October 15, 2020

Good morning. Don't forget to submit your dogs!

Today's word count is 1,044, or a 4-minute read.

1 big thing: How a conservative Supreme Court could save the ACA

Illustration: Annelise Capossela/Axios

Even a solidly conservative Supreme Court could find a pretty easy path to preserve most of the Affordable Care Act — if it wants to, Axios' Sam Baker writes.

The big picture: It's too early to make any predictions about what the court will do, and no ACA lawsuit is ever entirely about the law. They have all been colored by the bitter political battles surrounding the ACA.

  • Even so, a handful of factors — the specifics of this case, the court's recent precedents, even a few threads from Amy Coney Barrett's Supreme Court confirmation hearings — can at least help draw a roadmap for a conservative ruling that would leave most of the ACA intact.

How it works: There are two steps to the current ACA case. First, the justices will have to decide whether the law's individual mandate has become unconstitutional. If it has, they'll then have to decide how many other provisions have to fall along with it.

Severability is a question of congressional intent — whether Congress still would have passed the rest of a law if it knew it couldn't have the piece the courts are striking down. And conservative judges make a point of relying only on a law's text when determining congressional intent.

  • That should make the current case easy, the blue states defending the ACA argue: Congress zeroed out the mandate and left the rest of the law intact — a pretty clear sign that it intended for the rest of the law to operate in the absence of the mandate.

The other side: The red states challenging the law say the courts should instead look to Congress' belief when it passed the ACA in 2010 that the mandate was inextricably tied to protections for pre-existing conditions.

Go deeper.

2. The coronavirus is surging again

Data: The COVID Tracking Project, state health departments; Note: After a database error, Missouri has not reported cases since Oct. 10; Map: Andrew Witherspoon, Sara Wise/Axios

Coronavirus infections jumped by almost 17% over the past week as the number of new cases increased in 38 states and Washington, D.C., Sam and Axios' Andrew Witherspoon report.

Why it matters: The U.S. is headed solidly in the wrong direction — and at a dangerous time, as experts say the fall and winter will likely make the pandemic worse. They had hoped we could get cases under control before then, but that seems unrealistic.

By the numbers: The U.S. racked up an average of up 51,000 new cases per day over the past week.

  • The number of new infections rose in 38 states, spanning every region of the country.
  • Five states — Alaska, Mississippi, Montana, New Mexico and South Dakota — saw their case counts rise by over 50%.
  • The pace of new infections slowed down in only two states: Texas and Washington.

Testing also increased over the past week.

  • The U.S. is now conducting roughly 1 million tests per day, up about 6% from the week before.
  • But the increase in cases is bigger than the increase in testing, which is a sign of an actual worsening outbreak.

The big picture: The U.S. has consistently failed to control the virus, and we are failing to control it now.

  • Experts say the fall and winter will likely make things worse. If that bears out, those increases will come on top of a caseload that's already too high.

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3. Outpatient visits bounce back

Reproduced from The Commonwealth Fund; Chart: Axios Visuals

Outpatient visits have returned to their pre-pandemic levels after declining by nearly 60%, according to a new analysis by the Commonwealth Fund.

Why it matters: The massive drop-off in people seeking medical care was bad both for providers and for patients, many of whom delayed care for conditions that may have worsened.

Yes, but: Visits vary by age, provider specialty and insurance type.

  • Visits by young children still are still well below the baseline.
  • And while dermatology and adult primary care visits are substantially up, behavioral health and cardiology visits remain down.

What we're watching: Telemedicine visits initially surged, but have since dropped off. However, they're still above pre-pandemic levels, and experts predict that this may be a lasting side effect of the pandemic.

Related: As people return to their doctors, health insurers will have to start paying claims again.

  • UnitedHealth Group's profit in the third quarter dipped 10% as people sought health care at rates "more closely approaching normal," executives said on an earnings call yesterday.

4. Medicaid enrollment projected to spike

States expect Medicaid enrollment to jump by more than 8% in fiscal year 2021, according to a new KFF brief.

  • States anticipate Medicaid spending to grow by 8.4%, compared to 6.3% growth in fiscal year 2020. This growth is expected to be primarily driven by enrollment.

The big picture: The program is serving as a safety net for the millions of Americans who have lost access to their employer health insurance during the pandemic.

  • But states are already facing enormous budget shortfalls as a result of the economic downturn, and increased Medicaid costs will only make the problem worse.

Between the lines: "To reduce Medicaid spending during economic downturns, states typically turn to provider rate and benefit restrictions, however, with providers facing revenue shortfalls and enrollees facing increased health risks due to the pandemic, these methods to control costs may not be as viable," the authors write.

Go deeper: Medicaid will be a coronavirus lifeline

5. Overdose deaths spiked in early 2020

Overdose deaths increased by about 10% in the first three months of 2020, Axios' Marisa Fernandez reports.

  • Overdose deaths in rural South Dakota increased the most by 50%, from 62 to 93 fatalities.
  • Both California and Florida increased by 20%, adding about 1,000 more overdose deaths than last year.

What's next: The agency estimates the U.S. will suffer more than 75,500 drug-related deaths in 2020, surpassing last year's record.

6. Catch up quick

Illustration: Aïda Amer/Axios

First lady Melania Trump disclosed on Wednesday that her 14-year-old son, Barron Trump, also tested positive for COVID-19 in a statement detailing her experiences with the virus. Barron exhibited no symptoms and has since tested negative.

A company that makes internet-connected thermometers has shown success in predicting likely COVID-19 hot spots days or even weeks before case counts rise, Axios' Bryan Walsh reports.

University of Alabama's football coach Nick Saban and athletic director Greg Byrne said in statements Wednesday that they have tested positive for COVID-19.

French President Emmanuel Macron on Wednesday declared a state of health emergency and instated a curfew on some of the regions that have been hardest hit by the coronavirus, France 24 reports.

Italy on Wednesday reported 7,332 new positive COVID-19 tests — breaking its previous record for most infections added in a single day — while the U.K. reported nearly 20,000 new cases.