February 22, 2021

AMERICAN RESCUE PLAN AND COVID-19

February 22, 2021

The new Biden Administration arrived in the nation’s capital with ambitious plans to work cooperatively with Congress in dealing with the many problems associated with the coronavirus pandemic. The president’s American Rescue Plan is a centerpiece of that effort. Major committees on Capitol Hill have responded positively and have begun to set in motion legislation to achieve several important objectives aimed at combining individual bills into a $1.9 trillion COVID-19 relief package, which the House Budget Committee “marked up” and passed today, combining the individual Committee proposals into a single reconciliation bill that will be taken up on the House floor at the end of the week, with enactment expected in mid-March.

As described in the previous issue of this newsletter, reconciliation legislation is a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. Some limitations exist in this approach because budget reconciliation cannot be used for any and all federal legislation. Instead, bills must contain provisions that affect revenue and spending, with no extraneous items allowed, according to a restriction known as the “Byrd Rule.”

The House Education and Labor Committee’s portion of the reconciliation bill provides $170 billion to K-12 and postsecondary education, with $40 billion dedicated to higher education to make necessary COVID related improvements on campus and provide additional student supports. Funding will be provided to institutions via the Higher Education Emergency Relief Fund (HEERF) created in the CARES Act

The House Energy and Commerce Committee bill includes more than $46 billion for COVID-19 national testing efforts and $20 billion to improve vaccine distribution. Additional funds will be used to incentivize states to expand their Medicaid programs, allow new mothers to stay on the program for up to a year, and eliminate a cap on Medicaid drug rebates beginning in 2023.

House Ways and Means Committee legislation has features that include capping the cost of coverage in the individual health insurance market through increasing Affordable Care Act (ACA) tax credits for 2021 and 2022. ACA plans would be available at no cost for individuals making up to 150% of the federal poverty level and also for unemployment insurance beneficiaries. The bill includes additional direct payments of $1,400 to individuals and an extension of temporary federal unemployment benefits.

Proposed legislation by the House Oversight and Reform Committee provides $340 billion to state and local government jurisdictions. Aid would be split with states receiving 60% of funding and localities obtaining the other 40%. This funding can be utilized for a host of different COVID related needs as determined by state and local officials, including further assistance to postsecondary institutions.

The House Small Business Committee would add $7.25 billion for the Paycheck Protection Program (PPP) and also create a new program to support the restaurant industry.

The Senate is expected to take up the House passed bill next week, with the House’s increase of the federal minimum wage to $15 in 2025 the item most at risk of being eliminated. In separate news, the important Senate Committee on Health, Education Labor & Pensions will have Patty Murray (D-WA) serve as chairperson and Richard Burr (R-NC) as ranking member.

return to February 2021 trends

PALIMSEST AS METAPHOR

Kristen Truong

February 22, 2021

The Oxford English Dictionary defines palimpsest in various ways, including (1) a parchment or other writing surface on which the original text has been effaced or partially erased, and then overwritten by another, (2) a manuscript in which later writing has been superimposed on earlier (effaced) writing, (3) having been reused or altered while still retaining traces of its earlier form, (4) as a structure characterized by superimposed features produced at two or more distinct periods in physical geography and geology, and (5) a multilayered record. Based on these definitions, the term may be considered metaphorically in relation to this newsletter, with COVID-19 serving as an apt illustration of a topic that has been discussed on several occasions in these pages over the last several months.

The coronavirus pandemic is the equivalent of a verbal diorama under construction where events continue to unfold. Older controversies remain unresolved while new ones appear at regular intervals. Meanwhile, it essentially seems likely that the final chapter will not be written any time soon. Going back more than one year ago, debates continue about the origin of this disease. Did it arise in China and in Wuhan in particular? Was the source a wet market that sold bats and other animal kinds of foods or did this ailment emerge accidentally from an infectious disease laboratory?

Early guidelines from authoritative organizations, such as the WHO and the CDC indicated that the disease was not transmissible and that wearing masks for protective reasons was unwarranted. Moving ahead to the current month, debates are underway regarding whether one, two, or three masks should be worn. Which medications and related forms of treatment to use in treating infected patients and whether to do so in hospitals or elsewhere represent other areas of disagreement. Somewhat alarmingly, social distancing and lockdown policies are viewed as causing more problems rather than producing constructive solutions for them. While health officials advocate having children return to their classrooms, some teacher unions disagree on the wisdom of doing so. Even though vaccines are available, locales around the U.S. differ on which population subgroups should be given priority to receive them while anti vaxxers resist being immunized at all.

Over the years, this newsletter has contained items about improvements in health care as well as concerns worth addressing. Advances in genomics are associated with new breakthroughs that are destined to arise at regular intervals. Another page of the current issue of this newsletter discusses how research soon may allow calculation of polygenic risk scores (PRS) for suicide death, a top 10 cause of fatality in the U.S. The possibility of this development, which could be marketed directly to consumers, is accompanied by ethical concerns. Anticipated benefits are prevention of suicide and reduced stigma that might be offset by an increase in adverse psychological effects. Innovations in the health realm often are perceived as having significant individual and community-level benefits. Yet, there remains a likelihood of other concerns becoming manifested that relate not only to access to insurance and employment, but also to increased anxiety and depression.

return to February 2021 trends

GENTRIFICATION IMPACTS ON HEALTH

Kristen Truong

January 20, 2021

According to a manuscript published in December 2020 in the Journal of Urban Health, gentrification can be defined as “the process in which neighborhoods with low SES experience increased investment and an influx of new residents of higher SES.” Differing perspectives of policy makers, urban planners, sociologists, environmental scientists, economists, residents, and others have led to debates as to whether gentrification is ultimately of net benefit or harm. Although it is associated with increased proximity to material resources, such as green space, recreational facilities and new businesses, income and education may remain a barrier to accessing these resources. Changes often accompanying gentrification (i.e., limited affordable healthy housing, food insecurity from the need to pay high rent on limited income, increased stress, and changes in social networks) may affect certain residents negatively.

Gentrification can bring about improved neighborhood conditions, reduced rates of crime, and property value increases. It also equally can foster negative conditions associated with poorer health outcomes, such as disrupted social networks from residential displacement and increases in stress. While neighborhood environment consistently is implicated in health outcomes research, the authors indicate that gentrification rarely is conceptualized as a public health issue. They posit that as gentrification occurs across the U.S., it is important to understand how this process has an impact on health. Moreover, while aging cities reinvest in the revitalization of communities, empirical research examining relationships between gentrification and health can help inform policy decisions.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

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Kristen Truong

January 20, 2021

PERSONAL RESPONSIBILTY AMID SOCIAL DETERMINANTS

Kristen Truong

January 20, 2021

A debate with a lengthy history involves the degree to which individuals should be held responsible and accountable for misfortunes that occur in their lives versus assigning blame to external forces beyond their personal control. For example, if someone is responsible for personal health, then, all else being equal, that individual should be held accountable for it. Given this line of reasoning, it can be argued that responsibility for health has an important role to play in distributing the benefits and burdens of health care (e.g., charging higher health insurance premiums for those engaged in unhealthy behavior or giving lower priority of care to putatively responsible parties), but some caution is advisable. That health is influenced by social, economic, and environmental factors is a matter of consensus, which leads to a counter argument that in light of social determinants of health, individuals typically are not responsible for their health, rendering inappropriate policies that employ a responsibility-for-health criterion. According to an article published in the January 2021 issue of the journal Bioethics, this debate implicates a number of overlapping concepts and questions that often are difficult to separate. Also, maintaining that social determinants undermine responsibility for health may be latching on to the wrong target.

This perspective holds that social determinants of health are relevant to such policies, but not by globally undermining responsibility. Instead, social determinants are sometimes responsibility-undermining, sometimes responsibility-preserving, and often relevant to whether individuals should be held accountable for their health regardless of their responsibility. A more nuanced appraisal is called for regarding ways in which the social determinants of health are relevant to such policies. After arguing that responsibility is possible amid the social determinants of health, some important ways in which these determinants are directly relevant to individuals’ accountability for their health are surveyed and hurdles are highlighted that any policy holding individuals accountable for their health on the basis of their responsibility must clear. A proposition is advanced that distinguishing responsibility and accountability, and the ways in which social determinants are relevant to each, helps make clear the ways in which the social determinants of health are and are not relevant to policies that employ a responsibility‐for‐health criterion. Thus, it can be maintained that individuals have an obligation to preserve and promote their health, and that they are often responsible for their success or failure to do so, without committing to the thought that they are thereby accountable for their health.

return to December 2020 - January 2021 trends

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Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

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Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

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Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

January 20, 2021

When Back To School Meets Stay At Home

Students typically flock to higher education institutions amid a recession, but the COVID-19 pandemic has created a host of new financial and health challenges for those who intended to enroll in a program in the fall. A new analysis, When Back to School Meets Stay at Home, from the Georgetown Center on Education and the Workforce shows that 75% of households in which at least one member intended to take postsecondary classes responded to the pandemic by changing their plans. Some completely canceled them, while others changed the number of classes they took, enrolled in a different program or institution, or took classes in a different format. Taking classes in a different format was the most common change in fall postsecondary plans, experienced by 39% of households with postsecondary plans. More than one-third of households (37%) with such plans, however, reported that a household member had canceled a plan entirely. Postsecondary plans were most likely to be canceled in households in which individuals intended to take classes in certificate or associate’s degree programs. Lower-income households also were more likely to have individuals who canceled their postsecondary plans in response to the pandemic. The analysis can be obtained here.

Equity-Minded Faculty Workloads: What Can And Should Be Done Now

Recent social movements have revealed the systemic ways that racism and sexism remain entrenched in academic cultures. Faculty workload is taken up, assigned, and rewarded in patterns, and these patterns show important yet overlooked areas where inequity manifests in academe. Faculty from historically minority groups are disproportionately called upon to do diversity work and mentoring, while women faculty do more teaching and service. These activities are vital to the functioning of the university, yet are often invisible and unrewarded, leading to lower productivity and decreased retention. The COVID19 pandemic, which disproportionately has affected the lives and careers of women and faculty from historically minority groups, makes calls for equity-minded workload reform critical. A report from the American Council on Education summarizes findings and insights learned from the Faculty Workload and Rewards Project (FWRP), a National Science Foundation ADVANCE-funded action research project. The FWRP worked with 51 departments and academic units to promote equity in how faculty work is taken up, assigned, and rewarded, drawing from theories of behavioral economics and the principles of equity-mindedness. The report then makes recommendations for how academic units can promote workload equity by identifying the following six conditions linked to equitable workloads: Transparency, Clarity, Credit, Norms, Context, and Accountability. The report can be obtained here.

2021 Federal Health Insurance Exchange Weekly Enrollment

According to a report from the Centers for Medicare & Medicaid Services (CMS), approximately 8.3 million individuals selected or were re-enrolled automatically in plans using the HealthCare.gov platform during the 2021 Open Enrollment period. That’s about the same number as last year, although two fewer states are using the federally facilitated platform for 2021 enrollment. While the number of new consumers declined by 3.6%, the number actively renewing coverage increased by 13.2% and the number automatically re-enrolled increased by 4.4%, increasing total plan selections by 7% of all plan selections during the 2020 Open Enrollment Period. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov. The final snapshot reports new plan selections, active plan renewals, and automatic renewals. It does not report the number of consumers who paid premiums to effectuate their enrollment. The report, which shows plan selections in each of the 36 states using HealthCare.gov under the Affordable Care Act for 2021 open enrollment that began on November 1 and ended December 15 can be obtained here.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

HEALTH REFORM DEVELOPMENTS

points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

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2021 Federal Health Insurance Exchange Weekly Enrollment Read More

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Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

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Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

January 20, 2021

COVID-19 Trends Among Individuals Aged 0–24 Years, United States

According to the January 13, 2021 issue of the CDC’s Morbidity and Mortality Weekly Report, studies consistently have shown that children, adolescents, and young adults are susceptible to SARS-CoV-2 infections. Children and adolescents have had lower incidence and fewer severe COVID-19 outcomes than adults, but cases among these groups have increased since summer 2020, with weekly incidence higher in each successively increasing age group. Trends among children and adolescents aged 0–17 years paralleled those among adults. Risk for disease introduction and transmission among children in child care centers and elementary schools might be lower than for high schools and institutions of higher education. To enable safer in-person learning, schools and communities should implement fully and adhere strictly to multiple mitigation strategies, especially universal and proper mask wearing, to reduce both school and community COVID-19 incidence to help protect students, teachers, and staff members from the disease.

Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation

Atrial fibrillation (AF) is an arrhythmia with a major impact on public health due to its increasing prevalence in aging populations and its association with adverse outcomes, including stroke and heart failure (HF), with more than a doubling of mortality risk. The effect of alcohol on AF risk has remained ambiguous since there is inconsistent evidence on the relation of alcohol intake with incident AF at lower doses. As reported in the January 13, 2021 issue of the European Heart Journal, researchers assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts. In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention. Compared to drinking no alcohol at all, just one alcoholic drink a day was linked to a 16% increased risk of AF over a median follow-up time of nearly 14 years.

HEALTH TECHNOLOGY CORNER

Targeting Cartilage EGFR Pathway For Osteoarthritis Treatment

There currently is no cure for osteoarthritis (OA), but a group of scientists believe they have discovered a method through which a simple knee injection could potentially stop the disease's effects. Researchers previously found that mice with cartilage-specific epidermal growth factor receptor (EGFR) deficiency developed accelerated knee OA. To test whether the EGFR pathway can be targeted as a potential OA therapy, investigators constructed two cartilage-specific EGFR overactivation models and showed that they could target a specific protein pathway in mice, place it in overdrive, and halt cartilage degeneration over time. Building on that finding, they were able to demonstrate that treating mice with surgery-induced knee cartilage degeneration through the same pathway could reduce the cartilage damage and knee pain dramatically via the state of the art of nanomedicine. Findings were published in the journal Science Translational Medicine on January 13, 2021.

Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens

The microbiota shields the host against infections in a process known as colonization resistance. How infections themselves shape this fundamental process remains largely unknown. Scientists from five institutes of the National Institutes of Health show in an article published in the January 15, 2021 issue of the journal Cell that gut microbiota from previously infected hosts display enhanced resistance to infection. This long-term functional remodeling is associated with altered bile acid metabolism leading to the expansion of taxa that utilize the sulfonic acid taurine that helps the gut recall prior infections and kill invading bacteria, such as Klebsiella pneumoniae (Kpn). Taurine is found naturally in bile acids in the gut. The poisonous gas hydrogen sulfide is a byproduct of taurine and low levels of it allow pathogens to colonize the gut, but high levels produce enough byproduct to prevent colonization. Supplying exogenous taurine alone is sufficient to induce this alteration in microbiota function and enhance resistance.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

117TH CONGRESS IS UNDERWAY

looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

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2021 Federal Health Insurance Exchange Weekly Enrollment Read More

PERSONAL RESPONSIBILITY AND SOCIAL DETERMINANTS

Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

January 20, 2021

Some welcome news arrived for higher education in the form of an added $23 billion in relief aid stemming from the $900 billion coronavirus-relief package that was passed by Congress in December 2020. This amount is in addition to the $14 billion in direct aid to public and private higher education institutions that was furnished through the Coronavirus Aid, Relief, and Economic Security (CARES) Act last March. The assistance is aimed at offsetting new costs that colleges and universities have assumed that are associated with the implementation of online learning and coronavirus prevention measures. Many institutions also have been devastated financially by steep declines in auxiliary revenue derived from tuition as a result of declines in enrollment and also from related sources involving campus housing, dining operations, and campus facility rentals to outside groups.

As the year 2021 opened in January, there are no signs that the pandemic is declining. New mutations are proving to be more transmissible and the number of fatalities and hospitalizations from the disease have attained record levels in many states across the nation in recent weeks. The availability of vaccines is a hopeful sign, but the number of individuals who have been fortunate enough to receive them is paltry in comparison to the size of the overall U.S. population. When the day arrives that student enrollment reaches pre-pandemic levels, it appears reasonable to suppose that students could face higher out-of-pocket costs as institutions raise tuition to fill any revenue gaps. That possibility means that the federal government will be called upon to provide financial assistance to enable students from disadvantaged backgrounds to benefit from participation in higher education offerings.

Federal Aid To Higher Education In 2021

Page two of this issue of the newsletter lists funding made available under the Consolidation Appropriations Act, 2021 (P.L. 116-260) for a variety of activities. Some items not listed on that page, which have a bearing on higher education are as follows:

$754 million for the Health Resources and Services Administration (HRSA) Title VII Health Professions And Title VIII Nursing Workforce Development Programs.

$15 million for the HRSA Health Careers Opportunity Program (HCOP), a federally funded grant that provides students from economically or educationally disadvantaged backgrounds an opportunity to develop the skills needed to compete successfully for, enter, and graduate from health professions schools.

$51.5 million for the HRSA Scholarships for Disadvantaged Students Program, which provides scholarships to full-time, financially needy students from disadvantaged backgrounds, who are enrolled in health professions and nursing programs.

An additional $35 billion for the Higher Education Relief Fund directed towards public institutions and public and private Historically Black Colleges and Universities (HBCUs).

A change in how eligibility for Pell Grants is determined means an additional 555,000 students will qualify for Pell Grants each year and 1.7 more million students will qualify to receive the maximum Pell award annually. The subsidy on interest for some federal student loans is being expanded. Approximately $1.3 billion in capital loans owed to the federal government by HBCUs is being forgiven.

Another important provision will make it easier for students to fill out the Free Application for Federal Student Aid (FAFSA) form. After several years of work in Congress to achieve this result, simplification will benefit an estimated 20 million families who fill out these complicated forms every year. Reducing FAFSA from 108 questions to 36 will remove a major barrier to helping more low-income students pursue higher education.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

117TH CONGRESS IS UNDERWAY

looks at some major appropriations that were enacted for fiscal year 2021. Read More

HEALTH REFORM DEVELOPMENTS

points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

DEVELOPMENTS IN HIGHER EDUCATION

lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

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Equity-Minded Faculty Workloads: What Can And Should Be Done Now
2021 Federal Health Insurance Exchange Weekly Enrollment Read More

PERSONAL RESPONSIBILITY AND SOCIAL DETERMINANTS

Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

HEALTH REFORM DEVELOPMENTS

Kristen Truong

January 20, 2021

During the Obama and Trump Administrations, the Patient Protection and Affordable Care Act of 2010 has been a centerpiece of health policy initiatives. The U.S. Supreme Court played a decisive role in 2012 by ruling that the law would remain in effect despite an attempt by Republicans to eliminate it over a provision involving an individual mandate that originally was intended as a penalty to be imposed on individuals who decided not to seek insurance coverage. The high court ruled that if the mandate was considered a tax instead of a penalty, then the law would remain intact. When Congress eliminated the tax in 2017 in overall legislation signed into law by President Trump, Republican Attorneys General around the nation argued in federal court that ending the tax provided a rationale for scuttling the entire Affordable Care Act (ACA), which no longer can be considered constitutional. The Supreme Court accepted the case and a ruling is expected to be issued later this year.

Meanwhile, total national healthcare spending in 2019 grew 4.6%, which was similar to the 4.7% growth in 2018 and the average annual growth since 2016 of 4.5%, according to a new analysis conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The share of the economy devoted to health spending was relatively stable in 2019, at 17.7% compared with a 17.6% share in 2018. The 4.6% growth in health care expenditures was faster than the 4.0% overall economic growth as measured by Gross Domestic Product (GDP) in 2019. The growth in total national healthcare expenditures in 2019 reached $3.8 trillion, or $11,582 per person, up from 2018 when total national health expenditures were $3.6 trillion, or $11,129 per person. Spending for personal health care, which includes health care goods and services, accounted for 84% of total health care spending in 2019 and increased 5.2%, a faster rate than the 4.1% it increased in 2018. The faster growth in personal health care spending was driven largely by growth for hospital care, retail prescription drugs, and physician, and clinical services. The report includes health expenditure data though 2019, but not any of the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care spending.

Undoing Trump Administration Health Policies

A common practice whenever a new administration led by one political party replaces an administration of the other political party in the nation’s capital is to undo policies implemented by the predecessor group. For example, one Trump administration regulatory initiative created Association Health Plans that do not have to comply with either ACA individual or small-group requirements, In June 2018, the Labor Department finalized a rule to expand the ability of employers, including sole proprietors without common law employees, to join together and offer health coverage through such plans. These short-term limited duration vehicles can be in effect for one year and also be subject to renewal for as many as 36 months while continuing to be exempt from the Affordable Care Act’s consumer protections. Other high profile policies that democrats found to be objectionable involved the joint federal-state Medicaid program. Examples are demonstration projects that allow work requirements and block granting of federal Medicaid funds.

Mechanisms Likely To Be Used By The Biden Administration To Reverse Trump Policies

A 50-50 split between democrats and republicans in the Senate means that tie votes can be broken by Vice President Kamala Harris. With democrats in control of the House and a fellow party member occupying the White House, legislative objectives can be achievable through the enactment of laws. A related approach would be to use budget reconciliation procedures to pass some tax and spending measures in areas, such as ACA enhancement, pandemic relief, and climate change. The process begins with a budget resolution. Next, reconciliation legislation is then considered using a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. Limitations exist since budget reconciliation cannot be used for any and all federal legislation. Instead, bills must contain provisions that affect revenue and spending, with no extraneous items allowed, according to a restriction known as the “Byrd Rule.” Named after its principal sponsor, Senator Robert C. Byrd, D-WV), the rule provides six definitions of what constitutes extraneous matter. The Byrd rule has been in effect during Senate consideration of 21 reconciliation measures from late 1985 through the present.

return to December 2020 - January 2021 trends

More December 2020 - January 2021 TRENDS Articles

SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

117TH CONGRESS IS UNDERWAY

looks at some major appropriations that were enacted for fiscal year 2021. Read More

HEALTH REFORM DEVELOPMENTS

points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

DEVELOPMENTS IN HIGHER EDUCATION

lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

When Back To School Meets Stay At Home
Equity-Minded Faculty Workloads: What Can And Should Be Done Now
2021 Federal Health Insurance Exchange Weekly Enrollment Read More

PERSONAL RESPONSIBILITY AND SOCIAL DETERMINANTS

Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

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January 20, 2021

117th CONGRESS IS UNDERWAY

Kristen Truong

January 20, 2021

The early days of the opening of the first session of the 117th Congress began in an unprecedented manner. As legislators in both chambers gathered to certify electoral votes cast in the 2020 election, a mob assaulted the U.S. Capitol on January 6, inflicting a major disruption of the proceedings. Once order was restored, officials were able to continue later that same evening to take action they had begun to perform earlier that day. Just as dramatically, almost immediately thereafter, voices emphatically called for removing President Trump from office at once for what was perceived as his role in inciting the building’s marauders. Steps rapidly were initiated that resulted in an effort to impeach him for the second time in only 13 months.

Prior to the start of the new session of Congress, its immediate predecessor 116th version was characterized by an agreement reached in late December 2020 to provide funding to prevent a federal government shutdown. President Trump signed into law the Consolidation Appropriations Act, 2021 (P.L. 116-260) on the 27th of that month to appropriate more than $1.4 trillion for fiscal year 2021, along with the inclusion of $900 billion for pandemic relief that involves funding for vaccine distribution and COVID-19 testing. This legislation cleared the U.S. House of Representatives and Senate on a bipartisan basis one week beforehand. A 2,124-page bill, it covers an extensive range of programs, including many that pertain to the health sphere. Some examples of what the agreement provides are as follows:

$42,934,000,000 for the National Institutes of Health, including $404,000,000 from the 21st Century Cures Act (Public Law 114-255), an increase of $1,250,000,000, or 3%, above fiscal year 2020. The agreement provides a funding increase of no less than 1.5% above fiscal year 2020 to every Institute and Center (IC).

$7,874,804,000 in total program level funding for the Centers for Disease Control and Prevention, which includes $6,963,296,000 in budget authority and $856,150,000 in transfers from the Prevention and Public Health (PPH) Fund.

$338,000,000 for the Agency for Healthcare Research and Quality.

$2,000,000 increase for a total of $43.3 million for Area Health Education Centers for new competitive grants to expand experiential learning opportunities through simulation labs designed to educate and train healthcare professionals serving rural, medically underserved communities, that shall include as an allowable use the purchase of simulation training equipment.

As the result of an election in Georgia on January 5, two Democrats won contests for the U.S. Senate, so that beginning on Inauguration Day, Vice President Kamala Harris will be able to exert a tie breaking vote in that chamber, which means that Democrats will be in control of both Congress and the White House. It can be expected that they will use this opportunity to fulfill their legislative objectives.

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SIR ISAAC AND THE WHOLE BIRD

Kristen Truong

January 20, 2021

Sir Isaac Newton in 1686 presented his three laws of motion in the Principia Mathematica Philosophiae Naturalis. His first law states that “Every object persists in its state of rest or uniform motion in a straight line unless it is compelled to change that state by forces impressed on it.” A cursory review of the print and broadcast media in the U.S. indicates that a considerable amount of polarization exists in how the performance of U.S. presidential administrations is evaluated. As Trump bureaucrats exit stage right on January 20, certain media punditi can be expected to continue to extol perceived legislative and regulatory accomplishments by his executive team, which also happened to be roundly derided by opponents. Meanwhile, with the entrance of the Biden Administration stage left, it is likely that his supporters in the media will provide high encomia for whatever policies unfold while detractors on the other side of the ideological divide will continue steadfastly to circulate views that are somewhat less than totally enthusiastic.

This form of polarization often is characterized by the political terms right wing and left wing. Given the many challenges facing this nation, however, perhaps it is not unreasonable to hope for the emergence of bipartisan solutions that reflect the whole bird instead of its dual avian appendages. For example, the spheres of physical and mental health at both individual and community levels represent areas that are ripe for seeking meaningful bipartisan consideration. To illustrate, a manuscript published in the issue of the journal Neuropsychopharmacology in January 2021 describes the “Adolescent Brain Cognitive Development (ABCD)” study, an investigation currently underway to obtain a better understanding of the development of healthy and disrupted brain and behavioral development.

This research is the largest in the U.S. to date assessing brain development, examining youth from age 9 to 10 for approximately 10 years into young adulthood. Its dataset has a wealth of measured attributes of youths and their environment, including neuroimaging, cognitive, biospecimen, behavioral, youth self-report and parent self-report metrics, and environmental measures. Initial driving questions of the ABCD Study included examination of risk and resiliency factors associated with the development of substance use. The effort since then has expanded beyond this early set of questions by greatly informing an understanding of the contributions of biospecimen-derived (e.g., pubertal hormones, genomic, and epigenetic factors), neural, and environmental factors to the etiology of mental and physical outcomes from middle childhood through early adulthood.

The arrival of the coronavirus in 2020 and subsequent mutations of this disease that have evolved offer compelling evidence once again beyond a shadow of any doubt that while driving through life, humans cannot always count on being in full control at the wheel. National and international attention on the importance of health issues are galvanizing factors that emphasize the importance of focusing on crafting bipartisan solutions for pressing mental and physical health problems. A new Administration in the nation’s capital has a superb opportunity to show that it will rise to the occasion of meeting many key challenges that must be addressed.

return to December 2020 - January 2021

More December 2020 - January 2021 TRENDS Articles

SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

117TH CONGRESS IS UNDERWAY

looks at some major appropriations that were enacted for fiscal year 2021. Read More

HEALTH REFORM DEVELOPMENTS

points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

DEVELOPMENTS IN HIGHER EDUCATION

lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

When Back To School Meets Stay At Home
Equity-Minded Faculty Workloads: What Can And Should Be Done Now
2021 Federal Health Insurance Exchange Weekly Enrollment Read More

PERSONAL RESPONSIBILITY AND SOCIAL DETERMINANTS

Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

November 23, 2020

MOVING FROM A GERM THEORY OF DISEASE TO THE MICROBIAL THEORY OF HEALTH

Kristen Truong

November 23, 2020

Owing to significant advances in microbiome science over the past two decades, a brink has been reached in a paradigm shift regarding the role of microbes in disease and health, from the Germ Theory of Disease to the Microbial Theory of Health. This shift will necessitate a change in the approaches taken to design targeted infection control. In particular, knowledge of the microbiome will need to be leveraged when attempting to reduce the risk posed by infectious agents through use of targeted hygiene, and by fostering/balancing exposure to naturally diverse microbial communities. A paper appearing in the November 2020 issue of the American Journal of Infection Control considers theories over the last 30 years that have had an impact on hygiene policy and consumer practice, from the Germ Theory of Disease and the Hygiene Hypothesis, to the Microbial Theory of Health, including the concept of Bidirectional Hygiene. A high-level review of the literature on pathogen transmission and the cycle of infection in the home and everyday settings is presented.

The authors believe it is time to restore public understanding of hygiene, and specifically targeted hygiene, as a tool for preventing transmission of pathogens (breaking the chain of infection) and, consequently, transmission of infectious diseases. Shifting the paradigm from a Germ Theory of Disease toward a Microbial Theory of Health, wellness, and disease prevention should not be allowed to undermine the critical role that targeted personal and surface hygiene practices play in interrupting the dissemination of infectious agents. Additionally, the authors indicate that it is critical to restore the public understanding of the basic principles of good hygiene practices and the importance of the concept of targeted hygiene as a means of minimizing the dissemination of infectious agents. The Microbial Theory of Health, including age-appropriate and health-appropriate hygiene practices for home and everyday life, should usher in a new era in which pathogen reduction can be accomplished without indiscriminate elimination of potentially beneficial microbes from the human and environmental microbiomes.

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POPULATION HEALTH SCIENCE AND THE COVID-19 PANDEMIC

Kristen Truong

November 23, 2020

The first half of 2020 saw the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV -2), a novel coronavirus that in a matter of weeks became a global pandemic with unparalleled consequences. It took only about three months from the time of the first diagnosis on December 31, 2019, in Wuhan, China, for the virus to be diagnosed in countries essentially all over the world. According to an article published in the November 2020 issue of the American Journal of Epidemiology, lessons are beginning to emerge that make it possible to sharpen thinking about COVID-19 by viewing it through the lens of population health science. Epidemiology lends itself to a focus on categorical outcomes, aiming to understand causes of cases. An infectious disease pandemic also lends itself naturally to categorical thinking. By contrast, a dimensional approach aims to expand that lens beyond simple case categorization, to thinking of the fuller range of health manifestation.

COVID-19 dynamics indicate that population health is best served by thinking dimensionally across a range of health indicators, expanding the focus beyond clearly defined categorical outcomes, even in the case of an infectious disease pandemic. This recognition frames how to think about the causes of the pandemic and how that might shape approaches to it. Deaths from the virus might be due to a disease that is uncurable or one that overwhelms the health system. Hence, there also should be interest in hospitalization rates and in the availability of acute care if it is needed to look after those sick with coronavirus. Economic indicators and their health consequences also should be of concern to population health, including increases in cardiovascular disease, depression, and suicide, all of which have been associated with adverse economic conditions. Even in the case of a single infection, thinking of a dichotomous outcome (being infected or not) underlies a variety of causes and outcomes that are important both for understanding the pandemic consequences and guiding what to do to mitigate these consequences.

return to November 2020 trends

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

November 23, 2020

State Of Lung Cancer In The U.S.

The third annual "State of Lung Cancer” report from the American Lung Association finds that while survival rates have improved overall, this type of cancer remains the leading cause of cancer mortality in the U.S. The report also highlights racial disparities at all stages, from diagnosis to treatment. Early diagnosis rates and surgical treatment rates are lower among Black patients and other non-white groups than white patients. At the same time, Hispanic individuals are 39% more likely to receive no treatment than white patients. Across the board, screening remains a challenge. Nearly eight million individuals were at high risk for lung cancer and ought to have been screened last year, but fewer than 6% of them ended up being screened for the disease. This year’s report examines the lifesaving potential of lung cancer screening, which can detect the disease at an earlier stage when it’s more curable, and the importance of advancements in lung cancer research that holds the promise for better treatment options. Additional information can be obtained here.

A Global Grand Challenge Of Achieving Healthy Human Longevity

The National Academy of Medicine (NAM) and global collaborators in October 2019 with the participation of 49 countries and territories launched the Healthy Longevity Global Competition to catalyze breakthrough research and generate transformative and scalable innovations by mobilizing action across disciplines and sectors, from basic research to technology, care delivery, financing, community development, and social policy. During the first phase of the competition over three years, more than 450 Catalyst Awards will be distributed globally, representing over US$30 million in seed funding to attract bold, audacious research ideas. In the second phase, “Accelerator Awards” will provide additional substantial funding or support for projects that have demonstrated proof of concept with potential for commercialization. In the third and final phase, one or more Grand Prizes totaling over US$4 million will reward breakthrough achievements with the promise of global impact. An international commission will assess the evidence and develop a comprehensive policy strategy for healthy aging. The commission’s report, to be released in mid-2021, will be informed by three workstreams: (1) social, behavioral, and environmental enablers, (2) health care and public health systems, and (3) science and technology. Information about this endeavor can be obtained here.

U.S. Maternal Death Rates Are The Highest Among Wealthy Countries

The United States has the highest maternal mortality rate among 11 high-income countries, according to a new international comparison from the Commonwealth Fund. The high rates of deaths from complications of pregnancy and childbirth reflect several factors that include an overall shortage of maternity care providers and the limited availability of postpartum care. The new study points to a number of policies that could lower maternal mortality in the U.S.

Implementing universal, comprehensive maternity care coverage and lowering barriers to accessing care.
Ensuring continuous maternity care from preconception to the postpartum period, also known as the “fourth trimester,” when the majority of maternal deaths occur.
Expanding the maternity care workforce, with a larger role for midwives, ensuring paid leave for all after giving birth.

The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

November 23, 2020

Chronic Pain And High-Impact Chronic Pain Among U.S. Adults, 2019

According to a Data Brief released in November 2020 by the National Center for Health Statistics (NCHS), in 2019, 20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequently limited life or work activities (referred to as high-impact chronic pain) in the past three months. Chronic pain and high-impact chronic pain both increased with age and were highest among adults aged 65 and over. Non-Hispanic white adults (23.6%) were more likely to have chronic pain compared with non-Hispanic black (19.3%), Hispanic (13.0%), and non-Hispanic Asian (6.8%) adults. The percentage of adults with chronic pain and high-impact chronic pain increased as place of residence became more rural. Chronic pain and chronic pain that frequently limits life or work activities are among the most common reasons adults seek medical care and are associated with decreased quality of life, opioid dependence, and poor mental health.

Black, Hispanic Patients Hospitalized For COVID-19 At Disproportionately High Rates

Results of a study by researchers at the Stanford University School of Medicine and Duke University published on November 17, 2020 in the journal Circulation show that Black and Hispanic patients made up nearly 60% of COVID-19 hospitalizations. This disproportionate number is attributed to societal structures reinforcing health disparities among racial and ethnic groups. The study looked at data from 7,868 patients hospitalized for COVID-19 between January 17 and July 22 at 88 U.S. hospitals participating in the American Heart Association COVID-19 Cardiovascular Disease Registry. Hispanic and Black patients had a disproportionate risk of landing in the hospital: 33% were Hispanic, 25.5% were Black, 6.3% were Asian and 35.2% were white. Data from the U.S. Census Bureau for ZIP codes where participating hospitals are located show Hispanic individuals make up just 9% of the local population, Black persons constitute 10.6%, Asian inhabitants represent 4.7%, and non-Hispanic white residents account for 59.3%.

HEALTH TECHNOLOGY CORNER

Exploration Of The The Link Between Obstructive Sleep Apnea And Autoimmune Disease

Obstructive Sleep Apnea (OSA) damages the health of 35% of adult Americans. Disordered sleep results in increased risk of several autoimmune disorders, but the molecular links to autoimmunity are poorly understood. New research by University of Georgia scientists reported in the December 2020 issue of the journal Clinical Immunology identified four cytokines associated with autoimmune disease, whose median serum levels were significantly different for OSA patients receiving airways therapy, from the levels in untreated OSA patients. Immune system disorders are a result of either low activity or over activity of the immune system and include well known conditions, such as lupus and rheumatoid arthritis. OSA occurs when throat muscles relax temporarily, narrowing or collapsing the airway and momentarily cutting off breathing during sleep. The main treatment for OSA is continuous positive airway pressure, or CPAP, which pumps air through a mask to keep the airway open. About 40% of patients can't tolerate CPAP. The results of this study may lead to better approaches to treatment and possibly new drug therapies.

Pre-Recorded Audio Messages Help Improve Outcomes For Patients With Heart Failure

Patients who are hospitalized with heart failure can reduce their odds of requiring re-hospitalization, a heart transplant, or death by reviewing recorded audio messages repeatedly about self-care at home, according to late breaking research presented on November 17, 2020 at the American Heart Association’s Scientific Sessions virtual meeting. “My Recorded On-Demand Audio Discharge Instructions (MyROAD®)” is a re-playable audio card containing information for patients with heart failure who have been discharged from the hospital. The MyROAD audio card begins with a general statement and then has four sections about diet, physical activity, medication, and self-monitoring behaviors specific to heart failure to help answer frequently asked questions about the condition and what to expect at home. The study was conducted by investigators at the Office of Nursing Research and Innovation at the Cleveland Clinic Health System. It involved a randomized controlled trial of about 1,000 patients (average age 72.8 years, 58.7% male) who were hospitalized with heart failure at four sites in Northeast Ohio.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

November 23, 2020

Whenever a new President of the United States takes office, a key responsibility is to select cabinet nominees and directors of various agencies. Many positions must be confirmed by the Senate, which means that it will be important to learn which political party will control that chamber in January. Regardless of whether Democrats or Republicans occupied the White House or controlled the House and Senate, no group has been successful in reauthorizing the Higher Education Act in recent years. That legislation last was reauthorized in 2008 for a five-year period. It will be interesting to see if the 117th Congress will enjoy more success in passing a bill that can be sent to the President to be enacted into law.

Viewed historically, the Department of Health, Education, and Welfare (HEW) was created on April 11, 1953. It lasted until the Department of Education Organization Act was signed into law by President Jimmy Carter, which provided for a separate Department of Education in 1979. HEW subsequently became the present day Department of Health and Human Services (HHS) on May 4, 1980. Along with a new Education Secretary, other political appointees will include Under Secretaries, Assistant Secretaries, and Deputy Secretaries, with a resultant impact on Department policy areas, including higher education and accreditation. These new officials can be expected to conduct a close review of policies implemented during the Trump administration with an inclination to modify priorities and possibly restore some regulations that were revised during the past four years. Accreditation is one of many higher education aspects that could be affected by such modifications. Another topic featured during Democratic primaries was to provide assistance to students burdened with educational debt as discussed below.

The Volume And Repayment Of Federal Student Loans

Between 1995 and 2017, the balance of outstanding federal student loan debt increased from $187 billion to $1.4 trillion (in 2017 dollars). During the Democratic primaries, several candidates expressed interest in providing financial assistance to lower the amount of debt for students. A report from the Congressional Budget Office (CBO) in November 2020 examines factors contributing to that growth, including changes to student loan policies, and how they affected borrowing and repayment. Much of the overall increase in borrowing occurred because the share of borrowers who attended for-profit schools increased substantially. Students who attended for-profit institutions were more likely to leave school without completing their programs and to fare worse in the job market than students who attended other types of schools. They also were more likely to default on their loans. Also, the incidence of default and participation in income-driven repayment plans, which limit how much borrowers must repay regardless of how much they borrow, increased over the period. Both of those factors resulted in larger outstanding student loan balances. The 117th Congress furnishes an opportunity to determine whether federal assistance should be provided as a means of lowering student loan debt.

Race And Ethnicity In Higher Education

The American Council on Education launched its Race and Ethnicity in Higher Education Project in 2019 with aims to: provide a data-informed foundation from which the higher education community can examine racial disparities in educational opportunities and outcomes; draw insights; raise new questions; and make the case for why it is vital to discuss racial equity gaps present in U.S. higher education. The Council released on November 16, 2020 its Race and Ethnicity in Higher Education: 2020 Supplement. The report examines over 150 indicators, looking at academic experiences and outcomes, and how these educational journeys differ, by race and ethnicity. Invited scholarly essays also provide further context around race and ethnicity in higher education that data alone cannot tell. A focus is on how average figures mask concentrations of debt, most notably held by more economically vulnerable populations, such as students who have not completed their degrees. Moreover, failure to disaggregate the borrower population ignores substantial portions of society whose student loan experience is quite different. Black borrowers and their families are accumulating more debt on average and their struggles with repayment result in some of the highest default rates. Data presented in the report may prove helpful to policymakers in efforts to address these kinds of disparities.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

November 23, 2020

According to one definition in the Oxford English Dictionary (Third Edition), “reform is the action or process of making changes in an institution, organization, or aspect of social or political life, so as to remove errors, abuses, or other hindrances to proper performance” Viewed from that perspective, the term signifies an effort to make improvements. Although the U.S. in recent decades has made significant strides in the realm of health care through efforts to reduce the ranks of the uninsured, more work continues to be necessary. The Patient Protection and Affordable Care Act, also known as the ACA, that became law in 2010 represented an attempt to increase the number of individuals with health insurance, reduce costs, and improve quality. Some positive results were achieved, but not enough.

Apart from deliberate efforts by policymakers to bring about such improvements, unanticipated events also can play a decisive role. The COVID-19 pandemic that continues to wreak havoc across the entire U.S. in 2020 offers a vivid illustration of such an occurrence. Responses to the coronavirus have varied extensively depending on where individuals live, such as in mandates involving social lockdowns and wearing masks. Two different governmental approaches are characterized by having both upsides and downsides. A top-down orientation would place the federal government in charge of all major decisions affecting individual and community health status. An implicit assumption is that officials in Washington, DC have the expertise to devise plans that will work equally effectively in mid-town Manhattan and Los Angeles as they would in Wetumpka, Alabama and Valley City, North Dakota. An opposing point of view is that all major decision-making should be located at a more local level in order to take into account key demographic factors that distinguish inhabitants of different parts of this nation. Thus, COVID-19 furnishes an excellent opportunity to begin to give thorough consideration to whether a more unified approach to any future pandemics should be implemented instead of relying on what presently amounts to a series of disjointed state-by-state responses.

The U.S. Supreme Court And The Individual Mandate
Senate confirmation hearings on the nomination of Judge Amy Coney Barrett to occupy a seat on the U.S. Supreme Court revealed a concern by many Democrats that placing her on the federal bench would jeopardize the Affordable Care Act. In November 2020, in the case of California v. Texas, the high court undertook an effort to rule on the constitutionality of the ACA. The case was brought by a group of Republican-led states and is supported by the Trump administration. Their argument is that since Congress eliminated the individual tax mandate in 2017, the entire law now must be invalidated. Some members of the court, including Chief Justice John Roberts, signaled they would support allowing the individual mandate to be severed from the remainder of the 2010 health care law, meaning that the rest of the ACA would continue to exist.

What To Expect From A Biden Administration

According to a report from the Blue Cross Blue Shield Administration, millions of children have missed routine vaccinations this year, causing a precipitous drop in immunizations that threatens to leave communities throughout the U.S. at risk of losing protection against highly contagious diseases, including measles, whooping cough, and polio. Not only will health officials chosen by President Biden be involved in the distribution of coronavirus vaccines that become available, they will be faced with the task of ensuring that vaccinations against these other diseases achieve more acceptable levels.

Democrats will continue to control the U.S. House of Representatives in 2021-2022. If they can do likewise in the Senate, certain policy goals will be easier to achieve. Otherwise, it will be necessary to seek compromises with Republicans on the following issues that will require the passage of legislation: (1) Expand and support Affordable Care Act (ACA) coverage provisions, including the expansion of existing tax credits to more individuals. (2) Create a public insurance option for individuals to enroll voluntarily, with automatic enrollment for certain uninsured individuals and no premiums for Medicaid-eligible individuals in the 14 states that chose not to expand Medicaid, and (3) Lower the eligibility age for Medicare from 65 to 60 years. Apart from legislation, a tool that the new administration can use to influence coverage and other health reforms is waiver authority. The Centers for Medicare & Medicaid Services (CMS) have the ability to do so for both state Medicaid programs and for insurance reforms.

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CHANGING OF THE GUARD

Kristen Truong

November 23, 2020

Elections have consequences and one them is that the locus of political power can undergo significant transformations. A shift from President Donald Trump’s occupancy of the White House to having former Vice President Joseph Biden become the next resident in January 2021 will have a major impact on what transpires in the new 117th Congress. Another important influence on what will occur there will depend on the outcome of two U.S. Senate races that are scheduled for January 5 in Georgia. Democrats will need both seats in order to attain the magic number 50. Once it is reached, Vice President-Elect Kamala Harris will become the tie-breaking vote. If Republicans are successful in retaining just one of those two seats, they will remain in control of the Senate, which will have a dramatic effect on the extent to which President-Elect Biden and his Democratic colleagues in the House of Representatives are able to have their desired legislative objectives enacted into law.

The next page of this newsletter provides some details of policy initiatives that Democrats have expressed a strong interest in achieving in the next session of Congress, such as additional pandemic aid, creating a government-run public insurance option, and lowering the Medicare-eligibility age to 60. A major function of Congress is to produce legislative bills in both chambers. Competition to reach the enactment stage is brisk as reflected in what occurred during 2019-2020 in the 116th Congress as of November 18, 2020.

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Prior to reaching agreement on the size of another package of financial aid in response to COVID-19, Congress found it necessary to agree on legislation to provide funding to prevent a federal government shutdown at the beginning of the new fiscal year on October 1, 2020. Legislators were successful in doing so by producing a $1.4 trillion stopgap spending measure to fund the federal government at current levels through December 11, 2020. Still pending is the necessity of completing work on the 12 annual appropriations bills for fiscal year 2021. A convenient way of doing so would be to agree to pass an omnibus appropriations package to fund the government through the end of September 2021.

An unknown when this article was written on November 17 is whether any members of Congress will become members of President-Elect Biden’s cabinet or take positions in government agencies. Apart from the upcoming Senate races in Georgia, it remains too soon to know the exact composition of both legislative chambers at the start of the next session of Congress in January.

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COVID-19: A DELICATE COEVOLUTIONARY DANCE

Kristen Truong

November 23, 2020

Humans and viruses represent two highly dedicated coevolving foes that have been pitted against each other for millennia. An article published in the November 10, 2020 issue of Proceedings of the National Academy of Sciences of the USA aims to show how an evolutionary perspective can advance understanding of the progression and consequences of the COVID-19 pandemic. This objective is addressed by having a diverse group of scientists with expertise from evolutionary medicine to cultural evolution provide insights about the disease and its aftermath.

As an illustration, at a granular level, consideration is given to how viruses might affect social behavior, and how quarantine, ironically, could make humans susceptible to other maladies due to a lack of microbial exposure. A psychological level describes ways in which the pandemic can affect mating behavior, cooperation (or the lack thereof), and gender norms, and how disgust can be used better to activate “behavioral immunity” to combat disease spread. A cultural level discusses shifting cultural norms and how they might be harnessed more effectively to combat disease and the negative social consequences of COVID-19.

Fundamentally, the existential conflict waged between viruses and humans is a consequence of the fact that nutrients and the machinery of cellular reproduction in Homo sapiens offer irresistible targets for exploitation by smaller and faster evolving organisms. While viruses benefit from rapid replication rate and mutation potential that enable them to adapt quickly to exploit their hosts, natural selection has provided humans with a complex physiological system that can target viruses at a cellular level. It is significant that humans have proven to be exceptionally quite adept through displays of communication ability, intelligence, and innate curiosity in producing extraordinary scientific tools to erect insurmountable walls for limiting the spread of certain viral diseases.

As the authors indicate, an evolutionary perspective can be helpful in understanding the nature of the virus that currently plagues the earth, our own nature in responding to its threats, and the interactions between them. Such an approach to the pandemic furnishes a valuable lens through which it becomes possible to ascertain which strategies a virus might use, our countervailing strategies, and which additional strategies it will become imperative to acquire.

Ten insights are listed and described in the manuscript. They are: (1) the virus might alter host sociability, (2) “generation quarantine” may lack critical microbial exposures, (3) activating disgust can help combat disease, (4) the mating landscape is changing and there will be economic consequences from a decrease in birth rates, (5) gender norms are backsliding and gender inequality is increasing, (6) an increase in empathy and compassion is not guaranteed, (7) we have not evolved to seek the truth, (8) combating the pandemic requires its own evolutionary process, (9) cultural evolutionary forces impact COVID-19 severity, and (10) human progress continues. Essentially, the paper is a call to action and also an opportunity to make new beneficial discoveries to improve health status.

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HISPANIC GENDER DIFFERENCES IN HOSPITALIZED HEART PATIENTS

Kristen Truong

October 21, 2020

Trends Archives

More than 3,000,000 women in the U.S. die of heart failure (HF) annually. Women significantly are underrepresented in studies that inform practice guidelines, especially women hospitalized for HF despite associated negative outcomes. HF is common in Hispanic individuals, the largest ethnic minority group in this nation, who are mostly of Mexican origin. Since there were no studies of gender differences in Mexican-Hispanic persons hospitalized for HF, as reported in the September-October 2020 issue of the periodical Women’s Health Issues, researchers sought to describe gender differences in demographic and clinical characteristics, clinical presentation, treatment, in-hospital outcomes, and discharge status in Mexican-Hispanic patients hospitalized for HF.

Compared with men, women were equally affected by obesity, on average six years older (p < .01), and more likely to be widowed (31% vs 6%; p < .001). Women had significantly higher ejection fractions, more total comorbid conditions, more hyperlipidemia, more arthritis, more anxiety, and were less likely to be treated with digoxin and more likely to be treated with calcium channel blockers. At discharge, women were significantly less likely to receive an angiotensin-converting enzyme inhibitor or an aldosterone receptor blocker and had a higher systolic blood pressure. A conclusion reached from this investigation is that key gender differences in chronic illness burden, treatment, and discharge status were found, highlighting the heterogeneity of women with HF and the need for further gender-specific research to develop care strategies specific to women of all races and ethnicities.

Return to October 2020 TRENDS

BIG DATA, RESEARCH, AND ETHICS CHALLENGES FOR IRBs

Kristen Truong

October 21, 2020

Trends Archives

The increased use of big data has shifted the way in which biomedical research is designed and implemented. This kind of research has begun to pursue opportunities afforded by big data by relying on large‐scale databases, multiplication of data sources, advanced storage capacity, and novel computational tools that allow for high‐velocity data analytics. Big data also enable researchers to draw health insights from data sources that are not strictly medical, such as data from wearable trackers, social media, and Internet searches that open new prospects to accelerate health‐related research and potentially elicit breakthroughs that will benefit patients. Currently, a large portion of health‐related research depends on big data, while the novelty of techniques and methods brought by big data research brings new challenges to institutional review boards (IRBs). It is unclear, however, if those entities should be the responsible oversight bodies for big data research and, if so, which criteria they should use.

According to a manuscript published in the September-October 2020 issue of the journal Ethics & Human Research, big data investigations shift the way biomedical researchers design and carry out their studies because their work departs from the traditional research model since it is largely exploratory rather than hypothesis driven. The methodological novelty of big data research models brings new challenges and questions to IRBs, including whether they are the bodies responsible for assessing these projects. Given current technologies, analytic methods, and regulations, IRBs cannot take their traditional review frameworks as given since big data research models might not fit within the traditional national review policies for the protection of human subjects. Health-related big data research also challenges IRBs in referring to existing safeguards for ethics research, such as informed consent, privacy, confidentiality, and minimal risk. A threefold consideration is involved. First, individuals whose data are used in research often are not sufficiently informed concerning the use of their data. Second, breaches in data privacy and confidentiality represent a major source of risk stemming from the informational richness of large data repositories, which makes them a primary target for actors outside the research domain. Third, correlations arising from health‐related big data analytics can be abused by various actors for unethical purposes, such as discriminating against applicants to health insurance services or jobs based on health risk indicators.

Return to October 2020 TRENDS

More February 2021 TRENDS Articles

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