Antibody Tests Were Hailed as Way to End Lockdowns. Instead, They Cause Confusion

May 28, 2020

Aspen was an early COVID-19 hot spot in Colorado, with a cluster of cases in March linked to tourists visiting for its world-famous skiing. Tests were in short supply, making it difficult to know how the virus was spreading.

So in April, when the Pitkin County Public Health Department announced it had obtained 1,000 COVID-19 antibody tests that it would offer residents at no charge, it seemed like an exciting opportunity to evaluate the efforts underway to stop the spread of the virus.

Aspen was an early COVID-19 hot spot in Colorado, with a cluster of cases in March linked to tourists visiting for its world-famous skiing. Tests were in short supply, making it difficult to know how the virus was spreading.

So in April, when the Pitkin County Public Health Department announced it had obtained 1,000 COVID-19 antibody tests that it would offer residents at no charge, it seemed like an exciting opportunity to evaluate the efforts underway to stop the spread of the virus.

“This test will allow us to get the epidemiological data that we’ve been looking for,” Aspen Ambulance District director Gabe Muething said during an April 9 community meeting held online….

Read the full Kaiser Health News article

COBRA Subsidies Might Mitigate Risk, Yet Face Challenges

May 28, 2020

The Trump administration recently released guidance that will allow the newly unemployed to retroactively opt into COBRA months from now. Meanwhile, a coalition of large companies is lobbying for the federal government to subsidize employer plans’ COBRA benefits.

COBRA allows newly terminated or furloughed employees to continue their health insurance coverage. Under normal circumstances, former employees have 60 days after their final date of coverage to opt into COBRA.

By Peter Johnson

The Trump administration recently released guidance that will allow the newly unemployed to retroactively opt into COBRA months from now. Meanwhile, a coalition of large companies is lobbying for the federal government to subsidize employer plans’ COBRA benefits.

COBRA allows newly terminated or furloughed employees to continue their health insurance coverage. Under normal circumstances, former employees have 60 days after their final date of coverage to opt into COBRA.

The administration expanded that window on May 4, releasing guidance that allows eligible people to opt into COBRA for as long as 60 days after the end of the federal state of emergency for the COVID-19 pandemic. That expands risk to self-insured employers and commercial payers.

David Anderson, research associate at the Margolis Center for Health Policy at Duke University, says that COBRA’s high cost limits “is really attractive to older folks with complex medical conditions, because their benefits that they get out of it are way more than the premium they pay in. Under the new guidance, where timelines get even weaker, you have even stronger selection pressures. People can get in later, they can get [in] with even more retroactivity — that’s expensive.”

Full COBRA subsidies might help mitigate that risk, though either way insurers will probably do fine, according to Citi Research health care analyst Ralph Giacobbe.

“For the managed care sector, [extending COBRA eligibility] reflects some increased risk to commercial players, but we continue to view the lower utilization backdrop as a meaningful driver, more than offsetting this incremental COBRA change,” Giacobbe wrote in a note.

Lobbying groups representing large employers back the proposed federal subsidies of COBRA coverage, and requested the government pay 90% to 100% of COBRA premiums during the pandemic.

“The lower the subsidy goes, the less healthy people take COBRA,” says James Gelfand, ERISA Industry Committee senior vice president for health policy. “You start to get opposition from employer and insurer groups, because you are creating incentives by which you are hurting the risk pool for the existing plans.”

The public, meanwhile, may find COBRA subsidies unsavory. Plus, federal subsidies of large businesses are never popular — and, as Anderson points out, a full COBRA subsidy could be exactly that in practice.

Datapoint: Zing Health Scores Investment From Newlight Partners

May 27, 2020

Newlight Partners LP last week said it has made a “significant investment,” up to $150 million, in Zing Health, a Chicago-based insurer focused on providing coverage to underserved seniors. The provider-led, technology-focused Medicare Advantage organization launched its first offerings in the 2020 plan year. As of May 2020, Zing Health serves 354 members in Illinois.

Newlight Partners LP last week said it has made a “significant investment,” up to $150 million, in Zing Health, a Chicago-based insurer focused on providing coverage to underserved seniors. The provider-led, technology-focused Medicare Advantage organization launched its first offerings in the 2020 plan year. As of May 2020, Zing Health serves 354 members in Illinois.

Source: AIS’s Directory of Health Plans

Nonwhite, Disabled Enrollees Are More Likely to Switch from MA to FFS, Study Shows

May 27, 2020

Previous research has suggested that disabled adults who rely on services such as home health and nursing home care are more likely to switch from Medicare Advantage to traditional, fee-for-service (FFS) Medicare. Now, a new study appearing in Health Affairs confirms researchers’ assumptions that such switching is more prevalent among MA beneficiaries who are nonwhite and/or from vulnerable sociodemographic groups.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City and the University of California San Francisco examined five years of data from the National Health and Aging Trends Study to assess switching between MA and traditional Medicare 12 months before and after the onset of a disability.

By Lauren Flynn Kelly

Previous research has suggested that disabled adults who rely on services such as home health and nursing home care are more likely to switch from Medicare Advantage to traditional, fee-for-service (FFS) Medicare. Now, a new study appearing in Health Affairs confirms researchers’ assumptions that such switching is more prevalent among MA beneficiaries who are nonwhite and/or from vulnerable sociodemographic groups.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City and the University of California San Francisco examined five years of data from the National Health and Aging Trends Study to assess switching between MA and traditional Medicare 12 months before and after the onset of a disability.

They found that 10.6% of people who were initially in MA switched to traditional Medicare and that the incidence of switches per 1,000 person-years climbed from 53.5 before disability to 65.6 after disability.

The authors also observed that nonwhite respondents had higher rates of switching both before and after disability — particularly those who started in MA plans. Before disability onset, those who were in MA plans had 94.3 vs. 63.6 switches per 1,000 person-years for those in traditional Medicare. The rates after disability were 81.9 vs. 71.0 switches per 1,000 person-years.

“One potential reason why a person with special needs or other chronic conditions may switch to fee-for-service Medicare is the network,” observes Matt Kazan, a principal with Avalere Health. If patients are diagnosed with a new disease and then discover that the providers they need aren’t in network, they tend to move to open-network FFS.

But switching out of MA plans “may have unanticipated financial impacts on patients, given that in most states Medigap plans to supplement traditional Medicare coverage can refuse coverage to those with preexisting conditions if a person is not new to Medicare,” pointed out the study’s authors.

Kazan says it would be interesting to see study results using more current data given that from 2011 to 2016, certain Affordable Care Act payment and risk adjustment changes were being phased in, and MA beneficiaries now have access to more home-based supports thanks to CHRONIC Care Act provisions contained in the Bipartisan Budget Act of 2018.

New Research Rewrites History of When COVID-19 Took Off in the U.S. — and Points to Missed Chances to Stop It

May 26, 2020

New research has poured cold water on the theory that the Covid-19 outbreak in Washington state — the country’s first — was triggered by the very first confirmed case of the infection in the country. Instead, it suggests the person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February, a month later.

The work adds to evidence that the United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country — and that those opportunities persisted for longer than has been recognized up until now.

New research has poured cold water on the theory that the Covid-19 outbreak in Washington state — the country’s first — was triggered by the very first confirmed case of the infection in the country. Instead, it suggests the person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February, a month later.

The work adds to evidence that the United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country — and that those opportunities persisted for longer than has been recognized up until now.

“Our finding that the virus associated with the first known transmission network in the U.S. did not enter the country until mid-February is sobering, since it demonstrates that the window of opportunity to block sustained transmission of the virus stretched all the way until that point,” the authors wrote in the paper. The paper has been posted to a preprint server, meaning it has not yet been peer-reviewed or published in a journal….

Read the full Stat article