Category Archives: Health Insurance Coverage Adequacy

Experts agree that Trump’s coronavirus response was poor, but the US was ill-prepared in the first place

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As the coronavirus pandemic exerts a tighter grip on the nation, critics of the Trump administration have repeatedly highlighted the administration’s changes to the nation’s pandemic response team in 2018 as a major contributor to the current crisis. This combines with a hiring freeze at the Centers for Disease Control and Prevention, leaving hundreds of positions unfilled. The administration also has repeatedly sought to reduce CDC funding by billions of dollars. Experts agree that the slow and uncoordinated response has been inadequate and has likely failed to mitigate the coming widespread outbreak in the U.S.

As a health policy expert, I agree with this assessment. However, it is also important to acknowledge that we have underfunded our public health system for decades, perpetuated a poorly working health care system and failed to bring our social safety nets in line with other developed nations. As a result, I expect significant repercussions for the country, much of which will disproportionately fall on those who can least afford it.

Decades of underfunding

Spending on public health has historically proven to be one of humanity’s best investments. Indeed, some of the largest increases in life expectancy have come as the direct result of public health interventions, such as sanitation improvements and vaccinations.

Even today, return on investments for public health spending is substantial and tends to significantly outweigh many medical interventions. For example, one study found that every US$10 per person spent by local health departments reduces infectious disease morbidity by 7.4%.

However, despite their importance to national well-being, public health expenditures have been neglected at all levels. Since 2008, for example, local health departments have lost more than 55,000 staff. By 2016, only about 133,000 full-time equivalent staff remained. State funding for public health was lower in 2016-2017 than in 2008-2009. And the CDC’s prevention and public health budget has been flat and significantly underfunded for years. Overall, of the more than $3.5 trillion the U.S. spends annually on health care, a meager 2.5% goes to public health.

Not surprisingly, the nation has experienced a number of outbreaks of easily preventable diseases. Currently, we are in the middle of significant outbreaks of hepatitis A (more than 31,000 cases), syphilis (more than 35,000 cases), gonorrhea (more than 580,000 cases) and chlamydia (more than 1,750,000 cases). Our failure to contain known diseases bodes ill for our ability to rein in the emerging coronavirus pandemic.

Failures of health care systems

Yet while we have underinvested in public health, we have been spending massive and growing amounts of money on our medical care system. Indeed, we are spending more than any other country for a system that is significantly underperforming.

To make things worse, it is also highly inequitable. Yet, the system is highly profitable for all players involved. And to maximize income, both for- and nonprofits have consistently pushed for greater privatization and the elimination of competitors.

As a result, thousands of public and private hospitals deemed “inefficient” because of unfilled beds have closed. This eliminated a significant cushion in the system to buffer spikes in demand.

At any given time, this decrease in capacity does not pose much of a problem for the nation. Yet in the middle of a global pandemic, communities will face significant challenges without this surge capacity. If the outbreak mirrors anything close to what we have seen in other countries, “there could be almost six seriously ill patients for every existing hospital bed.” A worst-case scenario from the same study puts the number at 17 to 1. To make things worse, there will likely be a particular shortage of unoccupied intensive care beds.

Of course, the lack of overall hospitals beds is not the most pressing issue. Hospitals also lack the levels of staffing and supplies needed to cope with a mass influx of patients. However, the lack of ventilators might prove the most daunting challenge.

Limits of the overall social safety net

While the U.S. spends trillions of dollars each year on medical care, our social safety net has increasingly come under strain. Even after the Affordable Care Act, almost 30 million Americans do not have health insurance coverage. Many others are struggling with high out-of-pocket payments.

To make things worse, spending on social programs, outside of those protecting the elderly, has been shrinking, and is significantly smaller than in other developed nations. Moreover, public assistance is highly uneven and differs significantly from state to state.

And of course, the U.S. heavily relies on private entities, mostly employers, to offer benefits taken for granted in other developed countries, including paid sick leave and child care. This arrangement leaves 1 in 4 American workers without paid sick leave, resulting in highly inequitable coverage. As a result, many low-income families struggle to make ends meet even when times are good.

Can the US adapt?

I believe that the limitations of the U.S. public health response and a potentially overwhelmed medical care system are likely going to be exacerbated by the blatant limitations of the U.S. welfare state. However, after weathering the current storm, I expect us to go back to business as usual relatively quickly. After all, that’s what happened after every previous pandemic, such as H1N1 in 2009 or even the 1918 flu epidemic.

The problems are in the incentive structure for elected officials. I expect that policymakers will remain hesitant to invest in public health, let alone revamp our safety net. While the costs are high, particularly for the latter, there are no buildings to be named, and no quick victories to be had. The few advocates for greater investments lack resources compared to the trillion-dollar interests from the medical sector.

Yet, if altruism is not enough, we should keep reminding policymakers that outbreaks of communicable diseases pose tremendous challenges for local health care systems and communities. They also create remarkable societal costs. The coronavirus serves as a stark reminder.

 

 

Health Insurers aren’t that worried about coronavirus

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Health insurance companies are not concerned yet that the new coronavirus is going to drive up their medical claims and spending, Axios’ Bob Herman reports.

The big picture: More people will need expensive hospitalizations to treat COVID-19, which has turned into a full-blown public health emergency.

  • But insurers view the outbreak as an “extension of the flu season,” according to a Wall Street bank that spoke with insurance executives last week.

What they’re saying: Barclays held its health care conference digitally last week, and several insurance executives reiterated their companies’ profit projections for this year — relatively remarkable statements considering economists believe a recession is imminent.

  • “We’re not expecting a material financial impact,” said Matt Manders, a top Cigna executive.

Between the lines: A lot more cases and hospitalizations are coming. But those will be partially offset, from an actuarial perspective, by delays or cancellations of costly elective procedures like joint replacements — something that hospitals are starting to do.

  • “There is a net saving” when non-emergency procedures are eliminated, Anthem CFO John Gallina told Barclays analysts.

The bottom line: The coronavirus is throttling almost every business in America. Large insurers think they’re mostly immune, and if medical claims start to rise uncontrollably, they will increase everyone’s premiums next year.

  • “We would price for this for 2021 to the extent there’s any meaningful impact,” Humana CFO Brian Kane said. “I would imagine the industry will as well.”

 

 

 

Too much for the health care system to handle

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Illustration of a giant virus cell crushing a crumbling red cross.

A severe coronavirus could easily overwhelm the U.S. health care system, Axios health care editor Sam Baker writes.

Most pandemics put health care workers at particular risk, both to become infected and then to spread the infection.

  • Experts were sounding the alarm even before the first U.S. cases about limited supplies of masks and protective equipment.
  • If health care workers do get sick in large numbers, staffing shortages would make it all the harder to care for new patients.

Experts fear a shortage of ventilators and intensive-care beds, if the outbreak becomes severe.

  • The U.S. has roughly 46,500 beds designated for ICU use, but even in a moderate scenario, it’s projected that 200,000 people could need ICU treatment, according to a report from Johns Hopkins.
  • Yes, but: Many younger, healthier patients will likely be able to recover at home, leaving hospital capacity dedicated mainly to seniors and people with other health complications.

What we’re watching: The coronavirus also seems likely to expose structural gaps in the health care system.

  • Insurers have promised to make coronavirus testing available for free, and a handful of hospital systems have imposed temporary freezes in billing patients for coronavirus treatments.
  • But relying on individual acts of corporate benevolence won’t provide any blanket assurance that care will be affordable, especially to the poor or uninsured — and if people don’t get care because they’re afraid of the cost, rightly or not, that risks further spreading the infection.

Go deeper: Listen to Sam and Dan examine the health care issue.

 

 

 

 

Taking a look at the Biden healthcare plan

Posted on by • Posted in 2020 Election Issues, ACA, Competition, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, High Deductible Health Plans, High Drug Prices, Medicaid, Medicaid Expansion, Medicare, Public Option, Surprise Bills, Underinsured, Uninsured • Leave a comment

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Now that the Democratic primary campaign has produced a clear front runner, it’s worth examining Joe Biden’s healthcare plan, which aims to expand the Affordable Care Act (ACA) by increasing access and affordability. As the graphic above highlights, former Vice President Biden has a broad—if at this point, still fairly high-level—proposal that includes a Medicare-like public option along with a variety of other ACA tweaks that aim to offer consumers more options and lower their healthcare costs.

These include allowing individuals in states without Medicaid expansion to join the pubic option premium-free, providing unlimited subsidy eligibility, and limiting drug price increases to the level of consumer inflation.

An independent analysis projects Biden’s plan would cost $2.25T and add an additional $800B to the deficit over 10 years. While large at first blush, these costs pale in comparison to Sen. Bernie Sanders’ Medicare for All plan, which would add a projected $12.95T to the deficit over the same period.

Of course, there are still many unanswered questions in Biden’s proposal, including how much consumers would pay under the public option, how much the public option plan would reimburse providers as a percentage of Medicare, and how the public option would impact competition among private insurers.

A public option offered at a significant discount has the potential to drive private plans out of business, which some project could eventually result in Medicare for All as an ultimate consequence. The devil will, as always, be in the details.

 

California accuses healthcare sharing ministry of misleading consumers

Posted on by • Posted in ACA, Deceptive Advertising, Essential Health Benefits, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Policy, Individual Health Insurance, Individual Mandate, Internal Revenue Service (IRS), Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans, Womens Health • Leave a comment

https://www.healthcaredive.com/news/california-accuses-healthcare-sharing-ministry-of-misleading-consumers/573900/

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Dive Brief:

  • The California Department of Insurance issued a cease and desist order to a major Christian group Wednesday for misleading consumers about their health insurance plans and acting as a payer without proper certification, joining a handful of other states scrutinizing the limited coverage.
  • Deceptive marketing by Aliera Healthcare, which sells health ministry plans, and Trinity, which runs them, led to roughly 11,000 Californians belonging to the unapproved “lookalike” plans that don’t cover pre-existing conditions and other required benefits, with no guarantees their claims will be paid, the state’s insurance regulator said.
  • Healthcare sharing ministries (HCSMs) are organizations where members share a common set of religious or ethical beliefs and agree to share the medical expenses of other members. They’re increasingly controversial, as policy experts worry the low-cost insurance attracts healthier individuals from the broader insurance market, creating smaller and sicker risk pools in plans compliant with the Affordable Care Act.

Dive Insight:

Aliera, founded in 2011 and based in Georgia, and Trinity allegedly trained sales agents to promote misleading advertisements to consumers, peddling products that don’t cover pre-existing conditions, abortion, or contraception. The shoddy coverage also doesn’t comply with the federal Mental Health Parity and Addiction Equity Act and the ACA.

The deceptive advertising could have pressured some Californians to buy a health sharing ministry plan because they believed they missed the deadline for buying coverage through Covered California, the state’s official insurance marketplace.

“Consumers should know they may be able to get comprehensive coverage through Covered California that will protect their health care rights,” California Insurance Commissioner Ricardo Lara said in a statement.

HCSMs, which began cropping up more than two decades ago as a low-cost alternative approach to managing growing medical costs, operate either by matching members with those who need help paying medical bills or sharing costs on a voluntary basis. They’re often cheaper than traditional insurance, but they don’t guarantee payment of claims, rarely have provider networks, provide limited benefits and usually cap payments, which can saddle beneficiaries with unexpected bills.

About 1 million Americans have joined the groups, according to the Alliance of Health Care Sharing Ministries.

At least 30 states have exempted HCSMs from state regulation, according to the Commonwealth Fund, meaning the ministries don’t have to comply with health insurance requirements. California does not exempt the religious-based groups from the state insurance code.

In January, Aliera and its subsidiaries, which includes Trinity, were banned from marketing HCSMs in Colorado after being accused of acting as an unlicensed insurer. One month later, Maryland issued a revocation order against Aliera for trying to sell an unauthorized plan in the state. Earlier this month, Connecticut issued a cease and desist order for conducting an insurance business illegally.

Aliera argues states are limiting the choices available to consumers, telling Healthcare Dive it was “deeply disappointing to see state regulators working to deny residents access to more affordable programs.”

“We will utilize all available opportunities to address the false claims being made about the support and management services we provide to Trinity HealthShare and other health care ministries we represent,” Aliera said.

However, Aliera and Trinity don’t meet the Internal Revenue Code’s definition of a health sharing ministry, according to California’s cease and desist, meaning their beneficiaries don’t meet California’s state individual insurance mandate.

The state can impose a fine of up to $5,000 a day for each day the two continue to do business, along with other financial penalties.

 

 

 

 

White House to Walk Back 3 Policy Announcements

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https://www.axios.com/trump-coronavirus-oval-office-speech-e0f6685f-ffd4-4e28-9794-0e16ee71321b.html

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The White House had to walk back three policy announcements from President Trump’s Oval Office announcement Wednesday that are causing more confusion than comfort during the coronavirus outbreak.

Why it matters: COVID-19 is already here in the U.S., and in some communities, it’s spreading rapidly. Trump’s travel restrictions won’t stop the infection in states where person-to-person spread is rampant.

 

1) Europe travel ban: Trump said Americans will be exempt “who have undergone appropriate screenings.”

  • His words caused people in Europe to buy tickets at premium prices back to the U.S. in a panic, per the Washington Post.
  • But it will only apply to foreign nationals who have been in the Schengen region of Europe within 14 days of arrival in the U.S. It does not apply to permanent U.S. residents, citizens or immediate family of citizens, per the Department of Homeland Security.

 

2) Health insurers: “Have agreed to waive all copayments for coronavirus treatments,” Trump said.

  • But insurers have agreed to wave copayments for testing, not treatment.

 

3) Trade: The White House walked back Trump’s statement that the travel restrictions “apply to the tremendous amount of trade and cargo, but various other things as we get approval.”

 

The big picture: Although Trump spent extra time making sure businesses knew he’d ease economic uncertainty, stocks fell more than 8% on Thursday morning and halted briefly for the second time this week.

  • What to watch: More mayors and governors are handling outbreaks by limiting mass gatherings of a certain size. In Seattle, that’s no more than 250 people. In San Francisco and Washington, D.C., it’s no more than 1,000.

 

 

 

 

Congressional doctor predicts 70 million-150 million U.S. coronavirus cases

Posted on by • Posted in 2020 Election Issues, Coronavirus, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Out of Pocket Expenses, Pandemic, Public Health, Public Safety, Underinsured, Uninsured • Leave a comment

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Congress’ in-house doctor told Capitol Hill staffers at a close-door meeting this week that he expects 70-150 million people in the U.S. — roughly a third of the country — to contract the coronavirus, two sources briefed on the meeting tell Axios.

Why it matters: That estimate, which is in line with other projections from health experts, underscores the potential seriousness of this outbreak even as the White House has been downplaying its severity in an attempt to keep public panic at bay.

Dr. Brian Monahan, the attending physician of the U.S. Congress, told Senate chiefs of staff, staff directors, administrative managers and chief clerks from both parties on Tuesday that they should prepare for the worst, and offered advice on how to remain healthy.

Between the lines: Forecasting the spread of a virus is difficult, and the range of realistic possibilities is wide.

  • But other estimates, including statistical modeling from Harvard epidemiologist Marc Lipsitch, have said that somewhere between 20% and 60% of adults worldwide might catch the virus.

Yes, but: These estimates include people who will get sick and make a full recovery, and many people will catch the virus without ever feeling seriously ill.

  • Monahan told staffers that about 80% of people who contract coronavirus will ultimately be fine, one of the sources said.
  • Monahan’s office declined to comment.

Meanwhile, Democratic and Republican leaders on Capitol Hill have told lawmakers they have no immediate plans to close Congress, despite it being a potential petri dish for the virus.

  • Many lawmakers fit high-risk profiles because they’re over 60, have underlying health conditions and are mixing in close quarters with visitors, staff and reporters.

 

 

 

Coronavirus updates: State Department urges Americans not to travel abroad

Posted on by • Posted in 2020 Election Issues, Coronavirus, Health Insurance Coverage Adequacy, Health Policy, Infection Control, Infectious Virus, Novel Coronavirus, Out of Pocket Expenses, Pandemic, Public Health, Public Safety, Uncertainty, Underinsured, World Health Organization (WHO) • Leave a comment

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The State Department issued a global level 3 health advisory late Wednesday advising Americans to “reconsider travel abroad due to the global impact” of the novel coronavirus pandemic.

The big picture: President Trump announced hours earlier European travel to the U.S. will be restricted for 30 days, with some exemptions, and the NBA suspended its season. There are more than 126,000 cases in over 100 countries and territories and more than 4,600 deaths. There are over 1,300 cases in the U.S.

LAST 48 HOURS
  • Travel restrictions: The Trump administration’s new rules affect European member states of the Schengen Area, which includes most but not all of the EU. The United Kingdom and Ireland are not in the zone and are not affected by the restrictions.
    • In Israel, all travelers entering from any country — including Israeli citizens — are required to self-quarantine for 14 days.
  • Travel advisory: “Many areas throughout the world are now experiencing COVID-19 outbreaks and taking action that may limit traveler mobility, including quarantines and border restrictions,” the State Department advisory reads. “Even countries, jurisdictions, or areas where cases have not been reported may restrict travel without notice.”

 

  • U.S. cases: Nearly 40 states reported at least 1,220 cases as of Wednesday, and roughly two dozen have declared a state of emergency. The novel coronavirus has now killed at least 30 Americans in five states.
    • Washington, D.C., Mayor Muriel Bowser announced a state of emergency Wednesday, as well as six new COVID-19 cases. There are now 10 presumptive cases in D.C. — including person-to-person transmission and at least two individuals who contracted the virus from unknown causes.
    • A staffer in the D.C. office of Sen. Maria Cantwell (D-Wash.) has tested positive to the virus — the first known case of a congressional staffer becoming infected with the virus.
    • California’s Los Angeles County announced six additional cases on Wednesday — including one that health officials presume is the county’s second case of community spread transmission.
    • The state’s health officials now recommend that events larger than 250 people be canceled.
    • There are now four deaths in California after Los Angeles County announced Wednesday the death of an “older adult” who “traveled extensively over the past month,” including to South Korea.
    • Virginia announced that a teenager in the Chickahominy Health District, who recently traveled internationally, has tested positive for COVID-19 on Wednesday, marking 9 current cases in the state. The affected teen did not attend school.
    • The states with the most cases as of Wednesday are: Washington, New York and California — where three TSA officers at Mineta San Jose International Airport were confirmed to have tested positive for the virus Tuesday night.
    • Maryland now has 9 confirmed cases after a 70-year-old Montana resident who was visiting Anne Arundel County came in close contact with someone who had contracted the virus, Maryland Gov. Larry Hogan said Wednesday.
    • New York Gov. Andrew Cuomo said he planned to deploy the National Guard to the New York City suburb New Rochelle on Tuesday to establish a one-mile “containment zone” and help contain the spread of the novel coronavirus.

 

  • Pandemic classification: The World Health Organization classified the outbreak as a pandemic Wednesday.
  • Global impact: Cases continue to surge in Spain, Germany, France and Italy, which is on complete lockdown with more than 12,000 cases — second-highest to China.
  • Business: Twitter announced Wednesday night that it instructed all employees globally to work from home.
  • Google recommended Tuesday that all its employees in North America work from home until at least April 10 amid the novel coronavirus outbreak, one of the most sweeping cautionary edicts.
    • The Securities and Exchange Commission is the first federal agency to direct its staff at its D.C. office to work remotely after an employee with respiratory problems was told they may have the virus.
    • IBM is encouraging its employees who live or work in New York City and Westchester County to work from home. Amazon, Facebook, Microsoft and Salesforce have similar practices in place.
    • Deloitte has recommended its staff return from areas impacted by COVID-19 to work from home for 14 days from their return date. The consulting firm has asked workers to defer nonessential international and domestic travel.

 

  • Australia: Actor Tom Hanks confirmed Wednesday he and his wife, Rita Wilson, tested positive for the virus while in Australia, which now has 128 cases.
  • Federal aid: The Department of Health and Human Services announced Wednesday it is allocating over $560 million to states and local areas to assist with COVID-19 response.
  • Cruise ship: Nearly 300 people left the docked Grand Princess ship in Oakland, Calif. on Tuesday, with more than half sent to Travis Air Force base and 98 to Lackland Air Force base in Texas, Gov. Gavin Newsom said Tuesday.
  • Community spread warning: Some areas in the U.S. have passed the point of containment and communities should focus on mitigation plans, such as canceling events, CDC director Robert Redfield said Tuesday.
  • Conferences and events: Music festival Coachella has been postponed until October. Many international and domestic conferences affecting all businesses, trades and entertainment are being either postponed or canceled.

 

  • Financial impact: U.S. stocks have taken a toll with various dips and corrections all week. Worries are growing that the outbreak could shrink global GDP and perhaps sink the U.S. dollar.
  • Oil: Already struggling with mounting debt and falling market valuations, energy companies are at serious risk for mass bond defaults.
  • Diagnostics: Health insurers and regulators are working to ensure coronavirus diagnostic tests are covered — but that doesn’t necessarily mean COVID-19 treatment will be affordable. Concerns linger as to how the health care system can meet the demands of high-volume testing.
  • Universities: As colleges cancel classes and boot students off campus because of the coronavirus, they’re creating logistical and financial nightmares that could leave many students in a bind.
  • Tourism: White House advisers are looking at policy changes to help relieve the travel and hospitality industry. Tourism and travel operators have had to reprice globally, as airlines, hotels and travel operators see major declines in bookings and revenue.
  • Social media: A large part of the problem is the “infodemic,” as stories get shared that are designed to drive fear rather than build understanding about the illness, according to NewsWhip data provided to Axios.