What happens when the public health emergency associated with COVID-19 ends?

Link: https://contingencies.org/the-great-unwinding/

Excerpt:

The ongoing COVID-19 pandemic has now spanned three years. A lot has changed and will continue to change once society and every industry, especially health care, adjusts to the new post-COVID world. With the pandemic, a federal public health emergency (PHE) was declared, and legislation was then passed that had a major impact on how health care is administered from both an operational and financial perspective. Many temporary provisions were put into place that mostly impact Medicaid but ultimately affect all health insurance payers. As we look ahead to a point at which the PHE ends, those temporary provisions start to end in what many in the industry are calling the “unwinding of the PHE.” This article aims to provide an overview of the flexibilities that have been offered as a result of legislation tied to the PHE, examine the impacts of increased Medicaid enrollment, and assess how the risk profile of covered lives for all health insurance payers has changed.

The PHE that has been in effect because of the virus SARS-CoV-2 (which causes the disease COVID-19, or simply COVID), was declared on March 12, 2020, retroactively effective as of Jan. 31, 2020. 

….

Where does this leave us now? At the time of this writing, the PHE is under its ninth renewal (90-day extensions) and is set to expire July 15, 2022. HHS has previously informed states that at least 60 days’ notice will be provided, which means the end of the PHE will occur July 2022 or later. States receive the additional FMAP bump through the end of the quarter in which the PHE ends, which is slated to be Sept. 30, 2022. Before the omicron wave, many thought the PHE would end in early 2022. Popular opinion seems to have shifted to a later time period, with mid-to-late 2022 being the likely end of the PHE. Any continued uncertainty with the pandemic, such as another wave of cases, is likely to extend the PHE.

As we get close to the end of the PHE though, the focus shifts from case counts and test kits to the virus becoming endemic and moving past the PHE. This puts, front and center, the unwinding of all of the operational and financial elements that have been tied to the PHE since FFCRA was passed. When the unwinding starts, it will radically change the risk profile of Medicaid and all other health payors. Measuring and mitigating against this changing risk profile is where the nature of our profession as actuaries becomes critical. The biggest driver in the changing risk profile is the enrollment growth that has occurred with Medicaid since the pandemic began, as a number of these new members are at risk of losing their coverage.

Author(s): Colby Schaeffer

Publication Date: May/June 2022

Publication Site: Contingencies

Despite a First-Ever ‘Right-to-Repair’ Law, There’s No Easy Fix for Wheelchair Users

Link: https://khn.org/news/article/power-wheelchair-users-right-to-repair-law-no-easy-fix/

Excerpt:

The multibillion-dollar power-wheelchair market is dominated by two national suppliers, Numotion and National Seating and Mobility. Both are owned by private equity firms that seek to increase profits and cut spending. One way they do that is by limiting what they spend on technicians and repairs, which, when combined with insurance and regulatory obstacles, frustrates wheelchair users seeking timely fixes.

The $70 billion durable medical equipment market has been an attractive target for private equity investment because of the aging U.S. population, the increasing prevalence of chronic conditions, and a growing preference for older adults to be treated at home, according to the investment banking firm Provident Healthcare Partners. Medicare’s use of competitive bidding favors large companies that can achieve economies of scale in manufacturing and administrative costs, often at the price of quality and customer service.

Regulations set by Medicare and adopted by most Medicaid and commercial health plans have led to lower-quality products, no coverage for preventive maintenance, and enough red tape to bring wheelchairs to a halt.

Power wheelchair users have long been fighting for the right to repair their wheelchairs themselves or through independent repair shops. Medicare and most insurance companies will replace complex wheelchairs only every five years. The wheelchair suppliers that have contracts with public and private health insurance plans restrict access to parts, tools, and service manuals. They usually keep a limited inventory of parts on hand and wait until health plans approve repair claims before ordering parts.

Some chairs require a software passcode or a physical key for any repairs. Wheelchair users who make fixes themselves may void their warranty or lose out on insurance payments for repairs.

Author(s): Markian Hawryluk

Publication Date: 2 June 2022

Publication Site: Kaiser Health News

2021 Academy Legislative/Regulatory Review

Link: https://www.actuary.org/sites/default/files/members/alerts/pdf/2022/2022-CP-1.pdf

Excerpt:

The American Academy of Actuaries presents this summary of select significant regulatory and
legislative developments in 2021 at the state, federal, and international levels of interest to the U.S.
actuarial profession as a service to its members.

Introduction

The Academy focused on key policy debates in 2021 regarding pensions and retirement, health, life,
and property and casualty insurance, and risk management and financial reporting.


Responding to the COVID-19 pandemic, addressing ever-changing cyber risk concerns, and analyzing
the implications and actuarial impacts of data science modeling continued to be a focus in 2021.


Practice councils monitored and responded to numerous legislative developments at the state, federal,
and international level. The Academy also increased its focus on the varied impacts of climate risk and
public policy initiatives related to racial equity and unfair discrimination in 2021.


The Academy continues to track the progress of legislative and regulatory developments on actuarially
relevant issues that have carried over into the 2022 calendar year.

Publication Date: 15 Feb 2022

Publication Site: American Academy of Actuaries

On Social Spending, the Question Isn’t “Can We Afford It?” but “Who Will Pay?”

Link:https://jacobinmag.com/2021/11/social-spending-biden-reconciliation-bill-build-back-better

Excerpt:

There are three possible answers to the question of who pays for social expenses. First, governments can pay by taxing their citizens to fund social programs. Second, employers can pay by using corporate revenues to provide employment-related benefits. Third, individuals and families can pay out of pocket, rely on unpaid labor from friends and relatives, or make do without.

For much of the twentieth century, the United States had a workable answer to the “Who pays?” question that drew on a mix of all three sources. Government provided certain social benefits like Social Security, Medicare, and public education. Aided by government tax incentives, many employers offered a wide range of benefits like health insurance and pensions, creating what political scientist Jacob Hacker refers to as a “public-private welfare regime.” And with one-third of the labor force unionized, and even nonunion employers pressured to match union-scale wages and benefits, many workers earned enough to support their families and handle the social expenses not covered by government- and employer-based programs.

….

For its part, government social spending has been uneven. Large universal programs like Medicare and Social Security have proven resistant to most retrenchment efforts, and Obamacare included a major expansion of Medicaid — though this was blocked in some Republican-dominated states. Meanwhile, more means-tested programs targeting low-income Americans have proven more vulnerable. In a context where employers have sharply cut back their commitment to providing social benefits, and individuals and their families are faced with stagnating wages, government’s response has proven inadequate.

Author(s):Barry Eidlin

Publication Date:28 Nov 2021

Publication Site: Jacobin

Nursing homes warn vaccine mandate could lead to staff shortages

Link: https://thehill.com/policy/healthcare/570807-nursing-homes-warn-vaccine-mandate-could-lead-to-staff-shortages

Excerpt:

The Biden administration’s vaccination requirement is putting a squeeze on nursing homes as they try to balance protecting residents and retaining low-wage staff that have been reluctant to get the shot.

Later this month, the administration will outline a policy that requires all staff working at nursing homes to be vaccinated or risk the facilities losing federal funding.

The specifics of the policy are sparse so far, but it would effectively be a mandate for an industry that relies heavily on Medicare and Medicaid funding.https://aef67baff698e02f95a8ec2b0d53753d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

Only about 62 percent of nursing home and long term care facility staff are fully or partially vaccinated nationally, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).

…..

“The biggest group of unvaccinated staff are certified nurse aides. They’re making close to minimum wage. They can make that, maybe even more, plus maybe even better benefits out in retail jobs, restaurant jobs. The vast majority of those employers are not imposing mandates,” Grabowski said.

Author(s): NATHANIEL WEIXEL

Publication Date: 4 September 2021

Publication Site: The Hill

Will States Resist Fresh Billions for Medicaid Expansion?

Link: https://www.governing.com/now/Will-States-Be-Able-to-Resist-Billions-for-Medicaid-Expansion.html

Excerpt:

As part of the most recent federal stimulus, states that haven’t expanded Medicaid under the Affordable Care Act can receive additional matching funds. Rather than paying 10 percent of the cost for new recipients, they’d only have to pay 5 percent over the next two years. Additional subsidies mean they would actually cost themselves money by refusing to expand. Florida, for instance, would come out ahead by $1.25 billion, even after paying its share of expanded coverage. Still, Gov. Ron DeSantis and legislative leaders remain opposed.

….

It’s true that the 95 percent match rate will only last for two years. But plenty of states have put in place triggers that would end their expansion programs if the federal share ever dipped below 90 percent, notes Trish Riley, executive director of the National Academy for State Health Policy.

Author(s): Alan Greenblatt

Publication Date: 31 March 2021

Publication Site: Governing

Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

Link: https://www.nytimes.com/2021/03/13/business/nursing-homes-ratings-medicare-covid.html

Excerpt:

Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are.

Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported.

In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.

Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings.

At homes whose five stars masked serious problems, residents developed bed sores so severe that their bones were exposed. Others lost the ability to move.

Author(s): Silver-Greenberg, Jessica; Gebeloff, Robert.

Publication Date: 13 March 2021

Publication Site: New York Times

Is WA Gov. Jay Inslee Single-handedly Responsible for America’s COVID Outbreak?

Link: https://townhall.com/tipsheet/bethbaumann/2021/03/13/is-wa-gov-jay-inslee-single-handedly-responsible-for-americas-covid-outbreak-n2586203

Excerpt:

Washington State’s Aging and Long-Term Support Administration, which falls under the Department of Social and Health Services, directed nursing homes to accept COVID-positive patients that were no longer needing “acute care” in a hospital. The goal was to “transition” those patients to “alternative settings” 

“Our primary strategy to create capacity in acute care hospitals is working with participating patients and families to transition to nursing homes,” a March 20, 2020 memo stated. “Once in the nursing home, Home and Community Services staff will work the eligible individual and their family to transition to a permanent home and community-based setting of their choice.”

In exchange for taking in those patients, nursing home facilities would receive an additional $100 Medicare add-on for up to six months, The Post Millennial. That funding was part of two Medicaid waivers the state filed. 

Author(s): Beth Baumann

Publication Date: 13 March 2021

Publication Site: Townhall

Cuomo Killing the Disabled and the Elderly: This Time It’s Personal

Link: https://marypatcampbell.substack.com/p/cuomo-killing-the-disabled-and-the

Graphic:

Excerpt:

But the other problem, of course, was that Cuomo wasn’t the only governor who sent sick people back into nursing homes. In addition to New York, there was also Michigan, California, New Jersey, and Pennsylvania.

Except it seems Cuomo was the only one who had his staff falsify data. So perhaps the others can get away with just admitting they made decisions that were very unwise.

As it is, the New York state legislature is starting an impeachment investigation, and I assume they’re not going to half-ass it like other impeachments we have heard tell of.

Author(s): Mary Pat Campbell

Publication Date: 11 March 2021

Publication Site: STUMP on Substack

County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access

Link: https://www.sciencedirect.com/science/article/pii/S2352340921000639

Graphic:

Excerpt:

The dataset summarized in this article is a combination of several of U.S. federal data resources for the years 2006-2013, containing county-level variables for opioid pill volumes, demographics (e.g. age, race, ethnicity, income), insurance coverage, healthcare demand (e.g. inpatient and outpatient service utilization), healthcare infrastructure (e.g. number of hospital beds or hospices), and the supply of various types of healthcare providers (e.g. medical doctors, specialists, dentists, or nurse practitioners). We also include indicators for states which permitted opioid prescribing by nurse practitioners. This dataset was originally created to assist researchers in identifying which factors predict per capita opioid pill volume (PCPV) in a county, whether early state Medicaid expansions increased PCPV, and PCPV’s association with opioid-related mortality. Missing data were imputed using regression analysis and hot deck imputation. Non-imputed values are also reported.

Taken together, our data provide a new level of precision that may be leveraged by scholars, policymakers, or data journalists who are interested in studying the opioid epidemic. Researchers may use this dataset to identify patterns in opioid distribution over time and characteristics of counties or states which were disproportionately impacted by the epidemic. These data may also be joined with other sources to facilitate studies on the relationships between opioid pill volume and a wide variety of health, economic, and social outcomes.

Author(s): Kevin N. Griffith, Yevgeniy Feyman, Samantha G. Auty, Erika L. Crable, Timothy W. Levengood

Publication Date: April 2021

Publication Site: Data in Brief