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Report: 146,000 Alabamians with pre-existing conditions could lose coverage, see premium increases

Chip Brownlee | The Trace

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Note: This piece was originally published in October 2018.


As many as 146,000 people in Alabama who have pre-existing conditions and purchase their health insurance coverage through the individual market could see premium increases or lose their coverage if the Affordable Care Act is overturned in court, according to a new report from the House Oversight Committee’s Democratic staff.

Earlier this year, Attorney General Jeff Sessions wrote to House leadership notifying them his attorneys in the Department of Justice would no longer defend the Affordable Care Act’s individual mandate from challenges in court. As a result, the plaintiffs in the case making its way through federal courts now say the law’s provisions that protect individuals with pre-existing conditions from discrimination in the health insurance marketplace would also be invalidated without the ACA’s core provision.

Sessions even noted that his decision to no longer defend the law is a break from the tradition of DOJ attorneys defending federal laws.

“As you know, the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Sessions said, noting he thought there were special considerations when it comes to the Affordable Care Act.

At the same time, Alabama Attorney General Steve Marshall recently signed on to the multi-state lawsuit seeking to overturn the Affordable Care Act, more commonly referred to as Obamacare. The case, Texas, et al. vs. the United States, et al., is currently being heard in the United States District Court for The Northern District of Texas, where 17 other Republican attorneys general and two Republican governors are suing to overturn the Affordable Care Act.

“The Trump Administration’s decision not to defend key federal protections against insurance company discrimination threatens more than 130 million people with pre-existing health conditions in the United States, including 146,000 people who obtain coverage through the individual market in the State of Alabama,” the report reads.

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Of the 146,000 people in Alabama with pre-existing conditions enrolled in an individual market plan, 88,000 of them have conditions severe enough that insurers could deny them coverage altogether, should the protection provisions of the ACA be overturned.

People who purchase their coverage on an individual basis are most at risk because they lack group buying power available to those who have insurance through their employers.

But, in total, more than 900,000 people in Alabama have a pre-existing condition. While the legal peril facing the law poses a greater threat for those who buy their insurance coverage on an individual basis, thousands of others who have health insurance through their employers could also be threatened.

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“As a result of the Trump Administration’s decision not to defend this provision, employer plans once again will be able to exclude coverage for preexisting health conditions to new employees for up to a year if they did not maintain continuous insurance coverage before enrolling in the employer’s insurance plan,” the report found.

The Democratic staff report is based on data from the 2016 American Community Survey, which is compiled by the Census Bureau.

Without the individual mandate, insurers who provide individual plans in the health insurance marketplace have warned that premium price hikes could come in 2019. States have already reported increases, largely because payers fear healthy individuals will flee the ACA market, leaving higher-cost, more at-risk insurees.

Women and older adults would also lose protections if the law were overturned. As many as 140,000 women who currently purchase health insurance on an individual basis could face denials or premium increases, the Democratic report found. Thirty-one thousand women who are in households above the limit to qualify for federal financial assistance could bear the full cost of those increases.

For Alabamians between the ages of 50 and 64, 91,000 purchase health insurance through the individual market and could lose protections from the Affordable Care Act if it were to be overturned.

Nationally, as many as 10,030,000 people across the country who purchase insurance through the individual market have pre-existing health conditions and may lose federal protections against coverage denials or premium increases as a result of the administration’s decision not to defend the law.

Of that number, 4,823,000 have pre-existing health conditions severe enough that insurers may deny them coverage altogether.

 

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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CDC confirmed expanded “close contact” definition to Alabama officials in August

It is unclear why the CDC waited until late October to update or clarify its public-facing guidance on its website.

Eddie Burkhalter

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(STOCK PHOTO)

New federal guidance on how a person is determined to have been in close contact with someone infected by COVID-19 won’t impact how Alabama works to mitigate the disease, said the state’s top health official. That’s because the state was already aware of the expanded definition in August before the change was made public last week.

It is unclear why the CDC waited until late October to update or clarify its public-facing guidance on its website when it was giving more precise definitions to at least one state health department and receiving questions from public health officials about the definition.

The delay in announcing the change is raising questions about how state health officials nationwide have been determining the public’s possible exposure to the deadly disease and if contact tracing and mitigation efforts will be made more time- and resource-intensive with the more inclusive definition in place.

The CDC on Wednesday expanded the definition of “close contact” to mean a person can be at risk of contracting COVID-19 if that person is within six feet of an infected person for a period of at least 15 minutes over a 24-hour period.

The previous definition stated a person should quarantine if they were within six feet of an infected person for at least 15 minutes. Alternately, in other areas of the CDC’s website, the language stated “a total of 15 minutes” in the definition of close contact.

“What they changed their definition to is something they had verbally confirmed to us months ago, and we have always been using that definition,” said Alabama State Health Officer Dr. Scott Harris, speaking to APR on Friday.

Harris said a support team from the CDC was in Alabama in July as the Alabama Department of Public Health was preparing plans to reopen schools. Harris said the question was asked of CDC staff because his department was getting questions on the definition of close contact from school officials.

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APDH staff took the definition then of “a total of 15 minutes” to mean that there could be several exposures over a period of time equaling that 15 minute threshold, so they asked CDC to clarify that assertion.

“When those folks were here we asked the CDC people directly. Can you confirm for us what that means, and they said, it adds up to a total of 15 minutes in a 24-hour period,” Harris said. “And we even got somebody to commit to that in an email somewhere.”

Melissa Morrison, CDC’s career epidemiology field officer working at the ADPH in Montgomery, in an Aug. 13 email to ADPH’s director of the office of governmental affairs, quotes a statement Morrison attributes to her CDC colleague, CDC public health advisor Kelly Bishop. Harris shared the email with APR.

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“Yes, I did get a response from the contact tracing team. The 15 minutes for a close contact is cumulative, and they said ‘The time period for the cumulative exposure should start from 2 days before the cases’ illness onset (or, for asymptomatic patients, 2 days prior to positive specimen collection date) until the time the patient is isolated,” Morrison quotes Bishop in the email.

In the August email, Bishop goes on to say, as attributed by Morrison, that “as of now there is no established upper limit on the time period (i.e. 48, 72 hours etc).”

The CDC’s expanded definition was reflected in an Aug. 20 statement from the Alabama Department of Public Health.

“The 15-minute time is a cumulative period of time. For example, a close contact might be within 6 feet of a COVID-19 positive person for 5 minutes each at 8 a.m., noon and 5 p.m. This is a standard based on guidance from the CDC,” the statement reads.

In an email to APR on Friday, Harris said he’d discussed the matter with Morrison on Friday who “emphasized that the guidance this week from CDC was NOT a change but rather a clarification. They simply used the MMWR corrections story as a convenient time to make the point.”

Harris was referring to a CDC’s Morbidity and Mortality Weekly Report released Wednesday that detailed findings by Vermont health officials showing that a prison worker contracted COVID-19 during an eight-hour shift in which the worker had 22 close contacts with an infected inmate totaling 17 minutes.

The CDC in statements to numerous news outlets, and to APR, cite that Vermont study in connection to Wednesday’s definition change.

“That’s kind of why they said it out loud,” Harris said of the study and the Wednesday announcement. “But I have to say, when I saw that updated guidance I thought, ‘I can’t believe anybody ever thought otherwise.’”

Different pages on the CDC’s website on Saturday defined close contact as both being “a total of 15 minutes or more” and “a total of 15 minutes or more over a 24-hour period,” confusing the matter further, and numerous other state health departments had not yet updated their websites Saturday to reflect the CDC’s expanded definition.

A CDC spokesman in an email to APR on Wednesday noted the Vermont study on the prison worker and said “CDC clarified the amount of time it would take for someone to be considered a close contact exposed to a person with COVID-19.”

“The CDC website now defines a close contact as someone who was within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period. Previous language defined a close contact as someone who spent at least 15 minutes within 6 feet of a confirmed case,” CDC spokesman Scott Pauley told APR by email Wednesday.

Pauley didn’t respond to APR’s question on Friday asking why the CDC waited until Wednesday to update its guidance online, given that ADPH had confirmed the definition of close contact in August. He also didn’t respond to a request to verify the statement Morrison attributed to her CDC colleague in the August email.

“To us, we thought if it says a total, that means you must be adding up smaller amounts to get to 15 minutes, or you wouldn’t use the word total,” Harris said. “When they changed it this week, I don’t know the details of why that happened, but I think, obviously, everybody didn’t have the same message everywhere.”

Dr. Bertha Hidalgo, an epidemiologist and assistant professor at UAB’s Department of Epidemiology, told APR on Friday that her understanding prior to Wednesday’s expanded definition was that a contact was defined as someone who was exposed to the COVID-19 positive individual for at least 15 min or more at a time and explained that the updated guidance complicates how public health officials will engage in contact tracing.

“This means significant efforts for contact tracing moving forward, in effect needing to identify every person that person came into contact with during the possible exposure timeframe,” she said.

It was unclear Monday how the definition change impacts Alabama’s Guidesafe COVID-19 exposure notification app, which notifies a user if they come into close contact with an infected person. The app was developed by ADPH and University of Alabama at Birmingham, thanks to a partnership between Apple and Google’s combined development of the technology, and alerts users to possible exposure while keeping all users’ identities anonymous.

Sue Feldman, professor of health informatics, UAB School of Health Professions, in a message to APR on Friday said that due to the anonymity of the app, it would be difficult, but not impossible, to update the app to take into consideration the CDC’s expanded guidance.

“We are taking this into consideration for our next update,” Feldman said in the message.

Also unclear is how many other states that have similar exposure notification apps, also using Google and Apple’s technology, aren’t yet using the expanded definition of a “close contact.” Colorado is to roll out that state’s app on Sunday, and according to Colorado Public Radio News the app will notify a user that they’ve been exposed if they come “within six feet of the phone of someone who tested positive for at least ten minutes.”

New York’s exposure notification app also appears to use the old CDC guidance, and will alert users if they come “within 6 feet of your phone for longer than 10 minutes,” according to the state’s website.

The updated definition, which health departments refer to when conducting contact tracing, is likely to have a serious impact on schools, workplaces and other group settings where personal contact may stretch over longer periods of time including multiple interactions.

It greatly expands the pool of people considered at risk of transmission. “It’s easy to accumulate 15 minutes in small increments when you spend all day together — a few minutes at the water cooler, a few minutes in the elevator, and so on,” Johns Hopkins Center for Health Security epidemiologist Caitlin Rivers told The Washington Post. “I expect this will result in many more people being identified as close contacts.”

The clarification comes as cases and hospitalizations are rising both in Alabama and nationwide. Alabama’s 14-day average of cases has increased 41.2 percent over the past two weeks. The percentage of tests that are positive has increased from roughly 13 percent to more than 20 percent over the past 14 days. The U.S. average of new daily infections is now at its highest point of the pandemic, with 481,372 cases reported in a week, according to CNN and Johns Hopkins University.

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Health

Study: COVID-19 infection rates more than double without lockdowns

Infection and fatality rates would have been higher without stay-at-home orders, a new UAB study found.

Micah Danney

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(STOCK PHOTO)

New research from the University of Alabama at Birmingham says that if there had been no stay-at-home orders issued in the U.S. in response to the coronavirus pandemic, the country would have experienced a 220 percent higher rate of infection and a 22 percent higher fatality rate than if such orders were implemented nationwide.

Seven states never imposed stay-at-home orders, or SAHOs. The study analyzed daily positive case rates by state against the presence or absence of statewide SAHOs between March 1 and May 4, the period when such orders began to be implemented. Twelve states lifted their SAHOs before May 4.

The researchers defined SAHOs as being in effect when a state’s governor issued an order for residents of the entire state to leave home only for essential activities and when schools and nonessential businesses were closed.

“During March and April, most states in the United States imposed shutdowns and enacted SAHOs in an effort to control the disease,” said Bisakha Sen, the study’s senior author. “However, mixed messages from political authorities on the usefulness of SAHOs, popular pressure and concerns about the economic fallout led some states to lift the restrictions before public health experts considered it advisable.”

The research also sought to determine if the proportion of a state’s Black residents was associated with its number of positive cases. It found that there was.

“This finding adds to evidence from existing studies using county-level data on racial disparities in COVID-19 infection rates and underlines the urgency of better understanding and addressing these disparities,” said study co-author Vidya Sagar Hanumanthu. 

The research can help advance a greater understanding of racial disparities in the health care system as a whole, and help leaders make future decisions about shutdowns as the virus continues to spread, Sen said.

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“While the high economic cost makes SAHOs unsustainable as a long-term policy, our findings could help inform federal, state and local policymakers in weighing the costs and benefits of different short-term options to combat the pandemic,” she said.

The study was published Friday in JAMA Network Open.

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Elections

Jones to attend Auburn student forum, Tuberville hasn’t yet responded to invitation

Jones has agreed to attend the forum, but it was unclear whether Tuberville planned to attend.

Eddie Burkhalter

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Sen. Doug Jones, left, and Senate candidate Tommy Tuberville, right.

The College Democrats at Auburn University and the College Republicans at Auburn University have asked U.S. Senator Doug Jones, D-Alabama, and his Republican opponent, Tommy Tuberville, to attend a student forum on Wednesday.

“We are excited to invite the candidates running for our U.S. Senate seat and provide this opportunity for any Auburn student to hear directly from them, and we hope it will inform our student bodies’ decisions with the November 3rd election only days away,” said Carsten Grove, president of the College Democrats at Auburn University, in a statement.

Jones has agreed to attend the forum, Auburn University College Democrats confirmed for APR on Sunday, but it was unclear whether Tuberville planned to attend. The student organization  was still awaiting a response from Tuberville’s campaign.

Jones has for months requested Tuberville join him in a debate, but Tuberville has declined.

“AUCR takes great pleasure in coming together with AUCD to co-host the Alabama Senate candidates in this forum. We are looking forward to a very informative and constructive event,” said Lydia Maxwell, president of the College Republicans at Auburn University.

Dr. Ryan Williamson, assistant professor of political science, is to emcee the forum, which will be open to all Auburn University students in the Mell Classroom Building at 6 p.m., according to a press release from the College Democrats at Auburn University.

Students will be permitted 30 seconds to ask a question of either candidate, and each candidate will have two minutes to answer, according to the release.

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Capacity at the forum will be limited and precautions taken due to COVID-19. Any student with an Auburn ID is welcome and attendance will be first come, first served.

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National

Vote on Amy Coney Barrett confirmation could come as early as today

The final Senate vote on her confirmation is expected to come Monday evening.

Brandon Moseley

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Judge Amy Coney Barrett during her confirmation hearings in the U.S. Senate Judiciary Committee. (VIA CSPAN)

Republicans in the Senate on Sunday voted to end debate on the confirmation of Amy Coney Barrett as a United States Supreme Court justice. The final Senate vote on her confirmation is expected to come Monday evening.

Sen. Richard Shelby, R-Alabama, voted to cut off debate and advance Barrett’s confirmation. The Republican Senate majority voted to end debate on the confirmation of Barrett on a 51 to 48 vote. The move means that Senate Majority Leader Mitch McConnell, R-Kentucky, is likely to put forward the vote on Barrett’s confirmation sometime Monday.

Democrats continue to filibuster and use the Senate’s rules to delay the vote as long as possible, but it appears that Republicans have enough votes to confirm Barrett to the court.

“After speaking with Judge Barrett, I am confident that she is the right choice to serve on the Supreme Court,” Shelby said. “Judge Barrett is exceptionally qualified for this role and maintains strong conservative values and a deep commitment to our Constitution.”

U.S. Sen. Doug Jones, D-Alabama, voted with his party and voted “no” on moving forward on Barrett’s confirmation. Jones said after Justice Ruth Bader Ginsburg died that he would not support any Trump nominee before the Nov. 3 general election.

Jones did not speak with Barrett and said to reporters that he has not watched any of Barrett’s confirmation hearings.

Barrett is a Notre Dame graduate and instructor. She currently serves on the Seventh Circuit Court of Appeals. She was appointed by Trump in 2017. After graduating from law school, Barrett clerked for D.C. Circuit Judge Laurence Silberman and for Supreme Court Justice Antonin Scalia.

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Barrett practiced both trial and appellate litigation in Washington D.C. at Miller, Cassidy, Larroca & Lewin, and at Baker Botts. She worked for more than 15 years in academia, shaping the next generation of legal minds and supporting the professional development of her students, before being appointed to the federal judiciary by Trump.

Republicans, including Coach Tommy Tuberville, have been very critical of Jones for his refusal to support Barrett and his “no” vote on the confirmation of Justice Brett Kavanaugh. Tuberville is challenging Jones in the Nov. 3 general election.

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