As COVID-19 cases surge across the country, Americans are being asked to hunker down for the holidays and limit large gatherings. I’m sad I won’t be hosting my usual 20-plus family members and friends, but I will be counting my blessings. Happy Thanksgiving to all of you, and I'll hold in my heart those who can’t be with their loved ones this holiday: the families of the more than 250,000 Americans who have died from COVID-19; our frontline health care workers who cared for them and are caring for people right now; essential employees manning grocery stores, factories, and fulfillment centers; those incarcerated and the families they miss; journalists working tirelessly around the clock — and everyone just dealing with this pandemic, too far away, or too far out of the bubble.
Programming note: We’ll be back after Thanksgiving, in the first week of December. (!)
Dying Without Treatment
By Adrienne Faraci, Communications Manager
Communities of color are increasingly suffering from opioid use disorder. Even as the white overdose death rate has decreased in recent years, the rate among Black, Latino, and indigenous communities has skyrocketed.
What’s Happening: Experts on drug policy cite several factors for the increase. People of color are less likely to have access to health care, making it more difficult to get medications that are the gold standard for treating opioid use disorder. Because of racial disparities in justice involvement, they are also more likely to be incarcerated in jails and prisons, where these medications are often unavailable. And communities of color often have serious structural issues to overcome, such as a lack of stable housing, food, and education, which makes recovery harder.
Bottom Line: “We have medication, we have a variety of harm reduction interventions that are demonstrated by evidence to improve outcomes for people with opioid use disorder. But unfortunately, there are significant policy failures in the U.S. — rooted in stigma — that make these services hard to access, and for communities of color, that access gap is a lot greater,” says Sarah Twardock, AV Public Health Manager.
What’s Next: Advocates and researchers are promoting legislation that expands access to treatment and decriminalizes substance use, while practitioners are speaking up to demand more resources for treatment locally and working with people on the streets to deliver services. Making it a fiscal issue as state and local governments contend with budget shortfalls amid COVID-19 is also top of mind: “If a state legislature wants to pass legislation that expands access to treatment through any of these systems, particularly the criminal justice system, they're going to have to make the argument that it's going to save money,” says Regina LaBelle of the O’Neill Institute for National and Global Health Law at Georgetown University.
Related: What a Biden administration faces in the worsening opioid crisis, via The Washington Post. “For Biden, whose son Hunter has struggled with addiction, the issue is personal.”
Related: A surge in street fentanyl is leading to thousands of deaths in the Western U.S., NPR reports.
Related: A federal judge has approved Purdue Pharma’s settlement, calling it "a critical building block” to resolving lawsuits against the embattled company, despite objections from states still engaged in litigation.
Building on a Shaky Foundation
By Rhiannon Meyers Collette, Communications Manager
The federal government is considering expediting Medicare coverage and payment for breakthrough medical devices — but there are reasons to be worried about this proposed rule, writes my colleague Rhiannon Euhus, analyst with AV's Low-Value Care portfolio (yes, there are two Rhiannons at one organization — AV's Fleetwood Mac game is strong.)
What’s Happening: The U.S. Food and Drug Administration already has fairly low standards for approving medical devices, a flaw that has led to people receiving ineffective — at times unsafe— devices that are later pulled from the market (Essure anyone?). And FDA approval does not indicate value — so accelerating payment for ineffective and low-value medical devices only serves to increase spending without any guarantee of better outcomes (in fact, patients could be harmed).
Why It Matters: This proposal pushes us in the wrong direction at a time when we can least afford to foot the bill for low-value care. “Many more ineffective, expensive, and possibly harmful medical devices may not only be approved, but paid for by taxpayers and Medicare beneficiaries despite their dubious value for patients,” Euhus writes. That's especially problematic at a time when COVID-19 is wreaking havoc on budgets and an economic slowdown is draining the fund that sustains Medicare.
By Rhiannon Meyers Collette, Communications Manager
Telehealth has exploded in popularity during the pandemic as people prefer to see their doctors from the comfort and safety of their own homes. But as federal policymakers consider expanding telehealth in Medicare and Medicaid, it's important to keep in mind that access to telehealth has not been equitable.
What’s Happening: Access issues are especially problematic for dual-eligible beneficiaries, a group of individuals who qualify for both Medicare and Medicaid and tend to have more complex health care needs. Dual-eligible individuals tend to have less access to the internet and disproportionately have health conditions like dementia or impaired vision which make it difficult to communicate virtually. In addition, telehealth — when used as a supplement rather than a substitute for health care — may drive up spending at a time when Medicare and Medicaid are already stretched thin.
Why It Matters: Dual-eligible beneficiaries have been the hardest hit by COVID-19 and deserve better health care delivery mechanisms which is why any expansion of telehealth needs to be closely monitored to make sure it is equitable and doesn't lead to increased spending. “Innovation in care delivery and payment should result in more health, not more health spending,” says Arielle Mir, AV’s VP of Complex Care. “As policymakers consider ways to permanently expand coverage of telehealth services, it’s important to better understand the factors that limit equitable access to this kind of care and to prioritize addressing those limitations.”
Our Co-Founder John Arnold’s Twitter thread on student loan cancellation sparking debate about the political and fiscal trade-offs of short-term solutions versus structural reform.
How a more equitable and humane approach to incarceration for emerging adults can create a more just system and help those in it flourish, in this opinion piece by Joel Castón, who has been incarcerated for 26 years, and Tyrone Walker, who was incarcerated for almost 25 years and is now an associate with the Justice Policy Institute. This video highlights the model they helped originate: D.C. Jail’s Young Men Emerging Unit.
Steps you can take to avoid a surprise medical bill for coronavirus testing, via Sarah Kliff in The New York Times.
Public defenders in D.C. saying the U.S. Parole Commission is keeping too many people in jail amid the pandemic, even though “their charges have been dismissed, they have been determined eligible for release by a judge, or they have been ‘no-papered,’ ” via dcist.
Experts in higher education offering five policies the Biden administration can address to better protect students, via New America.
Tiana Herring of the Prison Policy Initiative writing on why reducing the numbers of those incarcerated before their trials did not negatively impact public safety in 13 jurisdictions studied.
News that Jeff Bezos has committed nearly $800 million to fight climate change, including joining AV and 20 others to fund the Environmental Defense Fund’s MethaneSAT, a satellite that will measure sources of methane pollution around the world, via Forbes.
The latest blog post from the Center for Health Care Strategies, Inc. providing insight into how COVID-19 has been particularly challenging for individuals with intellectual and developmental disabilities.
Alaska becoming the second state to adopt ranked-choice voting in statewide elections, via Anchorage Daily News.
Why birth control is basic health care that all people — regardless of who they are or where they live — should have access to and deserve, from Gillian Sealy, Interim CEO of Power to Decide. She discusses the impact of birth control since it became legal for all women in 1972 in this op-ed in The Hill.
Steak-umm is at it again, serving as a voice of reason on Twitter.
What We're Watching
I’ve started the eight-part Netflix series “Trial 4,” about the case of Sean Ellis, who was convicted at 21 of the murder of Boston police officer John Mulligan. While it runs a bit long, this documentary is a detailed and timely look at policing misconduct and systemic injustice — as well as how false statements from the perch of authority can have lasting and damning repercussions. Ellis went through three trials before being convicted and sentenced to life, and he served more than 20 years before a new lawyer, Rosemary Scapicchio, uncovered serious flaws in the investigation and helped him secure his freedom and a retrial. (Detectives in the case were later convicted of corruption.) “The film exposes how Boston police historically sought Black suspects to charge in unsolved crimes. As Boston Globe columnist Adrian Walker puts it, ‘The cops were just looking for someone to pin this murder on,’ ” writes CNN. Filmmaker Remy Burkel talked to Boston.com about what he learned while working on the series, including the implications for young people caught up in the criminal justice system (“being put away for the rest of their life as teenagers, whether they committed a crime or not, that’s not going to help them or offer them redemption”) and the power of the local district attorney: “DAs have a huge, huge amount of power, and they are elected officials. People have to get out and vote if they want to change things, like people in Boston did by voting in Rachael Rollins.”
What We're Listening To
How the CalSavers retirement program is helping private-sector workers save more for their future, in the latest podcast from Georgetown University's Center for Retirement Initiatives. Executive Director Angela Antonelli speaks with California Treasurer Fiona Ma, Chair of the CalSavers Retirement Savings Board, and Katie Selenski, Executive Director of CalSavers, about the history and goals of the program, how it’s faring during the pandemic, and lessons learned. For some background, this story is a good primer on this “auto-IRA,” which makes saving the default option for employees and widens access for part-time, hourly, and gig workers.
Also: Is working from home working? Do you miss your colleague from accounting? (Yes, I miss my friend Jillian from Accounting.) In this Hidden Brain podcast, economist Nicholas Bloom discusses our worldwide experiment. I’m among the 51 percent working from home who does not have a dedicated office (other than my patio) and suffers “flow interruption” from my homeschooled children, but like many, I see both the payoffs and downsides.
Some Final Inspiration
The story behind Dolly Parton’s role in funding Moderna’s coronavirus vaccine. It began with a car accident and an unlikely friendship, writes The Washington Post.
New Funding Opportunity: As part of efforts to to better understand how to improve the systems that deliver care to a population of more than 12 million people who are dually eligible for Medicare and Medicaid, we are seeking to fund researchers who are guided by the following principles: policy relevance, rigor and independence, and alignment with our strategy. Learn more here.
Stephanie DiCapua Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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