Top of mind: HHS’s reversal of Obama-era transgender nondiscrimination healthcare protections

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

On June 12, the Trump Administration finalized a rule that proposed to revise, and in effect reverse, Obama-era protections offered in Section 1557 of the Affordable Care Act (ACA). Section 1557, known as the Health Care Rights Law, prevents discrimination of patients based on “race, color, national origin, sex, age, or disability.” In 2016, the Obama Administration expanded the definition of sex to encompass aspects of gender identity as well—extending protections to transgender and gender non-conforming individuals. 

The finalized rule will drastically impact how LGBTQ individuals navigate their health care and health insurance, with regard to nondiscrimination protections. The rule would essentially affect aspects of coverage related to access, cost-sharing, and health plan benefits, specifically, denial of treatment based on someone’s gender transition and/or a provider’s moral or religious beliefs.

The U.S. Department of Health and Human Services (HHS) released a statement following this news expressing that reinstating the original definition of the protections offered would relieve the American people of approximately $2.9 billion in “unnecessary regulatory burdens”. These so-called burdens also include eliminating mandates for regulated entities to provide patients and customers with language accessibility pertaining to health care literature.

Considering the nexus of a global pandemic, civil unrest due to systemic racism, compounded by the epidemic of fatal violence against Black transgender people – the timing of this rule is not only inopportune but exceptionally cruel. The National Consumers League is appalled at the reversal of these protections during a pandemic that is disproportionately impacting vulnerable communities. We urge health insurers and providers to do the right to protect patients by keeping politics out of professional medical judgment when providing services to their patients and customers.

Keeping meatpacking workers safe in the age of COVID-19: A view from the front lines

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

Meatpacking plants across America have become hot spots for COVID-19. Many plants have had to close due to the rapid increase in cases, with hundreds of workers contracting COVID-19 and a tragic number dying from the deadly virus.

Many packing plants have reopened over the past couple of weeks but the question still remains:  what measures have been put in place to address working conditions?

We interviewed someone who has firsthand knowledge of what is happening on the inside.  Robyn Robbins is the director of occupational health and safety at the United Food and Commercial Workers Union (UFCW). She has worked for UFCW for the past 24 years and prior to this position she was the Assistant Director for 18 years. UFCW is one of the largest labor unions in America. The Union represents workers in meatpacking, poultry, food processing industry, retail grocery, and healthcare—all considered to be essential workers.

Robbins told us: “Many workers are getting sick and dying, and the industry has a history of exploiting workers.” Indeed, the meat industry does not have an admirable record on protecting workers from hazards long before COVID-19. Meatpacking plants on average can employ up to 5,000 workers under one roof, and the conditions are very challenging.  Workers work closely on production lines, sometimes “shoulder to shoulder,” and the areas where they congregate off the line—such as break rooms and locker rooms—can get crowded.  The virus can spread quite easily under these conditions. And the industry has not done enough to allow workers to socially distance both on the production floor and off, or to notify the union when workers are infected, and who else has been exposed, so that the spread of the virus can be contained.

Even amid the pandemic, the demand for meat and poultry is constant. As a result, meatpacking plants have reopened, albeit not at full capacity.  Robbins noted that OSHA (Occupational Safety and Health Administration)—the federal agency that regulates safety and healt—has taken a backseat and has not done on-site inspections. “There are no safety standards that regulate COVID-19 and no clear requirements or regulations that companies are required to follow and therefore there is no way to force companies to actually take precautionary measures recommended by the CDC to protect workers,” Robbins said. She went onto say that “OSHA is the only Federal government entity that can require companies to do anything to protect workers during this pandemic.”

UFCW local union representatives and stewards are in the plants and work hard to get companies to do the right thing to protect workers through the collective bargaining process. “The challenge is trying to get the companies to space workers out on the production floor, which does require some slowing down of line speeds; some of the companies are doing the right thing by spacing workers out but many are not, and are relying too much on protective equipment and plastic barriers, which have not been proven to offer any protection, when it is really about putting more distance between people,” Robbins told us. Social distancing in break rooms is another challenge. Companies have made some effort to effectively separate tables and are putting tents outside for workers to take breaks in those designated areas. They are also staggering shift times in order to reduce the number of workers in break areas at any one time.

Robbins noted: “not all companies are testing workers when they should be, which is a major problem.” UFCW is calling on meatpacking plants to test workers, but companies are reluctant. “If companies worked more closely with the union, they would collectively be able to come up with strategies to isolate workers, redistribute the work, and be more effective over all in addressing the issues relating to COVID-19 and meatpacking workers.”

UFCW doesn’t agree that reopening of plants should take place where there have been outbreaks and where unsafe working conditions exist, unless the companies have taken the steps necessary to protect workers from exposure to COVID-19. “The companies that did shut down made the right decision to sanitize and clean the plants,” said Robbins. “Some have also started screening workers, set up hand sanitizing stations, providing masks, spacing out common areas, giving workers face shields and putting up plastic barriers on the floor between workers where it is possible – although again, there is no data to show that plastic barriers do anything to stem the spread of the virus.”

But this is still not enough. UFCW wants to see workplaces reconfigured so that workers can be six feet apart, both on the production floor and off. This is crucial for stemming the spread of the virus.

Robbins said sick leave policies vary tremendously. “There are 500 local unions around the country, and the UFCW has been pushing for 14 days’ sick leave, successfully bargaining for this in contracts. Some companies are using a combination of different ways to allow workers to stay home when sick, many suspending their normal sick leave policy and making them more flexible. Some companies use a combination of paid sick days and short-term disability so that workers can stay home to recover and then return to work in a safe way. But not all companies are doing this; a few are even revoking paid sick leave policies that were in place at the beginning of this crisis.  This only will result in sick workers coming to work, because they have to in order to earn a living, and the virus will continue to spread, both inside plants, and outside in their communities.  It is bad corporate policy.”

Due to the thousands of cases of COVID-19 in meatpacking plants and many plants not operating at full capacity, meat shortages may continue. In closing, we so appreciate UFCW representing worker interests and Robyn Robbins’ service on NCL’s Board of Directors.

Observing World Food Safety Day: Food safety, foodborne illnesses, and the pandemic.

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

Happy World Food Safety Day! June 7 is a special day designated by the United Nations to draw global attention to the health consequences of contaminated food and water.

The concept of food safety encompasses all practices that are used to keep our food safe and relies on the joint efforts of everyone involved in our food supply. “Everyone” refers to all actors in the food chain, farmers, manufacturers, wholesalers, retailers, restaurants, caterers, and many more. Laws and regulations are in place to reduce the risk of contamination under the Food Safety Modernization Act, which is transforming the nation’s food safety system by shifting the focus from responding to foodborne illness to preventing it.

In the United States, the Centers for Disease Control and Prevention CDC estimates that each year 48 million people get sick from a foodborne illness, 128,000 are hospitalized, and 3,000 die. There are more than 250 types of foodborne diseases, caused by bacteria, viruses, and parasites. Some common foodborne illnesses that are found in our country include:

Norovirus: a contagious virus that causes vomiting and diarrhea. You can get norovirus from:

  • Direct contact with an infected person
  • Consuming contaminated food or water
  • Touching contaminated surfaces, then putting unwashed hands in your mouth

Salmonella: lives in the intestines of people and animals. can come from infection from a variety of sources, including:

  • Eating contaminated food or drinking contaminated water
  • Touching infected animals, their feces, or their environment.
  • The bacteria cause about 1.35 million infections, 26,500 hospitalizations, and 240 deaths in the United States every year.

Clostridium perfringens: a spore-forming bacterium that is found in the environment as well as in the intestines of humans and animals. It is also commonly found in raw meat and poultry, beef, poultry, gravies and dried of pre-cooked foods

  • Infections often occur when foods are prepared in large quantities and kept warm for a long time before serving. Outbreaks often happen in institutions, such as hospitals, school cafeterias, prisons, and nursing homes, or at events with catered food.

Campylobacter: the most common bacterial cause of diarrheal illness in the United States.

  • Causes 1.5 million illnesses each year.
  • caused by eating raw or undercooked poultry or consuming something that has come into contact with raw or undercooked poultry, seafood and untreated drinking water.

Staphylococcus (Staph): a gastrointestinal illness caused by eating foods contaminated with these toxins.

  • symptoms include sudden nausea, vomiting and stomach cramps, diarrhea.
  • Not washing hands if food is contaminated with Staph, the bacteria can multiply in the food
  • Foods that are not cooked after handling, such as sliced meats, puddings, pastries and sandwiches are especially risky if contaminated with Staph.

As we note efforts worldwide to ensure that our human food supply is safe, we would be remiss in 2020 if we did not note the increased food safety concerns during the COVID-19 pandemic.

According to the CDC, there is currently no evidence to support transmission of COVID associated with food. It is important that consumers wash hands with soap and water for 20 seconds when handling food. The CDC highlights that, because of poor survivability of these coronaviruses on many surfaces, there is likely low risk of spread from food products or packaging. The CDC also reinforces the need to avoid cross-contamination of foods in preparing food safely by keeping raw meat separate from other foods, cooking meat to the recommended temperature, which kills harmful bacteria and ensuring that perishable foods are refrigerated.

It is also important to always rinse fresh fruits and vegetables under running water, including melons and other produce with skins and rinds. Scrub the produce firmly with a clean brush, also remember to clean the lids of canned goods before opening them, says the FDA. Washing produce and cooking meats, fish, and poultry thoroughly is key during this pandemic, especially with so many people preparing their meals at home. Our message to consumers and restaurants and anyone who handles food: as we mark World Food Safety Day, follow these important food safety practices to help prevent foodborne illness and stay healthy and safe during these uncertain times.

The National Consumers League supports expanded COBRA coverage

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By Sally Greenberg, NCL Executive Director

In a perfect world, every person in the United States would have quality health care coverage, irrespective of whether they were employed or whether their employer-offered health insurance. The National Consumers League (NCL) has long advocated for universal access to health insurance for every American.

For political reasons, however, we still have a hybrid, expensive, and patchwork health care system. Thankfully, the Affordable Care Act addresses some of these disparities for millions, but our health care system in the United States still leaves many gaps in who can get coverage. And now, with the COVID-19 pandemic, the gaps in our social safety net have been made very stark indeed. Estimates are that 27 million Americans who have lost their jobs have lost their health insurance as well, according to an analysis from the Kaiser Family Foundation.

An estimate from the Robert Wood Johnson Foundation found between 25 million and 43 million people could lose their employer-sponsored insurance in the coming months if job losses continue.

However, help is on the way.

The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act passed the House of Representatives on May 15, 2020. The bill addresses the COVID-19-induced massive unemployment/loss of health insurance crisis for Americans who receive their health insurance through their employer.

The HEROES Act allows individuals eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage to maintain their employer-sponsored coverage after a layoff, reduction in hours or furlough without having to pay premiums through January 2021. The bill also would provide two special enrollment opportunities for individuals to obtain health insurance: (a) during the emergency period for Medicare-eligible individuals residing in an emergency area who have not previously enrolled in Medicare and (b) during an eight-week enrollment period for an Affordable Care Act exchange for individuals who are uninsured for whatever reason. The bill would authorize veterans without a disability or health insurance to qualify for special enrollment in the Veterans Affairs (VA) healthcare system for a 12-month period. Finally, the bill would expand the Medicaid expansion pathway provided for in Families First, which covered 100 percent of testing costs. HEROES would expand this pathway to include full federal coverage for COVID-19 treatment and vaccines without cost-sharing for certain Medicaid enrollees.

There are issues, of course, with handing over billions of dollars to the health care industry through expanded COBRA that they might not have received otherwise. Among them, they pay excessive salaries to their CEOs that should trouble all of us who pay insurance premiums.

There is also the possibility that increasing access to private insurance via COBRA subsidies could stunt nationwide efforts to expand Medicaid for more vulnerable populations, to some degree.

But this is a case where we cannot let the pursuit of perfection be the enemy of the good. For nearly 40 million Americans struggling with loss of employment, passage of the HEROES Act will mean that they will not have to worry that neither they, nor their families, will lose health insurance.

We agree with Actors’ Equity, which issued this statement before the HEROES Act was adopted, “it is time for Congress to consider a 100% COBRA subsidy to ensure that no one loses their health care in the middle of a pandemic.” Similarly, our friends at Families USA have echoed the call for fully subsidizing COBRA coverage for displaced workers, among other robust consumer assistance measures. To read more, click here.  

Fully or heavily subsidizing COBRA coverage will have multiple benefits – particularly for consumers with chronic illnesses who have already satisfied their annual deductible- who would either be faced with potentially starting a new deductible from scratch, or with an entirely new provider altogether. By subsidizing COBRA coverage, families will be able to seek medical care, access vaccines and testing for COVID, and will have the full array of health care protections. It is a measure that will be good for the entire nation and will lessen the already frightening and painful loss of employment.

As a result, NCL strongly supports the HEROES Act provisions to subsidize COBRA benefits to the many millions who have lost employment. The House of Representatives has done its part. Now we need the Senate to approve the HEROES Act and move it to the President’s desk for signature. The nation will be far healthier if everyone can have access to health care in the age of this catastrophic COVID-19 pandemic.

A prescription for surviving COVID-19 nutritionally intact: eat well, get sunshine

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

Overeating or eating poorly during this pandemic is understandable. However, a healthy diet is vital for you and your family’s health. As most people are aware, a healthy diet consists of protein, fruits, vegetables, and grains and is low in salt, unsaturated fats, and free sugars. But there’s more to it than that.

While it’s important to have protein in one’s diet, it is not always necessary to get protein from meat products. One of the best sources is legumes (as known as beans) such as white peas, kidney beans, moong, masoor, chickpeas, lentils, and many others according to Thrive Global. Consider whipping up a salad, making tasty lentil soup with carrots and cilantro, or a chickpea curry to quench your taste buds! Preparing a simple, easy, and delicious meal doesn’t have to be hard, you can find many recipes and cooking guides on YouTube or Google Search.

Eating healthy sometimes means breaking bad habits, so the first step is by keeping healthy and nutritious snacks around, such as cheese with an apple, hummus and carrots, or nuts and dried fruit. Eating yogurt once a day is a good habit to get into along with fruit and cereal. If you’re full from a good breakfast, you are less likely to snack on junk food. Thrive Global noted that certain bacteria are highly recommended to keep you healthy and fit.

Remember to top up on your fruits! They are a rich source of minerals and vitamin C, which is especially good for boosting your immune system during COVID-19. Rangers, Apples, kiwis, and persimmons are just a few fruits rich in vitamin C. Kale, brussels sprout, broccoli, and parsley are also on the list. Vitamin D is also important in the immune response to COVID-19 due to its anti-inflammatory properties. Vitamin D is usually sourced by the action of sunlight on the body but since many of us are staying at home due to the lockdown and unable to get the necessary daily exposure, we must depend on vitamin D rich food sources such as; salmon, swordfish, oysters, mushrooms, and eggs, according to 10FAQ Health. And these vitamin D rich foods can make for very delicious dishes like garlic butter baked salmon or chargrilled oysters. Check out recipe sites like Food Network for more meal ideas.

Eating healthy is particularly important during the time of COVID-19. By incorporating foods of color—carrots, beans, various cheeses, kale, and more—you can make delicious dishes. Try new recipes and enjoy a healthy nutritious meal. And remember, eating healthy contributes to the boosting of the immune system. Let us all try to stay healthy and safe during COVID-19!

Alcohol consumption during COVID-19: What the consumer needs to know

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

While most people are stuck at home in America during the COVID-19 pandemic, many have increased their alcohol purchase and consumption. During the Great Depression, President Franklin D. Roosevelt reportedly stated at the end of prohibition, “what America needs right now is a drink.” American’s are now facing another crisis, a pandemic and are adhering to this call.

According to a survey done by the research firm Nielsen, off-premise sales of alcohol spiked nationwide following stay-at-home orders. A new study from Alcohol.org stated that 1 in 3 Americans are drinking alcohol while working from home during COVID-19 lockdown. About 32 percent of Americans are more likely to be drinking while working from home, with 36 percent of men and 26 percent of women drinking while working.

In 2018, National Survey on Drug Use and Health (NSDUH) disclosed data showing that 86.3 percent of Americans ages 18 or older reported that they drank alcohol at some point in their lifetime; 70 percent reported they drank in the past year; 55.3 percent reported that they drank in the past month. NSDUH also indicated in 2018 that 14.4 million adults ages 18 and older had Alcohol Use Disorder in the United States. This includes 9.2 million men and 5.3 million women. The survey went onto disclose an estimated 401,000 youth ages from 12 to 17 had Alcohol Use Disorder.

According to Healthline, Americans expressed that their daily routine has changed and many have faced unemployed. This increased uncertainty, anxiety, and fear brought on by the pandemic has resulted in binge drinking.

What is defined as “binge drinking”? The Centers for Disease Control and Prevention (CDC) defines it as a pattern of drinking that brings a person’s alcohol concentration (BAC) to 0.08 g/dl or above. This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours.

Binge drinking has some serious risks and is associated with many health problems, including:

  • sudden infant death syndrome;
  • obesity;
  • chronic diseases such as high blood pressures, stroke, heart disease, and liver disease;
  • cancer of the breast, mouth, throat, esophagus, liver, and colon;
  • memory and learning problems;
  • alcohol use disorders;
  • and fetal alcohol spectrum disorders.

The CDC stated in 2010 that alcohol misuse cost Americans an estimated $249.0 billion. These costs resulted from losses in workplace productivity, health care expenditures, criminal justice costs, and other expenses. Binge drinking was responsible for 77 percent of these costs or $191 billion.

Many consumers are unaware that the U.S. Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB) has not mandated “Alcohol Facts” on alcoholic beverages. Consumers have access to labeling information that contains nutritional facts on every single thing they consume except alcoholic beverages. As a result, consumers have little means of knowing the most basic information about alcoholic beverages. At the National Consumers League (NCL), we think the need for alcohol labeling is long overdue. Over the last two decades, NCL has petitioned the federal government for standardized “Alcohol Facts” and, this summer, will be calling for action on Alcoholic Beverage Labeling. Join your voice with ours by signing the forthcoming petition addressed to TTB and demand the drafting and implementation of rules that mandate a standardized “Alcohol Facts” label on all alcoholic beverages. It’s time to end the confusion so consumers can make informed and responsible purchasing and consumption decisions.

NCL expresses concern about Trump Administration’s NBPP rule for 2021

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May 26, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—The National Consumers League (NCL), the nation’s pioneering consumer advocacy organization, expresses concern about the Trump Administration’s Notice of Benefit and Payment Parameters Rule for 2021.

The following statement is attributable to NCL’s Executive Director Sally Greenberg:

“As the COVID-19 pandemic continues to take a toll across the country, consumers should not be subjected to additional obstacles when trying to access the care they need. We are therefore deeply troubled by the Department of Health and Human Services (HHS) decision to permit health plans to use accumulator adjustment programs in its Notice of Benefit and Payment Parameters Rule for 2021.

This is a step in the wrong direction at a time when consumers are struggling to make ends meet. Under these programs, health insurers are not required to count manufacturer cost-sharing assistance toward patients’ annual deductibles, even when no medically appropriate generic equivalent is available. Many patients typically rely on very specific treatments that have no generic or other alternative, resulting in already high out-of-pocket spending. Removing this cost-sharing assistance will force those patients to pay thousands of dollars more in unexpected costs at the pharmacy. These new costs could push some to forego those medications, leading to worsened health outcomes. This could compromise medication adherence and will lead to increased health care costs over time.

Given the significant financial pressure this will place on patients and the negative impact it could have for our health care system as a whole, we ask that HHS reconsider the reversal of its original protections against these programs. Any subsequent course of action should seek to take the burden off of consumers. Employers and insurers must recognize that this is not the time to create barriers to care and refrain from implementing accumulator adjustment programs in 2021.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

NCL expresses concern about Trump Administration’s NBPP rule for 2021

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Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832
Washington, DC—The National Consumers League (NCL), the nation’s pioneering consumer advocacy organization, expresses concern about the Trump Administration’s Notice of Benefit and Payment Parameters Rule for 2021.

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An old threat to public health is resurfacing amidst COVID-19 worries

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By Sally Greenberg, NCL Executive Director

While all of us have learned to adapt to the ‘new’ ways to stay healthy we can’t let our need to avoid contact with others get in the way of the important steps we have always taken to keep disease at bay; staying up to date on vaccinations.

Since the COVID-19 pandemic hit, most of us have dutifully complied with stay-at-home orders to avoid contracting the virus. While that is critically important, there are other diseases that we must guard against. While the world awaits a COVID-19 vaccine, we need to keep ourselves and our families safe by protecting overall health. This includes taking steps to diminish the risk of other dangerous outbreaks that would weaken our immune systems and put additional strain on the healthcare system.

Before the coronavirus, low vaccination rates were already a concern for many populations. But in the last several weeks, we have been alarmed to learn that the numbers of people receiving vaccinations—from the very young to the very old—have plummeted. That is extremely worrisome for public health officials.

In fact, prominent organizations like the World Health Organization (WHO) and the National Foundation for Infectious Diseases (NFID) have stressed the importance of maintaining vaccination against illnesses like the flu and pneumonia, which affect lung health during the pandemic. This is even more important for those with underlying conditions and those over the age of 65 who are more vulnerable to these diseases.

Early in the pandemic, we thought children might be spared from much of the outbreak. That turns out not to be true. Children need their vaccinations more than ever! Time has proven that there is still much we don’t know about the Coronavirus and how it affects the vulnerable—so staying up-to-date on pediatric vaccines is equally important.

Hesitation to visit the doctor’s office is completely understandable, but I can speak from personal experience that our health care providers are making doctor visits very safe.

When I visited the doctor on a non-coronavirus issue, they staggered patient appointments so patients never had to share a waiting room; everyone wore a mask; we observed 6-foot social distancing; there was an abundance of soap and water and hand sanitizer. The staff at the office was exceptional. They were organized, completely protected with all of the proper PPE, and very focused on making sure that I—the patient—felt safe and secure.

The best advice? Call ahead to ask your health care provider about the precautions they have in place and the best timing for a visit to update your vaccines. Adults, get your shingles, pneumococcal pneumonia, and flu shots. You don’t want those illnesses! And every child needs the array of measles, mumps, tetanus, diphtheria, whooping cough, and other vaccines recommended by the Centers for Disease Control (CDC) for children.

As we continue to live in this new world, we have a responsibility to ourselves, to our families, and our communities to stay as healthy as possible. Modern medicine’s gift to humankind is an array of extremely safe and effective childhood and adult vaccines to prevent diseases that once, collectively, have killed billions globally. As the COVID-19 pandemic has shown, we are lucky to have these vaccines. They keep us safe and healthy. We all have to do our part and get vaccinated from preventable diseases.

Top of mind: Full coverage should mean full coverage

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

The National Consumers League is troubled by the recent report by Public Citizen, “Insurers’ Offers of Free Care for Coronavirus Are Often Confusing and Limited.” In these traumatic and confusing times, it’s critical that consumers can rely on their healthcare insurers to follow the spirit of the law as well as the letter of the law. This includes being crystal clear about what is covered, under what conditions, and for how long. 

Public Citizen’s research into 25 of the largest health insurers turned up a range of concerning practices. Most fee waivers will expire by early summer, well before the crisis will subside. Few appear to cover costs of out-of-network care, a hardship when the urgency of the illness and overwhelmed facilities may make it untenable to get in-network care. The 60 percent of people in private insurance plans who are covered by their employers’ self-insured plans may not even be covered if the employer does not opt-in. And of long concern to NCL, even free tests may come with associated services the patient may not be aware of, and that lead to surprise billing not prohibited by the law.

We urge insurers to act in good faith. Use the savings you are accruing from lower elective care costs to fully cover the costs associated with this pandemic. Remove arbitrary restrictions. Be clear and fully transparent about what you are offering. Hold the course for the duration. The consumer community is here to help make it happen.