Trump Admin Makes Major Changes to Covid Vaccine Rollout

By Yuval Rosenberg

Trump Administration Makes Major Changes to Covid Vaccine
Rollout

The Trump administration on Tuesday announced some major changes
to its Covid-19 vaccine rollout strategy, saying it would release
all available doses and calling on states to start vaccinating
everyone age 65 and older and adults with certain health conditions
that make them more vulnerable to serious infection.

The changes are meant to accelerate a vaccination drive that is
far behind the administration’s original goals, a pace that has
drawn sharp criticism from health experts and Democratic lawmakers.
They represent a reversal for the administration, which had been
holding back about half of its supply of Pfizer and Moderna
vaccines to ensure that the required second doses would be
available. Those second doses are now expected to become available
through the next waves of production.

The transition team for President-elect Joe Biden had said last
week that it planned to quickly release all available doses of the
vaccines, setting off a
debate among health experts — and drawing
criticism from Health and Human Services Secretary Alex Azar and
Operation Warp Speed officials.

Azar said Tuesday that the administration always planned on
making the change once it was confident in vaccine production and
distribution capabilities. “This next phase reflects the urgency of
the situation we face,” Azar said, according to
The New York Times. “Every vaccine dose that is
sitting in a warehouse rather than going into an arm could mean one
more life lost or one more hospital bed occupied.”

Why it matters: “These changes
reflect a changing consensus about how best to distribute
the vaccines — shifting away from a strict risk-based
prioritization system, toward prioritizing getting as many shots
into as many arms as possible, as quickly as possible,”
Axios explains. But the Times notes that the new
strategy “threatens to create more confusion in states that had
already articulated different plans for who should receive the
vaccine next.”

Trump Administration Hands Republicans a Big Win on Medicaid
Funding

The Trump administration delivered a long-sought victory to
Republicans late last week by approving a request from Tennessee to
receive Medicaid funding as a block grant.

As part of a 10-year “experiment,” the state will receive a
fixed amount each year from the federal government to spend on
health care for low-income citizens, rather than a variable amount
determined by the level of participation in TennCare, the state’s
Medicaid program. In exchange, the state will gain more control
over how it operates the program, which serves roughly 1.4 million
people.

Tennessee is one of 12 states that have not expanded their
Medicaid programs as allowed under the Affordable Care Act.
Currently, federal funding covers two-thirds of the cost of
TennCare, with the amount rising and falling according to
participation levels. Under the terms of the agreement, Tennessee
will receive a set spending cap determined by historical data,
inflation estimates and projected growth rates. If the state spends
less than it has been budgeted while maintaining benefit levels, it
will share in the savings with the federal government.

Seema Verma, administrator of the Centers for Medicare &
Medicaid Services, said Friday that “this carefully crafted
demonstration could be a national model moving forward.”

Why it matters: Republicans have pushed for years to
convert Medicaid into a block grant program, seeing such a
structure as a way to limit the growth of federal spending on
health care while forcing states to be more efficient with their
funding.

Democrats and many health care advocates oppose the effort,
arguing that that blocks grants would violate the intent of the
Medicaid program and allow states to spend less than is needed on
the care of low-income Americans.

“No other state has sought a block grant, and for good reason,”
Michele Johnson of the Tennessee Justice Center
told Kaiser Health News. “It gives state officials
a blank check and creates financial incentives to cut health care
to vulnerable families.”

Speaking to The New York Times, Johnson
said the decision comes at a particularly bad time
as a pandemic rages across the country. “The only way this makes
sense is in the context of the Trump administration burning
everything down on their way out the door,” she said.

What happens next: It will take months
to get the experiment up and running, and the state still needs to
receive final approval from its legislature and negotiate standards
of care with the federal government. Meanwhile, President-elect Joe
Biden, who has opposed the block grant approach, could seek to
revoke the state’s waiver. Terminating the program could take
months, though, since CMS’s Verma has taken steps to make it more
difficult to end Medicaid experiments,
according to the Times’s Margot
Sanger-Katz.

Number of the Day: America’s $5.6 Trillion Infrastructure
Gap

The gap between America’s projected infrastructure investment
needs and its likely spending on those needs is projected to top
$2.6 trillion by 2029 and more than $5.6 trillion by 2039,
according to a new report from the American Society of Civil
Engineers.

The report says that a cumulative $6.1 trillion in
infrastructure funding will be needed through 2029, but only about
$3.5 trillion is expected over that time. It says a total of $13
trillion will be needed by 2039, but only $7.3 trillion is
expected.

The
report warns that underinvestment in
infrastructure could have severe economic consequences. “Overall,
if the investment gap is not addressed throughout the nation’s
infrastructure sectors, by 2039 the economy is expected to lose
more than $10.3 trillion in GDP,” it says. “As a result of this
underperformance, job losses will mount annually, and in 2039, the
U.S. economy is predicted to support 3 million fewer jobs than
under baseline conditions.”

The report projects that deficient infrastructure will cost U.S.
households more than $3,300 a year on average through 2039 as the
result of job cutbacks and decreased productivity.

President-elect Joe Biden is expected to announce a major
multi-trillion-dollar infrastructure initiative on
Thursday.

Column of the Day: Why It’s Time to Spend

Bloomberg columnist Conor Sen writes that markets see Democrats
— and their spending plans — as the best bet to boost the economy
right now:

“The explanation for this new economic narrative is
straightforward. Republicans scored decades of policy achievements
by lowering taxes and restraining inflation. What's needed to drive
higher levels of economic growth now is more government spending,
which can kickstart a cycle of hiring, investment and consumer
spending.
“How much spending will it take? Nobody knows for sure, but
the best way to figure out when we've done enough — or that
spending has become a problem — is to monitor inflation and
longer-term interest rates, not the size of the national debt or
federal budget deficits. Investors believe Democrats are more
committed to doing that than Republicans.”

In a related editorial, the Bloomberg Editorial Board says that
righting the economy will require “ambitious investment” to create
the jobs of the future and create growth that raises living
standards broadly, including the millions of Americans who have
been left behind by the economic trends of recent decades. “This
will require more public spending,” they write, “but with interest
rates on government borrowing at multi-decade lows, the financial

conditions are as conducive as they’ll ever
be.”

Read the
full column and the
editorial at Bloomberg.

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