Jun 19, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

Today's word count is 828, or a 3-minute read.

1 big thing: The murky rules around coronavirus testing coverage

Illustration: Aïda Amer/Axios

Some insurers' limits on coverage for coronavirus testing may push the bounds of federal law.

Why it matters: Testing people who aren't displaying symptoms is an essential part of the public health response to the coronavirus, but some insurers appear to be unwilling to pay the full cost of those tests.

The big picture: Congress passed legislation earlier this year requiring insurers to cover all coronavirus tests — including diagnostic and antibody — without cost sharing, and without "prior authorization or other medical management requirements."

  • Implementing guidance issued by the Departments of Labor, Health and Human Services and the Treasury added more detail, stating that tests "must be covered without cost sharing when medically appropriate for the individual, as determined by the individual’s attending healthcare provider in accordance with accepted standards of current medical practice."

Where it stands: Some insurers' policies specifically say that a patient must be showing symptoms in order to get tested without cost-sharing. That may be too restrictive.

  • "All tests, full stop, must be free without cost-sharing," a Senate aide who helped draft the coverage requirements told me. 
  • "I don't think it's open and shut ... but I think the stronger read of the statute and the FAQ is that they don't have the authority to limit it to tests that are medically necessary," said Christen Linke Young of the USC-Brookings Schaeffer Initiative for Health Policy.

The other side: The federal guidance document implementing Congress' requirements leaves room for insurers to impose some hurdles — such as requiring that tests be ordered by a health care provider.

  • "It is possible to interpret the language in [the legislation] to encompass broad surveillance-type testing, but that's not the federal government's position today, as I read it," said Sabrina Corlette, co-director of Georgetown's Center on Health Insurance Reforms.

Go deeper.

2. Racial disparities in clinical trials

Illustration: Eniola Odetunde/Axios

Black Americans are consistently underrepresented in clinical trials for diseases ranging from diabetes to heart disease to different cancers, despite being disproportionately affected by many of them, Axios' Eileen Drage O'Reilly and Alison Snyder report.

Why it matters: The COVID-19 pandemic is taking an unequal toll on underrepresented communities.

  • As researchers race to develop treatments, having diverse trial participants is key to creating safe and effective drugs and to understanding how socioeconomic and environmental factors influence diagnosis, treatment and outcome.

Case in point: This week, a steroid was hailed as a "breakthrough" treatment and the first to save lives of some people with COVID-19. The preliminary results from the University of Oxford found dexamethasone reduced deaths by one-third in ventilated patients.

  • Yes, but: There also is some evidence that African Americans may respond differently to glucocorticoids like dexamethasone, such as having a diminished response, says Namandjé Bumpus, professor and chair of the pharmacology department at Johns Hopkins University School of Medicine.
  • The study authors did not respond to requests for information about the racial and ethnic makeup of the 2,104 randomized patients in the study, which has not been peer reviewed or distributed as a preprint.
  • Meanwhile, the University of Pittsburgh Medical Center says its separate trial testing multiple COVID-19 treatments (including corticosteroids similar to dexamethasone) has about 50% African American patients and roughly 50% female participants enrolled so far.

Go deeper.

3. The latest in the U.S.
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

Children typically escape COVID-19's most severe complications, presenting a host of questions scientists are just starting to be able to answer, Alison and Eileen write.

President Trump said in an interview with the Wall Street Journal published Thursday that he personally thinks testing for the coronavirus is "overrated," arguing that it has led to an increase in confirmed cases in the U.S. that "makes us look bad."

Another 1.5 million Americans filed new applications for jobless benefits last week, the Labor Department said Thursday.

California on Thursday issued a statewide order requiring people to wear face coverings in public settings.

Nebraska Gov. Pete Ricketts told county governments they will not receive federal relief funds if they require people to wear masks while inside state courthouses and local government offices, the Omaha World-Herald reports.

4. The latest worldwide
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Things will never truly return to "normal" after the coronavirus. That's cause for eager anticipation, and also for dread, Axios' Dave Lawler writes.

The pandemic is not only making it harder for people in developing countries to afford food, it's making it harder to get food and supplies into those countries in the first place, Dave reports.

Britain plans to build a contact tracing app with Apple and Google after scrapping its original plans, Health Secretary Matt Hancock told reporters on Thursday. He did not give a date for when the app would be available, per the Financial Times.

CNET reports that the newly unveiled electric bus from the U.K. startup company Arrival has some features that make it suitable for the pandemic age by enabling social distancing.

5. Chris Christie's new lobbying gig

Three of New Jersey's largest tax-exempt hospital systems — Atlantic Health System, Hackensack Meridian Health and RWJBarnabas Health — have hired former Gov. Chris Christie to lobby the federal government on federal health care bailout funds and Medicare payment policies, Axios' Bob Herman reports.

Between the lines: Those three organizations have received more than $1 billion combined from the coronavirus bailout fund so far, according to data analyzed by Axios, and they oppose proposed Medicare rules that would force them to disclose negotiated prices.

Caitlin Owens