To get health care, many must navigate glitchy government technology : Shots

Eric Harkleroad/KHN (Images: Getty Images/Unsplash)

(Eric Harkleroad/KHN illustration; Unsplash; Getty Images)

Eric Harkleroad/KHN (Images: Getty Images/Unsplash)

In October, when Jamie Taylor’s household monthly income fit within new state income limits after Missouri’s 2021 expansion of Medicaid, she applied for health coverage. She received a rejection letter within days, stating that her earnings exceeded the acceptable limit.

It was the latest blow in Taylor’s ongoing campaign to get assistance from Missouri’s safety net. Taylor, 41, has spent hours on the phone, enduring four-hour hold times and dropped calls. Time-sensitive documents were mailed to her home in Sikeston but by the time they arrived she had little time to act.

Her latest rejection – she would later find out – resulted from a preprogrammed glitch in her application that a technician enrolling her failed to catch.

Taylor’s struggles to get a benefit she was in fact qualified for are not uncommon in Missouri or nationally. They stem from extremely outdated technology used by a humongous web of government agencies, from local public health to state-run benefits programs. Matt Salo, the National Association of State Medicaid Directors executive director, calls the need for technology upgrades “the next great challenge that government has to solve.”

The COVID crisis exposed just how antiquated and ill-equipped many systems are to handle the unprecedented demand. While private-sector businesses beefed up the ability to stream TV shows, created apps for food deliveries, and moved offices online, some public health officials tracked COVID outbreaks by fax machine.

Jamie Taylor dealt with four-hour hold times and dropped calls while trying to secure public benefits in Missouri. Others have encountered similar problems across the nation as the pandemic has highlighted the pitfalls of dated government technology.

Krissy Pruiett


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Krissy Pruiett


Jamie Taylor dealt with four-hour hold times and dropped calls while trying to secure public benefits in Missouri. Others have encountered similar problems across the nation as the pandemic has highlighted the pitfalls of dated government technology.

Krissy Pruiett

But momentum is finally building for government tech updates. With once-in-a-generation pools of money available from pandemic relief funding and higher than expected tax revenues, some efforts are underway. President Joe Biden issued an executive order in December calling on benefits enrollment to be streamlined. State lawmakers are urging the use of unspent COVID relief money to address the issue.

That’s critical because outdated information systems can trigger ripple effects throughout the public benefits system, according to Jessica Kahn, who is a partner at the McKinsey & Co. consulting firm and previously led data and systems for Medicaid at the Centers for Medicare & Medicaid Services. One example: Hard-to-navigate online benefits applications can push more applicants to call phone help lines. That can strain call centers that, like many industries, are having difficulty meeting staffing needs.

Some states are already eyeing improvements:

In Wisconsin, Democratic Gov. Tony Evers has directed up to $80 million to replace the state’s old unemployment infrastructure.

Kansas is among the first states working with the U.S. Department of

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Pfizer’s Paxlovid contract with the government has some surprises : Shots

A lab technician at a Pfizer factory in Germany inspects Paxlovid tablets as they move through the manufacturing process.

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A lab technician at a Pfizer factory in Germany inspects Paxlovid tablets as they move through the manufacturing process.

Pfizer

The United States is spending about $530 for each 5-day course of Pfizer’s COVID-19 pill, Paxlovid. But the contract for the first 10 million doses would allow the government to get a lower price if one of a handful of other wealthy countries gets a better deal on the drug.

It’s part of a purchase agreement that seems to be more favorable to the federal government overall compared to the COVID-19 vaccine contracts, says Robin Feldman, a professor at the University of California Hastings College of the Law, who focuses on the pharmaceutical industry and drug policy.

“I think this contract reflects a change in the national mood across time,” she says. “So with vaccines and some treatments on the shelves, the nation is less panicked. U.S. government officials feel less backed into a corner, more able to negotiate. “

The contract includes a buyback clause, meaning that in the event that Paxlovid’s emergency use authorization needs to be withdrawn, Pfizer would buy back unexpired treatment courses from the federal government.

Federal government gets a price match guarantee

The contract also has something called most favored nation pricing. It’s kind of like getting a product at a store with a price match guarantee, like Target or Best Buy. If one of six other wealthy countries, such as Japan or Germany, gets a lower price for Paxlovid, the U.S. can push the company for the same price.

“Getting a most favored nation clause is great for a buyer,” Feldman says. “Because a buyer can make an early deal, secure a product flow, and not have to worry that they’re being fleeced on price. Because the price may go down across time.”

(“Most favored nation” might also sound familiar because the Trump administration proposed testing it out to gradually lower a few dozen drug prices in Medicare Part B over seven years. The Centers for Medicare and Medicaid later rescinded the plan, citing concerns about access issues and the COVID-19 pandemic.)

NPR obtained the Paxlovid contract after filing a public records request.

James Love, director of global public interest advocacy group Knowledge Ecology International, was shocked to see this price clause in the Paxlovid contract obtained by NPR. He says the government often can’t even get this kind of clause when it’s paid for the research that went into a drug.

“Here they go like, ‘Well, we didn’t even pay for the R&D, but we still want the reference price,'” he says. “And they got it.”

In contrast, Pfizer’s vaccine contract explicitly says its price per dose – around $20 – cannot be used as a reference price, allowing the company to charge more money later: “This price shall not serve as the basis for

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