As the COVID-19 pandemic swept across the globe in 2020, the US faced a unique challenge in mobilizing and aligning its fragmented health insurance system to address the public health emergency. With 29 million people uninsured, 39% of households reporting insufficient savings to cover a $1000 emergency, 1 and 1 in 6 individuals having a medical bill in collections in early 2020, 2 the US faced the dual threat of overwhelmed medical facilities and an acute affordability crisis for patients who required testing and treatment for COVID-19.In response, the US mounted a multifaceted effort to shield patients from the financial sequelae of COVID-19. These efforts included a federal requirement that private insurers and employers cover the full cost of testing, and funds for the Health Resources and Services Administration (HRSA) to compensate (at Medicare rates) the costs of COVID-19 testing and treatment for those who are uninsured. The health insurance industry also contributed and waived patient cost-sharing requirements for COVID-19 treatment for most privately insured people. In March 2020, Congress established a $178 billion Provider Relief Fund to offset unreimbursed expenses for COVID-19 treatment (eg, personal protective equipment, additional staff time) and other revenue losses that occurred during the pandemic. As a condition of receiving these funds, recipients were prohibited from billing patients on an out-of-network basis for COVID-19 care, effectively shielding patients from out-of-network responsibilities and "surprise" medical bills. In addition, the US undertook an unprecedented effort to prepurchase vaccine doses and provided the HRSA with funds to ensure that vaccines would be administered at no outof-pocket cost to uninsured patients.Combined, these efforts constituted a temporary universal coverage system-within-a-system for COVID-19. That is, unlike every other disease treated in the US, for most patients the entire spectrum of testing and treatment for COVID-19 was covered at no out-ofpocket cost. But as the US contends with its fourth major wave driven by the Delta variant, major financial components of this temporary system have already been reduced or will expire.In early 2021, as vaccines became widely available and as the winter surge receded, insurers changed their approach toward patient responsibility for COVID-19 treatment costs. For example, Aetna and United removed cost-sharing waivers for commercially insured individuals in January 2021. Cigna followed in February, and Anthem in May with similar policies. By early summer 2021, nearly all major insurers required patient cost sharing for COVID-19 treatment. With COVID-19 hospitalizations estimated to cost between VIEWPOINT
An integrated WIC and obstetrical service model is feasible and can limit postpartum weight retention in obese women. Weight retention at 6 months postpartum between intervention and control participants was statistically significant. Further research should explore targeted interventions by obesity class to address weight retention for low-income, African American women who participate in WIC.
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