Trump Administration Files Additional Brief to Overturn the ACA

Arizona is on the list of states that wants the ACA to be repealed

Last week the federal government filed a brief asking the Supreme Court to overturn the Affordable Care Act. If successful, about 300,000 Arizonans would lose health coverage.  

Protections would be lost for more than 2.7 million Arizonans with pre-existing conditions. Insurance companies would once again be allowed to deny coverage to people who have reached their lifetime limits. 20,000 young adults in Arizona would not be allowed to remain on a parent’s health insurance plan until the age of 26.

Insurance companies would no longer be required to cover the 10 Essential Health Benefits and protections would be stripped from people with employer-based health coverage, those on a Marketplace plans, and families who use Medicaid, Medicare and/or KidsCare. 

The US Supreme Court is set to hear the California v. Texas lawsuit (that’s new name for it) in the coming months. Arizona is among the states that has signed on urging the court to overturn the ACA. You can click here to sign onto the letter urging the Attorney General to drop AZ from the list of states that wants to overturn the ACA.

The ACA has a Higher Risk of Being Overturned Than You Realize

The US Supreme Court has a different cast of characters than it did when the ACA was originally upheld back in 2012 by a 5-4 vote. Since then, Gorsuch replaced Scalia and Kavanaugh replaced Kennedy.  Both Scalia and Kennedy voted against the ACA- so not much on that score has changed.

Chief Justice Roberts voted with the majority that upheld the law.  His argument rested on the ACA’s link to the financial penalties for not having health insurance. But remember, the financial penalties for not having health insurance were removed from the IRS tax codes in the federal tax overhaul a few years ago, pulling out the structure that Roberts used in his argument.

In the 2012 Ruling, Justice Roberts wrote that: “… the Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax… because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” 

Roberts rejected the Administration’s argument that the federal government’s authority to regulate interstate commerce provides the authority needed for the ACA to be constitutional (the Court struck down that argument 5-4).

The bottom line is that the ACA, including its protections for folks with pre-existing conditions, may very well be in jeopardy if Roberts views the ACA as fundamentally different now that the financial penalties are gone.

Arizona Authorizes Crisis Standards of Care Patient Triage Protocol

Last week the ADHS announced that they’ve authorized “Crisis Standards of Care” within our hospital systems. The declaration allows for statewide triage protocols when the demand for healthcare exceeds the ability to provide care using normal standards of care.

Arizona is the only state to have made such a declaration and this is the first time it has ever been made in Arizona. See last week’s blog post to see how patients will be prioritized when Crisis Standards of Care are being used.

Here’s the document that officially activates the new crisis care standards for patient triage and prioritization. Now that we’re under the crisis standard, there are civil liability protections for healthcare providers and institutions who are following the approved Triage Protocol.

Hospitals are also urged to: 1) activate tactics identified in the Arizona Crisis Standards of Care; 2) prepare for surge; 3) limit surgeries; 4) activate hospital incident command; and 4) establish regular communication with local health jurisdiction.

These measures have become necessary because of the tremendous community spread of the virus in AZ and the resulting surge of patients into AZ hospitals.

University Modeling Team’s Update

Latest analysis shows that city/county face covering requirements may be slowing the acceleration of SARS CoV2 but hospital capacity still in peril

The week ending June 28 recorded 22,388 new Covid-19 cases, which is an 8% increase over last week’s revised tally of 20733 new cases, marking a grim 4-week period with 50–70% increases per week. However, this week’s increase looks to be about 30% from the previous week.

But don’t celebrate too much…  absolute levels of community-driven viral transmission have never been higher as evidenced by frequent daily and weekly record-setting numbers of newly reported cases.

While still reflecting enormous growth, it’s slightly less exponential suggesting that perhaps the local face covering ordinances may be showing a moderating effect on the still steep trajectory.

PCR testing capacity continues to increase but it’s not keeping pace with viral transmission as evidenced by the very high percentage of patients testing positive which was 21.8% this past week.  This figure is the worst in the nation by a wide margin and likely the highest percent positive in the world right now. 

Since the end of the stay at home order, COVID-19 hospitalization has increased 243%. Increases in general ward occupancy have been greater than increases in ICU occupancy (284% versus 140%).

Non-COVID patients are being squeezed our of hospitals as evidenced by the fact that while inpatient COVID hospitalizations are up over 250% all-cause occupancy is up 12% during that time period. This trend could be a result of non-COVID patients being triaged out of the hospital system. Continued increases in case counts are expected to drive additional hospitalizations for the foreseeable future.

Note: COVID patients are more labor intensive than typical ICU patients and therefore pose a more intense drain on provider resources.

The week ending June 21st is now the week with the largest number of reported deaths. Given that case counts are continuing to increase, a larger number of deaths in the coming weeks is expected.

Arizona State University Covid-19 Modeling and Evaluation Team – July 1 Update

The ASU Modeling and Evaluation Team updated their findings last week in their July 1 Update. provided selected findings from their July 1st update.  A pre-print of their work with specific model specifications and additional results is also available.

The team projects Arizona will reach 100% of existing hospital capacity in early-to-mid July absent further reductions in non-Covid hospitalizations or increased bed capacity.

How Has AZ Been Spending the State and Federal COVID Money?

A substantial amount of federal money has been provided to states to help with the public health responses to the pandemic. In addition, the state legislature allocated $50M to the ADHS to assist with the response.  I thought it would be interesting to provide a breakdown of how it’s been spent so far. It’s from a JLBC report. Last week, the ADHS notified the JLBC how it has spent some of that money. Here’s the dollar line item breakdown:

  • $71M for medical supplies and PPE; 

  • $10M for ventilators;

  • $9.2M for COVID-19 testing;

  • $8.2M for counties and $1.8M for tribes;

  • $8.1M for the St Luke’s surge hospital buildout;

  • $5.5M for ADHS overhead, advertising, I.T., and legal services;

  • $3.9M to expand childcare options for essential workers;

  • $2.2M to the Department of Emergency and Military Affairs;

  • $2.1M to operate the Arizona Surge Line;

  • $1.5M for serology/antibody testing;

  • $986K for lab equipment and supplies for the ADHS Lab; and

  • $452K for the Arizona “Testing Blitz”

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