Medicaid nearing ‘eye of the storm’ as newly unemployed look for coverage

https://www.fiercehealthcare.com/payer/medicaid-nearing-eye-storm-as-newly-unemployed-look-for-coverage?mkt_tok=eyJpIjoiTXpaa1pEa3pOVGN5T1RnMiIsInQiOiJNbUdDbys5YmFjZDh2MjB2WTd6T0ZRTUg1cGlIYnAyTjNhdzBHdnpEblpZVGxjZEpQM0xPSEFvVG9RdGJQbzdcL21KcmxGV2Vkb1RzWTQ4TnlQQlcxU1BIMXkrZEFMRWwxUDZpTGdpQVlpMVJMR01CRWFDMk1OSGpRSDlLK3RNUTEifQ%3D%3D&mrkid=959610

Medicaid nearing 'eye of the storm' as newly unemployed look for ...

As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers.

The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and healthcare in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

“Medicaid is absolutely going to be in the eye of the storm here,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “It is the backbone of our public health system, our public coverage system, and will see increased enrollment due to the economic conditions.”

Meeting those needs will require hefty investments―both in money and manpower.

Medicaid—which is run jointly by the states and federal government and covers about 70 million Americans―is already seeing early application spikes. Because insurance requests typically lag behind those for other benefits, the numbers are expected to grow in the coming months.

“We have been through recessions in the past, such as in 2009, and saw what that meant,” said Matt Salo, who heads the National Association of Medicaid Directors. “We are going to see that on steroids.”

The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act (ACA). That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage.

It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. “The pandemic is like a punch in the mouth.”

But even without expansion in those states, the Medicaid rolls could increase with more children coming into the system as their families’ finances deteriorate. Many states don’t have the resources or systems in place to meet the demand.

“It is going to hit faster and harder than we’ve ever experienced before,” Salo said.

The unique circumstances of social distancing impose new challenges for those whose jobs are to enroll people for coverage. In California, where more than a million people have filed for unemployment insurance since March 13, much of the workforce that would typically be signing people up and processing their paperwork is now working from home, which adds a layer of complexity in terms of accessing files and documents, and can inhibit communication.

“It’s going to be certainly more difficult than it was under the [2008] recession,” said Cathy Senderling-McDonald, deputy executive director for the County Welfare Directors Association of California. She said that although strides have been made in the past decade to set up better online forms and call centers, it will still be a heavy lift to get people enrolled without seeing them in person.

In some states, the challenges to the system are already noticeable.

Utah, for instance, has seen a 46% increase in applications for Medicaid. (These applications can be for individuals or families.) In March 2019, about 14,000 people applied. This March, it was more than 20,400.

“Our services are needed now more than ever,” said Muris Prses, assistant director of eligibility services for the Utah Department of Workforce Services, which processes Medicaid enrollment. The state typically takes 15 days to determine whether someone is eligible, he said, though that will increase by several days because of the surge in applicants and some staff working at home.

In Nevada, where the hotel- and casino-dominated economy has been hit particularly hard, applications for public benefits programs, including food stamps and Medicaid, skyrocketed from 200 a day in February to 2,000 in mid-March, according to the state Department of Health and Human Services. The volume of calls to a consumer hotline for Medicaid and health coverage questions is four times the regular amount.

In Ohio, the number of Medicaid applications has already exceeded what’s typical for this time of year. The state expects that figure to continue to climb.

States that haven’t yet seen the surge warned that it’s almost certainly coming. And as layoffs continue, some are already experiencing the strains on the system, including processing times that could leave people uninsured for months, while Medicaid applications process.

For 28-year-old Kristen Wolfe, of Salt Lake City, who lost her job and her employer-sponsored health insurance March 20, it’s a terrifying time.

Wolfe, who has lupus—an autoimmune disorder that requires regular doctor appointments and prescription medication―quickly applied for Medicaid. But after she filled in her details, including a zero-dollar income, she learned the decision on her eligibility could take as long as 90 days. She called the Utah Medicaid agency and, after being on hold for more than an hour, was told they did not know when she would hear back.

“With my health, it’s scary to leave things in limbo,” said Wolfe, who used her almost-expired insurance last week to order 90-day medication refills, just in case. “I am pretty confident I will qualify, but there is always the ‘What if I don’t?’”

Others have reported smoother sailing, though.

Jen Wittlin, 33—who, until recently, managed the now-closed bar in Providence, Rhode Island’s Dean Hotel―qualified for Medicaid coverage starting April 1. She was able to sign up online after waiting about half an hour on the phone to get help answering specific questions. Once she receives a check for unemployment insurance, the state will reassess her income—currently zero―to see if she still qualifies.

“It was all immediate,” she said.

In fact, she said, she is now working to help newly uninsured former colleagues also enroll in the program, using the advice the state gave her.

In California, officials are trying to reassign some employees—who are now working remotely―to help with the surge. But the system to determine Medicaid eligibility is complicated and requires time-intensive training, Senderling-McDonald said. She’s trying to rehire people who’ve retired and relying on overtime from staffers.

“It’s hard to expand this particular workforce very, very quickly by a lot,” she said. “We can’t just stick a new person in front of a computer and tell them to go. They’re going to screw everything up.”

The move away from in-office sign-ups is also a disadvantage for older people and those who speak English as a second language, two groups who frequently felt more comfortable enrolling in person, she added.

Meanwhile, increasing enrollment and the realities of the coronavirus will likely create a need for costly medical care across the population.

“What about when we start having many people who may be in the hospital, in ICUs or on ventilators?” said Maureen Corcoran, the director of Ohio’s Medicaid program. “We don’t have any specific answers yet.”

These factors will hit just as states―which will experience shrinking tax revenue because of the plunging economy—have less money to pay their share of the Medicaid tab.

“It’s all compounded,” said Lisa Watson, a deputy secretary at Pennsylvania’s Department of Human Services, which oversees Medicaid.

The federal government pays, on average, about 61% of the costs (PDF) for traditional Medicaid and about 90% of the costs for people who joined the program through the ACA expansion. The rest comes from state coffers. And, unlike the federal government, states are constitutionally required to balance their budgets. The financial squeeze could force cuts in other areas, like education, child welfare or law enforcement.

On March 18 (PDF), Congress agreed to bump up what Washington pays by 6.2 percentage points (PDF) as part of the second major stimulus bill aimed at the economic consequences of the pandemic. That will barely make a dent, Salo argued.

“The small bump is good, and we are glad it’s there, but in no way is that going to be sufficient,” he said.

 

 

 

The rich pull up the drawbridges

https://www.axios.com/coronavirus-rich-drawbridges-7567f493-1bed-494e-926c-be897823a706.html

 Animated illustration of a drawbridge made out of a hundred dollar note being pulled up.

From hastily-chartered superyachts to fortresslike country estates, the wealthiest Americans have found places to ride out the pandemic far away from the masses.

Why it matters: The contrast between the rich vs. poor experience of coronavirus exposes class differences — in housing, access to health care, etc. — that are less obvious in normal times.

Where it stands: Even as elected officials tell us that the novel coronavirus does not discriminate — New York Gov. Andrew Cuomo called it “the great equalizer” — it’s still true that the moneyed classes are walling themselves off and, on the whole, suffering less.

  • People with second (and third) homes have stampeded from hot spots like New York City to pastoral and less-afflicted areas — like the Hamptons, Cape Cod, Hilton Head and Palm Beach.
  • Thanks to “concierge medicine,” where people pay hefty annual fees in exchange for near-unlimited access to their doctors, the rich have been getting faster access to COVID-19 tests, plus more attention when they’re sick.

Headlines that tell the story:

  • “Chic Hamptons food stores ransacked by the wealthy amid coronavirus pandemic” (NY Post)
  • Private jets ‘pour in’ to Martha’s Vineyard as rich flee coronavirus” (The Telegraph)
  • “Billionaires are chartering superyachts for months at a time to ride out the coronavirus pandemic” (Business Insider)
  • “The U.S. has a shortage of coronavirus tests, so the ultra-wealthy are paying concierge doctors to do their own,” (Business Insider)

What they’re saying: “There is an undercurrent of unequal sacrifice,” Chuck Collins, a senior scholar at the progressive Institute for Policy Studies, tells Axios.

Seasonal vacation resorts don’t have the doctors, hospital beds and other resources to care for throngs of sick people — prompting calls for the moneyed interlopers (renters and owners alike) to go home.

  • The mayor of Honolulu wants the Trump administration to suspend nonessential travel to Hawaii.
  • The governor of New Jersey is urging people not to come to the Jersey Shore — even enlisting Mike “The Situation” Sorrentino to spread the “stay home” word.
  • The chiefs of Nantucket Cottage Hospital (which has 15 beds) and Martha’s Vineyard Hospital (25 beds) are asking people to keep off the islands.
  • Angry Cape Cod residents are circulating a (probably doomed) petition to close the bridges to their area.

While the wealthy were among the first in the U.S. to contract the virus (as they’re more apt to travel abroad), the brunt of the pandemic has hurt the working poor.

  • Per the WSJ: “The new coronavirus has struck hardest in working-class neighborhoods in New York City’s outer boroughs, city data shows, underlining how the pandemic has ravaged densely packed lower-income areas where social-distancing guidelines have proved difficult to implement.”

People who live in poverty are more likely to have underlying illnesses that make them more susceptible to coronavirus — asthma, heart disease, hypertension, diabetes.

  • “Income in the United States is our pre-existing condition,” Collins said. “This infection is landing on an extremely unequal society — much more unequal than 40 years ago.”

A tale of two pandemics: As soon as NYC schools closed, real estate agents were flooded with calls from people begging to rent houses in the Hamptons — where a single summer’s lease can easily cost $100,000 — immediately and sight unseen.

  • “You have people calling in and saying, ‘We’re going to be in a car tomorrow, give me a house that I can move into,’ ” Eddie Shapiro, founder and CEO of Nest Seekers International, tells Axios. “We’ve never seen that.”

To drive there, the renters would have had to pass through Queens — the city’s hardest-hit borough — where “apocalyptic” conditions at a 545-bed public hospital in Elmhurst have turned the neighborhood into a poster child for the virus’ wrath.

 

 

 

 

 

Trump rejects Obamacare special enrollment period amid pandemic

https://www.politico.com/news/2020/03/31/trump-obamacare-coronavirus-157788?fbclid=IwAR1nbCE7Uwvo2CNi6d6W5NG9zEIQulyh-noy1RXdk_0RJstMM0C5VYJ8mO4

Trump rejects opening ObamaCare special enrollment period amid ...

Before the coronavirus outbreak, nearly 30 million Americans were uninsured and as many as 44 million were under-insured, paying for bare-bones plans with soaring deductibles and copays. Today, millions more Americans will begin losing their employer-based health insurance because they’ve lost their jobs during this pandemic.

Meanwhile, the Trump administration is still actively trying to repeal the entirety of the Affordable Care Act in court, which would cause an additional 20 million people to lose insurance *in the middle of a pandemic*.

And today, Trump refused to reopen ACA enrollment to those millions of uninsured Americans for a special enrollment window, leaving them without any affordable options to get covered. People are going to die because they can’t afford to seek treatment or end up saddled with thousands of dollars of medical debt if they do. Remember this the next time someone tries to tell you Medicare for All is too radical.

What do you think?

The Trump administration has decided against reopening Obamacare enrollment to uninsured Americans during the coronavirus pandemic, defying calls from health insurers and Democrats to create a special sign-up window amid the health crisis.

President Donald Trump and administration officials recently said they were considering relaunching HealthCare.gov, the federal enrollment site, and insurers said they privately received assurances from health officials overseeing the law’s marketplace. However, a White House official on Tuesday evening told POLITICO the administration will not reopen the site for a special enrollment period, and that the administration is “exploring other options.”

The annual enrollment period for HealthCare.gov closed months ago, and a special enrollment period for the coronavirus could have extended the opportunity for millions of uninsured Americans to newly seek out coverage. Still, the law already allows a special enrollment for people who have lost their workplace health plans, so the health care law may still serve as a safety net after a record surge in unemployment stemming from the pandemic.

Numerous Democratic-leaning states that run their own insurance markets have already reopened enrollment in recent weeks as the coronavirus threat grew. The Trump administration oversees enrollment for about two-thirds of states.

Insurers said they had expected Trump to announce a special enrollment period last Friday based on conversations they had with officials at the Centers for Medicare and Medicaid Services, which runs HealthCare.gov enrollment. It wasn’t immediately clear why the Trump administration decided against the special enrollment period. CMS deferred comment to the White House.

Trump confirmed last week he was seriously considering a special enrollment period, but he also doubled down on his support of a lawsuit by Republican states that could destroy the entire Affordable Care Act, along with coverage for the 20 million people insured through the law.

People losing their workplace coverage have some insurance options outside of the law’s marketplaces. They can extend their employer plan for up to 18 months through COBRA, but that’s an especially pricey option. Medicaid is also an option for low-income adults in about two-thirds of states that have adopted Obamacare’s expansion of the program.

Short-term health insurance alternatives promoted by Trump, which allow enrollment year-round, is also an option for many who entered the crisis without coverage. Those plans offer skimpier coverage and typically exclude insurance protections for preexisting conditions, and some blue states like California and have banned them or severely restricted them. The quality of the plans vary significantly and, depending on the contract, insurers can change coverage terms on the fly and leave patients with exorbitant medical bills.

Major insurers selling Obamacare plans were initially reluctant to reopen the law’s marketplaces, fearing they would be crushed by a wave of costs from Covid-19, the disease caused by the novel coronavirus. But the main insurance lobby, America’s Health Insurance Plans, endorsed the special enrollment period roughly two weeks ago while also urging lawmakers to expand premium subsidies to make coverage more affordable for middle-income people.

Congress in last week’s $2 trillion stimulus passed on that request, as well as insurers’ petition for an open-ended government fund to help stem financial losses from an unexpected wave in coronavirus hospitalizations.

Democrats pushing for the special enrollment period are also grappling with the high costs facing many people with insurance despite new pledges from plans to waive cost-sharing. Obamacare plans and a growing number of those offered by employers impose hefty cost-sharing and high deductibles that could still burden infected Americans with thousands of dollar in medical bills.

House Energy and Commerce Chairman Frank Pallone (D-N.J.) on a press call Monday contended that “we also need to have free treatment” after Congress eliminated out-of-pocket costs for coronavirus tests.

“We did the testing, which is now free, and everybody, regardless of their insurance, gets it,” Pallone said. “But that has to be for the treatment as well.”

 

 

 

 

An explosion of coronavirus cases cripples a federal prison in Louisiana

https://www.washingtonpost.com/national/an-explosion-of-coronavirus-cases-cripples-a-federal-prison-in-louisiana/2020/03/29/75a465c0-71d5-11ea-85cb-8670579b863d_story.html?fbclid=IwAR2rjY1fk7FF2H1vhUxaeZ4c8F3_Vi1HUJhCUkhP-bjFdc_tbuHV8KrKN80&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Federal prison in Louisiana crippled by coronavirus cases as ...

A federal prison in Louisiana has, within days, exploded with coronavirus cases, leading to the death of one inmate on Saturday, the admission of a guard into a hospital intensive care unit, and positive test results for another 30 inmates and staff.

Patrick Jones, 49, was the first inmate in the Federal Bureau of Prisons diagnosed with the novel coronavirus, which causes covid-19, and the first to die.

At least 60 inmates at the Oakdale prison are in quarantine and an unknown number of staff are self-quarantining at home, said Corey Trammel, a union representative for correctional officers at the 1,700-inmate facility about 110 miles northwest of Baton Rouge.

“It’s been simultaneous, just people getting sick back to back to back to back,” Trammel said. “We don’t know how to protect ourselves. Staff are working 36-hour shifts — there’s no way we can keep going on like this.”

The prison bureau is not releasing the names of other infected inmates or staff, citing medical and privacy concerns. Jones complained of a “persistent cough” on March 19, the prison bureau said, and was transported to a hospital where he was diagnosed and placed on a ventilator.

The prison bureau also said Jones had “long-term, preexisting medical conditions” that increased his risk of developing the disease. Jones was convicted in 2017 of possession with intent to distribute crack cocaine within 1,000 feet of a junior college. He was serving a 27-year sentence.

Louisiana ranks 10th highest among states for reported coronavirus cases, with more than 3,300 people who have tested positive and another 137 who have died, government reports show. A week before the Oakdale prison had its first positive case, Gov. John Bel Edwards (D) issued a stay-at-home order and closed all public schools.

Trammel said the prison bureau has been slow to respond to the crisis across the country. The bureau last week banned family and friends from visiting inmates, but the officers’ union had lobbied the federal prison system to take this action for weeks to keep the disease from infiltrating the prison walls.

The Bureau of Prisons updates confirmed coronavirus cases most afternoons on its website, but there has been a lag between cases reported by the officers’ union and prison officials. As of Sunday afternoon, the prison system had only confirmed 14 inmates and 13 staff have tested positive.

At Oakdale, Trammel said staff also asked prison officials — weeks before the first coronavirus case — to shut down a prison labor program within the facility, where more than 100 prisoners make inmate clothing. The program, Trammel said, was not shut down until after the first inmate tested positive.

The Bureau of Prisons — which operates 122 prisons with more than 175,000 inmates — did not immediately respond Sunday to a request for comment. Oakdale Warden Rod Myers could also not be reached for comment.

Trammel said he asked the prison bureau on Saturday to send specialized medical teams to the facility to help with staffing shortages. He’s also asking for hazard pay, which would increase their salaries by 25 percent as they respond to the crisis. And he’s asking for more robust protective gear, including masks with respirators and perhaps face shields.

“We are bringing inmates to the hospitals and are staying right beside them around the clock,” Trammel said. “All we have is these itty bitty masks — a piece of towel over our faces — and nurses are coming into the room for a few minutes and they are all suited up.”

He also said he believes all Oakdale prison staff have now been exposed to the virus. Days ago, he interacted with an inmate who had a fever and still doesn’t know if the prisoner has received a test.

“We should all be in quarantine,” Trammel said. “We should not be going in to spread this monster of a virus.”

Prison reform advocates, who have been pushing for the early release of elderly and severely ill inmates due to covid-19, said the death of a federal inmate illustrates why government officials need to be doing a better job of protecting people like Jones.

“The conditions and reality of incarceration make prisons and jails tinderboxes for the spread of disease,” said Udi Ofer, director of the American Civil Liberties Union’s Justice Division. “A prison sentence should not become a death sentence. Our leaders must immediately take steps to release those identified by the CDC as most vulnerable to covid-19. With every hour of inaction that passes, the greater the human tragedy.”

 

 

 

 

KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

Image result for KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

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The past decade for the health law has been filled with controversy and several near-death experiences. But the law also brought health coverage to millions of Americans and laid the groundwork for a shift to a health system that pays for quality rather than quantity.

Yet the future of the law remains in doubt. Many progressive Democrats would like to scrap it in favor of a “Medicare for All” system that would be fully financed by the federal government. Republicans would still like to repeal or substantially alter it. And the Supreme Court recently accepted another case that could invalidate the law in its entirety.

In this special episode of KHN’s “What the Health?” host Julie Rovner interviews Kathleen Sebelius, who was secretary of Health and Human Services during the development, passage and implementation of the health law.

Then Rovner, Joanne Kenen of Politico and Mary Agnes Carey of Kaiser Health News, who have all covered the law from the start, discuss the ACA’s past, present and future.

Among the takeaways from this week’s podcast:

  • Although the creation of the ACA is often attributed to the Obama administration and the Democratic Congress at the time, work on a health care plan actually began well before then with small-group meetings among stakeholders, congressional hearings across the country and efforts by Sen. Ted Kennedy to galvanize interest. Much of those interactions were bipartisan and included industry leaders too.
  • Despite the vehement Republican opposition to the ACA and its many critical junctures (the death of Kennedy and his replacement by Republican Scott Brown; two tight Supreme Court decisions; and the calamitous debut of the marketplace website, among other issues), the law has proved popular. When Republicans gained control of the White House and Congress, their efforts to repeal the law helped focus consumers’ interest on the law and safeguard it.
  • How will the November election affect the law? If President Donald Trump is reelected, he is unlikely to renew the effort to repeal the law, but that doesn’t mean the assault on the law is over. Efforts to change the ACA could continue through the courts and through administrative rulemaking.
  • If a Democrat is elected, modifications to the law are generally expected to be incremental and perhaps deal with changes such as expanding the number of people getting subsidies and fix some glitches in the law.

 

 

 

Ten Years After: The ACA’s Success in Five Charts

Ten Years After: The ACA’s Success in Five Charts