Overnight Health Care: Democrats set sights on program to fill gap in Medicaid expansion

Overnight Health Care: Democrats set sights on program to fill gap in Medicaid expansion
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Welcome to Overnight Health Care. COVID-19 vaccines aren't perfect. The viral "Fork Hands" returns to explain how you can still get infected even if you're vaccinated.  

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Today: The Pentagon is requiring military members to get vaccinated against COVID-19 immediately. Meanwhile, Texas is banning vaccine mandates regardless of approval status. And hospital ICUs across the country are rapidly filling up.


But we'll start with some news on the reconciliation bill: 

Democrats eye new federal coverage program in states declining Medicaid expansion

We’ve known for a little while that Democrats hoped to cover people in the 12 states that have declined to expand Medicaid in the coming reconciliation bill. But how exactly are they going to do that? We got some new details. 

The likely plan is to first subsidize the coverage gap population to get private insurance on the Affordable Care Act marketplaces, until sometime around 2025 or 2026, which would give time to set up the new system, aides and advocates say.

Then, a new federal coverage program would kick in to provide health insurance to the coverage gap population in the 12 states that have not expanded Medicaid already.

Industry might not be too happy: The creation of a new federal health insurance program could be controversial and has drawn pushback from some in the health care industry, given that it could be a stepping stone to a larger, government-run "public option."

"We have significant concerns with any proposal that would establish a new Federal Medicaid look-alike program to fill the coverage gap," the Federation of American Hospitals wrote to Congress this month. "The formation and implementation of a new federal program or a Medicaid public option would be complex and costly, burdened by bureaucracy and rulemaking that would unnecessarily delay access to care for millions."


Read more here


Hospital ICUs reaching breaking point

Hospitals report that more than three-quarters of the intensive care units in the United States are full, as COVID-19 continues to rampage the country.

Earlier: HHS data from Tuesday found almost 77.3 percent of all ICU beds filled, with almost half of states surpassing three-fourths capacity.

Update: The data updated late Wednesday showed that more than 79 percent of all ICU beds were occupied with 28 percent of all beds filled with confirmed COVID-19 patients. Now, 29 states report their hospitals’ ICUs have exceeded 75 percent capacity.

Alabama has surpassed its ICU capacity as hospitals report 1,628 patients in ICU units, amounting to 102.5 percent of the state’s ICU beds. 

Other states are nearing their limit for ICU beds, with Florida, Georgia, Texas, Mississippi and Louisiana all at least 90 percent full. 

In all states but New Jersey, the majority of ICU beds are filled. The units in several hard-hit states, including Mississippi, Alabama, Georgia and Florida, are flooded with mostly COVID-19 patients. 

Significance: The high percentage shows that many hospitals are approaching or reaching their capacity to take care of the sickest patients, even as national hospitalizations for COVID-19 continue to climb. 

Health professionals have expressed concern that the current wave of hospitalizations could overwhelm the health care system as many hospitals deal with staff shortages amid burnout. 

Read more here


Pentagon requires military members get COVID-19 vaccine immediately


Now that the FDA has given full approval to Pfizer's COVID vaccine, the Pentagon is taking action. 

Defense Secretary Lloyd AustinLloyd AustinOvernight Defense & National Security — White House raises new alarm over Russia GOP lawmakers press administration on US weapons left behind in Afghanistan Overnight Defense & National Security — Texas hostage situation rattles nation MORE has ordered service members to “immediately begin” receiving the COVID-19 vaccine, according to a Pentagon memo released Wednesday.

“To defend this Nation, we need a healthy and ready force. After careful consultation with medical experts and military leadership, and with the support of the President, I have determined that mandatory vaccination against coronavirus disease 2019 (COVID-19) is necessary to protect the Force and defend the American people,” Austin wrote in the memo.

No timeline was given for when troops are required to get the shot, but Austin said he directed service branch secretaries to "impose ambitious timelines for implementation," and to report to him regularly on their progress.

The Defense Department held off on requiring COVID-19 vaccinations while the vaccines were under emergency use authorization, and will only mandate the vaccines that receive full approval, Pentagon press secretary John Kirby told reporters on Wednesday.

Read more here.



Texas governor bans COVID-19 vaccine mandates regardless of approval status

Consider the goalposts moved. 

Just days after the FDA approved the Pfizer-BioNTech vaccine, Texas Gov. Greg Abbott (R) issued an executive order on Wednesday banning any governmental entity in the state from requiring a COVID-19 vaccine, regardless of its approval status.

It marks a change from the governor's previous executive order, which banned mandates for vaccines administered under an emergency use authorization.

It did not mention employer mandates and preserves exceptions for places such as nursing homes, long-term care facilities and state-supported living centers.

What's next: Abbott asked the state legislature to consider whether state and local governments can mandate vaccines, and if so, what exemptions can apply. Texas lawmakers are currently convening in a special session. The House restored a quorum last week when enough Democrats returned to the state after staging a nearly six-week protest of the GOP’s elections bill.

Read more here.



Moderna completes submission for full FDA approval of vaccine

Moderna said Wednesday that it has completed its submission of data to the Food and Drug Administration (FDA) for full approval of its COVID-19 vaccine. 

The rolling submission of data to the FDA had begun in June, but is now complete. The completed submission comes two days after the FDA announced that it had given full approval to the Pfizer vaccine. 

The emergency use authorization that Pfizer had operated under and that Moderna still is covered under was only granted after a rigorous process. But full approval could help bring some hesitant people on board with getting the shots and make companies and governments more willing to mandate vaccinations. 

Stéphane Bancel, Moderna’s CEO, said in a statement that the submission is an “important milestone in our battle against COVID-19 and for Moderna,” noting that it is the company’s first time submitting for a full approval, formally known as a Biologics License Application. 

Moderna said earlier this month that its vaccine had maintained 93 percent effectiveness after six months, but noted that data was collected before the delta variant was dominant in the United States, which could change the equation. 

Read more here


What we’re reading

‘I’m still not planning to get it’: FDA approval not swaying some vaccine holdouts (The Washington Post)

These governors push experimental antibody therapy — but shun vaccine and mask mandates (Kaiser Health News)

The U.S. paid billions to get enough COVID vaccines last fall. What went wrong? (NPR)

Holes in reporting of breakthrough Covid cases hamper CDC response (Politico)


State by state

Washington hospitals see 1,100 new COVID-19 patients in one month, health system approaches breaking point (KING 5)

Nebraska state job ad touts lack of vaccine requirement (The Associated Press)

More children under 18 in N.J. are testing positive for COVID, data shows (NJ.com)

Top state health official and doctor on Maui promote controversial COVID-19 treatments that FDA warns are dangerous and even lethal (Honolulu Star Advertiser)


Op-eds in The Hill

Vaccination mandates are symptomatic of bigger problems in America