#7 • A Healthy Dose of Healthcare News • November 13, 2020

Anna Shvets — Copyright-free

This one is COVID-heavy, and with good reason — see Biggest News below. COVID cases are spiking in many states and several hospital systems are getting overwhelmed, but the good news so far is that fatalities are relatively stable. As states impose tighter restrictions on economic activity — and economic activity always affects medical activity in one way or another — other indicators should stay on our radar, such as rising suicide rates, rising child obesity, and rising homicide rates, all of which risk wreaking havoc with Americans’ physical and mental health.

In this edition, you will read about #7.1. the Pfizer vaccine, #7.2. the ACA’s uneventful court date, #7.3. open enrollment numbers after week 1, #7.4. an app to detect COVID-19, #7.5. new data about state spending on Medicaid including the expansion population, and bonus news on CPR testing.

#7.1. Biggest News: Habemus vaccinum! Pfizer’s vaccine is the most promising one yet

VACCINE: Covid-19 vaccine from Pfizer and BioNTech is strongly effective, early data from large trial indicate (STAT News)

Late-stage data from Pfizer’s vaccine trials show a 90% decrease in symptomatic cases for participants who received two shots three weeks apart. These are early results, but they are far superior to anything we’ve seen so far in the race for an effective vaccine against SARS-CoV-2. Amazingly, if the vaccine is approved, Pfizer said they could make 50 million doses available by the end of this year, and as many as 1.3 billion in 2021. As we wait for additional data, related questions are becoming more pressing. How will we distribute the vaccine quickly, affordably, and safely? Will there be mandates, and from whom? In any case, this is a victory for scientific research and something that should give us hope as we wrap up a difficult year.

#7.2. Healthcare on Trial: The ACA is alive and well after its day in court

SUPREME COURT: Supreme Court appears willing to leave Obamacare in place (CNBC)

Three days ago, SCOTUS heard the infamous Texas v. California ACA case, and the sky didn’t fall. As expected, the majority of Justices indicated that they would uphold the legislation no matter what. “I think it’s hard for you [Texas solicitor general Kyle Hawkins] to argue that Congress intended the entire act to fall if the mandate was struck down,” stated Chief Justice John Roberts. The decision is expected in late June, but no one is holding their breath. Back when the penalty for being uninsured was dropped to $0, few people chose to go without insurance. Even if the Court decides that the individual mandate is unconstitutional, the rest of the law will likely remain as is and Americans will hardly notice the difference. Let’s not ignore the fact that this is happening with a 6–3 conservative majority, and that this case was the stated reason for Democrats’ voting against Justice Coney Barrett’s confirmation.

#7.3. Against Conventional Wisdom: No atypical surge in the first week of open enrollment

INSURANCE: More people signing up for Obamacare despite its uncertain fate (CNN)

Over 818,000 people enrolled in an Obamacare plan during the first week of open enrollment, for a daily average of just under 117,000. That’s more than last year (OE7), but fewer than in 2018 (OE6) and far fewer than in 2017 (OE5) — see the table below, taken from this post. Current circumstances exert opposite forces on enrollment. On the one hand, some may have doubts about the future of the ACA and be reluctant to enroll. On the other hand, it could be assumed that the economic downturn has made plenty of people eligible for subsidized health insurance. Last year, 8.4 million people had elected a plan by the time the enrollment window closed, so the total numbers to be released in about a month will give a fuller picture of the situation.

#7.4. The One with the Virus: Toward a COVID-19 detection app

TECH: Artificial intelligence model detects asymptomatic Covid-19 infections through cellphone-recorded coughs (MIT News)

MIT researchers created an artificial intelligence model that can tell whether someone has COVID-19 unawares based on how they cough. The model could be turned into an app that detects COVID-19 in a non-invasive, highly-convenient manner. Big if true! The news is a couple of weeks old and was brought up today by economist John Cochrane. He noted an important barrier, which the article mentions in passing: the app would have to be FDA-approved. Aside from the major delays in commercialization that this requirement could engender, a more essential concern is the fact that the FDA has to get involved at all. After all, this is just an app that listens to your cough; it’s not a 3D-printed lung. But the FDA recently approved a video game, so nothing should surprise us anymore.

#7.5. Average is Over: Median state spending on Medicaid expansion beneficiaries is almost $1,000 more than on similar but less-privileged adults

INSURANCE: Medicaid Per Capita Expenditures (Centers for Medicare and Medicare)

This could qualify for the biggest news for this week, in my view. I’ve been watching this page from the Medicaid & CHIP Scorecard since it was last updated around a year ago. At the time, it had 12 unnamed states’ Medicaid spending data broken down by beneficiary type:

  1. Children
  2. Adults: non-expansion, non-disabled, under age 65
  3. Aged
  4. People with disabilities
  5. Adults: ACA Medicaid expansion.

Note categories 2 and 5: the main difference between them is that adults in category 2 are part of the original Medicaid and as such earn below the federal poverty line, while adults in category 5 are part of the Medicaid expansion group and earn below 138% of the federal poverty line.

I discovered today that the page was recently updated, which means we now know which state spends what amount on each beneficiary type. When comparing states with clean data (Table 1), we see that median per-capita spending on original, non-disabled, non-elderly adults is $5,718. Meanwhile, the median per-capita spending on expansion, non-disabled, non-elderly adults is $6,673. This is to say that the typical state spends almost $1,000 more on the less impoverished individuals in its Medicaid program. There are more alarming figures when looking at individual states: for example, California spends nearly twice as much on Medicaid expansion beneficiaries than on original adult beneficiaries. This data set offers more questions than answers, but I would like to highlight three things:

  • The expansion was implemented starting in 2014. The public only gained access to data — of unidentified states — in 2019, and we now just got access to a fuller data set. There has virtually been no research on the issue, so we don’t know for sure what is driving the higher spending levels for expansion beneficiaries.
  • The vast majority of expansion spending (90%) is paid for by the federal government, with the states picking up the rest. For spending on all other types of Medicaid beneficiaries, the federal government covers 62% of expenses on average.
  • President-elect Joe Biden plans on forcing all states to implement the Medicaid expansion.

🎁 Bonus news: The majority of people who get a positive CPR test likely don’t need to quarantine

COVID-19: Ep. 155 Kevin McKernan on PCR testing for COVID-19 (The Accad and Koka Report)

I hesitated to include this here, as it’s not made it into mainstream news, perhaps owing to the complex nature of the news. It’s, however, definitely bonus news-worthy. Genomics experts are sounding the alarm on the fact that the way in which we test for COVID-19 does not take into consideration the stage of development of the virus. It appear that the vast majority of people who test positive are, in fact, no longer infectious. As such, they are quarantining needlessly — missing work, not visiting loved ones, sweating over their fate — while, conveniently for testing centers, their positive results generate dozens more tests thanks to contact tracing. The sad thing is that we have the scientific means of discovering whether the virus is just starting to spread in one’s body or almost dead. Scientists are beginning to ask why those data aren’t made available to patients and the public in general. Let’s hope we get answers sooner rather than later. A lot is at stake.

Past editions:

AHDoHN #6: an imminent cybercrime threat on the healthcare system, a state getting rid of Healthcare.gov, private insurance’s opposition to the public reimbursement of life-saving devices, Microsoft’s latest foray in healthcare cloud tech, and median vs. mean physician visit costs.

AHDoHN #5; AHDoHN #4; AHDoHN #3; AHDoHN #2; AHDoHN #1



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