Author Archives: Shelby Taylor

The ACA meets COVID-19: Now What?

Before the Affordable Healthcare Act (ACA), 44 million Americans were uninsured. While the Affordable Care Act (ACA), passed in 2010, improved the provision and delivery of healthcare to over 16 million Americans, there are still gaps in coverage. Since its rollout, the ACA has faced several legal challenges including a lawsuit filed in 2016 against Sylvia Burwell, the HHS Secretary during the Obama Administration. This initial challenge sparked a nationwide injunction against certain ACA provisions. In what has been known as the landmark ACA case, U.S. v. Texas, 20 states sought to strike down the entire Act after challenging the individual mandate to maintain health coverage each tax year that was enacted following the passage of the Tax Cuts and Jobs Act of 2018 ( under the Trump Administration). The Supreme Court is expected to make its final ruling later this year as to whether ACA, in its entirety, will be upheld.

The COVID-19 crisis further complicates the ACA issues. A vaccine is likely not going to be available for the next year or so, meaning it will be available only after the Supreme Court will make its decision. Experts suspect that overturning the ACA will cost many Americans their insurance benefits, which limits their access to vaccines (when available), leaving Americans vulnerable to the continued spread of the virus. High-ranking elected officials view the continued pursuit of some courts to strike down the ACA as  “unconscionable” during a public health emergency such as this. 

Lawmakers are split on their views of the ACA in the wake of the 2020 Pandemic. Democratic lawmakers have expressed concerns over the problems that gaps in coverage will have on the spread of COVID-19, while Republican lawmakers have upheld their contention that Americans’ previously demonstrated intent to seek alternatives to ACA health plans, negates arguments that ACA should re-open enrollment. A House Republican further noted that coronavirus testing is free and the Administration reports that many states continue to expand Medicare to cover those experiencing loss of jobs and health coverage. 

In contrast to what Republican lawmakers presented in the ACA debate, nine states (Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island, and Washington) have made it possible for its citizens to obtain some form of medical coverage during the COVID-19 crisis. Typical of most insurance plans, individuals and families can only elect coverage during open enrollment once a year without a qualifying status change. Nonetheless, these nine states have created a special enrollment for citizens or extending the current open enrollment period. Insurers are supportive of these states and are looking for ways to mitigate any risks associated with new enrollees during the Pandemic.

Kaiser Family Foundation describes the use of ACA health plans as a safety net during the Pandemic that can be used by Americans who have lost wages due to reduced hours or business closings. Subsequent limits on health coverage may cause some to delay care which harms the health of the community. KFF further reports substantial out-of-pocket expenses for those hospitalized. The report insists that gaps in coverage will cause some people to delay treatment which could have serious consequences as the country tries to reduce the number of new or undiagnosed COVID-19 infections. As the ACA moves closer to its final day in court and the COVID-19 continues as a pandemic lawmakers are now asked to consider whether the health of the nation should suffer as a result of political turmoil.

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Misadventures in health reporting: Coronavirus 2020

Since the beginning of 2020, the Centers for Disease Control Prevention (CDC) has been mounting a response to a respiratory disease, that, at present, has been declared a public health emergency in 80 countries, including the US. The SAR-CoV-2 virus, also known as the Coronavirus (COVID-19), has elicited the concern and attention of public health authorities, the healthcare community, and the public-at-large. As the Coronavirus continues to grow globally and begins to emerge through cases in parts of the US, the greatest dilemma is who and what to believe. Social media has exploded over the recent conflicts in reporting between leaders in government and public health officials.

Americans should be concerned about the credibility and timeliness of reporting as this emergency continues to trend in the news. Here are some tips for those of you want to know if Coronavirus is happening the way it’s being reported.

  • Consider the source. There are many internet and social media outlets reporting on every facet of news, so it is easy to be compelled by a flashy headline or a credible name reference. An agency like the CDC and organizations such as the World Health Organization (WHO) are tasked with protecting the health of the public nationally and globally, and in many ways are responsible for the preparedness of their respective officials and effectiveness of subsequent responses at every level. Specifically, the CDC, in collaboration with the WHO, confirmed COVID-19 emerged as a virus spread by person-to-person contact—and was first detected in travelers from the Wuhan Province of China.
  • Remember news changes rapidly. Try not to get hung up on the evening news or trending social media updates about the virus, because these are likely to change within hours (sometimes minutes). Since January 21, the WHO released 42 “situation reports” on the Coronavirus, providing the most up-to-date and accurate developments concerning the virus. The purpose of these reports is to monitor the number of  confirmed cases and deaths globally, and to provide the public with routine updates on the WHO’s efforts to deliver supplies to support the global response to the Coronavirus. Similarly, the CDC continues to provide health notices to debunk the fear and stigma around the origin of the virus and the severity of the risk of its spread. Ultimately, you should expect to see changes in travel patterns, stories about the increased use of protective gear, and local and state officials making regular statements to the public.
  • At a White House Press Conference last month, Vice President Mike Pence made a statement on the impact of Coronavirus in America. Pence reported the risk to Americans as “low” while the incidence of Coronavirus grows in different regions of the country. Pence also assured Americans that the administration rolled out a new Coronavirus Taskforce to streamline information to the public and coordinate efforts with partnering countries to track the progress of the global response. Nonetheless, CNN reports that the CDC urges Americans to prepare themselves for the worst. The report goes on to suggest how daily life will change in the face of a Coronavirus epidemic. CNN reports an uncertain future based on conflicting remarks during the White House Press Conference.
  • Observe standard precautions. While the risk remains low, Americans are planning for the worst. California has declared a state of emergency after a recent Coronavirus-related death. Moreover, NBC News reports that President Trump signed an $8 billion spending package for CA to use in wake of the virus outbreak. To date, states affected by the virus have begun rolling out guidelines for treatment and possible quarantine of patients as new cases emerge. For instance, local health authorities in New York have implemented screening procedures for citizens returning to the US from countries affected by Coronavirus. Other states continue to publish statements of their efforts to prevent the transmission and spread of the Coronavirus through universities and schools in various communities.

What should be taken from the CDC and other state and local health authorities is that you should observe standard precautions, which can reduce the transmission of the virus. Health.gov posted a simple statement about preventing human-to-human spread of the virus by suggesting washing hands, covering mouths, and staying home if you’re sick. In the wake of uncertainty of the trajectory of the virus, Americans can be certain that our coverage of and reporting on the Coronavirus will be driven by how the administration, health authorities, and media want to frame the national and global response.

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Free Flu Shots Cost More than Expected

Typically, individuals and families with health insurance have the advantage of receiving free flu shots every season, but a recent report from the Kaiser Health Network paints a different picture of the true cost insurers pay to provide free vaccinations to its plan holders. While the cost of a yearly flu shot appears low, the millions of Americans who are vaccinated in the US do not realize that the costs of providing such services are recouped in the high insurance premiums consumers pay each month. Specifically, the true cost of this “free” service can be found in the explanation of benefits provided by insurers. Moreover,  Kaiser Health Network reported significant variations in the cost of flu shots among health care payers and insurers.

Cigna reported paying different prices for the vaccine in DC versus MD where distances between some clinics were 10 miles or less. For instance, in 2017, the Peterson Kaiser Family Foundation Health System Tracker reported flu vaccine costs ranging from $28 to $80, with a misleading median cost of $45.” Insurance payers such as Cigna indicate that geographic variations are major price factors, even in the DC/MD region.

Market dominance has also been attributed to the varied cost of flu shots. Sutter Health, a nonprofit medical network giant, tentatively settled a lawsuit with expected damages of $2.7 billion after being accused of violating antitrust laws. Self-insured employers initiated the lawsuit and were later enjoined by California’s Attorney General’s Office. The lawsuit accused the conglomerate of taking advantage of its market dominance by charging insurers higher rates to provide flu shots at affiliated health care facilities. The state alleged that Sutter Health, a major health care system in Northern California, used its market dominance to drive up the cost of services and apply an all-or-nothing approach when contracting with insurance companies.

US antitrust law prohibits the use of unfair tactics to control a market or form a monopoly. When determining whether a company engaged in antitrust behavior, the court considers the company’s effect on the market as well as if the business activity intended to remove competition. Federal and state authorities can bring charges against those who violate these laws, and both civil and criminal remedies are available to companies affected by unlawful business activity.

The Sutter Health settlement may have nationwide implications on price negotiation tactics between large hospital systems and insurance companies. The lawsuit revealed that Sutter Health uses tactics to unnecessarily increase insurance prices. For example, Sutter Health uses factors such as location, competition, and plan provider when determining the cost to administer the vaccine. But the Kaiser Foundation reported that, even in consideration of those factors, Medicaid pays significantly less for the flu vaccine, and the price appears to be comparable across locations within states. This public revelation may send a signal to other large health systems who might be involved in similar practices.

Nonetheless, it seems disadvantageous for consumers to pay the high cost of the flu vaccine when there is no guarantee of its effectiveness. The rising cost of the flu vaccine is indicative of a larger problem in the US health delivery system. While the flu vaccine has proven beneficial to most Americans, its administration across the country lacks efficiency due to unfair business practices. Lawmakers should use the Sutter Health antitrust lawsuit as an opportunity to examine this aspect of the healthcare market and develop meaningful policies to prevent unfair and predatory practices.

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