The public option is now a reality in 3 states

“Washington state first approved its public option in 2019 and made it available to consumers for enrollment in 2020. The state now has a year of experience getting the Cascade Care program up and running, and it’s already starting to tinker with the policy design. It’s also offering lessons for Colorado and Nevada (the other state to pass a public option this year, one week before Colorado).

As these states have drawn up their plans, one thing has become clear: The potential value of a public option is in keeping health care costs in check by keeping rates lower than those of private insurance plans. But it still remains to be seen whether a public option can expand health coverage to more people.”

“None of the states offer a “public” option like the one Congress contemplated in 2009, where the government sets up and administers its own health insurance plan.

“None of them are true public options in that sense,” says Katie Keith, who writes about insurance reform for Health Affairs and consulted with states as they developed public option legislation.

Instead, she compares them with public-private partnerships. States are contracting with private companies to create new insurance options to be overseen, if not run, by the government. States would face practical challenges to doing a “true” public option — namely, building up the financial reserves they’d need to pay out claims — so they’re taking another approach wherein private insurance companies will run the public option under rules set by the government.”

“The plans will be sold on the ACA marketplaces, alongside ACA-compliant private insurance. Only people who are eligible for ACA coverage through the individual and small-group market can sign up”

“How much to pay health care providers is the most important issue for any health insurance plan — those prices dictate the premiums charged to customers — and these states are taking divergent approaches in their calculations.”

“One challenge in trying to set lower provider rates is that doctors and hospitals might simply choose not to accept the public option plan. That was Washington’s experience in its first year: Some hospitals refused to contract with the public plan, and since an adequate provider network isn’t possible without a hospital, the plan has only been available in 19 of the state’s 39 counties.

Washington is trying to correct that issue through recently signed legislation that will, among other things, require hospitals in large systems to participate in at least one public option plan. Nevada and Colorado, having seen Washington’s network-adequacy issues, are setting up their own provider participation requirements from the start.”

How to supercharge vaccine production for the next pandemic

“But it’s one thing to come up with a vaccine, and entirely something else to manufacture it on a mass scale. That’s where the world has stumbled and where concerted planning now can make sure we’re prepared for the future. If we’re to have a better chance to fight the next pandemic — and there will be a next one — the US needs to build on these vaccine tech innovations and make investments to establish permanent facilities producing mRNA and adenovirus vaccines.”

“that slack won’t arrive naturally.

Weber, the former assistant secretary of defense for biodefense, has pushed for what he dubs a “10 + 10 Over 10” plan to prevent biological threats in the future. It is essentially a big government investment that could enable the kind of infrastructure necessary to have gotten to full vaccine availability in the US in, say, one or two months, not five.

The plan calls for $10 billion in additional annual funding for the Department of Defense, and another $10 billion per year for the Department of Health and Human Services, devoted to anticipating pandemic and other biological risks, for at least 10 years.

With that funding, government could finance the infrastructure for year-round vaccine manufacture.”

“The key is that these facilities need to be active during non-pandemic times, otherwise their expertise and readiness could deteriorate.”

“Pharmaceutical companies are not going to go this big on their own, and there’s no guarantee that the government will fund them sufficiently without pressure. In 2020 — during the pandemic — the Trump administration cut the DOD’s chemical and biodefense programs by 10 percent, with much of the cuts going to the vaccine component of the budget. To set this vision in motion, the US needs to not just reverse cuts like that but spend much more, in line with Weber’s $20 billion per year proposal.”

Marijuana and Pregnancy: What Does the Science Say?

“Studies on marijuana use during pregnancy are inconsistent and inconclusive. But cannabis is not known to be teratogenic—that is, to cause birth defects—in humans. The bulk of scientific evidence suggests that risks posed to developing fetuses are relatively minor and babies exposed to marijuana in utero still fall within normal ranges of outcomes.

A 2020 review looked at longitudinal studies on “the impact of prenatal cannabis exposure on multiple domains of cognitive functioning in individuals aged 0 to 22 years” and found that “evidence does not suggest that prenatal cannabis exposure alone is associated with clinically significant cognitive functioning impairments.” Researchers did note some differences—”those exposed performed differently on a minority of cognitive outcomes (worse on < 3.5 percent and better in < 1 percent)" — although "cognitive performance scores of cannabis-exposed groups overwhelmingly fell within the normal range." A 2016 review of studies on potential ties between in utero marijuana exposure and adverse birth outcomes—things like low birth weight and preterm delivery to miscarriage and stillbirth—found "maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors." Instead, any increases in adverse outcomes appeared "attributable to concomitant tobacco use and other confounding factors."" ... ""The best new evidence on this comes from a 2019 study out of Canada," Oster writes. Matching women who used cannabis with demographically similar women who didn't, researchers did "find evidence of worse birth outcomes among the cannabis users," including "an increased risk of prematurity and NICU transfer. The increases are moderate but statistically significant: preterm birth occurred in 10% of cannabis users and 7% of non-users." An August 2020 study from the same authors found marijuana use correlated with slightly higher incidences of intellectual disability and learning disorders, as well as higher chances of having autism spectrum disorder. "The percent increase is large—about 50%—and significant," Oster points out, though the researchers do note that the overall incidence rate is still small. Though the researchers tried to demographically match participants between groups, it can still be hard to totally compensate for the ways marijuana users may differ from non-users." ... "The biggest problem is that it's hard to isolate specific factors like marijuana consumption. The population of women who not only use marijuana during pregnancy but are also willing to admit to researchers that they do may differ from those who don't." ... "A review of evidence published in February 2020 "points to the possibility of lower birth weight, diminished IQ and more behavior problems among children whose mothers used cannabis during pregnancy, but notes it is very difficult to separate the marijuana use from other demographics or other variables,"" ... " With the limited evidence available, it may make sense for most pregnant women to avoid marijuana to minimize possible risks to their offspring. But the best choice for one woman and her baby won't be the best choice universally. For women who have extreme morning sickness that makes getting adequate nutrients through food and vitamins difficult, and for whom marijuana mitigates nausea, using cannabis might make sense. Likewise, women with certain mental health conditions helped by marijuana may deem it safer than their usual prescription drugs."

The Government Is Making Us Fat and Susceptible to Viruses

“In all the coronavirus coverage, one issue that rarely makes the headlines is the correlation between body weight and the severity of COVID-19’s effects. And one angle that virtually never makes the headlines is how the government funds the unhealthy foods that increase obesity rates, thereby increasing our susceptibility to such diseases.
Last month the Centers for Disease Control and Prevention (CDC) released a study showing that nearly 80 percent of those hospitalized with COVID-19 were overweight or obese. After age, body weight is the second greatest predictor of COVID-related hospitalization and death. Almost three quarters of all Americans ages 20 and up are overweight, and close to half of that group is considered obese.”

“Not only is the U. S. government not making any efforts to reduce the obesity epidemic, it is actively subsidizing food that contributes to the problem. The U.S. Department of Agriculture recommends that people fill half their plate with fruits and vegetables, yet the vast majority of its food subsidies—$170 billion from 1995 to 2010—go toward the major ingredients of junk food, such as corn, wheat, rice, soy, and milk.”

“We have the power to make real changes in the way we eat and move. The government could help that process by taking its thumb off the scale and ceasing to subsidize these foods.”

Medicaid for Kids could pay for itself

“examining how the rollout of Medicaid in the late 1960s affected people who were children at the time.

If you got health insurance through the program as a child, he found, you were less likely to die young; you were likelier to be employed and less likely to have a disability as an adult; and all these benefits actually wound up saving the government money.”

Private equity ownership is killing people at nursing homes

“When private equity firms acquire nursing homes, patients start to die more often, according to a new working paper published by the National Bureau of Economic Research.

Private equity acquisitions of nursing homes is a pressing topic: Total private equity investment in nursing homes exploded, going from $5 billion in 2000 to more than $100 billion in 2018. Many nursing homes have long been run on a for-profit basis. But private equity firms, which generally take on debt to buy a company and then put that debt on the newly acquired company’s books, have purchased a mix of large chains and independent facilities — making it easier to isolate the specific effect of private equity acquisitions, rather than just a profit motive, on patient welfare.

Researchers from Penn, NYU, and the University of Chicago studied Medicare data that covers more than 18,000 nursing home facilities, about 1,700 of which were bought by private equity from 2000 to 2017.

Their findings are sobering.

The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.”

“the increased mortality is concentrated among patients who are relatively healthier. As counterintuitive as that may sound, there may be a good reason for it: Sicker patients have more regimented treatment that will be adhered to no matter who owns the facility, whereas healthier people may be more susceptible by the changes made under private equity ownership.

Those changes include a reduction in staffing, which prior research has found is the most important factor in quality of care. Overall staffing shrinks by 1.4 percent, the study found, but more directly, private equity acquisitions lead to cuts in the number of hours that front-line nurses spend per day providing basic services to patients. Those services, such as bed turning or infection prevention, aren’t medically intensive, but they can be critical to health outcomes.”

“The combination of fewer nurses and more antipsychotic drugs could explain a significant portion of the disconcerting mortality effect measured by the study. Private equity firms were also found to spend more money on things not related to patient care in order to make money — such as monitoring fees to medical alert companies owned by the same firm — which drains still more resources away from patients.”

“The researchers make a point in their opening to stipulate that private equity may prove successful in other industries. But, they warn, it may be dangerous in health care, where the profit motive of private firms and the welfare of patients may not be aligned”

Charging patients just $10 more for medications leads to more deaths

“Researchers at Harvard University and the University of California Berkeley examined what happened when Medicare beneficiaries faced an increase in their out-of-pocket costs for prescription drugs. They found that a 34 percent increase (a $10.40 increase per drug) led to a significant decrease in patients filling their prescriptions — and, eventually, a 33 percent increase in mortality.

The rise in deaths resulted from people indiscriminately cutting back on medications when they had to pay more for them, including drugs for heart disease, hypertension, asthma, and diabetes.

“We find that small increases in cost cause patients to cut back on drugs with large benefits, ultimately causing their death,” the authors — Amitabh Chandra, Evan Flack, and Ziad Obermeyer — wrote. “Cutbacks are widespread, but most striking are those seen in patients with the greatest treatable health risks, in whom they are likely to be particularly destructive.””

“This finding challenges an important assumption embedded in American health care policy. In the 1970s and ’80s, the RAND Health Insurance Experiment concluded that small copays encouraged patients to use fewer health care services without leading to worse health outcomes. That helped establish a new economic argument for insurers to ask their customers to put more “skin in the game”: it would encourage more efficient use of health care services with no downside.

But that premise presumed people would be rational. For example, if they are being asked to pay more money for prescription drugs, they would cut back on less-valuable medications first. The Harvard/Cal study didn’t detect any such rationality. When costs went up, people just stopped filling their prescriptions for statins — high-value drugs that are effective in preventing heart attacks.

The researchers explained it like this: The way patients behaved when faced with higher out-of-pocket costs would suggest that they placed very little value on their lives. They literally stopped taking high-value drugs because of the price.”

“If patients can’t make good value judgments, the economic argument for cost-sharing starts to crumble, and it starts to seem like eliminating cost-sharing — increasing the likelihood patients will continue to take the medications they need to stay alive — would be a cheap way to “buy” people more health. As the researchers wrote, “improving the design of prescription drug insurance offers policy makers the opportunity to purchase large gains in health at extremely low cost per life-year.””

“Eliminating out-of-pocket costs would come with a price: Insurers would likely charge higher premiums to offset the loss of the copays and coinsurance that currently reduce their direct costs. But if the goal is better health outcomes, that is arguably a price worth paying.”

Study: Smoking bans saved countless lives — could they have increased drunk driving?

“While there is still some debate around the potential increase in drunk driving, there is a vast, peer-reviewed, scientific literature around the harms of secondhand smoke inhalation, and around the massive health benefits associated with the sharp decline in smoking in part due to smoke-free policies.

We know that smoking bans have been effective at reducing secondhand smoke exposure. Bans in restaurants, bars, and other hospitality establishments have the added benefit of ensuring that workers are not forced to carry the health costs against their will simply due to their place of employment. Bans have also been effective at reducing smoking and “reducing opportunities to smoke, changing smoking norms, and reducing smoking rates.”

Smoking and exposure to secondhand smoke increases the risk of cardiovascular disease, pulmonary disease, cancer, and death. Research has shown that heart attack admissions “rapidly declined” after the implementation of 100 percent smoke-free laws.

All of this to say that if there was in fact a small increase in fatal drunk driving accidents as a result of these bans, the bans were still worth it.”

Argentina becomes the first large Latin American country to legalize abortion

“According to the BBC, a minimum of 350,000 illegal abortions occur annually in Argentina, a figure that some activist groups feel is undercounting the real number. Illegal abortions can lead to health complications and even death for the people who experience them — the World Health Organization estimates that up to 13.2 percent of maternal deaths worldwide can be attributed to unsafe abortions.

Argentina has seen adherence to Catholicism decline in recent years, according to a study from the National Scientific and Technical Research Council (CONICET). The Buenos Aires Times reports that in 2019, 62.9 percent of the population identified as Catholic, a 13.6 percentage point drop since 2008. Simultaneously, while evangelicals gained new adherents, the share of people identifying with no religion grew the most, reaching nearly 20 percent of the population.”

“While Argentina is still a largely Catholic country, this decline could explain why Pope Francis’s comments opposing legalizing abortion did not have an overwhelming effect on the outcome of this vote. Francis, who was born and worked in Argentina for much of his life, has referred to abortion as being part of a “throwaway culture” and has rooted his opposition to the medical procedure as being based in science, according to Crux, a Catholic online newspaper.

According to France 24, Catholics weren’t alone in opposing the measure; they joined forces with the country’s growing evangelical wing to mobilize against abortion. They will likely fight to overturn this measure, especially as this change exposes Argentina’s religious fault lines.

But the victorious activists are the abortion rights feminists who have spent years fighting for abortion legalization.”

“Argentina became the biggest country in Latin America to legalize elective abortion”

Biden can do 3 things on day one to unwind Trump’s war on reproductive health

“Again and again over the last four years, the Trump administration has made it harder for Americans — and people abroad — to get basic reproductive health care.

In 2017, the administration reimposed and broadened a rule, sometimes called the Mexico City policy, barring health organizations around the world that get US aid from providing or even discussing abortions. The result was a reduction in access to abortion, as well as services like contraception and prenatal care.

The same year, Trump’s Health and Human Services Department issued rules weakening an Obama-era mandate requiring employers to offer insurance that covers birth control, allowing them to claim an exemption if they had a religious or moral objection. Those rules have been tied up by lawsuits, but just won a major victory at the Supreme Court in July.

And in 2019, the Trump administration finalized what reproductive health advocates call a “domestic gag rule,” barring health care providers that get federal family planning funds under the Title X program from performing or referring for abortions. As a result, hundreds of clinics have exited the program, cutting its ability to provide birth control services in half.

These actions have had a real and serious impact on patients, only compounded by a pandemic that has made it even harder for many Americans, especially low-income people of color, to access reproductive health care.

But there is likely an end in sight for many of the Trump administration’s policies: Since they were enacted by executive action, they can be undone by President-elect Joe Biden when he takes office, without any help from Congress.

Biden has promised to do exactly that”