|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
Taking executive action to bolster the Affordable Care Act
Thursday was healthcare day at the Biden White House, the latest in a series of themed days during which the President has issued executive orders on topics ranging from COVID response to climate change to racial equity. Facing a closely divided Congress, the new administration has focused so far on actions it can take unilaterally to advance its agenda, and as President Biden described it at a signing ceremony yesterday, his healthcare agenda is centered on “restoring the Affordable Care Act and restoring Medicaid to the way it was” prior to the Trump administration. The new executive order reopens the HealthCare.gov insurance marketplace for a “special enrollment period”, lasting from mid-February to mid-May, allowing approximately 15M uninsured Americans in 36 states (including 3M who lost employer-based insurance due to COVID) to sign up for coverage, many subsidized by the federal government. The order also instructs agencies to review many of the regulatory changes made by the Trump administration, including loosening restrictions on short-term insurance plans, and allowing states to use waivers to implement Medicaid work requirements. (Also included in Thursday’s action was a measure to immediately rescind the ban on taxpayer funding for abortion-related counseling by international nonprofits, the so-called “Mexico City rule”.)
Actually unwinding those Trump-era changes will take months (or possibly years) of regulatory work to accomplish, but Biden’s executive order puts that work in motion. Attention now turns to Congress, which the Biden team hopes will provide funding for increased subsidies for coverage on the Obamacare exchanges, along with allocating money for the administration’s aggressive COVID response plan. Yesterday’s executive order is best understood as the starting gun for the lengthy legislative and regulatory process that lies ahead, as the Biden administration tries to bolster the 2010 health reform law, and stamp its mark on American healthcare.
Mostly good news on the vaccine front
Two additional pharmaceutical companies released preliminary data on the efficacy of their vaccine candidates this week, promising new weapons in the fight against the coronavirus, but raising some concerns about the efficacy of vaccine candidates against the variants of the disease that have emerged abroad and now in the US. Novavax reported Thursday that its vaccine proved to be nearly 96 percent effective at preventing COVID caused by the original Wuhan strain of the virus, and 86 percent effective against the variant that has taken hold in United Kingdom, but only about 50 percent effective among participants in South Africa, indicating that the predominant variant there, which was identified in the US this week, is able to skirt the immunity provided by its vaccine. Johnson & Johnson (J&J) reported similarly positive, if mixed, results for its vaccine, which was 72 percent effective against the virus with a single dose among US trial participants, but just 57 percent effective in trials in South Africa. However, the J&J vaccine was successful at reducing severe COVID disease by 85 percent—meaning that it could provide a capable tool in reducing severe disease and deaths with just a single dose.
Not all the vaccine news was positive this week: Merck announced plans to discontinue trials of its two vaccine candidates due to poor results, and German public health officials recommended that AstraZeneca’s vaccine should not be given to those over age 65, due to insufficient evidence of efficacy. As the pipeline, supply and relative strengths of approved and candidate vaccines are weighed, experts are expressing greater optimism that a majority of Americans could be vaccinated by late spring. However, the spread of new, more contagious strains is highly worrisome, especially in light of likely reduced vaccine efficacy in preventing COVID infection as the virus mutates. It’s no coincidence that new variants are emerging in places with uncontrolled spread, like the US, South Africa, Britain and Brazil. Immunizing as many people as possible, as quickly as possible (with whichever vaccine is to hand), while maintaining proven public health measures, will be the key to winning the footrace between vaccination rollout and viral mutation.
California taps an insurer to run its vaccine rollout
In an attempt to improve its beleaguered COVID vaccine rollout, the nation’s most populous state struck an agreement this week with one of its largest insurance companies to serve as statewide vaccine administrator. California will contract with Blue Shield of California to create a centralized system to streamline appointment sign-ups, notification, and eligibility for its nearly 40 million residents, and to oversee vaccine distribution to counties, healthcare providers and pharmacies across the state. Oakland-based Blue Shield, which serves four million members across the Golden State, faces a tall order to improve the state’s widely criticized rollout. As of this week, California had only administered 49.5 percent of the doses it has received, placing it among the slowest states in the country even as new COVID cases continue to be reported at a high rate. Details have yet to be released on specific terms of the contract, other than the fact that Kaiser Permanente will run a separate vaccination program for its 9M members in California. Blue Shield has been very involved in Governor Gavin Newsom’s pandemic response efforts to date, and has long been a lobbying powerhouse in the state—and a major donor to Newsom’s campaign. California’s bet seems to be that moving vaccine distribution from individual counties to a centralized system will result in greater distribution efficiencies, which mirrors the Biden administration’s overall pandemic strategy at the federal level. But it bears watching to see if the capabilities of a large insurer—including an extensive network of providers, and a robust customer service platform—will be sufficient to solve the logistical, supply chain, workforce and communication challenges currently hampering vaccine rollout.