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Fall 2020 PIERCE COUNTY MEDICAL SOCIETY

BULLET N Serving Our Members and Community Since 1888

Inside this Edition

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President’s Page In Memoriam: Doug Jackman Meet Our New Executive Director TPCHD: Flu in the Time of COVID

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Cure for the Common Cold? PCPA Seeks Volunteers Annual Holiday Sharing Card Campaign PCMS 2020 Virtual Annal Meeting

Visit us at www.pcmswa.or g

Table of Contents PCMS Officers/Trustees

PIERCE COUNTY MEDICAL SOCIETY

BULLET N Serving Our Members and Community Since 1888

A. Alex Mohit, MD, PhD, President Ann Goetcheus Gehl, MD, President-Elect Aaron Pace, MD, Past President Dina C. Titova, MD, PhD, Vice President Courtney M. Kennel, DO, Secretary/Tresurer Julian S. Arroyo, MD H. Matt Davis, MD Irene Grias, DO Christine L. Hammer, MD C. Blake Perry, MD Nicholas Rajacich, MD Camille P. Samujh, DO, MPH

PCMS Foundation 3

Presidency Reinvented

In Memoriam: Doug Jackman

Meet Our New Executive Director

Annual Holiday Sharing Card Campaign

Cure for the Common Cold?

TPCHD: Flu in the Time of COVID

7 Major Downsides if the ACA is Overturned by the Supreme Court

PC Project Access Seeking Volunteers

Simple Ways to Beat Zoom Fatigue

Biden Victory: What it Means for COVID, Healthcare

PCMS 2020 Virtual Annual Meeting

Cover photo: “Red, Yellow & Orange” by Lance2, www.rgbstock.com

Charles Weatherby, MD, President Lawrence A. Larson, DO, Vice President Mark S. Grubb, MD Mary Eversole, Secretary

Staff Executive Director: Mary Eversole Membership Coordinator: Tanya McClain

The Bulletin

is published quarterly by PCMS. Contact Tanya McClain regarding deadlines for submitting articles and advertisements: tanya@pcmswa.org or 253-572-3667.

The Bulletin

is dedicated to the art, science and delivery of medicine and the betterment of the health and medical welfare of the community. The opinions herein are those of the individual contributors and do not necessarily reflect the official position of PCMS. Acceptance of advertising in no way constitutes professional approval or endorsement of products or services advertised. The Bulletin reserves the right to reject any advertising. Managing Editor: Mary Eversole Editorial Committee: PCMS Board of Directors Advertising Information: 253-572-3667; tanya@pcmswa.org

223 Tacoma Avenue South, Tacoma, WA 98402 Phone (253) 572-3667 Fax (253) 572-2470 Email pcms@pcmswa.org

PIERCE COUNTY MEDICAL SOCIETY

President ’s Page

Presidency Reinvented A. Alex Mohit, MD, PhD

o say that this past year has been difficult, would be a huge understatement. And we at PCMS have endured an especially difficult year. In addition to the issues that we have all jointly shared in the medical community, such as the COVID pandemic and accompanying economic hardships, the Society’s Executive Director, Bruce Ehrle sadly passed away unexpectedly at the beginning of the year. Bruce played a central role in PCMS’ underlying mission of advocacy, having been a Political Lobbyist in his past profession.

the Society. During the interviews, each of the candidates asked the Board about our vision for the role of PCMS in the future. Among the many opinions voiced, it became clear that we needed to refocus our efforts to include programs and initiatives that appeal particularly to younger physicians, many of whom come into Pierce County just after residency or fellowship, or after being hospital employed. We also strongly agreed on the importance of advocating for physicians and other Healthcare Providers to our Local, State and Federal Law Makers.

Naturally, as the incoming president, I was genuinely concerned about how we would proceed as an organi- As my year as PCMS President ends, I reflect on my initial zation without our well-liked and knowledgeable Exec- goals and plans for my tenure. I began the year hoping utive Director. However, the to promote physician wellBoard of Trustees as well being as a central theme ”...it became clear that we needed to refocus our as a few of the Past PCMS during my term. Howevefforts to include programs and initiatives that appeal Presidents stepped up to er, the COVID Pandemic help me formulate an inforced me to put many of particularly to younger physicians...also advocating for terim plan. I can still see all these plans on hold to fophysicians and other Healthcare Providers to our of us gathered in a Tacoma cus on the more immediate Local, State and Federal Law Makers.” General Conference Room needs of the Society and late at night with heavy the Pierce County Medical hearts about Bruce’s untimely death, formulating a plan Community at large. Not surprisingly during this crisis, to keep the Society moving forward. Sue Asher, PCMS there has been a great deal of camaraderie, as well as Executive Director prior to Bruce, graciously came out sharing of information amongst physicians and other of retirement to take over until we could find a perma- healthcare workers. It is through all this activity that I nent replacement. Together the Board, along with Sue, realize how much happier I and my colleagues on the sifted through the many very qualified candidates. And Board of Trustees are when working closely together. It through multiple weekly Zoom meetings, we were able is this sense of belonging and solidarity that is essential to select a candidate that not only shares our vision at in my happiness and fulfillment as a physician. I would PCMS, but also has the necessary skills and knowledge, not be surprised if this sentiment is shared by most of to lead us through uncertain times. Mary Eversole joined my colleagues. us in September as our new Executive Director and has been hard at work ensuring our legacy and mission. It has been a wonderful learning experience and great honor to serve as the President of PCMS this past year. I The Executive Director Candidate Interviews caused the would like to thank my colleagues on the Board of TrustBoard of Trustees to look at our goals for the future of ees that helped make it meaningful too.

FALL 2020

In Memoria m

Douglas R. Jackman October 22, 1935 - August 23, 2020

ouglas R. Jackman, 84, of Fort Collins passed August 23, 2020. He was born and raised in Igloo, South Dakota, the youngest son of Lon and Clara Jackman. He graduated with a Bachelor in History at Chadron State College in Nebraska. Prior to attending university he proudly served three years in the United States Marine Corp.

In 1967 Douglas married Connie Carson at the Swedish Methodist Church in Batavia, Illinois. They had two children, Susan and Scott and resided primarily in Gig Harbor, Washington. In 2001, Doug and Connie moved to Fort Collins where they have lived ever since. Douglas spent much of his career working as the Director of the Pierce County Medical Society; while working for the Medical Society he was recognized by his peers for his valuable contribution to the health and welfare of the community. He was a member of the Tacoma Rotary Club. He enjoyed giving back to his community; he delivered meals to Fort Collins residents through the Meals on Wheels program. He also volunteered for Poudre Wilderness as a hiking trail ambassador. Doug enjoyed sharing his love of the outdoors; he was an avid birder, loved bicycle touring and hiking. Doug was an enthusiastic runner and completed numerous marathons. He leaves his beloved wife of 53 years, Connie; his son Scott and Scott’s wife Lara with their two daughters Alyssa and Grace of Breckenridge; his daughter Susan and her two sons Daniel and Erik of Oslo, Norway. He was predeceased by his twin sister Donna Rose and his three brothers Lon, Bruce and Gordon. Doug’s kind and compassionate personality along with his friendly smile will be greatly missed by all. A reception for family and friends will be held on Friday, August 28th from 2 to 4 pm at Allnutt Drake Chapel located in Fort Collins. Memorial gifts in Douglas’ memory may be made to the Food Bank for Larimer County. Reprinted from Dignity Memorial

PIERCE COUNTY MEDICAL SOCIETY

E xecutive Director Report

Meet Our New Executive Director Mary Eversole

After an extensive search, we are excited to welcome Mary Eversole as PCMS’ new Executive Director

ary started Tuesday, September 1 and has rolled up her sleeves getting to know the organization and connecting with the organized medicine community by phone and Zoom, of course. A long-time Washington resident and graduate of Seattle University, she is returning home after nine years on the east coast.

“I am honored to help the passionate leaders and members of the Pierce County Medical Society achieve their vision for the future of the physician and physician assistant community,” said Eversole. Mary moves to PCMS from her most recent position as the Executive Director of the Vermont Insurance Agents Association in Williston, VT and she spent ﬁve years at the World Vision in various positions including External Relations Director for advocacy, major donor fundraising, and national events. “Mary brings abundant experience as an association leader and exceptional knowledge of grassroots advocacy,” said PCMS President Alex Mohit, MD, PhD. “Her inclusive leadership style will serve us well as we navigate through this once-in-a-century public health crisis and beyond.”

Mary’s Rapid-Fire Q&A: 1. What is the ﬁrst thing you want to do when life gets back to normal? Seeing friends, I have not been able to visit outside of my immediate “pod” since moving back home. 2. Are you a dog or cat person? Unequivocally a dog person. 3. Do you prefer beaches or mountains? Beaches! 4. Where is your favorite place in the world? That is a tie. Avalon, New Jersey where I summered as a child and St. Francis’ Hermitage in Assisi, Italy. It is the most peaceful place I have ever been too.

5. What is your favorite holiday movie? My top pick would be A Christmas Story. Elf is a close second. 6. What is the last book you read? “The Guardians” by John Grisham. 7. Is there anything else you want people to know? I am looking forward to getting to meet members in person and gathering as a community. We will come back big when we do! In the meantime, I am glad to connect with members by phone, email and Zoom.

FALL 2020

PIERCE COUNTY MEDICAL SOCIETY

Benefiting Pierce County Non-Profits Thanks to your generosity over $11,000 was raised last year from the Pierce County Medical Society Foundation Holiday Sharing Card and those funds were awarded to local organizations last month. The needs of Pierce County Non-Profits remains high to serve those in need. Your tax-deductible donation will make a difference! watch your mail box for information on how to participate in this year's Holiday Sharing Card Campaign! Donate anytime to the PCMS Foundation Mail your tax deductible donation by check to : PCMS Foundation 223 Tacoma Ave S Tacoma, WA 98402

promoting good health for all citizens of Pierce County FALL 2020

Cure for the Common Cold? No, not exactly, but according to a published study led by Dr. James Lenhart of Community Health Care in Pierce County, WA cold frequency and duration can be shortened considerably. The common cold is categorized as an upper respiratory tract infection with symptoms including runny nose, cough, headache, body aches and sore throat. The average James Lenhart, MD adult in the U.S. has 2 to 4 colds per year. Each cold lasts from 5 to 7 days. A common cold can result in the loss of 8-9 work hours. According to one study, those lost hours translate into a total economic loss of $25 billion per year! Dr. Lenhart, working with colleagues at Community Health Care and the University of Washington Institute of Translational Health Sciences, devised a micronutrient tablet containing vitamins and minerals known to boost the immune system - vitamins A, D, C, E, B6, B12, folic acid, zinc, selenium, and copper - to be taken daily. Study participants took the supplement over the course of two cold seasons and included non-smoking, males and females, ranging in ages from 18-65. Patients were randomly assigned to take either the micronutrient tablets or a placebo.

The results showed, that for the patient group taking the supplement, the odds of getting a cold were 0.74 times lower and revealed significantly lower frequency and duration of cough and runny nose, two symptoms known to spread common colds. This shortened frequency and duration of symptoms should translate into significant productivity gains during the “cold season” and a lot less misery on the part of the cold sufferers. Community Health Care is a 501(c)(3) non-profit health care system comprising 5 health care centers and 1 school-based health care center located across Pierce County, WA. This study was published in PLOS ONE (a nonprofit, Open Access health sciences journal empowering researchers to accelerate progress in science and medicine by leading transformation in research communication). For more information and the full published article on Dr. Lenhart’s study, go to this link: https://journals.plos.org/ plosone/article?id=10.1371/journal.pone.0237491 Submitted by: Cathy Hall, Marketing and Development Coordinator, Community Health Care, Tacoma WA, Office: (253) 7221508 Cell: (253) 988-1913

Bulletin Submissions If you have a clinical best practice to share with your colleagues, a success story about individual physicians or PAs or a health system, or news about health care innovation taking place in Pierce County that you would like considered for inclusion in an upcoming edition of the PCMS Bulletin, please send your submission to Mary Eversole at mary@pcmswa.org.

PIERCE COUNTY MEDICAL SOCIETY

The Health Status of Pier ce Count y

Flu in the Time of COVID Anthony Chen, MD, MPH

OVID-19 remains a primary focus at Tacoma-Pierce County Health Department. But efforts to “ﬁght the ﬂu, too” continue to show positive strides in helping protect the community.

Vaccination is essential. Vaccination continues to be the most effective influenza prevention tool. Last season in the United States, influenza vaccine was an estimated 45% effective overall in preventing medically attended, lab-confirmed influenza. Vaccination provided substantial protection (an estimated 55%) among children age 6 months to 17 years. Everyone age 6 months or older without contraindications should get vaccine every year. It is best to vaccinate early in the season, before influenza is active in the community. Never miss an opportunity to vaccinate. Continue offering vaccine into spring, as long as unexpired vaccine is available. To increase access to vaccination, we are partnering with MultiCare Health System and Mary Bridge Children’s Hospital to host free drive-thru flu shot events throughout Pierce County this fall. As of Oct. 29, we vaccinated 4,141 people at 7 events. In an optional post-vaccine survey, 527 people indicated they don’t usually get a flu shot but did get one this year. Influenza activity is low this season, so far. Non-pharmaceutical interventions that slow the spread of COVID-19—physical distancing, masking, handwashing, reduced travel—also slow the spread of influenza. These efforts likely contributed to the uneventful influenza season in the southern hemisphere this year, one of the mildest on record. Our influenza season in Pierce County is also off to a mild start. Of 84,201 total visits to emergency departments or urgent cares Oct. 1-24, only 444 (0.5%) were for influenza-like illness (ILI). Local hospitals admitted only 6 patients with ILI. No long-term care reported an ILI outbreak, and no provider reported an influenza death. While influenza activity is low locally, regionally and nationally, we must not be complacent. Influenza is unpredictable. High influenza activity coupled with a surge in COVID-19 cases could overwhelm our healthcare systems.

Like COVID-19, influenza is a serious respiratory illness. We need your help to encourage patients to take influenza seriously. It is not just a bad cold; it is a serious respiratory illness. Each year in Washington, influenza causes hundreds of deaths and thousands of hospitalizations. Last season, 14 Pierce County residents—including 2 children—died from influenza. Influenza and COVID-19 frequently have similar symptoms. Testing can help distinguish between the viruses. However, a positive test for one virus does not necessarily rule out infection with the other. We do not yet have good research or experience with influenza/COVID-19 coinfection. Theoretically, a person infected with both viruses could experience very severe illness. COVID-19 rates are high in Pierce County. While influenza and COVID-19 are both serious illnesses, COVID-19 spreads more easily and has a higher death rate. And unlike influenza, we are experiencing high rates of COVID-19. As of Nov. 5, we had 10,724 total cases and 197 deaths. Our 14-day case rate per 100,000 population was 156.1, with an average of 100.6 new cases daily over the last 14 days. While the elderly have experienced the highest death rates, 4 people under the age of 40 have died of COVID-19 . COVID-19 vaccine is imminent. COVID-19 and influenza are a double-threat to our most vulnerable. Influenza vaccination and nonpharmaceutical interventions help keep our community safe and keep patients from overwhelming our healthcare systems. And, hope is on the horizon for a COVID-19 vaccine. We will not promote a vaccine unless we determine it to be safe and effective. We expect to see doses for front line healthcare workers in Pierce County before the end of the year. We are already preparing for distribution of potential vaccines. To learn about taking part in the COVID-19 Vaccination Program, go to tpchd.org/preparing-for-covid-19-vaccine. Share our public facing flu page for updates, vaccine resources and more: tpchd.org/flu.

FALL 2020

PIERCE COUNTY MEDICAL SOCIETY

FALL 2020

7 major downsides if the ACA is overturned by Supreme Court

by Andis Robeznieks, Senior News Writer, AMA

When the U.S. Supreme Court hears arguments in the case of California v. Texas on Nov. 10, it will consider legal points pertaining to whether the Affordable Care Act (ACA) can remain in force without the individual mandate. What really is at stake, however, is health insurance coverage for more than 20 million people. The issue before the court is whether Congress intended to invalidate the entire ACA when it zeroed-out the tax for failure to comply with the law’s individual mandate to purchase health insurance and if the district court acted correctly when it ruled the ACA was invalid in its entirety without the tax. If the high court upholds the district-court ruling, the following would happen: • Patients would no longer have guaranteed coverage for pre-existing conditions, including COVID-19. • Young adults would no longer have coverage under their parents’ health insurance plan until age 26. • Insurers would be allowed to generate higher proﬁts and provide even less coverage for patient care. • 100% coverage for certain preventive services would cease. • Individual marketplace and premium subsidies based on income would be eliminated. • Medicaid eligibility expansion would end, as would federal funding for Medicaid expansion.

reinstated, leading to more bankruptcies due to health care costs. While the court originally declared the ACA constitutional in 2012, three new justices have been added to the court since then, most recently Amy Coney Barrett, who was appointed to replace the late Ruth Bader Ginsburg. Last December, the 5th U.S. Circuit Court of Appeals agreed partially with the district court. It ruled that the individual mandate was unconstitutional but sent the case back to the district court for further analysis on whether the mandate can be severed from the rest of the ACA. Earlier this year, 20 leading physician organizations joined the AMA in ﬁling an amicus brief arguing why the Supreme Court should declare the ACA constitutional with or without the tax. The brief also explains why it would be unwise to strike down a law “serving as the backbone of the safety net for the millions of Americans facing sudden unemployment” due to the COVID-19 pandemic. “Invalidating provisions that have expanded access to health insurance coverage such as the guaranteed-issue and community rating provisions—or the entire ACA—would have a devastating impact on doctors, patients, and the American health care system in normal times,” the amicus brief says. “However, striking down the ACA at a time when the system is struggling to respond to a pandemic ... would be a self-inﬂicted wound that could take decades to heal.” The ruling is expected to be issued in June 2021.

• Annual and lifetime caps on coverage could be

PIERCE COUNTY MEDICAL SOCIETY

Reprinted from JAMA Network

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FALL 2020

PIERCE COUNTY MEDICAL SOCIETY

Simple ways to beat Zoom Fatigue How many Zoom meetings do you participate in each week? Probably more than you used to. The use of Zoom and other video conferencing technology has skyrocketed during the global pandemic to help prevent the spread of COVID-19 and as many businesses adapt to remote work. Unfortunately, all those video calls can lead to “Zoom fatigue.” Studies show that an increasing share of remote workers have discovered that video conferencing can be both challenging and draining — even for those who are not huge fans of meetings of the in-person variety. Why? Here are a few reasons why you might find Zoom meetings so tiring. • You cannot take breaks Many busy professionals face back-to-back Zoom meetings each day — and as a result are sitting down and staring at a computer screen for long stretches of time. In a Zoom meeting, you feel compelled to keep your attention on the faces on the screen. But nonstop screen time is tough on both your body and eyes. With in-person meetings, you get to move around a bit and your eyes get a rest from screens. Not so with back-to-back Zoom meetings. Take regular breaks using the “20-20-20” rule: every 20 minutes, shift your eyes to look at an object at least 20 feet away for at least 20 seconds. Also, try to schedule Zoom meetings with more wiggle room in between so that you can look away from your computer, stretch or even take a short walk.

— and do a much better job — if you focus on one task at a time. The next time you are on a video call, close any tabs or programs that might distract you, put your phone away, and stay tuned in. • You are looking at yourself In face to face meetings, you do not see your own face while you are talking, of course. Not so with Zoom. The problem: Several studies show that many people do not like seeing themselves for long periods on the screen and many people get distracted by their own face in Zoom meetings. Here’s something to try: At the start of your next Zoom meeting, double check that your appearance is in order and then hide yourself from view. Others in the meeting can still see you, but you will no longer see your face on the screen.

• You are multitasking It is easy to minimize a Zoom call and try to get other work done. The problem with this approach is that you are only giving half of your attention to each task. You are not getting as much done as you think — especially quality work that requires concentration — and you are not paying attention to either the meeting or the task as you should. It is simple: Research shows that human beings are not equipped to effectively multitask, even though most of us continue to try. Studies show that you will get more done

• You are switching over almost exclusively to video communication During the pandemic, many of us have not just replaced in-person meetings with Zoom — we began hopping in a Zoom room for discussions that used to take place over phone or e-mail. That is a recipe for video burnout. Do not treat video as a default method of communication. Phone calls often work well and some instances, even better than a video conference.

FALL 2020

Biden Victory: What It Means for COVID, Healthcare by Nick Tate - Medscape - Nov 07, 2020 Joe Biden's victory sets the stage for healthcare to become a high-profile priority of his presidency. The former vice president has sketched out a big health agenda: ramping up the federal response to COVID-19, boosting the Affordable Care Act, creating a new "public option" to cover uninsured Americans, and expanding Medicare and Medicaid. But the president-elect's long to-do list on health is likely to face significant roadblocks in Congress and the courts, experts say. For instance, Biden's ambitious proposals on COVID-19 — including his recent call for a national mask mandate — could be waylaid by legal challenges and run into political hurdles on Capitol Hill, where he may face a divided Congress. Joseph Antos, PhD, a health policy expert with the conservative American Enterprise Institute, predicts Biden will encounter the same type of congressional "gridlock situation" that President Barack Obama ran into during his second term. "We have a situation that has been like this for a very, very long time — lack of cooperation, lack of recognition that either party is capable of rising above their own electoral views to deal with problems that the country actually has." Antos also suggests that Biden may also face enormous political pressure to address the economic fallout from the coronavirus,including record unemployment and business closures, before anything else. "I think it's really going to be efforts that are intended to promote economic development and promote the economy," he says. In addition, Biden's plans to expand Obamacare might face a new challenge from the Supreme Court in the year ahead. This month, the high court will take up a new case seeking to overturn the law. Even so, experts say Biden's plans on COVID-19 and expanding healthcare are likely to define his tenure in the White House as a central focus of his presidency.

PIERCE COUNTY MEDICAL SOCIETY

President-Elect Joe Biden

"Healthcare will be at the very top of the list of the president's priorities," says Sabrina Corlette, JD, co-director of the Center on Health Insurance Reforms at Georgetown University's McCourt School of Public Policy. "I do think, however, that the administration is going to be very preoccupied with the response to COVID-19 and the economic fallout...particularly in the first year." Here's a closer look at what we can expect from a Biden presidency: COVID-19: Federalizing Response Efforts Biden will move to federalize the response to COVID-19. He has said he will take back major responsibilities from the states —such as setting national policies on mask wearing, social distancing, and the reopening of schools and businesses, based on CDC guidance. In the days leading up to the election, Biden called for a national mask mandate, after waffling on the issue throughout the summer. He has said he will let public health science drive political policy. Biden is also planning to create his own task force to advise officials during the transition on managing the new surge in COVID-19 cases, vaccine safety, and protecting atrisk populations, Politico reported this week. He received a virtual briefing on the pandemic from a panel of experts as he awaited the election's outcome. "I think we will no longer have this confused and contradictory public messaging," Corlette says, "but I also think there will be humility and the recognition that the evidence continued next page

Continued from page 16... is evolving — that we don't have all the answers, but we're learning as we go."

The administration has spent some $225 million on COVID-19 testing efforts, with a particular focus on rural areas.

But national mandates on masks and social distancing will be challenging to enforce, experts say. They are also likely to face pushback from business interests, opposition from public ofﬁcials in GOP-led states, and even legal challenges.

Trump launched Operation Warp Speed to fast-track a vaccine. As part of that, the federal government has contracted with six drug companies, spending nearly $11 billion. The operation aims to provide at least 300 million doses of a coronavirus vaccine by January 2021.

Biden's ability to work with Congress — or not — may determine whether he is able to implement some of the key components of his coronavirus action plan, which includes: • Providing free COVID-19 testing for all Americans

Antos would like to see "a more sophisticated approach to social distancing" from the president-elect that takes into account the different challenges facing Americans depending on their income, work situation, and other factors during the pandemic.

• Hiring 100,000 contact tracers • Eliminating out-of-pocket expenses for coronavirus treatment • Delivering "sufficient" PPE for essential workers • Supporting science-backed vaccines and medical treatments being developed • Requiring the reopening of businesses, workplaces, and schools only after "sufficient" reductions in community transmission — under evidence-based protocols put forward by the CDC • Giving emergency paid leave for workers dislocated by the pandemic and more financial aid for workers, families, and small businesses • Shoring up safeguards to protect at-risk Americans, including older people • Boosting pay for healthcare workers on the front lines Biden has not detailed how he would pay for many of these initiatives, beyond promising to force wealthy Americans to "pay their fair share" of taxes to help. He has proposed a tax increase on Americans making more than $400,000 a year, which would require congressional approval. Antos says he expects Biden's proposed COVID-19 action plan to be virtually the same as Trump's in two areas: efforts to develop a vaccine and antiviral treatments.

"There are a lot of people in this country where working from home is ﬁne and their jobs are secure," he notes. "It's the person who used to work at a restaurant that closed, it's the line worker at a factory that has severely cut back its hours. It's basically lower-middle-class people, low-income people, middle-class people, and it's not the elite. "And the policies have not given enough consideration to the fact that their circumstances and their tradeoffs would differ from the tradeoffs of somebody who doesn't have anything to worry about economically. "So, what we need is a more supple policy [that] will give people the information they need and give them the ﬁnancial support that they also need...so they can make good decisions for themselves and their families. And we basically haven't done that." Obamacare on the Blocks? The Supreme Court's decision to take up another case seeking to overturn the Affordable Care Act could hand Biden's health agenda a major setback — and put the medical care for millions of Americans in jeopardy. On November 10, the high court will hear oral arguments on a lawsuit that would strike down all of Obamacare. A decision is not expected until next year. The court has previously upheld the 2010 law, which Biden helped usher through Congress as vice president. But the addition of right-leaning Supreme Court Justice Amy Coney continued next page 18

FALL 2020

Continued from page 17... Barrett to the bench last month gives the court a clear conservative majority that could mean the end of Obamacare, legal experts say. Republicans have opposed the law since its passage, but they have been unable to muster the votes to repeal it, or to pass an alternative. Antos, from the American Enterprise Institute, notes conservatives believe the law has increased costs for healthcare and insurance over the past decade, in part because of its protections for Americans with preexisting conditions and requiring insurers to provide comprehensive "gold-plated" policies. "It's driven up costs, offers plans that are not very strong, put high-risk folks into the same [insurance pool], which has increased costs for everyone, the employer mandate...these are all the reasons," he says. The Supreme Court isn't expected to deliver a decision on the Affordable Care Act before the middle of next year. But the uncertainty will likely push back Biden's proposals to expand on the law. Overturning Obamacare would have huge impacts on millions of Americans: • As many as 133 million Americans — roughly half the US population — with preexisting conditions could find it harder, if not impossible, to find affordable health insurance. That figure does not include Americans infected with COVID-19. • About 165 million who require expensive treatments — for cancer and other conditions — would no longer be protected from huge costs for care by federal caps on out-of-pocket expenditures the Affordable Care Act requires. • An estimated 21 million who now buy insurance through the Obamacare marketplaces could lose their coverage.

• Millions of people who use Medicare could face higher costs. • Federal subsidies for lower-income Americans to buy policies would disappear. Throughout the campaign, Biden repeatedly stressed the need to preserve the law's provision barring insurance companies from refusing coverage for Americans with preexisting conditions, such as diabetes, cancer, and heart disease. It also outlaws charging higher premiums on the basis of health status, age, or gender. Biden has also pledged to bolster the law as president. He has proposed a variety of add-ons to the Affordable Care Act he says will "insure more than an estimated 97% of Americans," according to the Biden campaign site. Biden's proposals include offering larger federal subsidies to help low- and middle-income Americans pay for policies purchased through Obamacare insurance marketplaces. The boldest of Biden's proposals is the creation of a "public option" for insurance — a Medicare-like program that small businesses and individuals could choose if they do not have coverage, cannot afford it, or don't like their employer-based coverage. It would also automatically enroll millions of uninsured Americans living in the 14 states that have not expanded Medicaid, which covers low-income people. But such a plan would require congressional approval — including a "super majority" of 60 Senate votes to block a likely GOP filibuster. That will be a significant challenge Biden will have to overcome, with Congress so evenly divided. The White House would also have to defeat heavy lobbying from some of the most influential industry interest groups in Washington, Corlette says.

• Another 12 million on Medicaid could ﬁnd themselves without insurance.

"I'm not even conﬁdent they would get all the Democrat votes," she says. "So, it's a going to be an uphill battle to get a public option passed."

• At least 2 million young adults ages 26 and under, now on their parents' health policies, could be kicked off.

Taken together, Biden's plans for expanding Obamacare are projected to cost $750 billion over 10 years. He has said continued next page

PIERCE COUNTY MEDICAL SOCIETY

Continued from page 18... much of that ﬁnancing would come from increasing taxes on the wealthy. That means it would likely require congressional approval, which Antos suggests is unlikely given the polarization on Capitol Hill. Medicare, Medicaid, and Drug Costs Biden has called for a host of reforms targeting Medicare, Medicaid, and rising drug costs. On Medicare, which primarily covers seniors 65 and older, Biden has proposed lowering the eligibility age from 65 to 60. That could extend Medicare to up to 20 million more Americans. On Medicaid, the healthcare safety net for low-income and disabled Americans, the president-elect supports increased federal funding to states during the current economic crisis, and potentially beyond. Medicare is likely to become a key focus of the new administration, in light of the pressures the pandemic is placing on Medicare funding. In April, Medicare's trustees said that the Part A trust fund for the program, which pays for hospital and inpatient care, could start to run dry in 2026. But those projections did not include the impact of COVID-19. Some economists have since projected that Medicare Part A could become insolvent as early as 2022. Medicare Part B, which pays for doctor and outpatient costs, is funded by general tax funding and beneﬁciary insurance premiums, so it is not in danger of drying up. Adding to those pressures is an executive order Trump signed in August temporarily deferring payroll taxes, a primary funding vehicle for Medicare and Social Security. Under these taxes, employees pay 6.2% of their earnings (on annual income up to $137,700) toward Social Security and 1.45%for Medicare taxes each pay period. Employers pay the same rate per paycheck, adding up to a combined 12.4% Social Security tax and 2.9% Medicare tax.

But to get a handle on Medicare and Medicaid funding issues, he is likely to need congressional support. Corlette and other experts say that could be a challenge while the nation remains in the grip of the coronavirus pandemic. In addition to his Medicare and Medicaid reforms, Biden has proposed several plans to lower drug prices, a subset of rising healthcare and insurance costs. U.S. spending on prescription drugs has increased nearly 42% over the past decade — from $253.1 billion in 2010 to $358.7billion in 2020 (projected) — according to the Centers for Medicare & Medicaid Services. In 2020, retail prices for 460 commonly prescribed drugs have spiked an average of 5.2%, according to new analysis by 3 Axis Advisors, a health research ﬁrm. That's more than double the projected rate of inﬂation. To control drug costs, Biden supports legislation approved by the Democratic-led House of Representatives last year that would empower Medicare to negotiate drug prices with drug companies, as private insurers do. Federal law now bars Medicare from negotiating prices on behalf of the 67.7 million Americans who use it. Drug companies and many GOP leaders argue that the current law is necessary to allow them to spend more on research and development of new medications. In addition, Biden supports the idea of lifting bans on importing drugs from foreign countries with lower costs. He also backs creating an independent review board to set price caps for new medications with no competitors, making high-quality generics more available, ending tax breaks for drug-company advertising, and limiting their leeway in raising prices. All of these proposals would likely require congressional approval and could face legal challenges in the courts. Reprinted from WebMD Health News © 2020

Biden has said he would reverse the tax cut when he takes ofﬁce.

FALL 2020

PIERCE COUNTY MEDICAL SOCIETY

VIRTUAL ANNUAL MEETING Installation of President Elect

ANN J. GOETCHEUS GEHL, MD COMMUNITY HEALTH CARE

DECEMBER 8, 2020 | 6:30 PM CONTACT THE PCMS OFFICE FOR ZOOM LINK 253-572-3667 OR tanya@pcmswa.org

This event is free and open to PCMS Members, partners and supporters.