With Alice Miranda Ollstein
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— More than 100,000 Americans are dead from the coronavirus, marking a period of deep health and economic pain.
— Federal and state officials have at times altered or hidden key coronavirus data, threatening to hamper the nation’s public health response.
— The White House is making a fresh bid to eliminate “surprise” medical billing as part of a next coronavirus aid package.
WELCOME TO THURSDAY PULSE — and a special kudos to those of you getting really creative about securing small joys during this pandemic.
100,000 AMERICANS DEAD FROM CORONAVIRUS — The U.S. surged past the milestone less than four months after the coronavirus arrived on our shores — marking a grim period defined by economic havoc, a deep fracturing of the nation’s political system and a constant undercurrent of death.
In the richest country in the world, far more people have now died from Covid-19 than in any other nation. The toll exceeds that of every U.S. military conflict dating back decades. And as far as public health crises go, this pandemic is on pace to be America’s deadliest since 1918.
— There’s more pain to come. If the U.S. averages just 461 coronavirus deaths a day from here on out, it would mean another 100,000 by the end of the year — a mark that’s conceivable even as the nation shows promising early signs of flattening the curve. The unemployment rate has skyrocketed in the meantime, and there are no guarantees that the economy will quickly bounce back even under the best of circumstances.
The political and public health response — once defined by assurances Americans would get through this together — has become a flashpoint in a culture war that’s relegated science to the sidelines.
— TRUMP: It could’ve been worse. “For all of the political hacks out there, if I hadn’t done my job well, & early, we would have lost 1 1/2 to 2 Million People, as opposed to the 100,000 plus that looks like will be the number,” he tweeted Tuesday.
— What’s needed next: Testing, tracing and lots of it, while researchers race to find a vaccine. It’s a job that the Trump administration is leaving largely to the states, as governors try to walk a fine line between keeping their citizens safe and returning the country to some semblance of normalcy.
HOW POOR DATA IS MASKING THE CORONAVIRUS THREAT — Tracking the coronavirus’ spread as the nation reopens could become even more complicated without good data — and early indications at both the federal and state levels aren’t promising, POLITICO’s Darius Tahir and Adam Cancryn report.
— At least 12 states so far have inflated testing numbers or deflated death tolls amid the push to lift stay-at-home orders. Others shifted their metrics for a “safe” reopening to more favorable ground — or sought to simply eliminate bad news by shuttering their modeling operations.
The trend has alarmed public health experts who warn the data manipulation undermines public trust in government, and threatens to have deadly consequences as more people venture out.
— Take D.C., for example. District officials have justified reopening plans through a decline in “community spread,” an ill-defined metric that Mayor Muriel Bowser has struggled to explain — and that doesn’t take the situation in nursing homes or correctional facilities into account.
— Or Georgia, one of at least a half-dozen states mixing antibody and diagnostic tests into its totals. The inclusion of antibody tests has inflated the total testing figure by nearly 78,000 — a clarification that the state only made after reporters discovered it had quietly been combining the two tests for weeks.
— The Trump administration deserves blame, too, for setting a poor example, public health experts argue. HHS has repeatedly cited misleading data. And unlike in past health crises, the CDC has largely abdicated its role as a central authority — giving states far more leeway to choose how they depict the reality on the ground.
THE WHITE HOUSE’S NEW ‘SURPRISE’ BILLING PLAN — The “surprise” medical billing issue is back, and just as complicated as ever, POLITICO’s Susannah Luthi and Rachel Roubein report.
The White House is renewing efforts to get a surprise billing fix into the next coronavirus aid package. Yet unlike prior attempts that got hung up over who would foot the bill, this proposal doesn’t mandate how doctors and hospitals would recover their costs from insurers.
— The plan envisions providers and insurers resolving payment issues on a case-by-case basis. That would likely drive up provider rates and raise premiums, obstacles that Sen. Patty Murray, the top Democrat on the Senate health panel, has already signaled could kill the effort.
— Some providers, insurers and employers are also wary. Doctors worry that the approach would hand health insurers too much leverage. Insurers and employers contend it could prompt a wave of lawsuits if there’s no easy way to resolve billing disputes.
— In the end, the issue is the same as it’s been for over a year. All sides support an elimination of surprise bills. But if the patient isn’t paying for those sometimes-hefty treatment expenses, some other part of the health sector will need to — and nobody wants to be the one stuck with the bill.
FIRST IN PULSE: SURPRISE BILLING’S REPEAT PROVIDERS — Most providers who bill out of network only do so sparingly. But there’s a small percentage who are billing out of network almost every single time, according to a new report from the Health Care Cost Institute.
The analysis of out-of-network claims found that the practice is particularly acute among pathologists, where more than one-third who billed for inpatient visits did so on an out-of-network basis more than 90 percent of the time. About one-fifth of pathologists billing for outpatient visits did so out of network more than 90 percent of the time.
“In every specialty, more than half of the sample’s providers never billed out of network,” the report concluded. “There were, however, some providers who almost exclusively billed out of network.”
PRE-PANDEMIC, UNINSURED RATE WAS RISING — Nearly 31 million Americans lacked health coverage even before the pandemic brought the economy to a halt, continuing a trend of rising uninsured rates during the Trump era.
Roughly 9.5 percent of the U.S. was uninsured in the first half of 2019, according to the CDC’s National Health Interview Survey, a figure that’s sure to have risen sharply in more recent months as millions lost their jobs and workplace coverage.
— Obamacare is expected to serve as a lifeline for the newly unemployed. The insurance marketplaces, along with expanded Medicaid programs, mean millions will have access to health plans that they wouldn’t have in prior crises.
But it’s unclear how large of a lifeline that will be. Just 4.6 percent of working-age Americans got coverage through the Obamacare exchanges last year, the CDC survey found.
FRANCIS COLLINS: ‘NO WAY OF KNOWING’ IF CORONAVIRUS CAME FROM A LAB — The NIH director left open the possibility that the virus escaped from a lab in Wuhan, China, telling POLITICO’s Zachary Brennan only that he’s sure it’s not manmade.
“Nature created this virus, and has proven once again to be the most effective bioterrorist,” Collins said in an interview.
— Trump has repeatedly suggested the virus came from a lab, as part of his efforts to pile blame for the pandemic on China. The Trump administration is still investigating its origins, with Collins saying he currently has “no way of knowing” if the virus had been isolated within Wuhan’s Institute of Virology.
— Collins was tight-lipped on NIH’s abrupt decision to pull funding from a study examining how coronaviruses spread from bats to people, declining to discuss individual grants. The group behind the study has alleged the grant was terminated for political, and not scientific, reasons.
ACLU SUES OVER FDA’S ABORTION PILL LIMITS — The American Civil Liberties Union is challenging an FDA rule that requires a drug used for abortions early in pregnancy be administered in person, POLITICO’s Alice Miranda Ollstein reports.
The lawsuit filed on behalf of a coalition of medical and advocacy groups argues that patients should be able to order mifepristone by mail following a video consultation with a clinic, especially as the Trump administration encourages the use of telehealth for other medical services during the pandemic.
Conservative lawmakers and anti-abortion advocates immediately blasted the legal filing, calling on the FDA to “hold the line” on the drug’s restrictions.
LARRY KRAMER, 1935-2020. The prominent AIDS activist, author and playwright died Wednesday morning at age 84.
The founder of Gay Men’s Health Crisis and Act Up, Kramer’s aggressive crusade for faster AIDS drugs research and activism against discrimination of gays and lesbians shined a light on LGBTQ issues and influenced national policy.
“He was very iconoclastic,” top infectious disease doctor Anthony Fauci told the Washington Blade. “Every once in a while, a giant among us passes, and I think this is one of those times when somebody who truly was a giant and an icon and a legend passes.”
The House Workforce Protections subcommittee holds a hearing on protecting federal workers from the coronavirus at 10:15 a.m. ET.
Nancy Messonnier, the director of the CDC’s National Center for Immunization and Respiratory Diseases, will speak at 11:05 a.m. ET at a vaccine event held by the National Academy of Sciences, Engineering and Medicine.
The FDA is finding high levels of a carcinogen in some versions of a popular diabetes medication, Bloomberg News’ Anna Edney reports.
“He called me a murderer and an incompetent idiot on the front page of the San Francisco Examiner magazine.” Anthony Fauci recounts in the New York Times how he first met Larry Kramer.
It’s clear coronavirus is disproportionately killing black Americans, but not as easy to understand exactly why that’s happening, The Atlantic’s Graeme Wood writes.
ProPublica’s Caroline Chen gives a rundown of what the coronavirus pandemic has taught us so far.