Missouri State of Mind

You can find me discussing Missouri’s abortion trigger statute here.

This is both a heartening and disheartening overview of how we have only five percent of American doctors who are black. Both an over-reliance on historically black colleges to feed the pipeline and a tragically slow effort to support diverse students interested in medicine from the earliest school grades have produced some resulting increase in black doctors, but arguably disappointing results.

CMS has returned to the thorny issue of non-Medicaid expansion state hospitals claiming (both contemporaneously and retroactively) DISH funds for uncompensated care provided. CMS maintains it has the authority to exclude uncompensated care pool days from the DSH calculation going forward, as noted by Modern Health Care. There is, after all, a CMS acknowledged access to DISH funds, short of Medicaid expansion, through the section 1115 waiver process.

It feels punitive, wail the hospitals in Texas, Florida, etc. who have mostly escaped the bite of DSH disqualification by presenting uncompensated care pool costs for DSH reimbursement. It was never designed to work like this, as DSH was designed to promote comprehensive care, nothing like what the services being pushed forward from the uncompensated care pools, notes CMS.

Indeed, the assumption of the drafters of the ACA appears to have been that the financials would drive Medicaid expansion and produce an organic evaporation of the need for huge uncompensated care pools. It may not be that, ten years out, twelve states would remain intransigent. Over ten years later, that has not happened, though the hospital associations of non-expansion states indicate that they wish it would.

The fascinating thing is that DSH is federal money, the thing that non-expansion states claim to repudiate. Now, we see a more nuanced argument: don’t tell us how to spend DSH funds. Or, acknowledging that DSH funds and uncompensated care pool funds are both supports designed to assist hospitals that seem large numbers of of uninsured patients, but insisting they are funds that may be used toward the same end.

There is a philosophical dispute lurking behind the argument over how to access DSH funds and how to spend them. Is it that needy people in on-expansion states may deserve DSH funded emergency care or urgent care but not comprehensive coordinated care?

The baby formula shortage is discussed in The Atlantic in a way that teases out the implications of Covid, manufacturing plants closed by bacterial infection, the effects of a concentrated market almost impervious to competition from imports, as well as the shifting sole source contracts for the WIC program.

But, what of the throwaway line noting that the 2022 baby boom has been accompanied by strikingly decreased rates of breast feeding by American women. Why is that? A place where lack of in-person health care has taken its toll?

Recently, it became quite heated at the California legislature’s hearing on AB 2098’s proposed changes to the definition of unprofessional conduct by a physician to include spreading of COVID vaccine disinformation. Professional licensure disputes can become quite heated, particularly when free speech rights are implicated.

What I want to know is what the Nuremberg Code has to do with all this? How would the Nuremberg Code be violated by the passage of AB 2098 into law?

Missouri’s Medicaid Expansion is proceeding, albeit at a slow rate. It is little solace for many, but still important to know that eligibility may be retroactive. Apply now.

How would you know?

A.J. Loiacono, CEO of Capital Rx, speaks truth about U.S. drug pricing:

“But you get to the last hop in the supply chain and something magical happens. All the prices in the United States disappear, not because the prices don’t exist, but because the entity that controls the last hop in the supply chain — carriers and PBMs — wish it to be so.”

Who will test the proposition whether prescription drugs should be bought and sold like popsicles, or whether the consumer benefits from all this secrecy in pricing?

The San Jose Mercury News reports:

“Then they peered into the genome to predict the embryo’s susceptibility for common diseases that may develop decades later: breast cancer, colorectal cancer, pancreatic cancer, prostate cancer, atrial fibrillation, coronary artery disease, Crohn’s disease, ulcerative colitis, lupus, vitiligo, and Type 1 and Type 2 diabetes.”

IVF today, in utero tomorrow?

Our current saline shortage echoes earlier saline shortages, in that supply is often tight following natural disasters (2017 hurricane Maria in Puerto Rico taking out Baxter’s manufacturing plant, etc.). There is nothing like a pandemic being fought with multiple vaccination injections to highlight this, as well. The war in Ukraine’s reduction in availability of petroleum products to make plastics has also played quite a role. But, our saline supply (meaning not only the bags and saline solution itself, but including the vials and syringes for administration) has often been precarious. This most recent shortage may have been entirely predictable once it became clear all the stars were in alignment for another shortage. And, yet, we are completely reactive in the face of the acknowledgement that some U.S. hospitals are receiving less than half of the saline and saline administration equipment needed — children’s hospitals even less because production is even lower for the very smallest size saline bags and saline administration equipment. Those same saline and saline product producers remain largely non-responsive to the Cares Act requirement of reporting of potential pipeline problems.