March 20, 2020

Governors warn states' health care systems are nearing capacity

Daily Briefing

    California Gov. Gavin Newsom (D) on Thursday ordered the first statewide lockdown in the country in hopes of stemming the spread of the new coronavirus, as governors throughout the United States warned that their states' health systems are quickly nearing capacity.

    Webinar Monday: How to support frontline staff amid the coronavirus pandemic

    The governors' warnings came as Senate Republicans unveiled a $1 trillion economic stimulus proposal that calls for sending $1,200 to every American.

    US sees spike of confirmed COVID-19 cases

    The United States saw its first COVID-19 case in late January. Since then, the country's number of reported cases of COVID-19 have been on the rise, and have particularly surged over the past two weeks as more diagnostic tests for the disease became available.

    As of Friday morning, state and federal officials had reported 12,392 cases of COVID-19—up from 5,881 reported cases on Wednesday. Officials as of Friday morning also had reported 195 deaths linked to the new coronavirus in the United States, up from 107 on Wednesday.

    California implements first statewide lockdown

    The rising number of COVID-19 cases has prompted federal, state, and local officials to implement strict measures intended to contain the virus' spread. For instance, many states have temporarily closed schools and set limits on social gatherings. Some states have ordered bars and dining establishments to restrict their services to carry-out and delivery and have ordered entertainment, recreational, and retail facilities to close down completely.

    Thursday night, Newsom issued an executive order making the state the first in the country to implement a statewide lockdown to prevent the new coronavirus' spread. The order, which Newsom said will remain "in place until further notice," requires all California residents to remain in their homes unless they are using essential services, seeking health care, or caring for a friend or relative. The order also permits California residents to take part in outdoor activities such as walking as long as they practice social distancing, meaning they keep six feet apart from individuals who don't live in their households.

    Newsom's order also requires all non-essential businesses in the state to close. The order permits banks, convenience stores, farmers markets, food banks, gas stations, grocery stores, laundromats/laundry services, pharmacies, and restaurants offering only carry-out and delivery services to remain open. Essential local and state government, law enforcement, and health care services also will continue operating, as well as businesses that fall under the 16 critical infrastructure sectors designated by the federal government.

    According to the Los Angeles Times, entities and individuals that violate the order could be charged with a misdemeanor offense.

    Governors warn of strained health systems as hospitals ask Congress for $100B in funding

    The order came after Newsom and governors from other states warned that their states' health care systems are quickly nearing capacity.

    Newsom projected that 25.5 million California residents, which is about 56% of the state's population, could have COVID-19 within eight weeks without strict measures to mitigate the new coronavirus' spread. Such a surge in COVID-19 patients would require almost 20,000 more hospital beds than the state is able to provide, Reuters reports.

    Newsom asked Congress to allocate $1 billion to California to support the state's COVID-19 response and requested that the Department of Defense deploy the Navy's hospital ship Mercy to the Port of Los Angeles.

    During a teleconference with President Trump and Vice President Pence on Thursday, Louisiana Gov. John Bel Edwards (D) said demand for care in the state could exceed its health care system's capacity within one week.

    Maryland Gov. Larry Hogan (R), who chairs the National Governors Association, called on greater coordination on the country's response to COVID-19. "We need all levels of government working together to get through this crisis," he said.

    Separately, major health care industry groups—including the American Hospital Association, the American Medical Association, and the American Nurses Association—on Thursday sent a letter to congressional leaders asking lawmakers to provide the industry with $100 billion in funding to help the industry handle increasing demands related to the United States' COVID-19 epidemic. "It is clear that the expenses associated with responding to COVID-19 will be extraordinary," the groups wrote.

    McConnell unveils $1T stimulus proposal

    Meanwhile, Senate Majority Mitch McConnell (R-Ky.) on Thursday unveiled a more than $1 trillion economic stimulus package that includes some key health care provisions and would provide cash payments to Americans and funding for businesses in an effort to curb the economic effects of the global COVID-19 pandemic.

    The proposal is considered the third step in Congress' three-step legislative plan to address the effects of the pandemic in the United States. According to Axios, the three-step plan would constitute "one of the largest and most expensive stimulus packages in American history."

    The proposal includes provisions intended to expand testing for COVID-19, encourage the development of new vaccines and treatments for the disease, and increase the health care workforce.

    The proposal would provide $1.32 billion in supplemental funding for community health centers for prevention, diagnostic, and treatment efforts related to COVID-19; create a 15% add-on payment for hospitals treating inpatients with COVID-19; allow the HHS secretary to create and implement a new payment regulation for rural and federally qualified health centers that provide telehealth services to certain patients; and loosen certain telehealth restrictions.

    Further, the proposal would temporarily suspend requirements that home dialysis patients see their physicians in person and would suspend Medicare sequester cuts from May 1 to Dec. 31, though it would extend the sequester cuts for a year past their current end date.

    In addition, the federal government under the proposal would provide direct payments of between $600 and $1,200 to individual Americans with annual incomes of $75,000 or less and between $1,200 and $2,400 for eligible married couples with a combined annual income of $150,000 or less. The federal government would base the payments on the income levels, marital status, and number of children reported in Americans' 2018 tax filings. The government also would provide qualifying Americans with direct payments of $500 for each of their children.

    The federal government also would provide direct payments to individuals and married couples with annual incomes above the $75,000 and $150,000 thresholds, but those payments would be reduced by $5 for every $100 in income above the threshold. That means an individual with an annual income of $99,000 or more and married couples with a combined annual income of $198,000 or more would not qualify for any payments.

    In addition, the proposal would extend this year's April 15 tax filing deadline to July 15 and waive penalties on coronavirus-related early withdrawals of up to $100,000 from retirement accounts. The proposal also would create flexibilities related to student loans and college work-study programs and calls for loan guarantees totaling $8 billion for cargo air carries, $50 billion for passenger air carriers, $150 billion for other large businesses, and $300 billion for small businesses.

    According to the New York Times, the proposal would alter a provision enacted earlier this week that requires small businesses to provide workers affected by COVID-19 with paid leave by limiting the amount employers must pay workers to $200 per day (Owens, "Vitals," Axios, 3/20; Smith et al., New York Times, 3/20; WGAL8, 3/20; Perano, Axios, 3/19; Luna, Los Angeles Times, 3/19; Whitcomb/Gorman, Reuters, 3/19; Deslatte/White, Associated Press, 3/20; Stancati/Sylvers, Wall Street Journal, 3/19; Herman, Axios, 3/19; Treene, Axios, 3/19; Cohrs/Kim Cohen, Modern Healthcare, 3/19; Cowan/Morgan, Reuters, 3/19; Sullivan, New York Times, 3/19).

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