Missouri State of Mind

This article suggests this difficulty in talking about the need to improve indoor ventilation may be because of its complexity. I think there is something else going on: easy to put COVID-19 preventive measures on the person (wash hands; stay distant; wear a mask; pursue vaccination) but harder to talk about measures that may well have to be addressed by others. After all, who will pay for all that increased better indoor ventilation in our schools and workplaces?

Maryland has long led the way with its all payor hospital payment system. This approach has not proven to be easily replicable elsewhere, however.

Now, New York tiptoes in to the area of medical-loss ratios or profitability caps for nursing homes. This should be interesting to watch.

The COVID-19-induced scrutiny of for profit nursing homes and their return on investment numbers might be worth expanding to other kinds of health care providers or venues.

Thanks to KFF, we now have some insight into what has happened to the medical-loss ratio in 2021. The short answer is that health care utilization, overall, is way down, so rebates for 2020 failure to achieve the medical-loss ration will be the order of the day for covered plans.

The even more interesting question is whether this trend will continue into 2021. After all, the pandemic is not quite yet history, recent legislation has extended ACA open enrollment and a whole lot more:

Looking ahead to rebates and premiums in 2022, insurers have the difficult task of predicting the continued impact of the pandemic. Insurers setting premiums for the 2022 plan year need to factor in several pandemic-related considerations, including but not limited to: potential pent-up demand for care, the negative impact of foregone care on the health of some enrollees, and the take-up of COVID-19 vaccinations and whether they need to be re-administered next year. Moreover, the Biden Administration and Congress have made several regulatory changes that will affect enrollment and costs in the Marketplaces for at least the next two years. Biden has opened a Special Enrollment Period (SEP) allowing anyone to sign up for Marketplace coverage until September. The American Rescue Plan Act of 2021 also temporarily expanded eligibility for Marketplace subsidies and increased the financial assistance to those who already qualified for subsidies. The Congressional Budget Office expects that these changes will drive more than a million additional enrollees into the individual market over the next two years, but the extent of enrollment growth and whether these new enrollees will be more or less expensive on average than current enrollees remains to be seen.

What a time to be an actuary or a forecaster!

There is an excellent article in The Atlantic on this topic. I have to wonder, when the breakthroughs become more widespread, as they inevitably will once COVID-19 vaccination becomes more widespread, if people will start to realize that other vaccinations (measles, mumps, etc.) also leave a certain number of people vulnerable even after vaccination and that degree of risk is variable for each individual. Will this help to dampen vaccination-resistance or enhance it?

True mass vaccination for COVID-19 appears to be upon us. No time like the present to consider whether vaccine-related injury from COVID-19 vaccinations should be added to the list of covered vaccinations for the Vaccine Injury Compensation Program. Make no mistake, the jockeying for position on whether COVID_19 vaccination-related injury should be covered began several months ago, especially over the inclusion of what are arguably vaccine administration (injury from improper administration, often from improper injection site thought to be too high on the arm or shoulder) should be included. Need something else to be worried about? I nominate this.

Or, so you would think. But the numbers are even worse elsewhere. As Dorothy Gale noted: “My, People come and go so quickly here!”

How can it be possible to provide quality care in such circumstances? How can it be possible to vaccinate all willing staff against COVID-19 in such circumstances?

This is a scandal with many contributors. The idea that New York nursing homes felt compelled to admit patients who had tested positive for COVID-19, or who had not tested negative for COVID-19, because they never pay attention to admitting only those they could really care for is the truth lurking behind the scandal.

Richard Mollot, executive director of the Long-Term Care Community Coalition, an advocacy group for elderly and disabled people. “There was little reason for nursing homes to think they should only take in patients if they have the ability to do so safely because those rules are not generally enforced on a regular basis.”

“We’ve created a separate and unequal hospital system and a separate and unequal funding system for low-income communities,” she [Dr. Elaine Batchlor] said in an interview. “And now with Covid, we’re seeing the disproportionate impact.”

“She has pleaded with the governor for help, tried to shame other institutions into accepting transfers of patients and spoken out about the failings of American health care.”

“Other institutions often rejected them, though, because only 4 percent of M.L.K. patients had private insurance, which typically reimburses care at higher rates than public insurers.”

Truth.

It is overwhelming enough to try to manage Covid-19 within the four geographic corners of a university, so it is a deeply admirable university, indeed, that acknowledges its role in spreading and preventing the spread of Covid-19 from inside its walls to the community at its gates.