#BreastCancer Pink is The Color of October

Breast cancer is a type of cancer that begins in the breast tissue. It is one of the most common types of cancer affecting women, although it can also occur in men. The history of breast cancer dates back thousands of years, and our understanding of the disease has evolved over time.

Ancient medical texts from ancient Egypt, dating back to around 1600 BCE, mentioned tumors in the breast. Some of these texts described a condition similar to breast cancer, referring to it as a “bulging mass” that could not be treated.

In ancient Greece, the physician Hippocrates (c. 460–370 BCE) described breast cancer as a systemic disease that could spread to other parts of the body. However, for many centuries, little progress was made in understanding or treating the disease.

It wasn’t until the 17th century that medical advancements began to shed more light on breast cancer. Researchers such as Thomas Paget, William Halsted, and George Beatson made major contributions to our understanding of breast cancer, including the identification of different types of tumors and the development of surgical techniques for their removal.

In the 20th century, advancements in medical technology and research further improved our understanding of breast cancer. The introduction of mammography in the 1960s allowed for earlier detection of tumors. The discovery of tumor markers and hormonal therapies in the following decades revolutionized treatment options.

Breast cancer awareness campaigns, such as the pink ribbon movement, gained momentum in the late 20th century and continue to raise public awareness about the disease.

Today, breast cancer research focuses on developing more effective diagnostic tools, personalized treatment options, and exploring the genetic and environmental factors that contribute to the development of the disease.

It is important to note that while significant progress has been made in understanding and treating breast cancer, it remains a serious health issue. Regular self-examinations, mammograms, and medical check-ups are crucial for early detection and successful treatment. If you have any concerns about breast health, it is always advisable to consult with a healthcare professional.

Breast cancer affects women of all races and ethnicities, and it is important to emphasize that no one is immune to this disease. However, research has shown that there are certain patterns in the incidence and outcomes of breast cancer among different racial and ethnic groups.

When it comes to African-American women, they have both higher breast cancer incidence rates and higher mortality rates compared to women of other racial and ethnic backgrounds. These disparities are influenced by a combination of factors, including socioeconomic status, access to healthcare, cultural beliefs, and genetic variations.

  1. Incidence Rates: African-American women have a higher incidence rate of breast cancer compared to women of other racial and ethnic backgrounds. According to the American Cancer Society, the breast cancer incidence rate is about 128.1 cases per 100,000 African-American women.
  2. Mortality Rates: Sadly, African-American women also have a higher mortality rate from breast cancer. The mortality rate is around 31.9 deaths per 100,000 African-American women, according to the American Cancer Society.
  3. Younger Age: Breast cancer tends to occur at a younger age in African-American women compared to women of other races. Studies have shown that breast cancer in African-American women is more commonly diagnosed before the age of 50.
  4. Aggressive Subtypes: It has been observed that African-American women are more likely to be diagnosed with aggressive subtypes of breast cancer, such as triple-negative breast cancer. This subtype is often associated with a poorer prognosis.
  5. Disparities in Survival: Despite advances in breast cancer treatment, African-American women have lower survival rates compared to women of other racial and ethnic backgrounds. These disparities highlight the importance of early detection, access to quality healthcare, and culturally tailored interventions.

It is essential to address these disparities through increased awareness, education, access to screening and treatment, and equal healthcare opportunities for all women. By promoting regular mammograms, early detection, and timely treatment, we can work towards reducing the impact of breast cancer in African-American communities. Remember to consult with your healthcare provider for personalized advice and support regarding breast health.

A new American Cancer Society (ACS) report finds that the death rate for breast cancer in the United States among women dropped 43% between 1989 when it peaked and 2020. During the last decade, death rates declined similarly for women of all racial/ethnic groups across the US except for American Indians/Alaska Natives (AIANs), who had stable rates. However, Black women are still more likely to die from breast cancer than White women across the US, even though Black women have lower breast cancer incidence rates.

AI/AN populations in the United States have unique cancer patterns due to their history and culture, where they live, how they get health care, and institutionalized racism. Many Native people live on reservation lands or in remote rural areas, where their primary health care is provided by a tribally operated health program or the Indian Health Service. Rural and urban Native people often experience more poverty, lower levels of education, and poorer housing conditions compared with the general US population. View the resources below to learn more about cancer in AI/AN communities.

Personal Commitment

My mom pictured on the right is a #breastcancersurvivor. I admire her strength and strong-willed ability to muster through unchartered territory. As some mother and daughter relationships we’ve had our share of rollercoaster rides – (1) thing for certain; (2) things for sure – she has been steadfast come hell or high water; if I had 1/3 of her strength the trajectory of my life would have more sunshiny days. I love you mom…

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Free Mammograms In Your State

Please note not all links have been verified.

Update – Medicare Advantage – No No

Medicare Advantage (MA) has received mixed reviews after 25 years of implementation. While it may benefit employers, unions, and states with retiree obligations, it has raised concerns for seniors, doctors, and the government. Seniors may receive worse care under MA compared to traditional Medicare, doctors face cumbersome prior authorizations, and the federal government spends more on MA per capita than traditional Medicare. Additionally, several major insurance companies offering MA plans are involved in lawsuits.

Medicare Advantage began life as a brilliant idea: a public-private partnership to keep older people healthier and reduce costs.

At the time in 1992, both President George H.W. Bush and his challenger, Bill Clinton, supported it. An editorial in The New York Times declared, “The debate over health care reform is over. Managed competition has won.” What finally emerged in 1997 — Medicare Choice, now known as Medicare Advantage — was hailed as a win-win-win for patients, providers, and payers.

Twenty-five years later, a different consensus is clear: Medicare Advantage (MA) is a failure for seniors, who receive worse care than they do under traditional Medicare; for doctors, who must negotiate costly and dangerous prior authorizations for their patients; and for the federal government, which spends more per capita on MA than on traditional Medicare. Further, eight of the ten largest insurance companies offering Medicare Advantage plans are currently defendants in False Claims Act lawsuits brought by whistleblowers or the Department of Justice.

But it’s been a winner for employers, unions, and states that have pension and health care obligations to their retirees. They push hard to get people off traditional Medicare and onto MA plans. That’s because retiree benefits often include supplemental or Medigap policies that former employers pay for, while Medicare Advantage plans are almost entirely paid for by the federal government. Medicare Advantage plans are also winners for the private insurance companies that offer and administer them. Their gross margins are typically two to three times greater than other insurance plans.


Evidence of Coverage (EOC) | Medicare

What is it?

If you’re in a Medicare Plan, your plan will send you an “Evidence of Coverage” (EOC) each year, usually in the fall. The EOC gives you details about what the plan covers, how much you pay, and more.

When should I get it?


Who sends it?

Your plan

What should I do if I get this notice?

  • Review any changes to decide whether the plan will continue to meet your needs in the next year. 
  • If you don’t get this important document, contact your plan.

Benefits Provided by Medicare Advantage

Medicare Advantage, also known as Part C, is offered by private insurance companies. It was introduced in the 1980s to provide competition and choice. Seniors may find that these private plans offer convenience, a wider range of benefits, and lower out-of-pocket costs than Original Medicare. More than 3,100 Medicare Advantage plans are available nationwide as of 2020, with the average beneficiary being able to choose from 28 different plans.

  • You are always responsible for copayments and coinsurances, and sometimes even for deductibles. Therefore, the cost could be quite high. There is an out-of-pocket limit – $8,300/year.
  • Your choice of doctors/hospitals is limited by the provider network within a specific geographic area. Members are required to pay an increased cost, sometimes up to the full price, for services outside the provider network.
  • Medicare providers may not always accept Medicare Advantage plans so your choices may be limited. Some doctors and hospitals do not participate in any Medicare Advantage plans and others only in a selected few.
  • Many plans require referrals for specialists and other services.
  • Medicare Advantage plans may change every year. Such changes may affect your premium, deductibles, copayments/coinsurances, and the scope of extra services.

Avoid Fake Covid Tests

How to avoid buying fake COVID tests online

The news is filled with images of long lines at in-person COVID testing sites and reports of limited supplies of at-home test kits. It’s not a surprise that, according to the U.S. Food and Drug Administration, fake and unauthorized at-home testing kits are popping up online as opportunistic scammers take advantage of the spike in demand.

Using these fake products isn’t just a waste of money, it increases your risk of unknowingly spreading COVID-19 or not getting the appropriate treatment. So, if you’re shopping online for COVID test kits and related items:

  • Make sure the test you’re buying is authorized by the FDA. Check the FDA’s lists of antigen diagnostic tests and molecular diagnostic tests before you buy to find the tests authorized for home use. (EUA is “emergency use authorization.”)
  • Check out a seller before you buy, especially if you’re buying from a site you don’t know. Search online for the website, company, or seller’s name plus words like “scam,” “complaint,” or “review.”
  • Compare online reviews from a wide variety of websites. You can get a good idea about a company, product, or service from reading user reviews on various retail or shopping comparison sites. Think about the source of the review. Ask yourself: Where is this review coming from? Is it from an expert organization or individual customers?
  • Pay by credit card. If you’re charged for an order you never got, or for a product that’s not as advertised, contact your credit card company and dispute the charge.

CMS Physician Fee Schedule

CMS releases 2022 Medicare physician fee schedule and QPP proposals

The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule on the 2022 Medicare Physician Fee Schedule(www.cms.gov) and Quality Payment Program (QPP).

Highlights related to the fee schedule include:

  • CMS proposes to retain everything temporarily added to the Medicare telehealth services list through 2023.
  • CMS proposes to increase the work relative value units (RVUs) for each of the chronic care management codes.
  • CMS acknowledges Medicare payments for vaccine administration services have become increasingly insufficient and seeks detailed comments on the cost of vaccine supplies and administration to create a new, more sustainable payment structure.
  • CMS proposes to delay full implementation of the Appropriate Use Criteria for Diagnostic Imaging program until Jan. 1, 2023, or Jan. 1 in the year after the COVID-19 public health emergency ends, whichever is later.

Highlights related to QPP include:

  • CMS proposes to add five new episode-based cost measures, including two chronic condition episodes, to the “Cost” category of the Merit-based Incentive Payment System.
  • Beginning with the 2022 performance period, CMS proposes to no longer require clinicians and small practices seeking reweighting of the Promoting Interoperability category to apply for hardship exemptions. For practices with 15 or fewer eligible clinicians, CMS would automatically assign a weight of zero to the category and redistribute its weight to other performance categories.
  • CMS proposes to modify the complex patient bonus to better target eligible clinicians who treat more complex and high-risk patients.

The bad news is that CMS proposes to decrease what it pays per RVU (i.e., the conversion factor) in 2022. CMS proposes to set the 2022 conversion factor at $33.58, or 3.75% lower than this year. The decrease is due to the expiration of a 3.75% increase that Congress applied in December 2020. A coalition of medical groups, including the American Academy of Family Physicians, is advocating for a legislative remedy to prevent the cut. 

Emotional Intelligence

The concept of emotional intelligence (EI) has been studied for decades. It wasn’t until 1995, with the publication of Daniel Goleman’s book Emotional Intelligence ,that EI was pushed to the forefront.

At the same time, employers still didn’t embrace EI in the workplace. Maybe it was because they believed that emotional intelligence myths like the idea that there actually isn’t such a thing. That has changed as research has found that emotional intelligence was the strongest predictor of workplace effectiveness.

Additionally, McKinsey & Company anticipates that the demand for technological, social and emotional, and higher cognitive skills will rise by 2030. And as we begin to embark on a post-COVID world, EI is more relevant than ever.

With that in mind, here’s how you can deploy emotional intelligence to improve both your personal and organizational work success

Create capacity

While “EI is a set of skills, attitudes, and behaviors,” it’s also a variable, states Bill Davies, a Principal Consultant at PSI Talent Management International. “I can be emotionally intelligent one moment and emotionally stupid the next. So, developing EI is about being more emotionally intelligent more of the time.”

Davies continues that whenever we’re tired or irritable, it’s possible to lose our capacity for EI. More detrimental is that these emotions allow us to become easily triggered. As a consequence, this leads defensive habits like micromanaging or aggressive body language.

Source: https://www.entrepreneur.com/author/john-rampton

Affordable Care Act’s Glitch

A new KFF analysis estimates 5.1 million people nationally fall into the Affordable Care Act’s “family glitch” that occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage.

The so-called glitch occurs because the ACA prohibits people with an offer of affordable employer coverage from purchasing subsidized coverage through the ACA marketplace. Under current rules, the affordability of employer coverage is based on what it would cost just to cover the worker and not their families.

Worker-only coverage with an out-of-pocket premium up to 9.83% of the worker’s household income is considered affordable, even if the additional cost of covering their dependents would push them above that threshold. President Biden hinted about a potential administrative fix to address the glitch in a recent executive order.

The analysis provides a demographic profile of those currently affected by the glitch:

• The vast majority (85%) are currently enrolled in employer-sponsored coverage and likely spending far more for their health insurance than people with similar incomes with subsidized coverage through the marketplace. Nearly a half million are uninsured.

• Most (54%) are children, and, among adults, most (59%) are women. • Texas (671,000), California (593,000), Florida (269,000), and Georgia (206,000) have the largest number of people affected by the glitch.

Understanding #Medicare Parts A, B, C & D

Do you really need to know the details of what Parts A, B, C, and D stand for? Doesn’t Medicare just pay its share of your bills and that’s it? Well, not entirely. Medicare’s architecture is more than a tad weird, but each of its building blocks determines the coverage you get and what you pay.

Besides that, however, is the simple fact that making sense of Medicare is difficult unless you understand what Parts A, B, C, and D actually mean.

Part A

Medicare Part A is usually described as hospital insurance — a term originally coined to distinguish it from medical insurance (Part B). But the phrase is misleading. “Hospital insurance” sounds as though Part A covers your entire bill if you’re admitted to a hospital, but it doesn’t work that way. The services you receive from doctors, surgeons, or anesthetists while you’re in the hospital are billed separately and are covered under Part B. And you don’t even have to be hospitalized to get services under Part A, because some are provided in settings outside the hospital or even in your own home.

A more accurate way to think of Part A is as coverage primarily for nursing care. It helps pay for the following:

  • The services of professional nurses when you’re admitted to a hospital or a skilled nursing facility (such as a nursing home or rehab center) for short-term stays or when you qualify for home health services or hospice care in your own home
  • A semiprivate room in the hospital or nursing facility
  • All meals provided directly by the hospital or nursing facility
  • Other services provided directly by the hospital or nursing facility, including lab tests, prescription drugs, medical appliances and supplies, and rehabilitation therapy
  • All services provided by a home health agency if you qualify for continuing care at home
  • All services provided by a hospice program if you choose to stop treatment for a terminal illness

The vast majority of people in Medicare are eligible for Part A services without paying any premiums for it. That’s because Part A is essentially paid for in advance by the Medicare payroll taxes that you or your spouse contributed from every paycheck while working.

But, of course, Part A services themselves aren’t free. You still pay deductibles and co-payments for specific services.

Part B

Many people in Medicare never need to go into the hospital, but almost everybody sees a doctor or needs diagnostic screenings and lab tests sooner or later. That’s where Part B — known as medical insurance — comes in. The wide range of services it covers includes the following:

  • Approved medical and surgical services from any doctor who accepts Medicare patients, whether those services are provided in a doctor’s office, in a hospital, in a long-term-care facility, or at home
  • Diagnostic and lab tests done outside hospitals and nursing facilities
  • Preventive services such as flu shots, mammograms, screenings for depression and diabetes, and so on, many of which are free
  • Some medical equipment and supplies (for example, wheelchairs, walkers, oxygen, diabetic supplies, and units of blood)
  • Some outpatient hospital treatment received in an emergency room, clinic, or ambulatory surgical unit
  • Some inpatient care in cases where patients are placed under observation in the hospital instead of being formally admitted
  • Inpatient prescription drugs given in a hospital or doctor’s office, usually by injection (such as chemotherapy drugs for cancer)
  • Some coverage for physical, occupational, and speech therapies
  • Outpatient mental health care
  • Second opinions for non-emergency surgery in some circumstances
  • Approved home health services not covered by Part A
  • Ambulance or air rescue service in circumstances where any other kind of transportation would endanger the patient’s health
  • Free counseling to help curb obesity, smoking, or alcohol abuse

You must pay a monthly premium to receive Part B services unless your income is low enough to qualify you for assistance from your state. Most people pay the standard Part B premium, which is determined each year by a formula set by law ($144.60 in 2020). If your income is over a certain level, however, you’re required to pay more.

You also pay a share of the cost of most Part B services. In traditional Medicare, this amount is almost always 20 percent of the Medicare-approved cost. Medicare Advantage health plans charge different amounts — usually flat dollar co-pays for each service.

Part C

The coverage provided by Part A and Part B together form what is known as traditional or original Medicare — so named because that was the extent of the program’s coverage when it began back in 1966. It’s also called fee-for-service Medicare because each provider — whether it’s a doctor, hospital, laboratory, medical equipment supplier, or whatever — is paid a fee for each service.

But these days Medicare also offers an alternative to the traditional program: a range of health plans that mainly provide managed care through health maintenance organizations (HMOs) or preferred provider organizations (PPOs). These plans are run by private insurance companies, which decide each year whether to stay in the program. Medicare pays each plan a fixed fee for everyone who joins that plan, regardless of how much or little health care a person actually uses. This health plan program is called Medicare Advantage or Medicare Part C.

Medicare Advantage plans must, by law, cover exactly the same services under Part A and Part B as traditional Medicare does. (So, if you need a knee replacement, for example, the procedure is covered — regardless of whether you’re enrolled in a Medicare Advantage plan or in the traditional program.) But the plans may also offer extra benefits that traditional Medicare doesn’t cover — such as routine vision, hearing, and dental care. Most plans include Part D prescription drug coverage as part of their benefits package.

Still, being enrolled in one of these plans is a very different experience from using the traditional Medicare program. Your out-of-pocket costs are different, and so are your choices of doctors and other providers.

Part D

Part D is insurance for outpatient prescription drugs — meaning medications you take yourself instead of having them administered in a hospital or doctor’s office. Medicare’s drug benefit was only added to the program in 2006, a full 40 years after Medicare began. Since then, it has saved huge amounts of money for millions of people and allowed many to get the meds they need for the first time.

Part D is a complicated benefit that takes a lot of getting used to. Here are just some of the peculiar ways it differs from other drug coverage you may have used in the past:

  • Coverage goes through four distinct phases during a calendar year, and in each phase the same drug can cost a different amount.
  • To get coverage, you must select just one private plan that provides Part D drugs out of many plans (at least 15) that are available to you.
  • Different plans cover different sets of drugs, and no plan covers all drugs.
  • Plans set their own co-pays for each drug, and these amounts can vary enormously, even for the same drug.
  • Plans may require you or your doctor to ask permission before they cover certain drugs or to try a less-expensive version before they cover the one you were prescribed.
  • Plans are allowed to change their costs and benefits or to withdraw from Medicare entirely each calendar year.

Source:  Patricia Barry

Black Doctors Work to Make Coronavirus Testing More Equitable

When the coronavirus arrived in Philadelphia in March, Dr. Ala Stanford hunkered down at home with her husband and kids. A pediatric surgeon with a private practice, she has staff privileges at a few suburban Philadelphia hospitals. For weeks, most of her usual procedures and patient visits were canceled. So she found herself, like a lot of people, spending the days in her pajamas, glued to the TV.

Read more…

What Changes May Occur With Trumps Healthcare Plan

Two years later, what has his administration done to change the ACA, and who’s been affected? Below are five of the biggest changes to the federal health law under President Trump.

1. Individual mandate eliminated

What is it? The individual mandate is the requirement that all U.S. residents either have health insurance or pay a penalty. The mandate was intended to help keep the premiums for ACA policies low by ensuring that more healthy people entered the health insurance market.

What changed? The 2017 Republican-backed tax overhaul legislation reduced the penalty for not having insurance to $0.

What does the administration say? “We eliminated Obamacare’s horrible, horrible, very expensive and very unfair, unpopular individual mandate. A total disaster. That was a big penalty. That was a big thing. Where you paid a lot of money for the privilege […] of having no healthcare.” — President Trump, The Villages, Florida, Oct. 3, 2019

What’s the impact? First of all, getting rid of the penalty for skipping insurance opened a new avenue of attack against the entire ACA in the courts, via the Texas v. Azar lawsuit. Back in 2012, the ACA had been upheld as constitutional by the U.S. Supreme Court, because the penalty was essentially a tax, and Congress is allowed to create a new tax. Last December, though, a federal judge in Texas ruled that now that the penalty is $0, it’s a command, not a tax, and is therefore unconstitutional. He also reasoned that it cannot be cut off from the rest of the law, so he judged the whole law to be unconstitutional. A decision from the appeals court is expected any day now.

Eliminating the penalty also caused insurance premiums to rise, says Sabrina Corlette, director of the Center on Health Insurance Reforms at Georgetown University. “Insurance companies were getting very strong signals from the Trump administration that even if the ACA wasn’t repealed, the Trump administration probably was not going to enforce the individual mandate,” she says. Insurance companies figured that without a financial penalty, healthy people would opt not to buy insurance, and the pool of those that remained would be smaller and sicker.

So, even though the $0 penalty didn’t actually go into effect until 2019, Corlette says, “insurance companies — in anticipation of the individual mandate going away and in anticipation that consumers would believe that the individual mandate was no longer going to be enforced — priced for that for 2018.” According to the Kaiser Family Foundation, premiums went up about 32%, on average, for ACA “silver plans” that went into effect in early 2018, although most people received subsidies to offset those premium hikes.

2. States allowed to add “work requirements” to Medicaid

What is it? Medicaid expansion was a key part of the ACA. The federal government helped pay for states (that chose to) to expand Medicaid eligibility beyond families to include all low-income adults, and to raise the income threshold, so that more people would be eligible. So far, 37 states and Washington have opted to expand Medicaid.

What changed? Under Trump, if they get approval from the federal government, states can now require Medicaid beneficiaries to prove with documentation that they either work or go to school.

What does the administration say? “When you consider that, less than five years ago, Medicaid was expanded to nearly 15 million new working-age adults, it’s fair that states want to add community engagement requirements for those with the ability to meet them. It’s easier to give someone a card; it’s much harder to build a ladder to help people climb their way out of poverty. But even though it is harder, it’s the right thing to do.” — Seema Verma, administrator of the Centers for Medicare and Medicaid Services, Washington, Sept. 27, 2018

What’s the impact? Even though HealthCare.gov and the state insurance exchanges get a lot of attention, the majority of people who gained health care coverage after the passage of the ACA — 12.7 million people — actually got their coverage by being newly able to enroll in Medicaid.

Medicaid expansion has proven to be quite popular. And in the 2018 election, three more red states — Idaho, Nebraska and Utah — voted to join in. Right now, 18 states have applied to the federal government to implement work requirements; but most such programs haven’t yet gone into effect.

“The one work requirement program that’s actually gone into effect is in Arkansas,” says Nicholas Bagley, professor of law at the University of Michigan and a close follower of the ACA. “We now have good data indicating that tens of thousands of people were kicked off of Medicaid, not because they were ineligible under the work requirement program, but because they had trouble actually following through on the reporting requirements — dealing with websites, trying to figure out how to report hours effectively, and all the rest.”

If more states are able to implement work requirements, Bagley says, that could lead “to the loss of coverage for tens of thousands — or even hundreds of thousands — of people.”

CMS administrator Verma has pushed back on the idea that these requirements are “some subversive attempt to just kick people off of Medicaid.” Instead, she says, “their aim is to put beneficiaries in control with the right incentives to live healthier, independent lives.”

3. Cost-sharing reduction subsidies to insurers have ended

What is it? Payments from the federal government to insurers to motivate them to stay in the ACA insurance exchanges and help keep premiums down.

What changed? The Trump administration suddenly stopped paying these subsidies in 2017.

What does the administration say? “I knocked out the hundreds of millions of dollars a month being paid back to the insurance companies by politicians. … This is money that goes to the insurance companies to line their pockets, to raise up their stock prices. And they’ve had a record run. They’ve had an incredible run, and it’s not appropriate.” — President Trump, the White House, Oct 17, 2017

What’s the impact? This change had a strange and unexpected impact on the new insurance markets set up by the ACA. Insurers were in a bind: They had to offer subsidies to low-income people applying for insurance, but the federal government was no longer reimbursing them.

“The first thinking [was], ‘Oh gosh, that’s going to cause premiums to go up, and it’s going to hurt the marketplace,’ ” says Christine Eibner, who tracks the ACA at the nonpartisan RAND corporation. “What ended up happening is, insurers, by and large, addressed this by increasing the price of the silver plan on the health insurance exchanges.”

This pricing strategy was nicknamed “silver loading.” Because the silver plan is the one used to calculate tax credits, the Trump administration still ended up paying to subsidize people’s premiums, but in a different way. In fact, “it has probably led to an increase in federal spending” to help people afford marketplace premiums, Eibner says.

“Where the real damage has been done is for folks who aren’t eligible for subsidies — who are making just a little bit too much for those subsidies,” Corlette adds. “They really are priced out of comprehensive ACA-compliant insurance.”

4. Access to short-term “skinny” plans has been expanded

What is it? The ACA initially established rules that health plans sold on HealthCare.gov and state exchanges had to cover people with preexisting conditions and had to provide certain “essential benefits.” President Obama limited any short-term insurance policies that did not provide those benefits to a maximum duration of three months. (The original idea of these policies is that they can serve as a helpful bridge for people between school and a job, for example.)

What changed? The Trump administration issued a rule last year that allowed these short-term plans to last 364 days and to be renewable for three years.

What does the administration say? “We took swift action to open short-term health plans and association health plans to millions and millions of Americans. Many of these options are already reducing the cost of health insurance premiums by up to 60% and, really, more than that.” — President Trump, The White House, June 14, 2019

What’s the impact? The new rule went into effect last October, though availability of these short-term or “skinny” plans varies depending on where you live — some states have passed their own laws that either limit or expand access to them. Some federal actuaries projected lots of people would leave ACA marketplaces to get these cheaper plans; they said that would likely increase the size of premiums paid by people who buy more comprehensive coverage on the ACA exchanges. But a recent analysis from the Kaiser Family Foundation finds that the ACA marketplaces have actually stayed pretty stable.

Still, there’s another consequence of expanding access to these less comprehensive plans: “People who get these “skinny” plans aren’t really fully protected in the event that they have a serious health condition and need to use their insurance,” Eibner says. “They may find that it doesn’t cover everything that they would have been covered for under an ACA-compliant plan.”

Medicare’s Uncapped Drug Costs Take A Big Bite From Already Tight Budgets

5. Funds to facilitate HealthCare.gov sign-ups slashed

What is it? The ACA created Navigator programs and an advertising budget to help people figure out specifics of the new federally run insurance exchanges and sign up for coverage.

What changed? In August 2017, the administration significantly cut federal funding for these programs.

What does the administration say? “It’s time for the Navigator program to evolve. … This decision reflects CMS’ commitment to put federal dollars for the federally facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process.” — CMS Administrator Seema Verma, written statement, July 10, 2018

What’s the impact? It’s hard to document what the impact of this particular cut was on enrollment. The cuts were uneven, and some states and cities got creative to keep providing services. “We have seen erosion in overall health insurance coverage,” Corlette says. “But it’s hard to know whether that’s the effect of the individual mandate going away, the short-term plans or the reductions in marketing and outreach — it’s really hard to tease out the impact of those three changes.”

Source: NPR

#COVID-19 & Testing

Although President Trump has said the military is “all mobilized” to help distribute a coronavirus vaccine, in the end that process will almost certainly rely heavily on the pharmacies, doctors and community hospitals we’re all familiar with.

The big picture: Deciding how to distribute a vaccine is, for now, a government-driven task, and Trump has invoked the logistical expertise of the military as a way to do the job. For the public, though, this won’t feel like a military exercise, with heavy trucks rolling into town and people lining up outside medical tents. It’ll feel like going to CVS.

Where it stands: Government officials have given conflicting accounts of who will be distributing a vaccine, once there is one.

Trump has said several times that the military would be part of the process, but McClatchy reported last month that no such preparations are under way and that the Pentagon is unlikely to be involved. Politico then reported that the Pentagon would be providing some logistical support, in conjunction with the Centers for Disease Control.

These are all behind-the-scenes logistics for allocating the available doses of an eventual vaccine. When the time comes for individual patients to get vaccinated, the process will seem far more mundane.

Details:  The leading vaccine candidates all need to be stored at sub-zero temperatures until they’re administered — something major pharmaceutical distributors and pharmacy chains are already equipped to do.

Most of the leading candidates require two shots. Keeping track of who’s been vaccinated and who’s due for their second dose is work that pharmacies, doctors and hospitals are used to.

So is navigating insurance coverage and payment.

There will also be waves of earlier and later vaccines to keep track of.

The vaccines are also expected to have side effects such as fever and chills that mimic virus symptoms, so it’ll be important for patients to get a consultation ahead of time and to be able to consult their providers if they need to.

What’s next: There will not be enough supply to vaccinate more than a small share of the U.S. population once distribution begins. High-level decisions about how to allocate the available doses will be wrenching and could be politically explosive.

But, while it falls to government institutions to make those decisions, it will likely be your local pharmacy or community hospital that will carry them out.

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