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6 posts from July 2020


Georgetown Professor Judy Feder Discusses Long Term Care Policy (July 29th)

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Federal policymakers have struggled unsuccessfully since at least the 1980s to create a national long term care (LTC) policy.  LTC coverage is available however it can only be obtained by pursing a complicated asset depletion process to qualify for coverage under the Medicaid program.  (Medicare is frequently assumed to provide LTC.  It does not.)  The 2010 Affordable Care Act's CLASS Act, that would have created a voluntary, public long-term care insurance option for employees, was determined in 2011 to be actuarially unworkable and in 2013 was repealed.  The 2013 American Taxpayer Relief Act's Commission on Long Term Care produced a report that contained service delivery and workforce recommendations but did not reach agreement regarding financing.  Though most comparative countries provide for LTC, the US remains without despite the fact with a rapidly aging population the demand for LTC services will significantly increase this decade and beyond (e.g., the number of Medicare beneficiaries is expected to grow from 55 to 80 million this decade), private LTC is largely unaffordable and less than 10% of the middle income population age 45 or older owns a commercial LTC insurance policy.        

During this 28-minute interview, Prof Feder begins by explaining why the 2013 LTC C0mmission failed to reach agreement regarding financing a LTC policy.  She moreover discusses or unpacks her and her colleagues 2018 paper (noted below) that, in sum, proposes a public catastrophic insurance along with a gap-filling private long term services and supports (LTSS) insurance, i.e., who is eligible, when, the amount of the benefit, how paid and financed.  She discusses recent Congressional efforts by Rep. Frank Pallone and others to legislate a policy and provides comment regarding the recently-released Biden campaign proposal regarding caregiver support (also noted below).     

Judy Feder is a Professor of Public Policy and, from 1999 to 2008 served as Dean of what is now the McCourt School of Public Policy, at Georgetown University.  Prof. Feder's health Downloadpolicy research began at the Brookings Institution, continued at the Urban Institute, and, since 1984, has been pursued at Georgetown.   Prof. Feder previously served as the Staff Director of the Congressionally-formed Committee on Comprehensive Health Care, known as the Claude Pepper Commission in 1989-90; served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services; as a Senior Fellow at the Center for American Progress (2008-2011); and, today as an Institute Fellow at the Urban Institute.  Prof. Feder is an elected member of the National Academy of Medicine, the National Academy of Public Administration, and the National Academy of Social Insurance; a former chair and board member of AcademyHealth and former board member of the National Academy of Social Insurance; and, a member of the Center for American Progress Action Fund Board and of the Hamilton Project’s Advisory Council.  In 2006 and 2008, Prof. Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district.  Prof. Feder earned her B.A. from Brandeis and her Master's and Ph.D. from Harvard.  

The 2018 paper, "A New Public-Private Partnership: Catastrophic Public and Front-End Private LTC Insurance" is at: https://www.umb.edu/mccormack.umb.edu/uploads/gerontology/Public_Catastrophic_Insurance_Paper_for_Bipartisan_Policy_Center_1-25-2018.pdf

The Biden campaign's July 21 "caregiving and education workforce" plan is at: https://www.documentcloud.org/documents/6998636-07-20-20-Caregiving-and-Education-Workforce-Plan.html.


210th Podcast: Stanford's Paul Ehrlich Discusses the On-Going (and Accelerating) Sixth Mass Extinction (July 23rd)

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Our planet is currently experiencing its sixth mass extinction.  Over the past 450 million years the planet has experienced five previous mass extinctions.  Each of which destroyed or extinguished between 70% and 95% of all plants, animals and micro-organisms.  While these five previous extinctions were moreover the result of volcanization, the current extinction crisis is human caused.  According to the UN's Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (or the IPBES), the five main causes of the current mass extinction are, in descending order, man-made changes in land and sea use; man's direct exploitation of animals and plants; man-made or anthropocentric global warming, i.e., the climate catastrophe, and man-made pollution. It should go without saying policy makers cannot coherently address human health without simultaneously recognizing or accounting for the state of the biosphere.  Nevertheless, federal policy makers refuse to discuss the ongoing extinction of life on earth.  For example, the House Select Climate Crisis Committee recently released report (I've cited in a previous post) fails to make any mention of the ongoing mass extinction or the loss of biodiversty nor did the committee discuss the issue during any of its hearings this Congressional session.  

During this 25 minute conversation, Professor Paul Ehrlich discusses moreover findings he and his colleagues make known in their two recent PNAS articles, findings by the UN's IPBES, e.g., half or more of all wildlife has disappeared from the planet over the past 50 years due in part to human caused reductions in geographic range, the relationship between the climate catastrophe and the extinction crisis, the decline in genetic variation moreover in foodstuffs, ever-increasing desperate efforts by the scientific community to bring this issue to the public's attention and comments on national policy makers perverse and tragic indifference to human-caused biological annihilation on the planet.   

Paul R. Ehrlich is President of the Center for Conservation Biology (CCB) and Bing Professor of Population Studies at Stanford University.  He is also co-founded the Millennium Assessment of Human Behavior (MAHB) with his wife, Anne (policy coordinator of the CCB) and Professor Donald Kennedy.  He is also Co-founder with Peter H. Raven of the field of co-evolution.  Professor Ehrlich is a fellow of the American Association for the Advancement of Science, the American Academy of Arts and Sciences, the American Philosophical Society, the Beijer Institute of Ecological Economics, and a member of the Paul EhrlichNational Academy of Sciences.  Professor Ehrlich has received several honorary degrees, the John Muir Award of the Sierra Club, the Gold Medal Award of the World Wildlife Fund International, a MacArthur Prize Fellowship, the Crafoord Prize of the Royal Swedish Academy of Sciences (given in lieu of a Nobel Prize in areas where the Nobel is not given), in 1993 the Volvo Environmental Prize, in 1994 the United Nations' Sasakawa Environment Prize, in 1995 the Heinz Award for the Environment, in 1998 the Tyler Prize for Environmental Achievement and the Dr. A. H. Heineken Prize for Environmental Sciences, in 1999 the Blue Planet Prize, in 2001 the Eminent Ecologist Award of the Ecological Society of America and the Distinguished Scientist Award of the American Institute of Biological Sciences, and in 2009 the Margalef Prize in Ecology and Environmental Sciences.  Professor Ehlich earned his Ph.D. from the University of Kansas.  

Professor Ehrlich's June 2020 Proceedings from the National Academy of Sciences article titled, "Vertebrates on the Brink as Indicators of Biological Annihilation and the Sixth Mass Extinction," is at: https://www.pnas.org/content/117/24/13596.

His related PNAS July 2017 article titled, "Biological Annihilation Via the Ongoing Sixth Mass Extinction Signaled by Vertebrate Population Losses and Declines" is at: https://www.pnas.org/content/114/30/E6089.  

The UN's IPBES 2019 report, "Global Assessment Report on Biodiversity and Ecosystems Services," is at: https://ipbes.net/global-assessment

The November 2019 letter by over 11,000 scientists published in BioScience warning of the climate emergency is at: https://academic.oup.com/bioscience/article/70/1/8/5610806


Georgetown's Prof JoAnn Volk Discusses Health Care Sharing Ministries (July 21st)

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The Trump administration has strongly supported alternative insurance plans in the individual market or those that do not meeting regulatory requirements, for example providing what are defined as "essential health benefits," under the Affordable Care Act.  (While the administration claims the ACA reforms are responsible for higher premiums, research shows price increases are largely due to the uncertainty caused by unending efforts to repeal the ACA, the elimination of the individual mandate and the White House's decision to end subsidies to marketplace plans.)  In 2017 the president issued an Executive Order instructing federal agencies to expand the scope of what are termed Short Term Limited Duration Insurance (STLDI) plans.  (A related rule was finalized in 2018, various entities filed suit opposing the final rule's STLDI expansion and this past Friday, the DC US District Court ruled 2-1 in favor of the government.)  Related to STLDI plans and much less discussed are what are termed Health Care Sharing Ministries (HCSMs).  Though these are not defined as health insurance plans, for example they do not guarantee payment of claims, they are marketed as such.  While HCSM plans are growing in number and in subscribers they are neither regulated at the federal nor state level.  Nevertheless, the Trump administration has recently published a proposed IRS rule that would treat HCSMs the same as health insurance, i.e., allow individuals to deduct their monthly HCMS fee from their personal income taxes or be reimbursed under a Health Reimbursement Arrangement.     

During this 21 minute conversation Prof. Volk begins by discussing the history of HCSMs.  She describes or defines HCSM plans, what benefits they offer, how they're financed and marketed.  She explains the adverse selection problem they present, why they are neither regulated at the federal or state level and the recently proposed IRS regulations that would, if finalized, grant tax advantages to those purchasing HCSM plans. 

Ms. JoAnn Volk is a Research Professor at the Georgetown University Center on Health Insurance Reforms (CHIR). There she directs research, authors papers, and provides technical assistance on state and federal regulation and legislation Grgtwn-Proofs-2019_0162-682x1024governing private health insurance, including health insurance marketplaces under the Affordable Care Act.  Prior to joining Georgetown, Ms. Volk represented the AFL-CIO before Congress and the Administration on a broad range of health care issues. Before that, she conducted health care research at Abt Associates and served as an aide to the Speaker of the New York State Assembly.  Ms. Volk serves as a consumer representative to the National Association of Insurance Commissioners and is a member of the Committee on Performance Measurement at the National Committee for Quality Assurance (NCQA).  She earned an MA in Public Policy from Johns Hopkins University and a BA from Franklin and Marshall College.  

The related November 2019 Congressional Research Service paper concerning HCSMs and STLDI plans is at: https://www.everycrsreport.com/files/20191113_R46003_be3db11a1571c61865168353aefa8cb572dc32dc.pdf.   

Prof. Volk's 2018 Commonwealth Fund HCSM issue brief is at: https://www.commonwealthfund.org/sites/default/files/2018-08/Volk_hlt_care_sharing_ministries.pdf

Prof. Volk's June 2020 CHIR Blog post regarding the proposed HCSM IRS rule is at: http://chirblog.org/new-federal-guidance-requires-taxpayers-subsidize-health-care-sharing-ministries/.

For a discussion of the July 17th US District Court's decision regarding the administration's final STLDI rule, see Katie Keith's July 19th review at: https://www.healthaffairs.org/do/10.1377/hblog20200719.720906/full/


Project COPE, A Research Project Studying the Effects of COVID-19, Is Soliciting Study Participants (July 15th)

Researchers from the University of South Carolina School of Medicine Greenville, Clemson University, Prisma Health and Indiana University are soliciting a wide range of health care providers, professionals and students to participate in surveys and video journals investigating the impacts of the COVID -19 pandemic under the title, Project COPE (Chronicling Healthcare Providers Pandemic Experiences). 

If you are interested in participating in Project COPE, i.e., sharing your experiences with the research team, please go to: https://infoprojectcope.wixsite.com/website?fbclid=IwAR3GzwlzHFbi47y5pZ0Qi2TRttrS6369ecYUs7PWDNsvF-e_3yNbK8ft2e4 and https://uofsc.co1.qualtrics.com/jfe/form/SV_0eSysYlam9i5ARD.

I am not currently a participant in the study nor have I accepted any endorsement moneys for posting this research solicitation. 

Thank you. 


House Select Committee on the Climate Crisis Releases It's "Solving the Climate Crisis" Report (July 12th)

This past June 30th the US House of Representatives' Select Committee on the Climate Crisis, specifically the Committee's Democratic majority, released a 547-page report titled, "Solving the Climate Crisis."  The report's healthcare chapter, "Improve Public Health and Manage Climate Risks to Health Infrastructure is at pages 313-338.  The report also comes with 21 one-page summaries concerning climate crisis-related subtopics ranging from agriculture to transportation.  The report text, presser, summary pages, et al., is at: https://climatecrisis.house.gov/report.  As a select committee, it cannot offer or pass legislation.  The committee was established in January 2019, is chaired by Tampa's Rep. Kathy Castor (D-FL-14) , the committee has held 16  hearings none since this past February.   The House Speaker Nancy Pelosi has moved no significant climate-crisis related legislation this session of the Congress.      

Considering my June 21 post below, the report, though expected, is far beyond disappointing. 

Possibly moreover, the report fails to recommend a carbon tax.  At page 286 the report states,"Congress could design . . . a carbon price" and goes on to list seven principles for designing carbon pricing. 

As for healthcare, first and foremost, the report concedes the catastrophic effects of the climate crisis.  The report simply recommends "investments in community preparedness and the resilience of hospitals and health infrastructure" and goes on to recommend more specifically, "strengthening national planning to address climate risks to public health," "improving data collections on climate-related health impacts," "ensuring resilient public health supply chains," "supporting community preparedness for the health impacts of disasters," "increasing the planning and preparedness of hospitals and health infrastructure," "strengthening the resilience of the veterans health systems," and "addressing the mental health implications of climate change." 


Professor Ruqaiijah Yearby Discusses Structural Racism in Health Care (July 8th)

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Being endemic in the US, racism is pervasive in health care.  It explains everything from the fact that the black to white infant mortality ratio has never dipped below to 2:1, to more generally, disproportionate un- and under-insured rates, compromised access, non-referrals, accelerated aging and and excess deaths.  More pernicious than interpersonal racism, structural or systemic racism, where the failure to provide equal benefit to racial and ethnic minorities, is embedded in health care along with education, employment, environmental, housing, transporation and numerous other federal policies.  As I've noted recently, this explains why COVID-19-related deaths among African American and Hispanics are far greater than among non-Hispanic whites.  (Before George Floyd was killed, he suffered a COVID-19 infection.)  Listeners will recall structural racism was an theme in my January 9th interview with Prof. Andrea Freeman regarding her recent book, Skimmed: Breastfeeding, Race and Injustice.  

During this 30-minute conversation, Prof. Yearby begins by defining the difference between structural and institutional racism.  She provides examples of structural racism, for example, home health workers (moreover women of color) are not protected under, for example, the 1938 Fair Labor and Standards Act, she discusses the link between hospital closures and race and the ongoing effect structural racism is having on minority communities during the current pandemic, i.e., how it compares to the H1N1 pandemic.  She concludes by discussing solutions to address or mitigate structural racism in health care and how proposed federal legislation to limit employer liability for COVID-19 infections could be justified.         

Ms. Ruqaiijah Yearby is a Professor, Member of the Center for Health Law Studies at Saint Louis University School of Law and also the Co-founder and Executive Yearby_ruqaiijahDirector of Saint Louis University’s Institute for Healing Justice and Equity.  She is also a Co-Principal Investigator of the Robert Wood Johnson Foundation grant entitled, “Are Cities and Counties Ready to Use Racial Equity Tools to Influence Policy?”  She, too, serves as a Research Consultant and Board Member for the RWJF grant “Investigating Conceptions of Health Equity and Barriers to Making Health a Shared Value.”  Her work has been cited in The Oxford Handbook of Public Health Ethics (2019), Dolgin & Shephard, Bioethics and the Law (4th ed 2019), Mark Hall, et al, Health Care Law and Ethics (9th ed 2018), Implicit Racial Bias Across the Law (Cambridge Univ. Press 2012), The Oxford Handbook of Bioethics (2007).  Professor Yearby earned her BS in Biology from the University of Michigan, an MPH from Johns Hopkins School of Public Health, and her JD from Georgetown University Law Center.  

Professor Yearby's publications are available at: https://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=549981

Per my noting of critical race theory (CRT), or its mention in a July 2nd Health Affairs blog, see: https://www.healthaffairs.org/do/10.1377/hblog20200630.184036/full/.

Concerning the federal government's response to date to the COVID-19 pandemic, listeners would be remiss if they did not read Part I of Robert Brenner's "Escalating Plunder," in the May-June issue of the New Left Review, at: https://newleftreview.org/issues/II123/articles/robert-brenner-escalating-plunder