News Release

Vaccine Monitor: Where People are Getting Information About COVID-19 Vaccinations

Those Most Hesitant About Vaccination are More Likely to Turn to Social Media for Information

Published: Feb 3, 2021

Additional Data Available Through Online Vaccine Monitor Dashboard

As vaccination efforts ramp up across the country, the KFF COVID-19 Vaccine Monitor examines where the public is getting its relevant information.

Large shares of the public report that they are getting at least a fair amount of vaccine information from television news, including cable (43%), network (41%) and local (40%) television, and from friends and family (40%). Somewhat fewer get at least a fair amount of information from social media (31%), a doctor, nurse, or other health care provider (31%) and other sources.

There are differences in people’s sources of vaccine information based on how enthusiastic they are about getting a vaccine.

Among those who say they “definitely will not” get a vaccine (13% of the public), the most-cited media source for at least a fair amount of vaccine information is social media (40%), followed by cable (37%), network (32%) and local (28%) television. Most likely, the vaccine hesitant are self-selecting social media information sources they are comfortable with.

Those who want to “wait and see” how the vaccine is working for others before getting it (31% of the public) are about equally likely to say they are getting at least a fair amount of relevant information from social media (37%) as cable (37%), network (36%) and local (41%) television.

In contrast, those who want to get the vaccine as soon as they can (41% of the public) are about twice as likely to say they have gotten at least a fair amount of information about the vaccine from cable news (51%) as from social media (25%) This may in part reflect generational differences in media consumption, as older Americans on average are more enthusiastic about getting vaccinated and less likely to turn to social media for vaccine information.

Available through the Monitor’s new online dashboard, the analysis also examines sources of vaccine information by age, race and ethnicity, and urban, suburban and rural communities; by cable networks including Fox, MSNBC and CNN; and by social media platforms including Facebook and Twitter. It may be that people self-select news sources that they feel reinforce their views rather than the sources leading to those views.

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and hesitancy, trusted messengers and messages, as well as the public’s experiences with vaccination.

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Contact

Craig Palosky
KFF

Also of Interest

News Release

New Survey: Passing a Law Preventing Perpetrators of Domestic Violence from Having a Gun is Identified as a Top Women’s Health Policy Priority for Federal Policymakers

Published: Feb 2, 2021

The new KFF Women’s Health Survey, a nationally representative survey of women and men, finds that a majority of women (56%) and 40% of men believe passing a law that prevents people who have committed domestic violence from having a gun should be a top policy priority for the new Congress and administration among a list of potential women’s health policy priorities.

Creating policies that ensure people are not discriminated against because of their gender identity or sexual orientation also ranked high as a priority with nearly half of women (48%) and more than one-third of men (36%) say this issue is a top priority. (On President Biden’s first day in office, he signed an executive order to prevent discrimination based on gender identity or sexual orientation.)

The survey found that top policy priorities differed by age. For example: paid time off following the birth or adoption of a child is ranked a top priority by 34% of men and 50% of women ages 18-49, compared with 18% of men and 37% of women ages 50-64.

On January 28th, President Biden signed a memorandum directing the Department of Health and Human Services to review the Trump administration rule that led to a decline in participating clinics and patients served under the Title X federal family planning program. Four in ten women (41%) and one in four men (23%) say providing more public funding to support access to family planning services and birth control is a top priority.

A majority of Black women (61%) say requiring states to allow women enrolled in public programs like Medicaid to keep their health coverage for a full year after childbirth should be a top priority for federal lawmakers, making it the highest priority issue for Black women.

For additional findings read the full brief, Public Perspectives on Women’s Health Policy Priorities for the Biden-Harris Administration and Congress. More results from the KFF Women’s Health Survey will be released in the coming weeks.

MethodologyKFF has conducted the KFF Women’s Health Survey approximately every four years since 2001 to provide a look into the range of women’s health care experiences, especially those that are not typically addressed by most surveys. KFF’s latest Women’s Health Survey surveyed 3,661 women and 1,144 men ages 18-64 between November 19 and December 17, 2020.

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Women's Health Policy Abortion Family Planning Gun Violence Maternal and Child Health Paid Leave Reproductive Health

Contact

Emma Anderson

Also of Interest

Public Perspectives on Women’s Health Policy Priorities for the Biden-Harris Administration and Congress

Published: Feb 2, 2021
Section:
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Findings

Key Takeaways

  • The Kaiser Family Foundation has conducted the KFF Women’s Health Survey approximately every four years since 2001 to provide a look into the range of women’s health care experiences, especially those that are not typically addressed by most surveys. The election year provided a unique opportunity to ask a nationally representative sample of 3,661 women and 1,144 men ages 18-64 about seven women’s health policies likely to be discussed with Democrats in power and how much of a priority they should be for the new President and Congress.
  • Of the seven policy issues we asked about, passing a law that prevents people who have committed domestic violence from having a gun is a top priority for the largest share of women (56%) and men (40%), and women across party lines.
  • The most important policy issue to Black women (61% said top priority), among those we asked about, is requiring that states allow women enrolled in public programs like Medicaid to keep their health coverage for a full year after childbirth.
  • Most people are unaware that Black women are more likely to die from pregnancy or childbirth than White women.
  • One of the policy issues with the biggest gender differences in the top priority ranking is passing a national law that all workers be offered paid time off from work following the birth or adoption of a child (46% of women say it should be a top priority compared to 29% of men). Only three in ten women (29%) and men (31%) know that the U.S. does not have a national policy where workers can take paid time off from work for the birth or adoption of a child.
  • Not surprisingly, attitudes toward passing a national law requiring states to keep abortion legal split along partisan lines with more than half of Republican women (63%) saying it is not too important or should not be done, in contrast to 54% of Democratic women who rank it as a top priority.

Introduction

The Biden-Harris Administration and new Congress, with Democratic majorities in the House and (effectively) the Senate, are expected to place a higher priority on certain women’s health issues than the previous administration. President Joe Biden and Vice President Kamala Harris prioritized many women’s health issues during their campaign, including reversing the Trump Administration’s Title X regulations, codifying Roe v. Wade, addressing the U.S.’s high maternal mortality rate, creating a national paid family and medical leave program, and reauthorizing the Violence Against Women Act.

KFF’s latest Women’s Health Survey surveyed 3,661 women and 1,144 men ages 18-64 (Methodology) between November 19 and December 17, 2020. Among several topics, we asked respondents how much of a priority seven key women’s health policies should be for the President and Congress – top priority, important but not a top priority, not too important, or should not be done. This issue brief examines attitudes toward those policy priorities and differences by gender, political party affiliation, and demographic factors.

Top Policy Priorities

We asked survey respondents about seven policy priorities around maternal health, paid leave, and sexual and reproductive health that are likely to be discussed with the change in control of the White House and the Senate. Women are more likely than men to say all these issues were a top priority. President Biden campaigned on many of these policy priorities, and indeed, there is variation in support of these policies by political affiliation. Across the board, women who identified as Democrats are more likely to say each of these were top priorities compared to Republican women or women who identify as political independents (Table 1).

Table 1. Top Women's Health Priorities for Biden-Harris Administration and Congress

Domestic Violence

As Senator, President Biden introduced the Violence Against Women Act (VAWA) that was signed into law in 1994 by President Bill Clinton. VAWA, which expired in 2018, helped establish many violence prevention efforts, including funding for rape crisis centers, shelters, and other supports for people who have experienced domestic violence. The House of Representatives passed the VAWA Reauthorization Act of 2019, but it stalled in the Senate due to Republican objections to a new provision that would prohibit perpetrators of domestic violence from purchasing or possessing a firearm. President Biden has said he will make VAWA reauthorization one of his top first 100-day priorities.

Of the seven policy issues we asked about, passing a law that prevents people who have committed domestic violence from having a gun is a top priority for the largest share of women (56%) and men (40%), and women of all political affiliations, though more Democratic (70%), independent (50%), and non-affiliated (52%) women than Republican women (38%) rank it a top priority (Figure 1).

A large majority of people say passing a law that prevents people who have committed domestic violence from having a gun is important or a top priority

Passing a law that prevents people who have committed domestic violence from having a gun is the most important issue to Asian women, with 73% saying this issue should be a top priority for the President and Congress. It is also the issue that the largest shares of White women (52%) and Hispanic women (58%) say should be a top priority.1 

Discrimination

Section 1557 of the Affordable Care Act (ACA) prohibits discrimination based on race, color, national origin, sex, age, and disability in health care, but the Trump Administration revised the law’s regulations and eliminated some of the protections from discrimination based on gender identity, sex-stereotyping, and sexual orientation. During his campaign, President Biden pledged to revise those regulations to again prohibit this type of discrimination in health care, and on his first day as President, he issued an Executive Order to that effect.

Creating policies that ensure people are not discriminated against because of their gender identity or sexual orientation is the next policy issue that has the next largest shares of both men (36%) and women (48%) who say it should be a top priority. Two-thirds of Democratic (66%) and nearly half of independent women (46%) also believe it should be a top priority. Two-thirds (67%) of LGBT women and 60% of LGBT men cite this issue as a top priority, compared to 47% of straight women and 34% of straight men (Figure 2).

The majority of LGBT women and men say creating policies that ensure people are not discriminated against because of their gender identity or sexual orientation should be a top priority

Maternal Health

The Medicaid program finances more than four in ten births in the U.S.; coverage for pregnant enrollees ends 60 days after delivery. In the 39 states (including D.C.) that have expanded Medicaid under the ACA, postpartum women have a pathway to affordable coverage after those 60 days if their incomes remain modest. In the states that have not expanded Medicaid, many women who have Medicaid coverage for their pregnancy are left without a pathway to coverage and become uninsured two months after giving birth. This happens because the income eligibility limits for traditional Medicaid are lower than they are for pregnancy-related Medicaid in those states.2  CDC data show roughly one-third of all pregnancy-related deaths occur one week to one year after a pregnancy ends. Black women are significantly more likely than women of other races to have a severe maternal morbidity event at the time of delivery that could lead to death or require long-term care.

In the campaign, President Biden supported efforts to develop policy responses to address the high rate of maternal deaths among Black women. One policy proposal that has gained some traction is extending Medicaid’s coverage for pregnancy from 60 days postpartum to 12 months postpartum. Also, the Biden Administration could approve pending state waivers to extend postpartum Medicaid coverage.

Nearly half (48%) of women say that requiring states to allow women enrolled in public insurance like Medicaid to keep their health coverage for a full year after childbirth should be a top priority. Among the policy issues we asked about, this is the most important issue to Black women (61% said top priority) (Table 2), women with incomes below 200% of the federal poverty level (FPL) (50%),3  and women enrolled in Medicaid (56%).

Table 2: Extending postpartum health coverage for a full year after childbirth is a top priority for the majority of Black and Hispanic women

Black women are 3.2 times more likely to die from a pregnancy-related complication than White women, but awareness of this substantial difference is not widely known. Among women with a college education or higher, Black women are 5.2 times more likely to die from a pregnancy-related complication than White women. When asked if Black women are more or less likely to die from pregnancy or childbirth than White women, one third of men (31%) and 42% of women know that Black women are more likely to die. About half of Black women (49%) and men (46%) are aware of the disparity (Figure 3).

Knowledge of higher pregnancy-related mortality rate among Black women differs by race, but a large share of people don't know

A majority also say developing and funding more programs to improve care for pregnant people should be a top priority or an important priority (Figure 4). About half of Black women (51%) and Democratic women (48%) say this should be a top priority. However, one-quarter of Republican women (25%) and one in five men (20%) say it is not too important or should not be done. To help improve care for pregnant people and improve maternal and infant outcomes, Congress took up several bills in the last session, including one sponsored by then-Senator Kamala Harris, that include, among others, proposals to improve data collection on maternity care; fund and require clinical training on health equity and implicit bias; use evidence-based quality improvement methods; diversify the perinatal workforce; and develop broader maternity care provider networks in rural areas.

A majority of people say developing and funding more programs to improve care for pregnant people is important or a top priority

The U.S. does not have a national paid parental leave policy. Federal employees were recently granted 12 weeks of paid parental leave following the birth or adoption of a child, but the 2019 KFF Employer Health Benefits Survey found that only 35% of non-federal workers are employed at a firm that offers paid parental leave for the birth or adoption of a child (voluntarily or required by states or local law), with substantial variation by firm characteristics.

Our survey finds that about three in ten women (29%) and men (31%) know that the U.S. does not have a national paid leave policy. The largest share of respondents to this question say they do not know. One-third of working mothers (32%) know that the U.S. does not have a national paid leave policy, slightly higher than non-working mothers (26%).

Among the policy priorities asked about, support for passing a national law that all workers be offered paid time off work following the birth or adoption of a child has the largest gender and age differences, with 34% of men and 50% of women ages 18-49 ranking it a top priority compared to 18% of men and 37% of women ages 50-64. A majority of women across party lines and race/ethnicity groups say that this issue is either important or a top priority, with larger shares of Democratic women (57%) and Black women (56%) than Republican women (30%) and White women (40%) saying it should be a top priority (Figure 5).

Nearly half of women say passing a national law that all workers be offered paid time off from work following the birth or adoption of a child should be a top priority

Family Planning

Though restricted under the Trump Administration, the Title X family planning program provides low- or no-cost family planning services and birth control to millions of low-income women and men. The services provided by Title X clinics help women avoid unintended, mistimed, or unwanted pregnancies and provide access to preventive care and STI screening and treatment. Annual funding for the Title X program has not increased for the past 10 years, though research suggests that the program would need more than twice that amount to adequately meet the need for publicly-funded family planning.

The majority of survey respondents say that providing more public funding to support access to family planning services and birth control should be a top or important priority (Table 3). This policy priority was rated a top priority for a larger share of Black women (48%), Hispanic women (45%), and Asian women (44%) compared to White women (36%). Larger shares of Democratic (93%), independent (80%), and non-affiliated (81%) women say this should be a top priority or important compared to Republican (64%) women. A larger share of women with incomes below 200% FPL (45%) say this should be a top priority compared to women with incomes ≥ 200% FPL (39%) (Figure 6). Three in ten men (30%) and about one-third of Republican women (34%) say this is “not too important” or “should not be done.”

Table 3: Providing more public funding to support access to family planning services and birth control is a top or important priority across race/ethnicity groups
Providing more public funding to support access to family planning services and birth control a top priority or important across gender and political party

Abortion Rights

It is widely expected that in the coming years, the U.S. Supreme Court will hear a challenge to the right to abortion established in Roe v. Wade. Ten states have laws that would ban all or nearly all abortions if Roe v. Wade were overturned. Seven states have laws that express the intent to restrict the right to legal abortion to the maximum extent permitted by the Supreme Court in the absence of Roe v. Wade. Passing a national law that would require all states to keep abortion legal, or codifying Roe v. Wade into law, would provide a federal right to abortion if Roe v. Wade were overturned by the Supreme Court. President Biden has pledged support for legislation codifying Roe v. Wade and the right to abortion in all states, though this extremely partisan issue would likely be met with resistance.

More than one-third (37%) of women say passing a national law that would require states to keep abortion legal should be a top priority, compared to about one-quarter (24%) of men. More than half (54%) of Democratic women say it should be a top priority, in contrast to 12% of Republican women. A larger share of respondents opposes this policy compared to other health and family policy issues tested in the survey, with 21% of women and 27% of men saying this “should not be done,” with a wide partisan split. Almost half of Republican women (46%) say that passing a national law requiring states to keep abortion legal should not be done, in contrast to 6% of Democratic women (Figure 7). A larger share of White women (25%) says passing a national law requiring all states to keep abortion legal should not be done, compared to Hispanic (19%), Asian (10%), and Black women (11%).

Most Democratic women think passing a national law requiring all states to keep abortion legal should be a top priority, while nearly half of Republican women think it should not be done

Conclusion

The KFF Women’s Health Survey outlines the level of support for many women’s health policy issues raised during the 2020 presidential campaign that may be priorities for the new presidential administration and Congress. The Biden-Harris Administration and new Congress may emphasize many women’s health issues in the coming years, but with a closely divided House and Senate it will be challenging to enact these policies, despite sizable public support for many of these them.

For an interactive tool to view cross-tabs by gender, party ID, and race/ethnicity, click on tab for cross-tabs. 

Methodology

The 2020 KFF Women’s Health Survey was designed and analyzed by researchers at the Kaiser Family Foundation (KFF) of a representative sample of 4,805 adults, ages 18-64 years old (3,661 women and 1,144 men). The survey was conducted online and telephone using AmeriSpeak®, the probability-based panel of NORC at the University of Chicago. U.S. households are recruited for participation using address-based sampling methodology and initial invitations for participation are sent by mail, telephone, and in-person interviews. Interviews for this survey were conducted between November 19 and December 17, 2020, among adults living in the United States. KFF paid for all costs associated with the survey.

The sample for this study was stratified by age, race/ethnicity, education, and gender as well as disproportionate stratification aimed at reaching uninsured women, women who identify as LGBT, and women 18-49 years old. The sampling also took into consideration differential survey completion rates by demographic groups so that the set of panel members with a completed interview for a study is a representative sample of the target population. Interviews were conducted in English and Spanish online (4,636) and via the telephone (169).

A series of data quality checks were run and cases determined to be poor-quality, as defined by surveys with a length of interview of less than 33% of the mean length of interview and with high levels of question refusal (>50%) were removed from the final data (n=96). Weighting involved multiple stages. First, the sample was weighted to match estimates for the national population from the 2020 Current Population Survey on age, gender, census division, race/ethnicity, and education. The second round of weights adjusted for the study’s sampling design. All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample of women is plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.

GroupN (unweighted)M.O.S.E
Men Ages 18-641,144+/- 4 percentage points
Women Ages 18-643,661+/- 2 percentage points
Women Ages 18-492,695+/- 2 percentage points
White Women Ages 18-641,813+/- 3 percentage points
Black Women Ages 18-64603+/- 5 percentage points
Hispanic Women Ages 18-64801+/- 5 percentage points
Asian Women Ages 18-64246+/- 8 percentage points
LGBT Women Ages 18-64392+/- 7 percentage points
Straight Women Ages 18-643,239+/- 2 percentage points
Women < 200% FPL1,471+/- 3 percentage points
Women ≥200% FPL1,943+/- 3 percentage points

For additional detail regarding the methodology, please contact womenshealth@kff.org.

Demographics of Survey Respondents
Women Unweighted Counts(unweighted %)Men Unweighted Counts(unweighted %)
Age
18-25427 (12%)175 (15%)
26-351092 (30%)275 (24%)
36-491176 (32%)300 (26%)
50-64966 (26%)394 (34%)
Race/ethnicity
White1813 (50%)672 (59%)
Black603 (16%)129 (11%)
Hispanic801 (22%)230 (20%)
Asian246 (7%)65 (6%)
Education
Less than HS211 (6%)58 (5%)
HS graduate633 (17%)214 (19%)
Some college1590 (43%)518 (45%)
College graduate1227 (34%)354 (31%)
Urbanicity
Urban/Suburban3113 (85%)996 (87%)
Rural548 (15%)148 (13%)
Region
Midwest844 (23%)284 (25%)
Northeast557 (15%)155 (14%)
South1353 (37%)407 (36%)
West907 (25%)298 (26%)
State
Lives in a Medicaid expansion state2359 (64%)757 (66%)
Lives in a non-Medicaid expansion state1302 (36%)387 (34%)
Insurance
Private insurance2153 (59%)753 (66%)
Medicaid697 (19%)107 (9%)
Other government insurance334 (9%)127 (11%)
Uninsured452 (12%)152 (13%)
Income
<200% FPL1471 (40%)315 (28%)
≥ 200% FPL1943 (53%)750 (66%)
Marital Status
Married/Living with Partner2033 (56%)590 (52%)
Divorced/Separated/Widowed/Never Married1628 (44%)554 (48%)
Sexual Orientation
LGBT392 (11%)100 (9%)
Straight3239 (88%)1037 (91%)
Political Affiliation
Democratic1620 (44%)368 (32%)
Republican795 (22%)320 (28%)
Independent697 (19%)319 (28%)
Total3,6611,144
SOURCE: 2020 KFF Women’s Health Survey

Women Ages 18-64 Topline

POL1. How much of a priority should the following be for the President and Congress?

NOR 11/19-12/17/2020Top NETTop priorityImportant but not a top priorityBot NETNot too importantShould not be doneDON’T KNOWSKP/REF
Developing and funding more programs to improve care for pregnant people85384714113-1
Requiring that states allow women enrolled in public insurance like Medicaid to keep their health coverage for a full year after childbirth8748391284*1
Passing a law that prevents people who have committed domestic violence from having a gun8856321174*1
Creating policies that ensure people are not discriminated against because of their gender identity or sexual orientation83483416114*1
Passing a national law that all workers be offered paid time off from work following the birth or adoption of a child8746411293*1
Providing more public funding to support access to family planning services and birth control81414117116*2
Passing a national law that would require all states to keep abortion legal643728331221*2
N = 3,661

POL2. As you may have heard, there is growing concern in the United States about the rate of women dying from causes related to pregnancy and childbirth. As far as you know, are Black women more or less likely to die from pregnancy or childbirth than white women, or do you not know?

NORC 11/19-12/17/2020
More likely42
About as likely13
Less likely3
Don’t know42
SKIPPED/REFUSED*
N = 3,661

POL8. As far as you know, does the United States have a national policy where workers can take paid time off from work for the birth or adoption of a child, or not?

NORC 11/19-12/17/2020
Yes32
No29
Don’t know38
SKIPPED/REFUSED1
N = 3,661

Men Ages 18-64 Topline

POL1. How much of a priority should the following be for the President and Congress?

NOR 11/19-12/17/2020Top NETTop priorityImportant but not a top priorityBot NETNot too importantShould not be doneDON’T KNOWSKP/REF
Developing and funding more programs to improve care for pregnant people7724532115511
Requiring that states allow women enrolled in public insurance like Medicaid to keep their health coverage for a full year after childbirth80344619136*1
Passing a law that prevents people who have committed domestic violence from having a gun79403919127*1
Creating policies that ensure people are not discriminated against because of their gender identity or sexual orientation723636271610*1
Passing a national law that all workers be offered paid time off from work following the birth or adoption of a child76294723158*1
Providing more public funding to support access to family planning services and birth control692346301812*1
Passing a national law that would require all states to keep abortion legal572432421527*1
N = 1,144

POL2. As you may have heard, there is growing concern in the United States about the rate of women dying from causes related to pregnancy and childbirth. As far as you know, are Black women more or less likely to die from pregnancy or childbirth than white women, or do you not know?

NORC 11/19-12/17/2020
More likely31
About as likely17
Less likely3
Don’t know48
SKIPPED/REFUSED1
N = 1,144

POL8. As far as you know, does the United States have a national policy where workers can take paid time off from work for the birth or adoption of a child, or not?

NORC 11/19-12/17/2020
Yes31
No31
Don’t know36
SKIPPED/REFUSED2
N = 1,144

Cross-tabs

Endnotes

  1. People of Hispanic origin may be of any race but are categorized as Hispanic throughout this brief while other groups are non-Hispanic. ↩︎
  2. Daw, et al. High Rates of Perinatal Insurance Churn Persist After the ACA, Health Affairs, September 16, 2019. ↩︎
  3. The FPL for a family of four in 2020 was $26,200. ↩︎
More On
Women's Health Policy Abortion Demographics Family Planning Maternal and Child Health Paid Leave Pregnancy Race/Ethnicity Reproductive Health

News Release

Also of Interest

COVID-19 Now Leading Cause of Death in the United States

Authors: Krutika Amin, Cynthia Cox, Chelsea Rice, and Hanna Dingel
Published: Feb 2, 2021

In January 2021, the number of deaths from COVID-19 increased so rapidly that it has clearly become the number one cause of death in the U.S., with an average of more than 3,000 people per day dying of COVID-19 in the U.S. as of Jan. 26. That number is significantly higher than other leading causes of death and is nearly 50% higher than the next leading cause. Heart disease, which is typically the number one cause of death in the U.S. each year, leads to the death of about 2,000 Americans per day, and cancer claims about 1,600 American lives per day.

The chart above combines data on COVID-19 mortality rates from KFF’s tracker with data from the Center for Disease Control (CDC) on weekly counts of death by jurisdiction and cause of death. COVID-19 deaths in the chart represent the average daily deaths in January 2021 (as of January 26, 2021). Deaths from other causes represent the weighted daily mortality rate averaged over MMWR weeks 1-52 during the year 2020. This CDC dataset does not include deaths due to accidents (which, before the pandemic, were typically the third leading cause of death, after heart disease and cancer), nor does it include suicides (which were typically the tenth leading cause of death before the pandemic). To avoid double-counting, the dataset excludes deaths confirmed to have an underlying cause of COVID-19. The chart could, however, understate the severity of COVID-19 because some of those deaths may have been misclassified as other causes. There were many more deaths in 2020 than expected, and confirmed COVID-19 cases only accounted for about three in four excess deaths.

With two vaccines available now in the United States that are more than 90% effective at preventing illness from the virus, these data are just one more way of illustrating the urgency of expediting COVID-19 vaccination. While the number of new COVID-19 cases appears to have taken a turn for the better in the latter half of January, it is difficult to know what the future holds, particularly with the potential spread of new variants.

Source

COVID-19 is the Number One Cause of Death in the U.S. in Early 2021

More On
COVID-19 Heart Disease Mortality

Also of Interest

This Week in Coronavirus: January 22 to January 28

Published: Jan 29, 2021

Here’s our recap of the past week in the coronavirus pandemic from our tracking, policy analysis, polling, and journalism.

The world surpassed 100 million COVID-19 cases this week, with the United States accounting for a quarter of them. The U.S. also accounts for one-fifth (433,200) of the world’s nearly 2.2 million reported deaths.

A new analysis shows that COVID-19 is currently the number one cause of death in the country. As of January 26, 2021, an average of more than 3,000 people per day died of COVID-19 in the U.S. this month, nearly 50% higher than the next leading cause.

The COVID-19 Vaccine Monitor reports the public’s eagerness to get a vaccine is rising across racial and ethnic groups, though Republicans and rural residents remain the most reluctant groups.  Nearly half (47%) of the public want to get the vaccine as soon as they can or have already been vaccinated. That is significantly higher than the third (34%) of the public in the most-eager “as soon as possible” category in December.

Data and analysis related to vaccine acceptance and hesitancy, trusted messages and messengers, demographic breakouts, and people’s experiences, are now featured in a new dashboard for the Monitor. The dashboard will be updated regularly to reflect the latest data and current issues.

As KHN reports on the challenge of ramping up vaccine production, Drew Altman dives into the discussion about how many vaccinations are needed, and by when, for herd immunity. Here are his estimated goalposts on the calendar and what it would take to vaccinate 70% of the country’s population by then:

July 4 → 2.4 million doses/day

Labor Day → 1.9 million doses/day

Jan 1, 2022 → 1.2 million doses/day

Reporting from KHN continues to show that vaccination is lagging for Black Americans and highlights the lack of data about who is being vaccinated. But there are disparities long before the point of getting shots in arms. KFF analysts this week examined why racial diversity within COVID-19 vaccine clinical trials is important, the clinical trial participation barriers among people of color, and examine the racial/ethnic composition of clinical trial participants for the Pfizer-BioNTech and Moderna coronavirus vaccines.

President Biden issued an executive order this week to reopen enrollment into the Affordable Care Act’s marketplaces for a special period in order to reduce the number of uninsured during the ongoing pandemic. An analysis finds that nearly 9 million uninsured Americans could get free or subsidized health insurance with the reopening. Another brief looks at opportunities to expand health coverage enrollment during the pandemic.

Here are the latest coronavirus stats from KFF’s tracking resources:

Global Cases and Deaths: Total cases worldwide stand at 101.5 million this week – with an increase of 3.9 million new confirmed cases in the past seven days. There were approximately 99,500 new confirmed deaths worldwide, bringing the total for confirmed deaths to nearly 2.2 million.

U.S. Cases and Deaths: Total confirmed cases in the U.S. approached 25.8 million this week. There was an increase of about 1.1 million confirmed cases between Jan. 21 and Jan. 28. Approximately 22,800 confirmed deaths in the past week brought the total in the United States to 433,200.

State Social Distancing Actions (includes Washington D.C.) that went into effect this week:

Extensions: CO, DE, IN, NH, NC, SC, WY

Rollbacks: CA, IL, NM, ND, OH, WY

The latest KFF COVID-19 resources:

  • KFF COVID-19 Vaccine Monitor: Nearly Half of the Public Wants to Get a Vaccine as Soon as They Can or Has Already Been Vaccinated (News Release, Report)
  • How Quickly We Need To Ramp Up Vaccinations To Get To Herd Immunity (Full Column, Axios Column)
  • Marketplace Eligibility Among the Uninsured: Implications for a Broadened Enrollment Period and ACA Outreach (News Release, Issue Brief)
  • Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends (Issue Brief)
  • Racial Diversity within COVID-19 Vaccine Clinical Trials: Key Questions and Answers (Issue Brief)
  • Opportunities and Resources to Expand Enrollment During the Pandemic and Beyond (Issue Brief)
  • COVID-19 is the Number One Cause of Death in the U.S. in Early 2021 (Issue Brief)
  • Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know (Issue Brief)
  • Updated: COVID-19 Coronavirus Tracker – Updated as of January 29 (Interactive)
  • Updated: State Data and Policy Actions to Address Coronavirus (Interactive)

 

The latest KHN COVID-19 stories:

  • Why Even Presidential Pressure Might Not Get More Vaccine to Market Faster (KHN, Daily Beast)
  • ‘We’re Not Controlling It in Our Schools’: Covid Safety Lapses Abound Across US (KHN)
  • Poll: Nearly Half of American Adults Now Want the Covid Vaccine — ASAP (KHN)
  • Remdesivir, Given to Half of Hospitalized Covid Patients in U.S., Is Big Win for Gilead — Boosted by Taxpayers (KHN, SF Chronicle)
  • Big Business Boosts Vaccine Effort, but It’s ‘Complex Choreography’ to Get Shots in Arms (KHN, NPR)
  • Vaccine Ramp-Up Squeezes Covid Testing and Tracing (KHN, LA Times)
  • Amid Covid Health Worker Shortage, Foreign-Trained Professionals Sit on Sidelines (KHN, US News)
  • If I Have Cancer, Dementia or MS, Should I Get the Covid Vaccine? (KHN, CNN)
  • California’s Top Hospital Lobbyist Cements Influence in Covid Crisis (KHN, LA Times)
  • Anti-Vaccine Activists Peddle Theories That Covid Shots Are Deadly, Undermining Vaccination (KHN, CNN)
  • Lost on the Frontline: New this week (KHN, The Guardian)
  • Readers and Tweeters Fight Stigma and Salute Front-Line Workers (KHN)
  • Huge Gaps in Vaccine Data Make It Next to Impossible to Know Who Got the Shots (KHN, The Guardian)
  • As Vaccine Rollout Expands, Black Americans Still Left Behind (KHN, NBC News)
  • Can the US Keep Covid Variants in Check? Here’s What It Takes (KHN, NBC News)
  • Vaccination Chaos Fuels Push to Recall Newsom (KHN, Daily Beast)
  • New Covid Cases Plunge 25% or More as Behavior Changes (KHN)
  • Kids Already Coping With Mental Disorders Spiral as Pandemic Topples Vital Support Systems (KHN, NPR)
  • Pandemic Sends a Couple Into Indefinite Long Distance Though Just Miles Apart (KHN, NPR)
  • At Colorado’s Rural Edges, Vaccines Help Assisted Living Homes Crack Open the Doors (KHN, Denver Post)
  • Journalists Stay on Top of Rocky Vaccine Rollout (KHN)
More On
COVID-19 Vaccines

Also of Interest

How Can Trump Administration Regulations Be Reversed?

Author: MaryBeth Musumeci
Published: Jan 29, 2021
Section:
0 / 0

Issue Brief

With the inauguration of President Biden and Democrats holding a slim majority in Congress, policymakers are likely to consider whether and how to reverse various health policy regulations issued by the Trump Administration. As with other recent outgoing administrations,1  the pace of regulatory activity accelerated in the last several months, with the Trump Administration finalizing a number of new regulations in its last days. Rule-making by federal agencies is governed by the Administrative Procedure Act (APA),2  which generally requires a notice of proposed rule-making (NPRM) followed by a public comment period.3  The agency then responds to comments and issues a final rule, with a future effective date.4  An exception to this process is an interim final rule, which requires the agency to find “good cause” to adopt a rule that takes effect immediately, before notice and comment; the agency subsequently considers public comments and may make changes when finalizing the rule.5  Final regulations generally can be rescinded or altered only by issuing a new NPRM, in which the agency provides a reasonable justification for the policy change.6 

Some additional processes, including the Congressional Review Act (CRA) and executive orders imposing a temporary moratorium on regulations in progress,7  may come into play when a new Congress and Presidential Administration take office, particularly when the outgoing Congress and/or Presidency was headed by the opposite political party. This brief explains options for rescinding or changing regulations at various stages8  and identifies some of the key candidates within health care that policymakers may be considering in the coming days, weeks, and months. Table 1 summarizes the processes available to change regulations, under either the CRA or administratively, from the perspective of a new presidential administration taking office.

Table 1:  Processes Available to Change Regulatory Actions of Prior Administration
StatusCongressional Review ActAdministrative Action
Regulation is finalized and in effectRegulation can be nullified by joint notice of disapproval passed by Congress and signed by President within limited timeframe.Agency must issue new NPRM to change regulation.
Regulation is published as final in the Federal Register but not yet in effectRegulation can be nullified by joint notice of disapproval passed by Congress and signed by President within limited timeframe.Historically, new administrations have directed agencies to suspend effective dates for a limited period of time. During this delay, the new administration can assess whether to issue a new NPRM or take other action under the APA.
Regulation was sent to the Federal Register for publication as final but has not yet been publishedRegulation can be nullified by joint notice of disapproval passed by Congress and signed by President within limited timeframe.New administration can order agencies to withdraw final rules that have not yet been published (except for those needed to comply with legal deadlines or necessary for public health and safety).
Regulation is proposed and has not been finalizedCRA does not apply.New administration can withdraw proposed regulation.
Executive order issued by prior administrationCRA does not apply.New administration can revoke executive orders.
NOTE:  Congressional Review Act and Administrative Action are separate processes that are independent of each other. SOURCES:  CRS, The Congressional Review Act:  Frequently Asked Questions (updated Jan. 14, 2020); Maeve P. Carey, CRS Insight, Can a New Administration Undo a Previous Administration’s Regulations? (Nov. 21, 2016); Anne Joseph O’Connell, Agency Rulemaking and Political Transitions, 105 Northwestern Univ. L. Rev. 471 (2011); CRS, Disapproval of Regulations by Congress:  Procedure Under the Congressional Review Act (Oct. 10, 2001).

1.  How can regulations be overturned using the Congressional Review Act?

The 1996 Congressional Review Act (CRA)9  allows Congress, with the President’s signature, to “disapprove” new regulations issued by administrative agencies, leaving those regulations with “no force or effect.”10  Under the CRA, whenever federal agencies issue new regulations, they must submit a report on the regulations to both the House and Senate before the regulations take effect.11  Members in either chamber then have 60 days12  to introduce a “joint resolution of disapproval,” which must be passed by both the House and the Senate and signed by the President. Notably, a new CRA review period opens for a new Congress for any regulations submitted during the final 60 working days of the prior Congress. Unlike other legislation by which Congress might overturn a regulation, CRA joint resolutions of disapproval cannot be filibustered in the Senate and require only a simple majority vote to pass, making it an attractive option for policymakers.13  A two-thirds majority vote in both chambers is still required to override a presidential veto of the joint resolution. The definition of a “rule” to which the CRA applies is broader than final regulations that were subject to notice and comment rule-making.14  The CRA also applies to interim final rules and agency guidance.15  However, it does not apply to proposed rules that have not been finalized16  (Table 1).

While the CRA is always available to Congress, it is of particular interest when a new Congress and President take office because it provides an opportunity for the new Congress to review certain regulations issued by the previous administration that were submitted before the previous Congress adjourned.17  This provides an opportunity for a new Congress and Administration to nullify regulations issued by a prior Administration, particularly where the prior Administration was headed by the opposite political party. The 60-day time period that governs which regulations are subject to CRA review refers to legislative days in the House and session days in the Senate (each of which are counted differently), and therefore can be longer than 60 calendar days.18  For regulations issued by the outgoing Trump Administration, the CRA window for the new Congress is estimated to apply to those issued on or after August 21, 2020, though that date is awaiting formal confirmation by the House and Senate Parliamentarians.19 

Though it has some procedural advantages, the CRA is a blunt instrument, not only invalidating the regulation at issue but also preventing the agency from issuing another regulation that is “substantially the same,” unless specifically authorized by Congress in a subsequent law.20  Unlike other legislation targeting regulations, which can be used to modify or repeal part of a rule, the CRA only allows Congress to invalidate a final rule in its entirety.21  Moreover, CRA action disapproving a regulation generally foreclosures subsequent rule-making that is substantially similar. There is not a lot of clarity on when subsequent regulations are substantially similar to those nullified under CRA, as the statute does not define this term, and courts have not had much opportunity to weigh in to date. Additionally, the statute does not specify who makes the determination about whether a subsequent regulation is substantially similar, creating additional ambiguity and uncertainty.

Since it was enacted in 1996, the most extensive use of the CRA to date was by the Republican-controlled 115th Congress and President Trump, who in 2017, nullified 15 rules issued by the Obama Administration.22  These included Department of Health and Human Services (HHS) regulations governing sub-recipients of Title X family planning grants, as well as regulations that had been issued by the Departments of the Interior, Defense, Education, and Labor; the Securities and Exchange Commission; the Social Security Administration; the Federal Communications Commission, and the Bureau of Consumer Financial Protection.23   Before 2017, the CRA only had been invoked once (by the Republican-controlled 107th Congress and President George W. Bush to nullify a Clinton Administration Department of Labor rule in 2001).24  Most recently, the CRA was used to overturn a Bureau of Consumer Financial Protection rule in 2018.25 

CRA actions generally are not subject to judicial review, though this area of the law is still developing. The CRA itself provides that actions taken under this statute are not subject to review by the courts.26  In the small number of cases to date, most courts have interpreted this prohibition broadly and dismissed cases that sought to challenge action under the CRA.27  However, a few federal trial courts have interpreted the prohibition to extend only to judicial review of congressional action under the CRA and agreed to hear lawsuits challenging administrative agency action under the CRA.28 

2.  How can an incoming Presidential administration change regulations issued by its predecessor?

A new Presidential administration’s ability to unilaterally (without Congress) alter regulations issued by the prior administration depends on the status of the regulation it wants to change. Key questions include whether the regulation is final or proposed; whether or not the regulation’s effective date has passed; and whether or not the regulation has been published in the Federal Register (Table 1).

Similar to actions by past incoming administrations involving a change in party control of the presidency, the Biden Administration upon taking office issued a memorandum freezing new or pending regulations until they are reviewed.29  Specifically, the memorandum directs administrative agencies to refrain from issuing or sending to the Federal Register for publication any proposed or final rules until they are reviewed by a Presidential appointee or designee.30  According to the memorandum, agencies also must immediately withdraw any rules that were sent to the Federal Register for publication but have not yet been published so that they can be reviewed by a Presidential appointee or designee.31  For rules that already have been published in the Federal Register or otherwise were issued but have not yet taken effect, the memorandum advises agencies to consider postponing the effective date for 60 days to provide an opportunity to review any questions of fact, law, or policy raised.32  The memorandum also provides that, during this 60-day period, agencies should consider opening a 30-day period for public comment on these issues.33  Finally, under the memorandum, agencies should consider whether delay beyond 60 days is required to review issues raised by the rules, including whether to publish an NPRM proposing further delay, and notify the Office of Management and Budget Director about any rules determined to raise substantial questions of fact, law, or policy.34  The memorandum applies to final regulations, as well as notices of inquiry, advance NPRMs, NPRMs, and agency guidance.35  In addition to actions available to the incoming administration to change regulations, litigation challenging regulations also may lead to change (see Box 1 for an example).

Box 1: Section 1557 as an Example of Regulatory Changes through Litigation

Lawsuits challenging final rules also can lead to regulatory changes. An example is the regulations implementing the Affordable Care Act’s non-discrimination provision, Section 1557, which have evolved due to several lawsuits as well as administrative agency changes.36  Provisions of the original implementing regulations that included gender identity and termination of pregnancy in the definition of sex discrimination issued by the Obama Administration in 2016 were vacated by a Texas federal trial court. Subsequently, the Trump Administration finalized revised regulations in 2020, citing the litigation in support of its changes, though the revisions go beyond the issues raised in the lawsuit.

Additional lawsuits were filed challenging the Trump Administration regulations, and two federal trial courts have issued nationwide preliminary injunctions blocking implementation of the provisions excluding sex stereotyping from the definition of sex discrimination and provisions incorporating a blanket religious freedom exemption from claims of sex discrimination. As a result, these provisions of the Trump Administration regulations are not in effect while the litigation is pending, though other provisions of the revised regulations did take effect. Other lawsuits challenging the Trump Administration regulations also are pending.

The Biden Administration will have to determine whether to continue to defend the Trump Administration regulations in court or whether to issue a new NPRM to develop revised regulations. Upon taking office, President Biden issued an executive order directing agencies to review all actions, including regulations, that may be inconsistent with preventing and combatting discrimination based on gender identity and sexual orientation.37  This order directs agencies to develop a plan to consider whether to revise, suspend, rescind, or promulgate new regulations, consistent with the APA, within 100 days.38  Based on this policy, it is likely that the Biden Administration will revisit the Trump Administration’s changes to the Section 1557 regulations.39 

3.  Which final regulations might be subject to the CRA or a temporary delay by the Biden Administration?

As the new Congress convenes and the Biden Administration takes office, policymakers will likely consider which Trump Administration regulations to review under the CRA or administratively. Table 2 lists examples of key health policy regulations that are potentially within the CRA window and/or subject to delayed implementation due to executive action. Choosing which regulations to target involves balancing a number of competing priorities. For the CRA, policymakers could weigh the likelihood of widespread support for a joint notice of disapproval, whether the agency will want to issue substantially similar regulations in the future, and the limited amount of floor time to take up CRA resolutions, given the need to address other legislation and confirm Biden Administration nominees. The prohibition on issuing similar regulations in the future could be a significant limiting factor for certain regulations – such as the ACA Marketplace and Medicaid managed care rules – even though they contain controversial individual provisions. When considering regulatory changes administratively, the Biden Administration is likely going to have to balance many competing priorities and account for the time that notice and comment rule-making requires. While the CRA process must be completed within a limited timeframe, other actions to change Trump Administration regulations will take longer.

Table 2: Key Health Policy Regulations Potentially Within Congressional Review Act Window And/Or Subject to Delay Because Not Yet In Effect
TopicRuleDate IssuedEffective Date
HHS regulations (agency-wide)Final SUNSET rule which sets expiration dates for HHS regulations unless they are periodically reviewed (which could increase administrative burden for the agency and lead to regulations lapsing)1/19/213/22/21
MedicareFinal rule implementing policy and technical changes to Medicare Advantage and Part D for CY 2022, including a provision permitting Part D plans to have two specialty drug tiers, among other changes1/19/213/22/21
MarketplacesFinal Notice of Benefit and Payment Parameters for 2022, which, among others provisions, allows states to eliminate healthcare.gov as a mechanism for signing up for coverage, restricts the use of special enrollment periods to sign up for coverage mid-year, and reduces user fees paid by insurers to fund Marketplace operations1/19/213/15/21
MedicaidFinal rule changing how prescription drug manufacturers report “best price” under the Medicaid drug rebate program (which is intended to facilitate private insurance prescription drug value-based purchasing arrangements but could lead to increased Medicaid costs)12/31/203/1/21 (some changes effective 1/1/22 or 1/1/23)
HHS granteesFinal rule removing regulatory prohibition on discrimination by HHS grantees on the basis of sex, religion, sexual orientation, or gender identity and removing requirement that HHS grantees recognize validity of same sex marriages1/12/212/11/21
MedicareFinal rule removing the safe harbor protection for drug rebates in Medicare Part D under the anti-kickback statute11/30/201/29/21 (some changes effective 1/1/2022)
Federally qualified health centersFinal rule requiring federally qualified health centers to provide access to insulin and epinephrine to certain low- and moderate-income patients at 340B prices12/23/201/22/21
HHS guidance (agency-wide)Final “Good Guidance” rule which withdraws HHS guidance if not included in a repository (which could increase administrative burden for the agency and result in guidance with beneficiary protections lapsing)12/7/201/6/21
MedicaidFinal Medicaid managed care rule that relaxes network adequacy, quality oversight, and beneficiary protections11/13/2012/14/20 (some changes effective 7/1/21)
Prescription drugsFinal rule allowing states and other entities to create drug importation programs10/1/2011/30/20
MedicareInterim final rule implementing the Most Favored Nation Model for Medicare Part B drugs11/27/2011/27/20 (public comments due 1/26/21)
COVID-19 public health emergencyInterim final rule making several policy changes in response to the COVID-19 public health emergency, including allowing states to make certain changes to Medicaid eligibility and benefits while receiving temporary enhanced federal matching funds during COVID-19 public health emergency, clarifying that Medicare Part B will cover the COVID-19 vaccine with no cost sharing while it is available under an Emergency Use Authorization, and prohibiting providers from billing people directly for administering COVID-19 vaccines that were purchased by the federal government11/6/2011/2/20 (public comments were due 1/4/21)
NOTES: CRA timeframes depend on when the rule is reported to Congress, not when it is issued by the agency. CRA window is subject to confirmation by the House and Senate Parliamentarians.

Endnotes

  1. See generally Congressional Research Service (CRS), Midnight Rulemaking:  Background and Options for Congress (Oct. 4, 2016), https://fas.org/sgp/crs/misc/R42612.pdf. ↩︎
  2. 5 U.S.C. § § 551-559. ↩︎
  3. 5 U.S.C. § 553; see also CRS, The Federal Rulemaking Process:  An Overview at 5-6 (June 17, 2013), https://fas.org/sgp/crs/misc/RL32240.pdf. ↩︎
  4. CRS, The Federal Rulemaking Process:  An Overview, supra. note 3 at 6. ↩︎
  5. CRS, The Congressional Review Act:  Frequently Asked Questions at 8 (updated Jan. 14, 2020) (citing 5 U.S.C. § 553 (b)(B)), https://fas.org/sgp/crs/misc/R43992.pdf; see generally CRS, The Federal Rulemaking Process:  An Overview, supra. note 3. ↩︎
  6. CRS, Midnight Rulemaking:  Background and Options for Congress, supra. note 1 at 6. ↩︎
  7. For historical use of the latter, see CRS, The Federal Rulemaking Process:  An Overview, supra. note 3. ↩︎
  8. This brief is a general overview and is not intended to be an exhaustive explanation of all technical issues and exceptions. ↩︎
  9. 5 U.S.C. § § 801-808. ↩︎
  10. 5 U.S.C. § 802 (a); see also CRS, Disapproval of Regulations by Congress:  Procedure Under the Congressional Review Act (Oct. 10, 2001). Regulations subject to the CRA that took effect before Congress disapproved them are “retroactively negated.” CRS, The Congressional Review Act:  Frequently Asked Questions, supra. note 1, at Summary page. ↩︎
  11. The regulations also must be submitted to the Comptroller General (Government Accountability Office). 5 U.S.C. § 801 (a)(1). ↩︎
  12. Excluding days either chamber is adjourned for more than 3 days during a session. 5 U.S.C. § 802 (a). ↩︎
  13. Id. at 1. ↩︎
  14. If an agency does not report an action to Congress as a rule, Congress can ask the GAO for an opinion about whether the CRA applies to that action. CRS, The Congressional Review Act:  Frequently Asked Questions, supra. note 1, at 12. ↩︎
  15. Id. at 7-8. ↩︎
  16. Id. at 8. ↩︎
  17. Daniel R. Perez, George Washington Regulatory Studies Center, Upcoming CRA Deadline has Implications for Regulatory Oversight by Congress (Dec. 11, 2019), https://regulatorystudies.columbian.gwu.edu/upcoming-cra-deadline-has-implications-regulatory-oversight-congress. ↩︎
  18. See generally Curtis W. Copeland and Richard S. Beth, CRS, Congressional Review Act:  Disapproval of Rules in a Subsequent Session of Congress (updated Sept. 3, 2008), https://fas.org/sgp/crs/misc/RL34633.pdf. ↩︎
  19. George Washington University Regulatory Studies Center, Congressional Review Act (last accessed Jan. 19, 2021), https://regulatorystudies.columbian.gwu.edu/congressional-review-act. ↩︎
  20. 5 U.S.C. § 801 (b)(2). ↩︎
  21. CRS, The Congressional Review Act:  Frequently Asked Questions, supra. note 1, at 14. ↩︎
  22. Daniel R. Perez, George Washington University Regulatory Studies Center, Upcoming CRA Deadline has Implications for Regulatory Oversight by Congress, supra. note 22. ↩︎
  23. Subsequently, the CRA was used to nullify a Bureau of Consumer Financial Protection rule in May 2018. For a list of all rules nullified by a CRA joint resolution of disapproval to date, see U.S. Gov’t Accountability Office, Congressional Review Act, FAQs, What congressional resolutions of disapproval have occurred under the CRA? (last accessed Jan. 19, 2021), https://www.gao.gov/legal/other-legal-work/congressional-review-act. ↩︎
  24. Id. ↩︎
  25. Id. ↩︎
  26. 5 U.S.C. § 805. ↩︎
  27. CRS, The Congressional Review Act:  Frequently Asked Questions, supra. note 1, at 20-21. ↩︎
  28. Id. at 21-23. ↩︎
  29. Ronald A. Klain, Assistant to the President and Chief of Staff, Memorandum for the Heads of Executive Departments and Agencies (Jan. 20, 2021) (Fed. Reg. publication forthcoming), https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/regulatory-freeze-pending-review/. ↩︎
  30. All actions under this memorandum are subject to exceptions allowed by OMB for emergencies or other urgent circumstances related to health, safety, environmental, financial, or national security matters. Rules subject to statutory or judicial deadlines also are exempt. Id. at ¶ ¶ 1, 4. ↩︎
  31. Id. at ¶ 2. ↩︎
  32. Id. at ¶ 3. ↩︎
  33. Id. ↩︎
  34. Id. ↩︎
  35. Id. at ¶ 6. ↩︎
  36. For additional information, see KFF, The Trump Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA and Current Status (Sept. 2020), https://modern.kff.org/racial-equity-and-health-policy/issue-brief/the-trump-administrations-final-rule-on-section-1557-non-discrimination-regulations-under-the-aca-and-current-status/. ↩︎
  37. President Joseph R. Biden, Jr., Executive Order on Preventing and Combatting Discrimination on the Basis of Gender Identity or Sexual Orientation (Jan. 20, 2021) , https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-preventing-and-combating-discrimination-on-basis-of-gender-identity-or-sexual-orientation/. ↩︎
  38. Id. at § 2. ↩︎
  39. When revising the Section 1557 regulations, the Trump Administration also eliminated explicit nondiscrimination protections related to gender identity and sexual orientation in 10 other HHS regulations that govern Medicaid managed care entities, state Medicaid programs, PACE organizations, group and individual health insurance issuers, Marketplaces, qualified health plan issuers, agents and brokers that assist with Marketplace applications and enrollment, and education programs that receive federal financial assistance. KFF, The Trump Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA and Current Status, supra. note 36. ↩︎
More On
Medicaid ACA Marketplaces Courts Prescription Drugs

Also of Interest

Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know

Authors: Bradley Corallo and Robin Rudowitz
Published: Jan 28, 2021

This data note discusses changes in the number of applications for Medicaid/CHIP coverage during the coronavirus pandemic. Application data include new applications for coverage that are received by state Medicaid/CHIP agencies and (if relevant) the State Based Marketplace; in many states, applications also include renewals and redeterminations. Data are from the Centers for Medicare and Medicaid Service (CMS) Performance Indicator Project, which is designed to track enrollment and an array of other measures to assess states’ Medicaid program performance. However, CMS has mostly focused on monthly enrollment totals, and other measures are either not publicly available or are not included in monthly summaries from CMS, though CMS recently highlighted changes in applications (see Methods box for more details about the data).

Enrollment in Medicaid/CHIP has increased steadily by more than 6 million individuals (9%) from February to September 2020, though it’s difficult to tease out the effects of the economic crisis with people losing their jobs from the requirement that states maintain coverage for people already enrolled in Medicaid during the public health emergency (PHE). The total number of Medicaid/CHIP applications has decreased by more than 150,000 (-6%) in the same time period, which might on the surface suggest that fewer people are applying for coverage even in the face of large job and income losses, but data limitations – in particular, the fact that application statistics do not distinguish between new signups and renewals – make it difficult to draw any clear conclusions.

For the median state, which is more stable than using the national total, the number of applications peaked in March 2020 (+12% from February) with a sharp decline in May 2020 (-22% from February), and applications only began increasing again in June and July 2020 (-16% and -13% from February) before leveling off in recent months (Figure 1). The decrease in applications is likely due to a number of factors and likely includes a reduction in renewals and redeterminations as well as the effects of lockdowns and closures due to the pandemic.

Figure 1: Medicaid/CHIP applications declined early in the pandemic, but data limitations make it difficult to interpret trends.

While the continuous coverage provisions of the FFCRA likely played a role in the decline of applications, it is difficult to parse out the impact based on the data available. In exchange for receiving an enhanced federal match rate on Medicaid spending, state Medicaid agencies must ensure continuous coverage for those enrolled as of March 2020. Initial guidance from CMS also specified that states could not move enrollees to a new eligibility category. As a result, most states likely stopped or slowed processing renewals. While states still could not disenroll people from Medicaid, some states may have started to process renewals over the summer contributing to an uptick in applications. States could start a new 12-month renewal period if all other eligibility criteria can be verified. These renewals could help stagger renewals at the end of the PHE. Available data do not identify new applications from renewals or redeterminations, and it is difficult to identify their role in declining application totals. In more recent guidance effective November 2, 2020, CMS reversed earlier guidance and specified that states are required to transition most enrollees determined ineligible for their current coverage to different coverage pathways for which they are eligible if such a transition is in the same tier of coverage (but cannot disenroll individuals). It is possible that this revised guidance could contribute to increases in application data in the upcoming months.

The declines in applications could also reflect challenges related to social distancing measures and office closures during the pandemic. Although all states provide online application options, the median state reported that 55% of Medicaid/CHIP applications completed online, suggesting that a large share of applicants rely on telephone, mail, or in-person applications. Office closures due to the pandemic could have limited some peoples’ options for filing Medicaid/CHIP applications, especially if they have limited access to the internet. It is also possible that prolonged changes in the economy and adaptations to provide better assistance and process new applications may have contributed to the increase in applications after the sharp decline in May. Timely information on the mode of applications is not currently available in national data sets, although it could help identify whether there have been changes in the modes that people apply for Medicaid/CHIP.

There is wide variation in application trends across states, with the majority of states seeing a decline from February 2020 (Figure 3). Variation in the number of applications is likely related to state-specific policies, economic conditions within states, and even seasonal patterns, such as open enrollment for federal and state-based health insurance marketplaces. Nebraska, for example, has seen a large increase in applications (67%) from February to September 2020, which the state attributed to early applications for the new Medicaid expansion program that began coverage in October 2020, according to a recent CMS Medicaid and CHIP Enrollment Trend Snapshot. Kentucky saw even larger growth, with a 224% increase in applications from February to September 2020, although the reason behind this increase is unclear. The majority of states (34 out of 49 with complete data) reported a decline in the number of Medicaid/CHIP applications since February 2020, with the lowest state (DC) seeing a 55% decline in applications in this time period (Figure 2).

Figure 2: Changes in the number of Medicaid/CHIP applications vary widely by state.​

Methods

This analysis is based on KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data. This data set is designed to track enrollment and an array of other measures to assess states’ Medicaid program performance. State Medicaid agencies submit data to CMS each month, and the data are typically used to track current enrollment in Medicaid and CHIP, usually with a 3- to 4-month lag when the data are made publicly available. Other measures aside from enrollment are either not made publicly available or not typically highlighted in monthly summaries, although CMS recently highlighted changes in states’ monthly Medicaid/CHIP applications.

Application data reflect all applications received by the state Medicaid and CHIP agency (or agencies) as well as the number of applications requesting financial assistance that have been received by the state-based marketplace (including Medicaid/CHIP applications, Advanced Premium Tax Credits, and Cost Sharing Reductions). Applications that are started on the federally facilitated marketplace are not included in the data. Additionally, 12 states use footnotes in the data between January 2020 and September 2020 to indicate that application counts include renewals and/or redeterminations (AK, DC, IA, MD, MO, NV, NY, OH, OK, PA, VT, VA), although inclusion of renewals/redeterminations or the number of renewals/redeterminations are not standardized measures in the publicly available data. For this analysis, we excluded two states (Kansas and Maine) that have missing data for one or more months between January 2020 and September 2020.

 

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Addressing the Risk of Medicare Trust Fund Insolvency

Published: Jan 27, 2021

In this Viewpoint for the Journal of the American Medical Association (JAMA), KFF’s Tricia Neuman and co-author Richard G. Frank of Harvard Medical School explain that the looming 2024 insolvency of the Medicare Hospital Insurance Trust Fund cannot be ignored for long.

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News Release

Nearly 9 Million Uninsured Americans Could Get Free or Subsidized Health Insurance if the Biden Administration Re-Opens ACA Marketplace Enrollment in Response to COVID-19

Published: Jan 27, 2021

Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden Administration were to re-open ACA marketplace enrollment, a KFF analysis finds.

Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden Administration were to re-open ACA marketplace enrollment, a KFF analysis finds.

The 8.9 million people eligible for free or reduced-cost coverage represent nearly 60 percent of the approximately 15 million uninsured people in the U.S. who could shop for health insurance coverage on the ACA Marketplaces, the analysis finds. Compared to the general non-elderly population, the uninsured people in these categories are more likely to be young adults aged 19 to 34, Hispanic, non-native English speakers, lacking internet access, high-school educated and working in service industries such as arts, entertainment and recreation.

Those eligible for free bronze plans also are more likely than the general non-elderly population to be unemployed or working part-time, and to live in rural areas. More than half of them live in Texas, Florida, North Carolina, or Georgia.

Free or reduced-cost bronze ACA plans generally carry steep deductibles, requiring policy holders to pay thousands of dollars for care out of pocket before coverage kicks in. However, the analysis finds that about 2 of every 3 uninsured people who are eligible for a free ACA bronze plan have household incomes low enough to be eligible for significantly lower deductibles if they purchase a more expensive silver plan instead.

Based on campaign pledges, President Biden is expected to move towards reopening Marketplace enrollment as soon as this week, for example by announcing a COVID-19 special enrollment opportunity (SEP). His administration is also expected to direct more resources to marketing and outreach, following several years in which the Trump administration pared back spending on such efforts.

The findings of the new analysis can inform government agencies or navigators engaged in outreach and marketing efforts. Uninsured people who are eligible for subsidies to buy Marketplace plans may be unaware of their options or need help understanding the tradeoffs.

KFF researchers estimate that more than $1 billion in unspent federal user fee revenue has accumulated that could be used by the new administration to invest in changes that would make it easier for consumers to enroll in health coverage.

For more data and analyses related to the ACA Marketplace and COVID-19, visit kff.org.

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Affordable Care Act Private Insurance ACA Marketplaces Enrollment Individual Market

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News Release

Vaccine Monitor: Nearly Half of the Public Wants to Get a COVID-19 Vaccine as Soon as They Can or Has Already Been Vaccinated, Up across Racial and Ethnic Groups Since December

People Who Know Someone Who Has Been Vaccinated are More Eager to Do So Themselves

Published: Jan 27, 2021

Most Convincing Messages to Promote Vaccination Highlight Effectiveness at Preventing Illness and a Return to Normal Life; Hearing about Rare Allergic Reactions and Side Effects May Discourage Some

New KFF Dashboard Features Key Data and Insights from the Vaccine Monitor

With millions of Americans getting their first COVID-19 vaccinations, the public’s eagerness to get a vaccine is rising across racial and ethnic groups, though Republicans and rural residents remain the most reluctant groups, the latest KFF COVID-19 Vaccine Monitor reports.

Based on a survey fielded just before President Biden took office, the latest Monitor report shows nearly half (47%) of the public want to get the vaccine as soon as they can or have already been vaccinated. That is significantly higher than the third (34%) of the public in the most-eager “as soon as possible” category in December.

An additional 31% say they want to “wait until it has been available for a while to see how it is working for others” before getting it themselves. One in five (20%) are more reluctant to get vaccinated, including 7% who say they will only get the vaccine “if required to do so for work, school or other activities,” and 13% who say they will “definitely not” get it.

 

The share who have already been or want to get vaccinated “as soon as possible” is up among Black, Hispanic, and White adults, though White (53%) adults remain more likely than Black (35%) and Hispanic (42%) adults to say so. Black (43%) and Hispanic (37%) adults are more likely than White adults (26%) to say they want to “wait and see” before getting vaccinated.

Similarly, there has been a shift toward greater enthusiasm for getting vaccinated across urban, suburban, and rural areas, though rural residents remain most hesitant. Democrats and independents also show increased enthusiasm, though Republicans’ views are little changed since December.

 

The Monitor shows that Republicans and rural residents are now the groups most likely to say they either definitely won’t get a vaccine or would only do so if required.

Data and analysis related to vaccine acceptance and hesitancy, trusted messages and messengers, demographic breakouts, and people’s experiences, are now featured in a new dashboard for the Monitor. The dashboard will be updated regularly to reflect the latest data and current issues, including an upcoming report on people’s sources of information related to the COVID-19 vaccine.

About a third (32%) of health care workers – a priority group for getting vaccinated – say they have gotten at least their first dose of a vaccine, and a quarter (26%) want to get it as soon as possible. Another quarter (28%) want to wait and see before getting vaccinated, while small shares say they would only get it if required (5%) or definitely would not get it (9%).

People’s enthusiasm for getting vaccinated correlates with whether they know someone who has already received a vaccine. For example, about half (52%) of those who want to get vaccinated as soon as possible know someone who has already gotten a dose, a much larger share than among those who say they’ll only get it if required (29%) or definitely won’t get it (36%).

“Perhaps more important than any message is the impact of seeing a neighbor, friend or family member get their shots without any adverse effects,” KFF President and CEO Drew Altman said. “It provides hope that vaccine confidence will build over time.”

Nearly half (47%) of the public now say that they have personally received at least one vaccine dose or know someone who has, though these experiences aren’t spread out evenly across groups. White adults (51%) are more likely than those who are Black (38%) or Hispanic (37%) to have either been vaccinated or know someone who has, and those with annual household incomes of at least $90,000 are almost twice as likely as those with incomes under $40,000 to say so (65% vs. 33%).

Key Messages: Information that May Make People More or Less Likely to Get Vaccinated

The Monitor also reports on the effects of different messages and information that might make people more or less likely to get vaccinated.

Among those who have not yet been vaccinated, majorities say they would be more likely to get a vaccine if they heard it was “highly effective” in preventing illness from COVID-19 (57%), that getting vaccinated offers protection from getting sick (56%), and that the vaccine offers “the quickest way for life to return to normal” (54%).

Nearly as many say they would be more likely to get vaccinated if they heard that “millions of people have already safely been vaccinated” (46%) and that vaccination is needed to “get the U.S. economy back on track” (45%).

Republicans are less likely than Democrats and independents to say that each message tested would make them more likely to get vaccinated. For example, 30% of Republicans say they would be more likely to get vaccinated after hearing that it would help get the economy back on track, compared to 57% of Democrats and 47% of independents.

In the other direction, the messages that most often make people say they would be less likely to get a vaccine include information about some people getting severe allergic reactions (39%) or experiencing short-term side effects such as fever or pain (33%).

These data are not surprising, as large shares of those who have not been vaccinated also say they are concerned about the vaccine’s long-term effects (68%), potential serious side effects (59%), and whether the vaccines are as safe (55%) and effective (53%) as claimed.

Fewer (31%) of those who have not been vaccinated are concerned about getting COVID-19 from the vaccine, though the shares saying so are significantly higher among Black (54%) and Hispanic (50%) adults. Black and Hispanic adults are also more likely than their White counterparts to be concerned about other adverse effects.

Most (57%) of those who have not been vaccinated against COVID-19 say they don’t have enough information about potential side effects of the vaccine, and about half (49%) say they don’t know enough about the vaccine’s effectiveness. Those most likely to say they don’t have enough information include people under age 50, Black and Hispanic adults, those with a high school education or less, and those with low household incomes.

A third (34%) of those who have not yet been vaccinated have heard one of three inaccurate claims about the vaccine and either believe the misinformation or aren’t sure if it is true. For example, nearly one in five (19%) say that they have heard that the vaccine includes live COVID-19 virus and believe that it is true (8%) or that they heard that and aren’t sure if it’s true (11%). Small shares report the same about the vaccine causing infertility (3% believe, 9% aren’t sure) and about having to pay out-of-pocket to get the vaccine (4% believe, 8% aren’t sure).

“Many people clearly feel like they need more information before they will get in line for a vaccine, and what they hear – positive or negative, true or false – may influence what they ultimately do,” KFF Executive Vice President Mollyann Brodie said. “Many are concerned about potential side effects and adverse reactions, particularly Black and Hispanic adults, presenting both a challenge and opportunity for outreach and education efforts.”

Designed and analyzed by public opinion researchers at KFF, the survey was conducted from Nov. 30-Dec. 8 among a nationally representative random digit dial telephone sample of 1,676 adults, including oversamples of adults who are Black (390) or Hispanic (298). Interviews were conducted in English and Spanish by landline (391) and cell phone (1,285). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and focus groups, this project will track the dynamic nature of public reactions as vaccine development unfolds, including vaccine confidence and hesitancy, trusted messengers and messages, as well as the public’s experiences with vaccination as distribution begins.

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COVID-19 Health Information and Trust Racial Equity and Health Policy Race/Ethnicity Vaccines

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