AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses important changes in Medicaid coverage following the Consolidated Appropriations Act of 2023, coronavirus statistics and reporting slowdowns—as well as the latest on Candida auris and the Marburg fever outbreak. AMA Chief Experience Officer Todd Unger hosts.
- Medicaid and CHIP Continuous Enrollment Unwinding toolkits available in English (PDF) and Spanish (PDF).
- Call the Marketplace call center at 1-800-318-2596 (TTY: 1-855-889-4325) or visit the site to get more details about Marketplace coverage.
- Get help from someone in your area, this free service can help you better understand your health care options.
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Unger: Hello. And welcome to the AMA Update video and podcast series. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Welcome, Andrea.
Garcia: Thanks, Todd. It's good to be here.
Unger: Well, let's start off with some big news regarding Medicaid and the fact that that could be ending for some people soon. What do we need to know there?
Garcia: Well, I think that many people have come to think of this as coinciding with the end of the public health emergency, which as we know of right now is set for May 11. But the Consolidation Appropriations Act of 2023 last month delinked the Medicaid continuous enrollment provision from that ending of the public health emergency. And so it's mandated that those provisions expire on March 31, so last Friday. That means as of April 1, state Medicaid agencies can start terminating Medicaid coverage for individuals who are no longer eligible.
Unger: Just ballpark, how many people could this impact?
Garcia: So an analysis by the Kaiser Family Foundation estimates that up to 14.2 million people could be disenrolled from Medicaid over the next year. A separate HHS analysis estimated that it's closer to about 15 million people that could lose coverage. About 6.8 million of those could be removed even though they're still eligible. And that same HHS analysis suggested that by the end of the unwinding, we could see more than 5 million children lose Medicaid. It also is predicted to impact Latino and Black beneficiaries disproportionately.
Unger: So those are huge numbers of people who could be affected by this. Where does AMA stand on this?
Garcia: So AMA is urging states to adopt a 12 month continuous eligibility policy to minimize those coverage gaps between disenrollment and reenrollment while also doing all they can to facilitate that transition in coverage from Medicaid and CHiP to either a subsidized ACA marketplace plan, employer covered health insurance or another form of affordable coverage.
And in a recent viewpoint, AMA President Jack Resneck said that we need to start with improved education and outreach on alternatives to those affected, including the availability of private marketplace plans. And we also could simplify that renewal process and eliminate administrative barriers to retaining Medicaid eligibility, such as those burdensome requirements that people return paper forms rather than relying on electronic data and other means of verification.
Unger: Andrea, is there anything that physicians can do to help here?
Garcia: So they can definitely help get the word out to patients who may be impacted. And we're going to be linking to toolkits and important points of contact in the description of this episode. They can also proactively have discussions with patients and remind them to update their contact information with both the state and health plan and watch for renewal forms in the mail.
Another good place to begin is localhealth.healthcare.gov. And that's the website where people can get help from someone in their area. The service is free. And it can help them better understand their health care options.
Unger: Well, that's very helpful information. And as we get further into this kind of winding down period, so to speak, how are the COVID numbers looking?
Garcia: Well, I think we're also seeing a winding down of COVID data reporting and tracking as well. And we've talked about The New York Times, after more than three years of daily updates, ending their COVID-19 data gathering operations. They're going to continue to publish virus data from the CDC weekly, which it says that's become the most reliable source of information on the virus's spread. And that change, of course, was spurred by the declining availability of data from state and local health officials. And few states now report more than once a week. And some no longer report data to the public at all.
Unger: Keeping these changes in mind, what is the latest data telling us?
Garcia: So if we look at daily hospital admissions, which that shows how many patients test positive for COVID in hospitals, it's a number that's reliably reported more so than case counts at this stage in the pandemic. So as of March 31, we're seeing on average about 5,700 daily COVID hospital admissions. Those COVID cases are less consistently reported than earlier due to that decrease in testing. But for the week of March 23 and March 29, there were around 138,000 reported cases, about a 16% drop from two weeks prior. And then as of March 28, that test positivity rate was about 7.1.
That's a decrease of about 5% from the prior reporting period. And we know that test positivity is also less consistent but still combined with cases can help show trends in infections. And then deaths, which we know are a lagging indicator, from March 23 to March 29, we had around 1,596 deaths so a 12% drop from two weeks ago.
Unger: Well, I guess as we see some things winding down, there are also new initiatives that are just starting up. One's a collaborative supporting public health that the AMA is part of. Tell us more about that.
Garcia: Yeah. So I think we've talked here often about how the pandemic exposed those longstanding and significant gaps in our public health infrastructure. And so last week a new health care industry coalition was announced. It's being led by Kaiser Permanente in collaboration with the AMA, ACHP, the Alliance for Community Health Plans and the American Hospital Association.
And we're proud to partner with these groups with the goal being improving connectivity between public health agencies and the health care sector. And we've gone through an extensive process to come up with promising actions and areas of consensus where we can make a difference. And some of those include building that connectivity between health care and public health before an emergency, focusing on clear communication channels that can be scaled up during an emergency, and some around data standards or health equity national standards for stratifying that data and, of course, modernizing infectious disease surveillance system and promoting interoperability across sectors.
So Dr. Harmon was at that event last week where the launch was announced. And there was really, I think, a sentiment in the room that with the public health emergency ending, this is what the country needs right now. So we'll continue to share progress as that coalition evolves.
Unger: Because it appears there's not going to be a shortage of public health issues facing us in the future. Just two of them we talked about over the past couple of weeks. Sometimes I feel like they come out of nowhere. And one about a developing fungus issue and another with the Marburg virus. Let's just take a quick minute to update folks on where those stand.
Garcia: Yeah. So there's not much new to report on C. auris, really just I think a reminder to physicians to keep an eye out for what may seem like a bacterial infection that doesn't respond to antibiotics. We know that diagnosing this infection can be difficult as there are a wide range of symptoms, including fever, chills and headache that can be easily confused with other conditions. And so many cases are being identified late after they've already had the opportunity to spread. And then, of course, remember that C. auris is a notifiable condition so report it quickly to public health departments.
Unger: And what about the Marburg virus?
Garcia: Yeah. So the ongoing Marburg virus outbreak in Equatorial Guinea and Tanzania is something we're certainly continuing to monitor. And we know the CDC is stepping up its efforts on multiple fronts to help with the outbreaks and to keep those infections from spreading. CDC did put out some travel guidance. They're encouraging travelers to both of those areas to avoid contact with sick people, to watch for symptoms for three weeks after leaving. And travelers to Equatorial Guinea should also take enhanced precautions and avoid non-essential travel to those provinces where the outbreak is ongoing.
In the U.S., we're going to see the CDC posting notices in international airports where most travelers arrive. There will be warnings to watch for symptoms of that virus for 21 days and to seek care immediately if you become ill. There's also going to be text reminders to watch for symptoms. We know that in the early stages, that infection can be difficult to distinguish from other illnesses so taking that travel history is going to be essential to helping clinicians spot cases of the virus early.
Unger: And I believe the CDC is also on the ground right now trying to help in Africa.
Garcia: Yeah. Standing up a center-led emergency response. So that's not all encompassing as it is when it stands up its emergency operations center, such as what they did for COVID-19. But it will refocus the efforts of staff in its National Center for Emerging and Zoonotic Infectious Diseases to respond to those outbreaks. We know there are nine CDC staff on the ground already in Equatorial Guinea. And they have a field laboratory. They're assisting with testing, case identification and contact tracing. CDC also has a permanent office in Tanzania that's assisting with the outbreak there.
Unger: Well, we'll definitely keep watching that. And for now, that wraps up today's episode. Andrea, thanks so much for being here today. And we'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.