coronavirus

The following memo has been floating around Twitter since last night. I was concerned that it might be a hoax, but this response Tweet from the official Henry Ford Health System account can only be interpreted as confirming that it's very real...just not public as of yet. It appears to be a legitimate internal policy memo being prepared in the event of a worst-case scenario:

With a pandemic, we must be prepared for worst case. With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.

— Henry Ford News (@HenryFordNews) March 27, 2020

@charles_gaba retweet this, your national audience needs to see this

Late last night, the U.S. Senate finally voted to approve a massive $2 TRILLION bailout/recovery bill in response to the Coronavirus pandemic. After a lot of haggling and drama, the final bill ended up passing unanimously, 96 - 0 (four Republican Senators weren't able to vote at all...due to being in self-isolation because of Coronavirus). It's expected to be quickly passed by unanimous consent in the House today and will presumably be signed by Donald Trump before nightfall.

And like that, the largest emergency economic influx bill in history is done.

There's a lot of explainers and thinkpieces being written about the bill as a whole...which elements are good, which are bad, which are flat-out offensive (especially the ~$500 billion in corporate giveaways, which still ended up in the final bill although they supposedly have some sort of oversight over which companies receive them and under what conditions), but my focus is of course on the healthcare aspects, and especially what it means for enrollment in ACA exchange plans and Medicaid via ACA expansion.

Thanks to Twitter follower V. Spell for the heads up on this chilling video from a local E.R. nurse here in Oakland County, Michigan.

I live around half an hour from both the hospitals she refers to (one is in Novi, the other in Southfield). Michigan has the fifth-highest number of confirmed cases and the eighth-highest per capita (as of this writing, we have around 2,300 confirmed cases of COVID-19), at 1 confirmed case per 4,300 residents.As of this writing, 43 Michigan coronavirus patients have died.

The video is about 7 minutes long, but I implore you to watch the entire thing. For those who can't view or hear it, i've transcribed it verbatim below.

For several years now, I've been urging Congress to upgrade the Affordable Care Act via a series of major improvements. Most notable among these is the need to #KillTheCliff...that is, to eliminate the so-called "Subsidy Cliff" which kicks in for ACA individual market enrollees who earn more than 400% of the Federal Poverty Line (roughly $50,000 for a single adult or $103,000 for a family of four).

As I've explained many tmes, the ACA's subsidy structure works pretty well for those earning between 100 - 200% FPL, and is at least acceptable for those earning 200 - 400% FPL (in fact, thanks to #SilverLoading, it works quite well for most of that population as well). The real problem kicks in above 400% FPL (and to a lesser extent below 138% FPL for those living in the 14 states which still haven't expanded Medicaid). In addition, the subsidy formula still doesn't make policies truly affordable for many of those receiving them.

In short, both the upper- & lower-bound Subsidy Cliffs need to be eliminated, and the underlying formula needs to be strengthened as well.

Besides effectively baking in a more-generous version of H.R. 1868 (Rep. Lauren Underwood's #KilltheCliff bill which I've been pushing for so hard for over a year now), the House Democrats' "Take Responsibility for Workers and Families Act" coronavirus stimulus/relief bill also includes some other important ACA-related provisions. Some of these are temporary, others would be permanent.

For a couple of weeks now, I've been posting constant updates as one state-based ACA exchange after another has announced a COVID-19-specific Special Enrollment Period in light of the ongoing pandemic crisis. Until now, though, there's been two ACA exchanges which haven't made such an announcement. One is the Big One, HealthCare.Gov, which hosts a whopping 38 states and which is facing increasing pressure to do so.

The other...is Idaho. Specifically, Your Health Idaho, the state's ACA exchange.

Dave Anderson brought this to my attention in the big "Take Responsibility for Workers and Families Act" coronavirus stimulus/relief bill being rolled out today as an alternative to the Senate Republican's "$500 billion corporate slush fund" bill being pushed by Mitch McConnell.

If you scroll allllllllll the way down to Pages 1,088 - 1,090, there are two provisions which relate directly to the Affordable Care Act's Advance Premium Tax Credits for exchange enrollees:

SEC. 103. RESTORATION OF LIMITATIONS ON RECONCILIATION OF TAX CREDITS FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN WITH ADVANCE PAYMENTS OF SUCH CREDIT.

(a) IN GENERAL.—Section 36B(f)(2)(B)(i) of the Internal Revenue Code of 1986 is amended to read as follows:

This just in via MNsure...

MNsure Announces Special Enrollment Period for Uninsured Minnesotans in Response to Growing COVID-19 Concerns

ST. PAUL, Minn.—Today MNsure announced a 30-day special enrollment period (SEP) for qualified individuals who are currently without insurance, in response to the potential growth of coronavirus (COVID-19) cases. This SEP that begins Monday, March 23, and runs through April 21, will allow uninsured individuals 30 days to enroll in health insurance coverage through MNsure.org.

“As more cases of COVID-19 are diagnosed throughout the state, we want to make sure every Minnesotan has the security of health insurance to ensure they can get the care they need if they contract this serious illness,” said MNsure CEO Nate Clark. “Uninsured Minnesotans can come to MNsure.org to sign up for coverage.”

Governor Tim Walz recently declared a peacetime emergency in response to the pandemic and stressed the importance of all Minnesotans to take care to avoid the spread of COVID-19.

California Responds to COVID-19 Emergency by Providing Path to Coverage for Millions of Californians

  • Covered California Expands Special Enrollment and Medi-Cal Seeks Waivers to Encourage Coverage
  • Effective immediately, anyone uninsured and eligible to enroll in health care coverage through Covered California can sign up through the end of June.
  • The Department of Health Care Services announces new steps to help those eligible for Medi-Cal sign up easily and get immediate coverage.
  • The moves come amid widespread disruption in the lives and livelihoods of Californians as public health officials seek to reduce the spread of COVID-19.
  • All medically necessary screening and testing for COVID-19 are free of charge, and all health plans available through Medi-Cal and Covered California offer telehealth options.
  • These actions build on increased state subsidies and the implementation of a state penalty, both of which took effect in January 2020

No one has been shouting from the rooftops louder than I have for HHS Secretary Alex Azar or CMS Administrator Seema Verma to join nearly all of the state-based ACA exchanges in announcing an official Special Enrollment Period (SEP) in light of the ongoing Coronavirus pandemic, and I'm still urging them to do so as soon as possible. The federal ACA exchange, HealthCare.Gov, hosts ACA enrollment for 38 states representing around 75% of the national population, so this is a pretty big deal.

Having said that, it's important to keep in mind that even without a COVID-19-specific SEP, many people already qualify to enroll in ACA-compliant healthcare coverage anyway, whether they're currently uninsured or because they're about to be...or because their personal circumstances are about to change. And none of these have anything to do with the COVID-19 crisis, although it's certainly going to cause a whole lot more people to qualify for two of those changes:

Special Enrollment Period (SEP)

This Just In via Vermont Health Connect...

The State of Vermont has made temporary changes to assure that Vermonters have access to health insurance. Please visit https://t.co/dXz4Cd2yQm for more information

— VT Health Connect (@VTHealthConnect) March 20, 2020

OK...that's about as vague and understated as you can get. Clicking the link doesn't make it any more obvious:

Stay informed and protect your health.

Last week I noted that House Democrats introduced the Families First Coronavirus Response Act, which includes a whole mess of important measures to deal with the economic and public health crisis fallout of the global pandemic. This act is by no means all that's needed, but it's an important start. The bill included, among other things, additional/emergency funding for:

via CMS:

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators. 

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

via the Colorado Dept. of Regulatory Agencies Insurance Division, it looks like Connect for Health Colorado is about to go ahead and establish their own COVID-19 Special Enrollment Period after all (this is from an internal draft document...the dates could still change, and it's not 100% guaranteed that they'll go ahead with it yet):

DEPARTMENT OF REGULATORY AGENCIES Division of Insurance 3 CCR 702-4 LIFE, ACCIDENT AND HEALTH

DRAFT Emergency Regulation 20-E-02

CONCERNING ESTABLISHING A SPECIAL ENROLLMENT PERIOD FOR ENROLLMENT IN AN INDIVIDUAL HEALTH BENEFIT PLAN RELATED TO COVID-19

...This emergency regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 10-1-108(7)(a), (7)(b)(III), 10-1-109(1), 10-16-105(2)(b), 10-16-105.7(3)(a)(II)(G), 10-16-105.7(3)(b)(II)(F),10-16-108.5(8), and 10-16-109, C.R.S.

Section 2 Scope and Purpose

Pages