Medicaid & Children; Private Equity & Mortality
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Medicaid Unwinding & Children
Yesterday we wrote about Medicaid unwinding - the post pandemic process of having Medicaid recipients re-apply for coverage. We noted that 13.3 million have lost coverage and that 2.48 million of those were children.
Sixty percent of these children come from Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota, and Texas—all Republican-led states.
The 10 states refusing the Affordable Care Act’s expansion of Medicaid to low-income adults have dis-enrolled more kids than all of the expansion states combined.
These 10 states are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. (link)
Health and Human Services Secretary Xavier Becerra sent letters the governors of all states urging them to better protect kids from losing Medicaid. In it he has a list of strategies states can implement to help protect these children and other recipients. The particular strategies he recommends are here.
Today’s actions are to help those kids get their healthcare back.
Also, on December 6th the Center for Medicare and Medicaid Services put out a proposed new rule to “encourage” states to behave better during the Medicaid unwinding. It gives CMS more oversight and leverage with the states.
Of course, if we had Universal Healthcare we could be talking about other important things.
(h/t West Virginia Citizen Action Group, Rogan’s List)
ACTION
Let’s tell our Members of Congress and Senators to pass legislation to protect children’s access to Medicaid during and after this “unwinding”.
Here is a RESISTBOT Action to do that. Text SIGN PEBBOA to 50409.
“I am your constituent and I just found out that 2.48 million children have lost their Medicaid insurance in the post pandemic unwinding. I want you to pass legislation to protect children’s access to Medicaid during and after this “unwinding” period. Thank you.”
EXTRA CREDIT ACTION #1
If you live in Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota, or Texas you can send a letter to your governor and state legislators asking them to adopt the measures outlined in HHS Secretary Becerra’s letter to the governor’s of those states that urges them to protect children’s access to Medicaid. Here is a link to find their contact info.
Template Text - “ I am your (name) and am your constituent. I live in (zipcode). I understand that in our state a very high number of children have lost Medicaid insurance during the post pandemic unwinding process. Secretary of HHS, Xavier Becerra sent a letter to all state governors in June of 2023 with actions we can take to help protect those children. I want you to take those actions. Please protect those children.”
EXTRA CREDIT ACTION #2
The Center for Medicare and Medicaid Services (CMS) is taking public comments on a rule to implement during the Medicaid unwinding period. It is called “CMS Enforcement of State Compliance With Reporting and Federal Medicaid Renewal Requirements” and will force states to abide by the Medicaid eligibility rules.
The rules are here and they are accepting comments until February 4th, 2024.
I told them “ I heartily approve of the new rules. I am so saddened to hear that as of today, according to the Kaiser Family Foundation, 2.48 million children have lost Medicaid healthcare. This will help provide the access to care that so many need. Thank you.”
Private Equity and Mortality
I received a note yesterday from a reader, who is a physician, asking if I could discover something about what effect private equity investment has on mortality.
Previously we noted that when a hospital is purchased by a private equity fund, the patients and community typically suffer. There are more accidents, more infections and a loss of unprofitable services. At that time I had no information about mortality.
Here is what I learned.
A study was conducted by the University of Pennsylvania’s Atul Gupta, NYU’s Sabrina T. Howell, Chicago Booth’s Constantine Yannelis, and NYU PhD candidate Abhinav Gupta reviewing 18,000 nursing homes. The bottom line was that when private equity purchased a location, deaths went up by 10%.
Their source was Medicare and Medicaid data covering more than 18,000 US nursing homes between 2004 and 2019. During this period, 1,700 facilities were bought by PE firms.
What’s behind the surge in death rates? It could partly reflect staff cuts. The researchers found an average reduction in staffing of 1.4 percent after PE companies bought nursing homes and a 3 percent drop in the number of hours that nurses and other staff were paid to provide basic services such as hygiene, infection management, and monitoring or bed turning. These routine tasks are critical to well-being and health outcomes, particularly of older patients.
The staffing reduction at private equity owned firms seems to have gone hand in hand with an increase in the use of anti-psychotic medications. The study found a 50% increase in the use of such drugs in private equity owned facilities. Those drugs are known to increase mortality in older, institutionalized patients with dementia.
With respect to hospitals, the data is confounded. Here is a link to a news story about the recent Journal of the American Medical Association (JAMA) publication about private equity’s impact on patients in hospitals. 386 hospitals are owned by private equity funds, about 9% of all private hospitals.
The study, which reviewed 5 million hospital visits, found that rates of hospital-acquired complications for patients increased by 25% at hospitals after they were purchased by private equity firms.
The increase was driven by a 27% increase in falls, which tend to happen on the general floors of the hospital; a 38% increase in central line infections, which are associated with ICU care; and a doubling of the rates of surgical site infections.
The increase in central line infections happened despite private equity-owned hospitals inserting about 16% fewer central lines — ports into large veins that are surgically implanted in patients who need regular intravenous medication, food or fluids.
Contrasting the rise in adverse events was a minor decrease in hospital deaths among the acquired hospitals. However, the researchers wrote that this apparent improvement could be a result of the healthier, less poor pool of patients observed among the acquired hospitals, or potentially that discharges of relatively sicker patients, as suggested by higher transfer rates, could have lowered in-hospital mortality through a selection effect. The mortality rate 30 days post discharge showed no improvement.
Dumping sicker patients to other facilities and obtaining lower mortality rates - yuck.
That’s the data for now. The US Senate committee on Labor and Health is investigating private equity in healthcare. When I spoke to the committee’s office they indicated that the chairman, Senator Ron Wyden of Oregon, would post the results of their investigation.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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