of the National Institute of Allergy and Infectious Diseases, said in interviews that his kids won’t be coming home for Thanksgiving because of coronavirus risks. “Relatives getting on a plane, being exposed in an airport,” he told CBS News. “And then walking in the door and saying ‘Happy Thanksgiving’ — that you have to be concerned about.”

Are Americans listening? Maybe not. Especially as airlines, reeling from major revenue blows since the pandemic took hold in March, tell passengers they can travel with peace of mind and sweeten the deal with special holiday fares.

The airlines argue more is now known about the virus and recent industry-sponsored studies show flying is just as safe as regular daily activities. They also tout policies such as mask mandates and enhanced cleaning to protect travelers from the coronavirus.

Time for a reality check.

Americans who do choose to fly will be subject to evolving COVID safety policies that vary by airline, a result of the continuing lack of a unified federal strategy. Under the Trump administration, government agencies such as the Federal Aviation Administration and the Centers for Disease Control and Prevention have failed to issue and enforce any national directives for air travel.

And, though President-elect Joe Biden has signaled he will take a more robust federal approach to addressing COVID-19, which may result in such actions, the Trump administration remains in charge during the upcoming holiday season.

Here’s what you need to know before you book.

Airlines Say It’s Safe to Fly During the Pandemic. Is it?

The airline industry pins its safety clearance to a study funded by its leading trade group, Airlines for America, and conducted by Harvard University researchers, as well as one headed by the Department of Defense, with assistance from United Airlines.

Both reports modeled disease transmission on a plane, assuming all individuals were masked and the airplane’s highly effective air filtration systems were working. The Harvard report concluded the risk of in-flight COVID-19 transmission was “below that of other routine activities during the pandemic, such as grocery shopping or eating out,” while the DOD study concluded an individual would need to, hypothetically, sit for 54 straight hours on an airplane to catch COVID-19 from another passenger.

But these studies’ assumptions have limitations.

Despite airlines’ ramped-up enforcement of mask-wearing, reports of noncompliance among passengers continue. Most airlines say passengers who outright refuse to wear masks will not only be refused boarding, but will also be putting their future travel privileges at risk. Recent press reports indicate Delta has placed hundreds of these passengers on a no-fly list. Some passengers may still try to skirt around the rule by removing their mask to eat or drink for an extended time on the flight, and flight attendants may or may not feel they can stop them.

And though public health experts agree that airplanes do have highly effective filtration systems spaced throughout the cabin that filter and circulate the air every couple of minutes, if someone who unknowingly has COVID-19 takes off their mask to eat or drink, there is still time for viral particles to reach others seated nearby before they get sucked up by the filter.

Public health experts said comparing time on an airplane with time at the grocery store is apples and oranges.

Even if you wear a mask in both places, said Dr. Henry Wu, director of Emory TravelWell Center and associate professor of infectious diseases at Emory University School of Medicine, the duration of contact in both locales can be very different.

“If it’s a long flight and you are in that situation for several hours, then you are accumulating exposure over time. So a one-hour flight is 1/10 the risk of a 10-hour flight,” said Wu. “Whereas most people don’t spend more than an hour in the grocery store.”

Also, both studies analyzed only one aspect of a travel itinerary — risk on board the aircraft. Neither considered the related risks involved in air travel, such as getting to the airport or waiting in security lines. And public health experts say those activities pose opportunities for COVID exposure.

“Between when you arrive in the airport and you get into a plane seat, there is a lot of interaction that happens,” said Lisa Lee, a former CDC official and associate vice president for research and innovation at Virginia Tech.

And while Wu said he agrees that an airplane cabin is likely safer than other environments, with high rates of COVID-19 in communities across the U.S., “there is no doubt people are flying when they’re sick, whether they know it or not.”

Another data point touted by the airline industry has been that out of the estimated 1.2 billion people who have flown so far in 2020, only 44 cases of COVID-19 have been associated with air travel, according to data from the International Air Transport Association, a worldwide trade group.

But this number reflects only case reports published in the academic literature and isn’t likely capturing the true picture of how many COVID cases are associated with flights, experts said.

“It’s very difficult to prove, if you get sick after a trip, where exactly you got exposed,” said Wu.

The low count could also stem from systemic contact-tracing inconsistencies after a person with COVID-19 has traveled on a flight. In a recent case, a woman infected with the coronavirus died during a flight and fellow passengers weren’t notified of their exposure.

That may be due to the decentralized public health system the U.S. has in place, said Lee, the former CDC official, since contact tracing is done through state and local health departments. The CDC will step in to help with contact tracing only if there is interstate travel, which is likely during a flight — but, during the pandemic, the agency has “been less consistently effective than in the past,” said Lee.

“Let’s say there is a case of COVID on a flight. The question is, who is supposed to deal with that? The state that [the flight] started in? That it ended in? The CDC? It’s not clear,” said Lee.

Is Now the Time to Fly?

Most airlines have implemented safety measures beyond requiring masks, such as asking passengers to fill out health questionnaires, enhancing cleaning on planes, reducing interactions between crew members and passengers, and installing plexiglass stations and touchless check-in at service desks.

But many have also stepped back from other efforts, such as pledging to block middle seats. United relaxed its social distancing policy for allowing empty middle seats between customers at the end of May, though there were complaints from customers before then about flights being full. American Airlines stopped blocking middle seats in July. Other airlines plan to fill seats after the Thanksgiving holiday, with Southwest stopping the practice of blocking middle seats starting Dec. 1, and JetBlue planning to increase capacity to 85% on Dec. 2. In January, Alaska Airlines plans to stop blocking middle seats and JetBlue will fly at full capacity. Delta announced this week that it will continue to block the middle seat until March 30.

This policy change is a result of airlines’ lack of cash on hand, said Robert Mann, an aviation analyst. It also reflects a rising demand from consumers who feel increasingly comfortable traveling again, especially as holiday gatherings beckon.

“It was easy to keep middle seats empty when there wasn’t much demand,” said Mann.

Now, they’re instead hoping that new COVID-era services will calm passengers’ fears.

American, United, Alaskan and Hawaiian, among others, offer some form of preflight COVID test for customers traveling to Hawaii or specific foreign destinations that also require a negative test or quarantine upon arrival. JetBlue recently partnered with a company to offer at-home COVID tests that give rapid results for those traveling to Aruba.

Airlines are likely to expand their preflight COVID testing options in the next couple of months. “This is the new dimension of airline competition,” said Mann.

But is it a new dimension of travel safety?

Emory’s Wu said there is certainly a risk of catching the coronavirus if you travel by plane, and travelers should have a higher threshold in making the decision to travel home for the holidays than they would in years past.

After all, COVID case rates are surging nationwide.

“I think the less folks crowding the airports, the less movement in general around the country, will help us control the epidemic,” said Wu. “We are worried things will get worse with the colder weather.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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.

USE OUR CONTENT

This story can be republished for free (details).

Sonia Brown’s husband died on June 10. Two weeks later, the 65-year-old registered nurse was back at work. Her husband’s medical bills and a car payment loomed over her head.

“She wanted to make sure all those things were taken care of before she retired,” her son David said.

David and his sister begged her not to go back to work during the coronavirus pandemic — explaining their concerns about her age and diabetes — but she didn’t listen.

“She was like the Little Engine That Could. She just powered through everything,” David said.

But her invincibility couldn’t withstand COVID-19, and on 29 July she died after contracting the deadly virus.

Sonia’s death is far from unusual. Despite evidence from the Centers for Disease Control and Prevention that adults 65 and older are at a higher risk from COVID-19, KHN and The Guardian have found that 338 front-line workers in that age group continued to work and likely died of complications from the virus after exposure on the job. Some were in their 80s — oftentimes physicians or registered nurses who cherished decades-long relationships with their patients and didn’t see retirement as an option.

The aging workers had a variety of motivations for risking their lives during the pandemic. Some felt pressured by employers to compensate for staffing shortages as the virus swept through departments. Others felt a higher sense of duty to their profession. Now their families are left to grapple with the same question: Would their loved one still be alive if he or she had stayed home?

‘All of This Could Have Been Prevented’

Aleyamma John was what her son, Ginu, described as a “prayerful woman.” Her solace came from working and caring for others. Her 38-year nursing career started in Mumbai, India. She immigrated with her husband to Dubai in the United Arab Emirates, where she worked for several years and had her two children. In 2002, the family moved to New York, and she took a job at NYC Health + Hospitals in Queens.

In early March, as cases surged across New York, Ginu asked his 65-year-old mother to retire. Her lungs were already weakened by an inflammatory disease, sarcoidosis.

“We told her very clearly, ‘Mom, this isn’t something that we should take lightly, and you definitely need to stay home.’”

“I don’t feel like the hospital will allow me to do that,” she responded.

Ginu described the camaraderie his mother shared with her co-workers, a bond that grew deeper during the pandemic. Many of her fellow nurses got sick themselves, and Aleyamma felt she had to step up.

Some of her co-workers “were quarantined [and did] not come into work,” he said. “Her department took a pretty heavy hit.”

By the third week of March, she started showing symptoms of COVID-19. A few days in, she suggested it might be best for her to go to the hospital.

“I think she knew it was not going to go well,” Ginu said. “But she found it in her heart to give us strength, which I thought was just insanely brave.”

Aleyamma ended up on a ventilator, something she assured Ginu wouldn’t be necessary. Her family was observing a virtual Palm Sunday service on 5 April when they got the call that she had died.

“We prayed that she would be able to come back, but that didn’t happen,” Ginu said.

Aleyamma and her husband, Johnny, who retired a few years ago, had been waiting to begin their next adventure.

“If organizations cared about their staff, especially staff who were vulnerable, if they provided for them and protected them, all of this could have been prevented,” Ginu said.

Commitment to Their Oath

In non-pandemic times, Sheena Miles considered herself semi-retired. She worked every other weekend at Scott Regional Hospital in Morton, Mississippi, mainly because she loved nursing and her patients. When Scott County emerged as a hot spot for the virus, Sheena worked four weekends in a row.

Her son, Tom, a member of Mississippi’s House of Representatives, called her one night to remind her she did not need to go to work.

“You don’t understand,” Sheena told her son. “I have an oath to do this. I don’t have a choice.”

Over Easter weekend, she began exhibiting COVID-like symptoms. By Thursday, her husband drove her to the University of Mississippi Medical Center in Jackson.

“She walked in and she never came out,” Tom said.

Tom said his mom “laid her life down” for the residents of Morton.

“She knew the chances that she was taking,” he said. “She just felt it was her duty to serve and to be there for people.”

Serving the community also was at the heart of Dr. Robert “Ray” Hull’s family medicine clinic in Rogers, Arkansas. He opened the clinic in 1972 and, according to his son Keith, had no intentions of leaving until his last breath.

“He was one of the first family physicians in northwest Arkansas,” Keith said. “Several people asked him if he was going to retire. His answer was always no.”

At the ripe age of 78, Dr. Hull continued to make house calls, black bag in hand. His wife worked alongside him in the office. Keith said the whole staff took proper precautions to keep the virus at bay, so when his father tested positive for COVID-19, it came as a shock.

Keith wasn’t able to visit his father at the hospital before he died on June 7. He said the funeral was even harder. Due to COVID restrictions on crowd sizes, he had to ask patients from Arkansas, Oklahoma and Missouri to stay home.

“There’s not a coliseum, arena or stadium that would have held his funeral,” Keith said. “Everybody knew my dad.”

‘She Was Afraid She Was Going to Get Sick’

Nancy MacDonald, at 74, got bored at home. That’s why her daughter, Bethany, said retirement never stuck for her. So in 2017, Nancy took a job as a receptionist at Orchard View Manor, a nursing home in East Providence, Rhode Island.

Although technically she worked the night shift, her co-workers could rely on her to pick up extra shifts without question.

“If somebody called her and said, ‘Oh, I’m not feeling well. I can’t come in,’ she was right there. That was just the way she was,” Bethany said.

Nursing homes across the country have struggled to contain breakouts of COVID-19, and Orchard View was no exception. By mid-April, the facility reportedly had 20 deaths. Nancy’s position was high-contact; residents and staff were in and out of the reception area all day.

At the onset of the pandemic, Orchard View had a limited supply of PPE. Bethany said they prioritized giving it to workers “on the floor,” primarily those handling patient care. Her mother’s position was on the back burner.

“When they gave her a[n N95] mask, they also gave her a brown paper bag,” she said. “When she left work, they told her to put the mask in the bag.”

Nancy’s managers reiterated that she was an essential employee, so she continued showing up. In personal conversations with her daughter, however, she was fearful about what might happen. At her age, she was considered high-risk. Nancy saw the isolation that Orchard View residents experienced when they contracted the coronavirus. She didn’t want that to be her.

“She was afraid she was going to get sick,” Bethany said. “She was afraid to die alone.”

Following her death on April 25, the Occupational Safety and Health Administration opened an investigation into the facility. So far, Orchard View has been fined more than $15,000 for insufficient respiratory protection and recording criteria.

A spokesperson for Orchard View told KHN the facility had “extensive infection control.” The facility declined to comment further.

Bethany MacDonald believes health care systems often exclude receptionists, janitors and technical workers from conversations on protecting the front line.

“It doesn’t matter what the job is, they are on the front line. You don’t have to be a doctor to be on the front line,” she said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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.

USE OUR CONTENT

This story can be republished for free (details).

USE OUR CONTENT

It can be republished for free.

On a Monday afternoon in March, four days after Gov. Gavin Newsom issued the nation’s first statewide stay-at-home order to slow the spread of the coronavirus, some of Southern California’s most famous landmarks were deserted and few cars traveled the region’s notoriously congested freeways.

Eight months later, businesses are open, traffic is back — and COVID-19 cases in the state are surging. 

“This is simply the fastest increase California has seen since the beginning of this pandemic,” Newsom said in a press conference Monday, when he announced a major rollback of the state’s reopening process, saying the state’s daily case numbers had doubled in the previous 10 days.

That same day, California Healthline’s Heidi de Marco returned to the landmarks she photographed in March. This time, it took her nearly two days — Monday and Tuesday — to document them because of traffic.

The biggest change was the greater number of vehicles on the road. Foot traffic had also stepped up, but most pedestrians and shoppers were wearing masks and not gathering in large numbers.

It turns out that activities such as strolling along the beach and window-shopping are not the primary way the disease is spreading in Los Angeles County. Public health officials there blame the surge on an increase in social gatherings, such as private dinners and sports-watching parties with people from multiple households, and the virus is spreading mostly among adults ages 18 to 29. In a bid to slow the virus, county public health director Barbara Ferrer announced additional restrictions on businesses, effective Friday. Among them, outdoor dining and drinking at restaurants and breweries will be limited to 50% of capacity, and outdoor gatherings can include only 15 people from no more than three households, including the host’s household.

KHN correspondent Anna Almendrala contributed to this report.

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.

USE OUR CONTENT

This story can be republished for free (details).

As a health journalist, a physician and a former foreign correspondent who lived through SARS in Beijing, I often get questions from friends, colleagues and people I don’t even know about how to live during the pandemic. Do I think it’s safe to plan a real wedding next June? Would I send my kids to school, with appropriate precautions? When will I trust a vaccine?

To the last question, I always answer: When I see Anthony Fauci take one.

Like many Americans, I take my signals from Dr. Fauci, the country’s top infectious disease expert and a member of the White House task force on the coronavirus. When he told The Washington Post that he was not wiping down packages but just letting them sit for a couple of days, I started doing the same. In October, he remarked that he was bringing shopping bags into the house. He merely washes his hands after unpacking them. (Me too!)

Now we are in a dangerous political transition, with cases spiking in much of the country and Fauci and the original task force largely sidelined. President-elect Joe Biden has appointed his own, but it can’t do much until the General Services Administration signals that it accepts the results of the election. And Fauci told me he has not yet spoken with the Biden task force. President Donald Trump has resisted the norms on government transition, in which the old and new teams brief each other and coordinate.

The past tumultuous months have been filled with information gaps (we’re still learning about the novel coronavirus), misinformation (often from the president) and a host of “experts” — public health folks, mathematical modelers, cardiologists and emergency room doctors like me — offering opinions on TV. But all this time, the person I’ve most wanted to hear from is Fauci. He’s a straight shooter, with no apparent conflicts of interest — political or financial — or, at 79, career ambition. He seemingly has no interests other than yours and mine.

So I asked him how Americans might expect to live in the next six to nine months. How should we behave? And what should the next administration do? Some answers have been edited for clarity and brevity.

Q: Are there two or three things you think a Biden administration should do on Day One?

There were some states in some regions of the country that somehow didn’t seem to have learned the lessons that could have been learned or should have been learned when New York City and other big cities got hit. And that is to do some fundamental public health measures. I want to really be explicit about this, because whenever I talk about simple things like uniform wearing of masks, keeping physical distance, avoiding crowds (particularly indoors), doing things outdoors to the extent possible with the weather, and washing hands frequently, that doesn’t mean shutting down the country. You can still have a considerable amount of leeway for business, for economic recovery, if you just do those simple things. But what we’re seeing, unfortunately, is a very disparate response to that. And that inevitably leads to the kind of surges that we see now.

Q: Do you think we need a national policy like a national mask mandate? The current administration has left a lot of COVID-19 management to the states.

I think that there should be universal wearing of masks. If we can accomplish that with local mayors, governors, local authorities, fine. If not, we should seriously consider national. The only reason that I shy away from making a strong recommendation in that regard is that things that come from the national level down generally engender a bit of pushback from an already reluctant populace that doesn’t like to be told what to do. So you might wind up having the countereffect of people pushing back even more.

Q: What would a national mask mandate look like to you? It means different things in different states. Many states require face coverings, but not specifically masks. Many 20-somethings use only a bandanna.

I think it is unlikely that there’s a substantial difference. I mean, the typical type of a mask is the surgical mask. It’s not an N95 mask. One that has thick cloth, you know, can be equally as effective. We believe there may be some small differences between them, but the main purpose is that you prevent yourself from infecting others. Recent studies have shown that [wearing a mask] also has the good effect of partially protecting you. So it goes both ways.

Q: Many places that have mask mandates have had trouble enforcing them.

That’s really one of the reasons there’s a reticence on the part of many people, including myself [to support a national mandate]. If you have a mandate, you have to enforce it. And, hopefully, we can convince people when they see what is going on in the country. But I have to tell you, Elisabeth, I was stunned by the fact that in certain areas of the country, even though the devastation of the outbreak is clear, some people are still saying it’s fake news. That is a very difficult thing to get over: why people still insist that something that’s staring you right in the face is not real.

Q: People often think of shutdowns as binary. You’re open or you’re shut. Often, when you answer questions about how to live, you start with. ‘Well, I’m in a high-risk group. …” So I would love to hear Dr. Fauci’s hierarchy of “Safe and important to keep open with precautions” and “Things that aren’t safe under any circumstances.”

The reason I answer with some degree of trepidation is because the people who are the proprietors of these businesses start getting very, very upset with me. There are some essential businesses that you want to keep open. You want to keep grocery stores open, supermarkets open, things that people need for their subsistence. You might, if it’s done properly, keep open some nonessential businesses, you know, things like clothing stores, department stores.

Q: We’re heading into the winter months. You could social distance in a restaurant or in an indoor gathering. But would you feel OK being in there without a mask?

If we’re in the hot zone the way we are now, where there’s so many infections around, I would feel quite uncomfortable even being in a restaurant. And particularly if it was at full capacity.

Q: I see you’ve been getting your hair cut. What do you think about hair salons?

I mean, again, it depends. I used to get a haircut every five weeks. I get a haircut every 12 weeks now — with a mask on me, as well as a mask on the person who’s cutting the hair, for sure.

Q: Transportation? Trains? Planes? Metro? Where are we at the moment?

It depends on your individual circumstances. If you are someone who is in the highest risk category, as best as possible, don’t travel anywhere. Or if you go someplace, you have a car, you’re in your car by yourself, not getting on a crowded subway, not getting on a crowded bus or even flying in an airplane. If you’re a 25-year-old who has no underlying conditions, that’s much different.

Q: Bars?

Bars are really problematic. I have to tell you, if you look at some of the outbreaks that we’ve seen, it’s when people go into bars, crowded bars. You know, I used to go to a bar. I used to like to sit at a bar and grab a hamburger and a beer. But when you’re at a bar, people are leaning over your shoulder to get a drink, people next to each other like this. It’s kind of fun because it’s social, but it’s not fun when this virus is in the air. So I would think that if there’s anything you want to clamp down on, for the time being, it’s bars.

Q: Some airlines and some states are telling people you have to get a coronavirus test before you get on the plane or visit another state. Does that make sense medically?

If you’re negative when you get on the plane — except in the rare circumstance that you’re in that little incubation window before you turn positive — that’s a good thing.

Q: If you had a national plan for testing, what would it be?

Surveillance testing. Literally flooding the system with tests. Getting a home test that you could do yourself, that’s highly sensitive and highly specific. And you know why that would be terrific? Because if you decided that you wanted to have a small gathering with your mother-in-law and father-in-law and a couple of children, and you had a test right there. It isn’t 100%. Don’t let the perfect be the enemy of the good. But the risk that you have — if everyone is tested before you get together to sit down for dinner — dramatically decreases. It might not ever be zero but, you know, we don’t live in a completely risk-free society.

Q: There are a number of vaccine candidates that are promising. But there’s also a lot of skepticism because we’ve seen the FDA come under both commercial and, increasingly, political pressure. When will we know it’s OK to take a vaccine? And which?

It’s pretty easy when you have vaccines that are 95% effective. Can’t get much better than that. I think what people need to appreciate — and that’s why I have said it like maybe 100 times in the last week or two — is the process by which a decision is made. The company looks at the data. I look at the data. Then the company puts the data to the FDA. The FDA will make the decision to do an emergency use authorization or a license application approval. And they have career scientists who are really independent. They’re not beholden to anybody. Then there’s another independent group, the Vaccines and Related Biological Products Advisory Committee. The FDA commissioner has vowed publicly that he will go according to the opinion of the career scientists and the advisory board.

Q: You feel the career scientists will have the final say?

Yes, yes.

Q: And will the decisions that are being made in this transition period — like the vaccine distribution plan — in any way limit the options of a new administration?

No, I don’t think so. I think a new administration will have the choice of doing what they feel. But I can tell you what’s going to happen, regardless of the transition or not, is that we have people totally committed to doing it right that are going to be involved in this. So I have confidence in that.

Q: When do you think we’ll all be able to throw our masks away?

I think that we’re going to have some degree of public health measures together with the vaccine for a considerable period of time. But we’ll start approaching normal — if the overwhelming majority of people take the vaccine — as we get into the third or fourth quarter [of 2021].

Q: Thank you so much. And have a nice Thanksgiving.

Take care, and you too.

[Editor’s note: Dr. Fauci has said his family is forgoing the usual family Thanksgiving gathering this year because his adult children would have to fly home and that travel would expose him to risk.] 

You can listen to the full interview on KHN’s “What the Health?” podcast.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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.

USE OUR CONTENT

This story can be republished for free (details).

Can’t see the audio player? Click here to listen on SoundCloud.

Since the mid-1980s, whenever there’s been a public health crisis, America — and six U.S. presidents — have turned to Dr. Anthony Fauci. As director of the National Institute of Allergy and Infectious Diseases (one of the National Institutes of Health), Fauci has helped guide the U.S. and the world through the HIV/AIDS epidemic, as well as various flu epidemics and outbreaks of SARS, Ebola and Zika.

Now Fauci is facing the difficult task of navigating the turbulent waters between the outgoing Trump administration and incoming Biden administration in the midst of an escalating pandemic. As a member of the Trump administration’s COVID-19 task force, Fauci has taken heat from President Donald Trump and his supporters for delivering news and advice that does not match what the president wants to hear. And with the transition delayed because the federal government has not yet recognized Joe Biden as president-elect, Fauci is not free to meet with Biden’s team.

On this special episode of KHN’s “What the Health?” podcast, Fauci sits down for an interview with KHN Editor-in-Chief Elisabeth Rosenthal, a fellow physician. They explore the thorny political landscape and discuss how regular Americans should prepare to get through the coming months — as the pandemic surges and we wait for vaccines to become available.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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.

USE OUR CONTENT

This story can be republished for free (details).

A toxic chemical ban signed into law in California will change the composition of cosmetics, shampoos, hair straighteners and other personal care products used by consumers across the country, industry officials and activists say.

The ban, signed by Gov. Gavin Newsom at the end of September, covers 24 chemicals, including mercury, formaldehyde and several types of per- and polyfluoroalkyl substances, known as PFAS. All the chemicals are carcinogenic or otherwise toxic — and advocates argue they have no place in beauty products.

When the law takes effect in 2025, it will mark the first major action to remove toxic substances from beauty products in almost a century. Federal regulation of cosmetics has not been updated meaningfully since 1938, and only 11 ingredients in personal care products are regulated by the Food and Drug Administration. By contrast, the European Union bans more than 1,600 cosmetic substances and ingredients from cosmetics.

The California law, passed by wide margins in both houses of the legislature, “is a milestone for cosmetic safety in the United States,” said Emily Rusch, executive director of the California Public Interest Research Group, which was heavily involved in shaping the bill.

The Personal Care Products Council, which represents big companies like Amway and Chanel, was hesitant but eventually supported the bill and worked directly with legislators on its final form. The industry’s buy-in will help give the California law national repercussions.

“If you’re doing business in the United States, you’re doing business in California,” said Mike Thompson, senior vice president for government affairs at the council. “I would assume that this would really, in many ways, set up a new standard.”

Breast Cancer Prevention Partners, another activist group, advocated strongly for the measure because many of the banned chemicals have been linked to breast cancer, said Janet Nudelman, the group’s director of program and policy.

For salon workers like Kristi Ramsburg, the bill could offer the peace of mind that comes from knowing her workplace is freer of toxics. Over the 20 years she’s worked as a hairdresser in Wilmington, North Carolina, Ramsburg has done hundreds of straightening jobs on her clients’ naturally frizzy hair. Performing the procedure known as a Brazilian Blowout three to four times a week exposed her to harsh and dangerous/toxic products including formaldehyde and phthalates.

She experienced “sore throats, dizziness. My vision changed, definitely,” she said. “You’d be almost crying at first.”

Studies dating to the early 1900s show that inhaling even small quantities of formaldehyde can lead to pneumonia or swelling of the liver. It’s been classified as a carcinogen, according to the FDA.

Ramsburg believes her exposure severely damaged her health. Over six years, she had surgeries to remove her gallbladder, ovaries and appendix. After her liver swelled dangerously, she suspected, based on medical consults and studies she read, that the formaldehyde she had been breathing for decades was to blame.

“I was just inundated with toxins constantly. I literally almost died,” she said.

Horror stories like Ramsburg’s are what motivated legislators, as well as the cosmetic industry, to support the California law.

Federal legislation that would have given the FDA more power to control or recall products containing the 11 federally regulated ingredients failed to gain traction in either chamber in recent sessions, despite the support of celebrities like Kourtney Kardashian.

Advocates say the inadequacies in federal regulation have been apparent for years. Current law does not require cosmetics to be reviewed and approved by the FDA before being sold to consumers. And the agency can take post-marketing action only if a cosmetic’s ingredients were found to be tampered with or its labeling is wrong or misleading.

The FDA couldn’t even intervene when asbestos was found in cosmetics sold at the youth-oriented Claire’s and Justice stores. In a 2019 letter, then-FDA Commissioner Scott Gottlieb wrote that his hands were tied because “there are currently no legal requirements for any cosmetic manufacturer marketing products to American consumers to test their products for safety.” No action was taken.

FDA scientists moved to ban formaldehyde from hair straighteners as early as 2016, according to internal agency emails, but weren’t successful. A 2019 study by government investigators found that using hair straighteners was linked with a higher risk of breast cancer, which rose with increased use. The study also found that using permanent hair dye was linked with an increased breast cancer risk.

After the federal legislation stalled, advocates changed their focus to California. The Golden State’s liberal leanings made it a likely place to pass a bill, while its status as the world’s fifth-largest economy meant any new law would have national impact. That has previously been the case, as when California set its own limits on car emissions or demanded nutrition labels for restaurant menus.

“It plays that pivotal role nationwide and has such a large economy, and so much of the cosmetic industry has a huge base here,” said Rusch, of the California Public Interest Research Group. “This type of landmark legislation has the effect essentially of setting a national standard. That was our intent.”

The Personal Care Products Council was open to the ban since the chemicals on the list — after some pruning during negotiations on the bill — include only those already prohibited in the European Union.

“You don’t want a patchwork of rules, either around the country or around the world. You want consistency,” Thompson said. “A lot of our companies may be already there, because they’re designing products for the European Union. … It’s just simpler for them to put out one product versus two.”

In recent years, growing consumer demand for transparency in beauty products has led to the development of a “clean cosmetics industry” whose products make up about 13% of high-end sales, double the percentage four years ago, according to the market research company NPD Group.

Drug and department stores have also increasingly moved toward “clean” products. CVS in 2019 removed parabens, phthalates and chemicals that contain or can give off formaldehyde from its store-brand products.

Advocates argue that the state law will force all companies to provide transparency and consistency about what, exactly, is in the products consumers put on their hair and faces.

“In order to ensure and give assurance to the public that the worst of the worst stuff is out of cosmetics, we felt we really needed to standardize and to put that into statute,” Rusch said.

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.

USE OUR CONTENT

This story can be republished for free (details).

Rulennis Muñoz remembers the phone ringing on Sept. 13. Her mother was calling from the car, frustrated. Rulennis could also hear her brother Ricardo shouting in the background. Her mom told her that Ricardo, who had been diagnosed with paranoid schizophrenia five years earlier, wouldn’t take his medication.

Within an hour, Ricardo Muñoz, 27, was dead. Muñoz, who had a knife, was killed by a police officer in Lancaster, Pennsylvania. The incident has striking similarities to the killing of Walter Wallace Jr. in Philadelphia six weeks later but has received far less national attention.

According to a Washington Post tracker, as of Nov. 18, police had killed 987 people in the U.S. in the past 12 months. Like Muñoz and Wallace, almost a quarter of those people had a diagnosis of a serious mental illness.

Two Sisters, Two Different Calls for Help

Ricardo Muñoz lived with his mother in Lancaster, but earlier on that September Sunday he had been across town at his sister Rulennis Muñoz’s house. Rulennis recalled that her brother had been having what she calls “an episode” that morning. Ricardo became agitated because his phone charger was missing. When she found it for him, he insisted it wasn’t the same one.

[khn_slabs slabs=”241884″ view=”inline”]

Rulennis knew her brother was in crisis and needed psychiatric care. But she also knew from experience that there were few emergency resources available for Ricardo unless a judge deemed him a threat to himself or others.

After talking with her mom, Rulennis called a county crisis intervention line to see if Ricardo could be committed for inpatient care. It was Sunday afternoon. The crisis worker told her to call the police to see if the officers could petition a judge to force Ricardo to go to the hospital for psychiatric treatment, an involuntary commitment. Reluctant to call 911, and wanting more information, Rulennis dialed the nonemergency police number.

Meanwhile, her mother, Miguelina Peña, was back in her own neighborhood. Her other daughter, Deborah, lives a few doors down. Peña started telling Deborah what was going on. Ricardo was becoming aggressive; he had punched the inside of the car. Back on their block, he was still yelling and upset and couldn’t be calmed. Deborah called 911 to get help for Ricardo. She didn’t know her sister was trying the nonemergency line.

The 911 Call

A recording and transcript of the 911 call show that the dispatcher gave Deborah three options: police, fire or ambulance. Deborah wasn’t sure, so she said “police.” Then she went on to explain that Ricardo was being aggressive, had a mental illness and needed to go to the hospital.

Meanwhile, Ricardo walked up the street to where he and his mother lived. When the dispatcher questioned Deborah further, she mentioned that Ricardo was trying “to break into” his mom’s house. She didn’t mention that Ricardo also lived in that house. She did mention that her mother “was afraid” to go back home with him.

The Muñoz family has since emphasized that Ricardo was never a threat to them. However, by the time police got the message, they believed they were responding to a domestic disturbance.

“Within minutes of … that phone call, he was dead,” Rulennis said.

Ricardo’s mom, Miguelina Peña, recalls what she saw that day. A Lancaster police officer walked toward the house. Ricardo saw the officer approach through the living room window, and he ran upstairs to his bedroom. When he came back down, he had a hunting knife in his hand.

In video from a police body camera, an unidentified officer walks toward the Muñoz residence. Ricardo steps outside, and shouts “Get the f–k back.” Ricardo comes down the stairs of the stoop and runs toward the officer. The officer starts running down the sidewalk, but after a few steps, he turns back toward Ricardo, gun in hand, and shoots him several times. Within minutes, Ricardo is dead.

After Ricardo crumples to the sidewalk, his mother’s screams can be heard, off-camera. Police made the body camera video public a few hours after Ricardo’s death, in an effort to dispel rumors about Ricardo’s death and quell rioting in the city. The county district attorney has since deemed the shooting justified, and the officer’s name was never made public.

Spotty Care, Dangerous Crises

Across the U.S., people with mental illnesses are 16 times more likely than the overall population to be killed by police, according to one study from the mental health nonprofit Treatment Advocacy Center.

Miguelina Peña said she tried for years to get help for her son.

Among the problems, the family couldn’t find a psychiatrist who was taking new patients, she said. Additionally, Peña speaks little English, and that made it difficult to help Ricardo enroll in health insurance, or for her to understand what treatments he was receiving. Ricardo got his prescriptions through a local nonprofit clinic for Latino men, Nuestra Clínica.

Instead of consistent medical care and a trusted therapeutic relationship, Ricardo got treatment that was sporadic and fueled by crisis: He often ended up in the hospital for a few days, then would be discharged back home with little or no follow-up care. This happened more times than his mother and sisters can recall.

“There was an occasion where a judge was involved, and the judge determined that he should be released home,” Peña said. “And my question is, why would the judge allow him to go home if he wasn’t doing well?”

Immediate Threats and Escalation

Laws in Pennsylvania and many other states make it difficult for a family to get psychiatric care for someone who doesn’t want it; it can be imposed on the person only if he or she poses an immediate threat, said Angela Kimball, advocacy and public policy director at the National Alliance on Mental illness. By that point, it’s often law enforcement, rather than mental health professionals, who are called in to help.

“Law enforcement comes in and exerts a threatening posture,” Kimball said. “For most people, that causes them to be subdued. But if you’re experiencing a mental illness, that only escalates the situation.”

People who have a family member with mental illness should learn what local resources are available and plan for a crisis, Kimball advised. But she acknowledged that many of the services she frequently recommends, such as crisis hotlines or special response teams for mental health, aren’t available in most parts of the country.

If 911 is the only option, calling it can be a difficult decision, Kimball said.

“Dialing 911 will accelerate a response by emergency personnel, most often police,” she said. “This option should be used for extreme crisis situations that require immediate intervention. These first responders may or may not be appropriately trained and experienced in de-escalating psychiatric emergencies.”

The National Alliance on Mental Illness continues to advocate for more resources for families dealing with a mental health crisis. The group says more cities should create crisis response teams that can respond at all hours, without involving armed police officers in most situations.

There has been progress on the federal level, as well. Kimball was happy when President Donald Trump signed a bipartisan congressional bill, on Oct. 17, to implement a three-digit national suicide prevention hotline. The number — 988 — will eventually summon help when dialed anywhere in the country. But it could take a few years before the system is up and running.

Rulennis Muñoz said the family never got to see how Ricardo would have responded to someone other than a police officer.

“And instead of a cop just being there, there should have been other responders,” Rulennis said. “There should have been someone that knew how to deal with this type of situation.”

This story comes from a reporting partnership with WITF, NPR and KHN.

The app builders had planned for pranksters, ensuring that only people with verified COVID-19 cases could trigger an alert. They’d planned for heavy criticism about privacy, in many cases making the features as bare-bones as possible. But, as more states roll out smartphone contact-tracing technology, other challenges are emerging. Namely, human nature.

The problem starts with downloads. Stefano Tessaro calls it the “chicken-and-egg” issue: The system works only if a lot of people buy into it, but people will buy into it only if they know it works.

“Accuracy of the system ends up increasing trust, but it is trust that increases adoptions, which in turn increases accuracy,” Tessaro, a computer scientist at the University of Washington who was involved in creating that state’s forthcoming contact-tracing app, said in a lecture last month.

In other parts of the world, people are taking that necessary leap of faith. Ireland and Switzerland, touting some of the highest uptake rates, report more than 20% of their populations use a contact-tracing app.

Americans seem not so hot on the idea. As with much of the U.S. response to the pandemic, this country hasn’t had a national strategy. So it’s up to states. And only about a dozen, including the recent addition of Colorado, have launched the smartphone feature, which sends users a notification if they’ve crossed paths with another app user who later tests positive for COVID-19.

Within those few states, enthusiasm appears dim. In Wyoming, Alabama and North Dakota, some of the few states with usage data beyond initial downloads, under 3% of the population is using the app.

The service, built by Google and Apple and adapted by individual countries, states or territories, either appears as a downloadable app or as a setting, depending on the state and the device. It uses Bluetooth to identify other phones using the app within about 6 feet for more than 15 minutes. If a user tests positive for COVID-19, they’re given a verification code to input so that each contact can be notified they were potentially exposed. The person’s identity is shielded, as are those of the people notified.

“The more people who add their phone to the fight against COVID, the more protection we all get. Everyone should do it,” Sarah Tuneberg, who leads Colorado’s test and containment effort, told reporters on Oct. 29. “The sky’s the limit. Or the population is the limit, really.”

But the population could prove to be quite a limit. Data from early-adopter governments suggests even those who download the app and use it might not follow directions at the most critical juncture.

According to the Virginia Health Department, from August to November, about 613 app users tested positive and received a code to alert their contacts that they may have exposed them to the virus. About 60% of them actually activated it.

In North Dakota, where the outbreak is so big that human contact tracers can’t keep up, the data is even more dire. In October, about 90 people tested positive and received the codes required to alert their contacts. Only about 30% did so.

Researchers in Dublin tracking app usage in 33 regions around the world have encountered echoes of the same issue. In October, they wrote that in parts of Europe fewer people were alerting their contacts than expected, given the scale of the outbreaks and the number of active app users. Italy and Poland ranked lowest. There, they estimated, just 10% of the app users they’d expect were submitting the codes necessary to warn others.

“I’m not sure that anybody working in this field had foreseen that that could be a problem,” said Lucie Abeler-Dörner, part of a team at the Big Data Institute at Oxford studying COVID-19 interventions, including digital contact tracing. “Everybody just assumed that if you sign up for a voluntary app … why would you then not push that button?”

So far, people in the field only have guesses. Abeler-Dörner wonders how much of it has to do with people going into panic mode when they find out they’re positive.

Tessaro, the University of Washington computer scientist, asks if the health officials who provide the code need more training on how to provide clear instructions to users.

Elissa Redmiles, a faculty member at the Max Planck Institute for Software Systems who is studying what drives people to install contact-tracing apps, worries that people may have difficulty inputting their test results.

But Tim Brookins, a Microsoft engineer who developed North Dakota’s contact-tracing app as a volunteer, has a bleaker outlook.

“There’s a general belief that some people want to load the app so that they can be notified if someone else was positive, in a self-serving way,” he said. “But if they’re positive, they don’t want to take the time.”

Abeler-Dörner called the voluntary notification a design flaw and said the alerts should instead be automatically triggered.

Even with the limitations of the apps, the technology can help identify new COVID cases. In Switzerland, researchers looked at data from two studies of contact-tracing app users. They wrote in a not-yet-peer-reviewed paper that while only 13% of people with confirmed cases in Switzerland used the app to alert their contacts from July to September, that prompted about 1,700 people who had potentially been exposed to call a dedicated hotline for help. And of those, at least 41 people discovered they were, indeed, positive for COVID-19.

In the U.S., another non-peer-reviewed modeling study from Google and Oxford University looking at three Washington state counties found that even if only 15% of the population uses a contact-tracing app, it could lead to a drop in COVID-19 infections and deaths. Abeler-Dörner, a study co-author, said the findings could be applicable elsewhere, in broad strokes.

“It will avert infections,” she said. “If it’s 200 or 1,000 and it prevents 10 deaths, it’s probably worth it.”

That may be true even at low adoption rates if the app users are clustered in certain communities, as opposed to being scattered evenly across the state. But prioritizing privacy has required health departments to forgo the very data that would let them know if users are near one another. While an app in the United Kingdom asks users for the first few digits of their postal code, very few U.S. states can tell if users are in the same community.

Some exceptions include North Dakota, Wyoming and Arizona, which allow app users to select an affiliation with a college or university. At the University of Arizona, enough people are using the app that about 27% of people contacted by campus contact tracers said they’d already been notified of a possible exposure. Brookins of Microsoft, who created Care19 Alert, the app used in Wyoming and North Dakota, said that offering an affiliation option also allows people who’ve been exposed to get campus-specific instructions on where to get tested and what to do next.

“In theory, we can add businesses,” he said. “It’s so polarizing, no businesses have wanted to sign up, honestly.”

The privacy-focused design also means researchers don’t have what they need to prove the apps’ usefulness and therefore encourage higher adoption.

“Here there is actually some irony because the fact that we are designing this solution with privacy in mind somehow prevents us from accurately assessing whether the system works as it should,” Tessaro said.

In states including Colorado, Virginia and Nevada, the embedded privacy protections mean no one knows who has enabled the contact-tracing technology. Are they people who barely interact with anyone, or are they essential workers, interacting regularly with many people that human contact tracers would never be able to reach? Are they crossing paths and trading signals with other app users or, if they test positive, will their warning fall silently like a tree in an empty forest? Will they choose to notify people at all?

Colorado’s health department said it’s issuing thousands of COVID codes a day. As of Wednesday, 3,400 people have used the codes to notify their contacts, it said. An automated system issues codes for positive COVID-19 tests even if the infected people don’t have the app, making it impossible to know how many users are acting on the codes.

“I have hope that the vast majority of Coloradans will take this opportunity to give this gift of exposure notification to other people,” said Tuneberg. “I believe Coloradans will do it.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Health insurance companies will have to give their customers estimated out-of-pocket costs for prescription drugs and disclose to the public the negotiated prices they pay for drugs, under an unexpected new Trump administration rule.

The administration said those requirements, part of a broader rule issued Oct. 29 forcing health plans to disclose costs and payments for most health care services, will promote competition and empower consumers to make better medical decisions.

The new rule does not, however, apply to Medicare or Medicaid.

The drug price provisions, which would not begin until 2022, were a surprise because they were not included in the original proposed rule issued in 2019.

It’s the departing Trump administration’s most ambitious effort to illuminate the complex, secret and lucrative system of prescription drug pricing, in which health plans, drug manufacturers and pharmacy benefit management firms agree on prices. The administration and Congress have tried and failed to reform part of that system — the rebates paid by drugmakers to the pharmacy benefit managers to get their products onto insurance plan formularies. Those payments, which some call kickbacks, are widely blamed for driving up costs to patients.

Patient advocates and policy experts, while generally supportive of the administration’s transparency concept, are divided on the cost-saving value of the new rule. Many say Congress needs to take broader action to curb drug prices and cap patient costs. Groups representing drugmakers, pharmacy benefit managers and commercial health plans have denounced the initiative, saying it will damage market competition and raise drug prices.

Advocates say the new rule will help patients in private health plans, including employer-based plans, and their physicians choose less expensive medications. It may even enable health plans to buy drugs more cheaply for their members. Three in 10 Americans say they have opted not to use a prescribed drug as directed because of the high cost, according to a KFF survey last year. (KHN is an editorially independent program of KFF.)

Under the new federal rule, starting in 2024 an insurance plan member can request and receive estimates of out-of-pocket costs for prescription drugs, both online and on paper, taking into account the member’s deductible, coinsurance and copays. Insurers say most plans already offer such cost-estimator tools.

Helping patients find drugs that cost them less could boost their compliance in taking needed medicines, thus improving their health.

“You can call your insurer now and ask what your copay is,” said Wendy Netter Epstein, a health law and policy professor at DePaul University in Chicago. “Patients often don’t do that. Whether or not this has an impact depends on whether patients take the initiative to obtain this information.”

Starting in 2022 under the new rule, private plans also will have to publish the prices they negotiated with drug companies and benefit management companies online in a digital, machine-readable format. That may be particularly helpful to employers that provide health insurance to workers, enabling them to seek the lowest price the drug manufacturer is offering to other purchasers.

The rule will not require plans to disclose rebates and other discounts they negotiate with drugmakers and pharmacy benefit managers.

That’s a disappointment to employers that provide health insurance for their workers. “We’d like a much clearer idea of how much we’re paying for every drug every time it’s dispensed,” said James Gelfand, senior vice president for health policy at the ERISA Industry Committee, which represents large self-insured employers. “We want to know where every cent in rebates and discounts is going. We’ll at least begin peeling back the onion. You have to start somewhere.”

But other experts argue the rule will do little to make medications more affordable. Indeed, they warn that publishing what health plans pay drug manufacturers could crimp some plans’ ability to get price concessions, raising the premiums and drug prices that plan members pay. That’s because manufacturers won’t want to give those discounts knowing other health plans and pharmacy benefit managers will see the published rates and ask for the same deals.

“Insurers and pharmacy benefit managers currently use rebates that are hidden from view to drive prices lower,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard University who studies prescription drug policy. “If you make that transparent, you kind of reduce the main strategy payers have to lower drug prices.”

Patient advocates also questioned how useful the published rates will be for patients, because plans don’t have to post list prices, on which patient cost-sharing amounts are based. There also are practical limits to patients’ ability to price-shop for drugs, considering there may be only one effective drug for a given medical condition, such as many types of cancers.

Still, if the public knows more about how much health plans pay for drugs — and can estimate the size of the rebates and discounts that aren’t being passed on to patients — that could heighten pressure on federal and state elected officials to tackle the thorny issues of high prices and gaps in insurers’ drug coverage, which powerful industry groups oppose.

“If the information is presented to consumers so they realize they are paying a higher price without the benefit of the rebates, you’ll get a lot of angry consumers,” said Niall Brennan, CEO of the Health Care Cost Institute, a nonprofit group that publishes cost data.

The Biden administration is expected to keep the new price disclosure rule for health plans. In July, the Biden campaign issued a joint policy statement with Sen. Bernie Sanders (I-Vt.) favoring increased price transparency in health care.

But Kesselheim and other experts say Congress needs to consider stronger measures than price transparency to address drug affordability. These include letting the federal government negotiate prices with drugmakers, limiting the initial price of new drugs, capping price increases and establishing an impartial review process for evaluating the clinical value of drugs relative to their cost. Those are policies Biden has said he supports.

“There’s a limit to what transparency can do,” said Shawn Gremminger, health policy director at the Pacific Business Group on Health, which represents large self-insured employers. “That’s why we’re increasingly comfortable with policies that get at the underlying prices of drugs.” As an example, he cited the Trump administration’s proposal to tie what Medicare pays for drugs to lower prices in other countries.

Commercial insurers, drug manufacturers and pharmacy benefit managers are strongly opposed to the drug transparency rule. “This rule will disrupt the marketplace dynamics and undermine the highly competitive negotiations that kept net prices for brand medicines at a growth rate of just 1.7% in 2019,” said Katie Koziara, a spokesperson for the Pharmaceutical Research and Manufacturers of America. She wouldn’t say whether her group would sue to block the rule.

The survival of the rule, which draws its legal authority from the Affordable Care Act, also depends on the U.S. Supreme Court upholding the constitutionality of that law in a case argued on Nov. 10.

This article is part of a series on the impact of high prescription drug costs on consumers made possible through the 2020 West Health and Families USA Media Fellowship.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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.

USE OUR CONTENT

This story can be republished for free (details).