President-elect Joe Biden has chosen California Attorney General Xavier Becerra to be the secretary of the Department of Health and Human Services, the Biden transition team announced this morning and the New York Times first reported last night.
Why it matters:If confirmed, Becerra would be the first Latino to lead the department. He’s also been at the forefront of health care legal battles, most prominently over the future of the Affordable Care Act.
Becerra has led the effort by a group of 20 states and the District of Columbia in defending the ACA against a GOP lawsuit aiming to strike down the law. The case was argued in front of the Supreme Court last month.
Biden plans to announce several other top health care advisors, people familiar with the rollout told NYT.
Between the lines:Whoever leads HHS will immediately be in charge of addressing what will likely still be an out-of-control pandemic, including the government’s efforts to distribute coronavirus vaccines.
The virus has disproportionately affected people of color, and Becerra’s selection follows increasing pressure on Biden from the Latino community and the Congressional Hispanic Caucus to diversity his cabinet, per NYT.
On the other hand, Becerra has little experience managing a large bureaucracy or in public health, per Politico.
The big picture: If a global pandemic and the future of the ACA weren’t enough, the HHS secretary could end up in charge of executing most of Biden’s health agenda, particularly if the Senate remains in Republican hands.
Becerra’s legal background could prove useful in enacting a lawsuit-proof regulatory agenda.
Bonus: Biden has selected Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital and a professor at Harvard Medical School, to lead the Centers for Disease Control and Prevention, Politico reported last night.
That brings the total number of enrollees to 2.9 million, a slight jump over last year but with more days to sign up over 2019.
During the fourth week of the 2020 open enrollment period, from November 22-28, 523,020 people selected plans using the HealthCare.gov platform.
That brings the total number of enrollees to 2,903,547 after the first four weeks of open enrollment. That’s an increase of 523,020 people from last year, which saw 2,380,527 consumers sign up for plans after the first four weeks.
It’s important to note, however, that in 2020 there were more days in this four-week period than last year, since the Centers for Medicare and Medicaid Services measures enrollment Sunday through Saturday. Nov. 1 was on a Sunday this year and on a Friday in 2019, so the first week of 2019 had only three days, while the first week this year measured a full seven.
The numbers are a dip from the third week of open enrollment, during which 758,421 signed up for coverage.
The HealthCare.gov platform is used by the federally facilitated exchange and some state-based exchanges. Notably, New Jersey and Pennsylvania transitioned to their own platforms for 2021, and due to this they’re absent from HealthCare.gov for 2021 coverage. Those two states accounted for 578,251 plan selections last year, 7% of all plan selections. These enrollees’ selections will not appear in CMS’ figures until it announces the state-based marketplace plan selections.
Open enrollment lasts six weeks and ends on December 14. Those who sign up within that time frame will see their coverage begin January 1, 2021.
WHAT’S THE IMPACT
This is the fourth snapshot of open enrollment figures by CMS during this sign-up period.
Of those selecting plans, 138,183 were new consumers, while 384,837 were renewing coverage. This brings the total number of new consumers to 659,455 since the beginning of open enrollment, while the tally for those renewing coverage now stands at 2,244,092. More than 4,386,530 consumers have been on the applications submitted to date.
A consumer is considered to be a new consumer if they did not have 2020 exchange coverage through Dec. 31 of this year and had a 2021 plan selection. They’re considered a renewing consumer if they have 2020 exchange coverage through Dec. 31 and actively select either the same plan or a new plan for 2021.
The numbers represent those who have submitted an application and selected a plan, net of any cancellations from a consumer, or cancellations from an insurer. The weekly metric represents the net change in the number of uncanceled plan sections over a given period.
Plan selections will not include those consumers who are automatically re-enrolled into a plan. To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. CMS did not report the number of effectuated enrollments.
In all, there were 1,749,555 HealthCare.gov users recorded during the fourth week, and 57,502 of the Spanish-speaking equivalent, CuidadoDeSalud.gov, bringing the four-week totals to 9,582,790 and 317,487, respectively.
To date, Florida tops in the number of plan selections over the first four weeks with 871,361 sign-ups, followed by Texas (471,849) and Georgia (198,090).
THE LARGER TREND
President-elect Joe Biden has said he is favorable to strengthening and expanding the Affordable Care Act, and favors a government-run public option to run parallel with private offerings.
But prior to Biden’s inauguration on Jan. 20, 2021, CMS may release a final rule based on a proposed rule it released late on Thanksgiving Eve to allow states to implement Section 1332 waivers to waive certain ACA requirements. This allows states to decentralize enrollment through insurers and web brokers. Opponents have said this will expose consumers to junk plans.
Georgia has already been approved for such a waiver.
According to a recent report from the Kaiser Family Foundation, insurer participation in the ACA marketplace in 2021 is seeing a third straight year of growth as several insurers are entering the market or expanding their service area.
For 2021, 30 insurers are entering the individual market, and an additional 61 are expanding their service area within states.
Despite taking a huge volume hit in Q2, most hospitals have managed to maintain positive operating margins—largely thanks to a $100B cash infusion from the federal government via the Coronavirus Aid, Relief and Economic Security (CARES) Act.
According to Kaufman Hall’s most recent National Hospital Flash Report, based on data from over 900 hospitals of all sizes nationwide, hospitals would have been operating at a significant loss without federal aid. As the graphic above shows, the average hospital operating margin without CARES Act relief funds would have been negative eight percent in April—and would still be in the red as of October, despite much of the cancelled elective business returning across the summer and early fall.
However, with the aid, hospitals operating margins only turned negative in April and May. When compared to the same time period last year, year-to-date (YTD) gross revenue is down almost five percent, though net patient service revenue per discharge is up—the result of longer lengths of stay, the 20 percent Medicare reimbursement bump for COVID-19 patients, and suspension of the two percent sequestration adjustment on Medicare fee-for-service payments. Yet hospital expenses per discharge are also up 13.5 percent, dampening profitability.
Though the CARES Act has been a stopgap solution for the vast majority of hospitals, a handful, most notably HCA Healthcare, have proactively returned the money. While motivations for doing so are varied, we’ve been hearing that the ever-changing reporting and spending requirements associated with CARES Act funding have many hospital leaders concerned about possible future claw-backs.
With COVID-19 hospitalizations now reaching record-breaking highs, potentially forcing another round of shut-downs, and with little movement on another round of federal relief, hospitals may be on their own for the time being—and the greatest hit to health system finances may still be yet to come.
We are now in uncharted and dangerous new territory in the coronavirus pandemic, with the US recording a record-high 2,800 deaths on Thursday, along with 200,000 new cases—the second highest daily total of the pandemic so far.
More than 100,000 Americans are now hospitalized with COVID-19, occupying more than 10 percent of the nation’s hospital beds, and creating capacity constraints at hospitals around the country. With the impact of Thanksgiving travel—which was the heaviest since March—yet to be seen in the numbers, and with hospitalizations and deaths lagging new case counts by several weeks (as an epidemiological rule of thumb, 1.7 percent of new cases will result in reported deaths from COVID after 22 days), we are almost certainly headed for a grim winter holiday season.
But the light at the end of the tunnel grew brighter this week, with the United Kingdom becoming the first Western country to approve a COVID vaccine. (China and Russia both rolled out vaccines prior to Phase 3 trials being completed.)
Doctors and hospital staff in the UK will begin to administer Pfizer’s vaccine next week, and the US Food and Drug Administration (FDA) is expected to approve the same vaccine for emergency use on or shortly after an outside panel of experts convenes on December 10th.
Moderna, whose vaccine is similar to Pfizer’s, submitted an application for emergency use this week, and it will be evaluated on December 17th.
In the meantime, a group advising the Centers for Disease Control and Prevention (CDC) held a public meeting this week to craft recommendations for which populations should be prioritized to receive the new vaccines, settling on healthcare workers and residents of long-term care facilities as first in line. While state public health officials will make the final decisions about who gets vaccinated, most are expected to follow the CDC’s guidelines. The two priority groups represent about 24M people, most of whom could be immunized by the end of this month if all goes according to plan. The end of the pandemic will not come quickly, or easily, but it will come—we are near the beginning of the end.
The owner of an Atlanta-based home healthcare provider was sentenced to five years and three months in prison for defrauding Medicaid out of nearly $1 million, the U.S. Justice Department said Dec. 2.
Diandra Bankhead, owner and operator of Elite Homecare, admitted to submitting thousands of claims for services that were never provided to children in the Georgia Pediatric Program between September 2015 and April 2018. Children who are eligible for services under the program typically suffer from physical and cognitive disabilities.
Ms. Bankhead and Elite Homecare submitted more than 5,400 claims to Georgia Medicaid, receiving $1.2 million in reimbursement. About $1 million was determined to be fraudulent, prosecutors said.
Prosecutors said Ms. Bankhead defrauded Medicaid in several ways, including submitting fraudulent credentialing information to become a Georgia Pediatric Program provider, submitting claims for in-home nursing services provided to families who had not hired Elite and submitting claims in which employees provided more than 24 hours of services in a day.
“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”
Ms. Bankhead pleaded guilty in federal court to one count of healthcare fraud in August 2019. She was also ordered to pay $999,999 in restitution.
Dallas-based Baylor Scott & White Health said it will lay off 102 employees in finance and accounting roles as part of an effort to reshape operations and reduce costs, according to The Dallas Morning News.
The duties of the affected workers will be outsourced to a third-party vendor in India. About 18 of the affected Baylor employees will be offered positions with the vendor, according to the report.
A spokesperson for Baylor Scott & White told Becker’s Hospital Review that the system will retain about two-thirds of its corporate finance department.
“Our system is continuously looking for ways to reduce costs and improve our ability to provide affordable and quality healthcare for our patients and members. As part of this, we are transforming the way we deliver our corporate finance services,” the nonprofit health system wrote in a statement obtained by Becker’s.
The cuts follow a larger round of layoffs and furloughs announced in May, which affected about 1,200 employees, or 3 percent of its workforce.
The health system said it is working to be more efficient and intentional in how resources are used. It is working to add front-line caregivers and has more than 2,000 open clinical jobs, a spokesperson told Becker’s.
“We care deeply about all our colleagues and are committed to supporting them through this process,” the statement read.
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HENRY KOTULA 