DCMedical News: Thursday, October 21, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, October 21, 2021
Reconciliation and Health Insurance
The Congressional Budget Office has reported (summary here, report here) that Medicaid and health insurance provisions in the wide-ranging reconciliation bill supported by House Democrats would reduce coverage costs for many individuals, and would cost a combined $553.2 billion over ten years.
The portions of the “Build Back Better” bill evaluated by CBO (full text of bill here) would establish a “federal Medicaid program” for states that did not expand Medicaid eligibility under the Patient Protection and Affordable Care Act (for adults with incomes up to 138% of the federal poverty level). The provisions would also increase the amount of premium tax credits on the health insurance exchanges.
The CBO estimate does not include the cost of expanding Medicare benefits to include hearing, vision and dental coverage. As reported by CQ, “In total, the CBO anticipates that 4 million more people would enroll in Medicaid and that 3.6 million more people would enroll in subsidized nongroup insurance plans. The CBO also estimates 1 million fewer people would be enrolled in unsubsidized nongroup plans and 2.8 million fewer people would be enrolled in employer-based coverage.”
InsideHealthPolicy (here) reported that “The White House released a memo Monday (Oct. 18) on the economic benefits of President Joe Biden’s Build Back Better agenda that specifically mentions extending the American Rescue Plan’s enhanced premium tax credits, closing the Medicaid coverage gap, funding home care and broadening Medicare coverage, indicating the White House was still pushing all of its health care priorities ahead of meeting with lawmakers Tuesday.”
Adashi and colleagues write (here) in JAMA that “The prospect of curtailing the ranks of the uninsured hinges on the continued viability of the ACA.”
CDC Meets Today, to Review FDA Actions on Vaccines
The CDC’s Advisory Committee on Immunization Practices meets today (Thursday) to review these actions of the FDA, taken Wednesday: authorization of a broad, flexible COVID-19 booster policy, including booster doses for the Johnson & Johnson vaccine as soon as two months after the first dose; allowing Moderna boosters for those 65 and older, immunocompromised, in high risk jobs or institutions, all six months after their first dose; and allowing “mixing and matching” of brands for booster shots.
The CDC Committee cannot alter the FDA’s emergency use authorizations, but can influence how public health resources are directed, and could also narrow the populations eligible for booster shots.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Labor Shortages Will Grow and Labor Costs Will Continue to Increase for Hospitals
Moody’s (report here) says “The delta variant of the coronavirus continues to pile on staffing challenges for hospitals as they spend more resources on recruiting and retaining employees, jack up benefit options and offer steep sign-on bonuses.”
Private Hospital Volume > NHS Hospital Volume for Hip and Knee Replacements
A report in The Financial Times (here) says “Private hospitals are delivering more hip and knee replacements than the NHS for the first time since the procedures were widely introduced in the 1960s and 1970s. With the NHS still focused on Covid-19, independent hospital chains including Circle Health Group, Nuffield Health, HCA Healthcare and Spire Healthcare have doubled the numbers of privately paid patients . . . Although the overall numbers of hip and knee operations remain lower than in 2019, the research found that 56 per cent of the total surgeries performed in the first eight months of this year were performed in private hospitals, compared with 40 per cent over the same period two years ago.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Hospitals Say Anthem, United, Using COVID-19 as “Cover” for Financial Shenanigans
A report in Kaiser Health News (here) says “Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims . . . Anthem, like other big insurers, is using the covid-19 crisis as cover to institute egregious policies that harm patients and pinch hospital finances, said Molly Smith, group vice president at the American Hospital Association. There’s this sense of ‘Everyone’s distracted. We can get this through,’ she said.”
Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care, AHA says.
A Decade of Innovation, Already
The Center for Medicare and Medicaid Innovation published a “refresh” (here) to kick off its second decade of innovation. “The Center for Medicare and Medicaid Innovation (CMS Innovation Center or ‘Innovation Center’) is launching a bold new strategy with the goal of achieving equitable outcomes through high quality, affordable, person-centered care. To achieve this vision, the Innovation Center is launching a strategic refresh.” Commentary by CMS officials in Health Affairs here.
United Healthcare Launches “Virtual First” Plans, Premiums 15% Less Expensive
The program (here) will direct patients to use digital resources first, the primary care equivalent of “step therapy,” that is, directing patients initially to automated, remote resources, less costly, but arguably less effective.
Says United, “Enrollees in the new plan will have access to 24/7 care from Optum providers for primary, urgent and behavioral healthcare services . . . They will pay $0 for virtual and in-person primary care and behavioral health visits, virtual urgent care and most generic medications, with unlimited chat, online scheduling and on-demand, same-day appointments. They will also have access to a wearable device well-being program that incentivizes them to earn more than $1,000 per year by meeting daily activity targets, such as for walking, cycling, swimming and strength training.”
COVID-19 and Vaccine Reading
From Nature.com (here), “The study shows that people who become infected with the Delta variant are less likely to pass the virus to their close contacts if they have already had a COVID-19 vaccine than if they haven’t. But that protective effect is relatively small, and dwindles alarmingly at three months after the receipt of the second shot.”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 22, 25, 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org