Public Option? Not So Fast, Say Health Insurers

 The nation's biggest health insurers are making it perfectly clear to lawmakers looking to fulfill campaign promises to establish a public option: you will face a massively financed lobbying and PR campaign if you even try.

And this isn't just in Washington. The industry has unleashed campaigns in at least two states so far -- Colorado and Connecticut -- where legislators are hoping to establish state-based public option plans.

Why do insurers care so much? When the status quo is extraordinarily profitable for most of them, they don't want a new competitor that might disrupt the insurance market. As a result, they're funneling millions of dollars collected from policyholders and taxpayers into what for all practical purposes is a front group to protect their ever-increasing profits.

Just recently we learned that CVS Health, which owns Aetna, alone poured $5 million into that group -- the Partnership for America's Health Care Future -- which is funded primarily by insurers and for-profit hospital chains, and run out of the PR and lobbying firm Forbes Tate.

The legislation in Connecticut facing fierce opposition from the insurers has the backing of State Comptroller Kevin Lembo and several Democratic legislators, but Gov. Ned Lamont (D) has remained quiet on the bill so far.

To try to move the governor into their camp, the CEOs of five insurers that do business in the state, including two that are based there, Cigna and Aetna, sent him a letter this month implying they would move jobs out of the state if the public option bill became law.

This tactic worked 2 years ago when lawmakers seemed to be on the verge of getting a similar bill to the governor's desk. According to published reports quoting Lembo, Cigna CEO David Cordani threatened that the company would leave Connecticut if a public option was established -- and this was despite the fact that Cigna doesn't sell coverage on the state's exchange and has relatively few large group customers in Connecticut. Cigna acknowledged it lobbied against the bill but denied the threat.

In response to the letter to Lamont, signed by CEOs of companies like Anthem and Cigna, Lembo issued a statement noting that insurers posted record profits during the pandemic and asked, "When will enough be enough ... Are legislators going to serve their constituents or do five corporations determine what becomes law in our state?"

Lawmakers and Connecticut residents are also hearing from Connecticut's Health Care Future, an offshoot of the Partnership. The Partnership spent heavily on TV and social media ads in Iowa and other states in the run-up to the Democratic primaries and caucuses last year. The ads attacked both Medicare for All, supported by Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), and the public option, which President Biden and other Democratic contenders backed.

Consistent in all the ads were messages like the ones I used to help write for similar front groups when I led communications at Cigna and worked with my peers across the industry to squash reforms our companies didn't like. The Partnership's ads claim that Medicare for All and even a public option would lead to higher taxes, job losses, and long waits for care. Left out of the ads: any mention of the fact that people would no longer have to pay premiums to insurers if they could enroll in Medicare or a public option.

The Partnership's affiliate in Colorado, Colorado's Health Care Future, is using essentially the same messaging, even though the legislation in that state is substantially different from the Connecticut bill. The Colorado legislation would give private insurers 2 years to begin to bring down the cost of healthcare, and the public option would only go into effect if they could not achieve the benchmarks set by the bill. One of the group's claims in Colorado is that a public option would lead to the closure of rural hospitals in the state. No mention is made of the fact that one of the Partnership's funders, HCA Healthcare, recently disclosed that its Colorado hospital's profit margins were more than 40%.

For-profit insurers are bigger, richer, and more powerful than ever. Recent mergers and acquisitions have bulked these companies up to the point that CVS Health is now No. 5 on the Fortune 500 list of American companies. UnitedHealth Group comes in at No. 7.

Their growth has been primarily at the taxpayers' expense. A whopping 72.4% of UnitedHealthcare's revenues in the U.S. during the first quarter of 2021 came from their government business, primarily through Medicare Advantage, Medicare Supplement plans, and the state Medicaid programs they manage. For several quarters, those programs have been their biggest -- and often only -- source of enrollment growth.

Medicare Advantage in particular has become a cash cow for big insurers. And history shows that the companies conduct business right on the line of what is legal -- often crossing it to maximize profits. Just recently, an analysis by HHS found that Humana overcharged CMS by nearly $200 million in just a single year (2015).

Insurers spend huge amounts lobbying Congress to keep the federal spigot flowing. And they have ramped up their Washington lobbying budgets to new heights this year, not only to protect their Medicare Advantage profits and to secure tax dollars to cover laid-off workers' COBRA premiums, but also, to keep a public option at bay. America's Health Insurance Plans spent more money lobbying Congress during the first 3 months of this year -- $3.9 million -- than any prior quarter. Centene, a big player in Medicare Advantage and Medicaid, increased its first quarter lobbying spend by 80%.

The big insurers have gotten bigger and more profitable as they've figured out how to game the system to their advantage in Washington and state capitals -- and they are prepared to spend whatever it takes to maintain that advantage. They certainly do not want a new competitor in the game that might be able to change the rules they've established. The status quo -- and its emphasis on profits over care -- suits them just fine.

Wendell Potter is a former vice president of Cigna turned whistleblower against the health insurance industry. He now leads the non-profit Center for Health & Democracy. After leaving the industry in 2008, he testified before Congress about the industry's abuses and became an advocate for systematically reforming America's healthcare system.

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/92368

NYC taxi commission to stop testing cabbies for marijuana

 Green light!

With marijuana now legal in New York, the city Taxi & Limousine Commission will no longer test cabbies and livery drivers for cannabis.

“Due to the change in the law, going forward, the TLC will no longer test for marijuana in required annual drug tests,” the agency wrote Friday in a memo to licensees obtained by The Post.

“Big mistake,” Fernando Mateo, founder and spokesman of the New York State Federation of Taxi Drivers, told The Post. “It’s irresponsible.”

“If they’re not going to be testing for marijuana, that means drivers will have the opportunity to smoke weed and drive,” he said. “I don’t want my kids in a car with a guy that smokes weed, and is allowed to smoke weed regularly, and not get tested. We have to draw the line somewhere.”

The agency cautioned drivers, “While the use of marijuana is now legal for adults, it is still the law that TLC-licensed Drivers must be sober when they operate a vehicle.” It also noted that testing for other drugs would remain unchanged.

A McGill University study published in March found: “Recreational cannabis legalization in the US was associated with a relative increased risk of fatal motor vehicle collisions of 15% and a relative increase in associated deaths of 16%.”

The TLC — which licenses drivers of the city’s taxis, livery cars, and Uber and Lyft vehicles — didn’t immediately return a request for comment.

https://nypost.com/2021/05/01/nyc-taxi-commission-to-stop-testing-cabbies-for-marijuana/

Beijing tops NYC in number of billionaires on latest Forbes list

 The Big Apple has taken a back seat to Beijing as the world’s billionaire capital, and that’s before a new state tax hike possibly pushes more fat cats to leave.

The Chinese capital has exactly one more billionaire than Gotham, 100 to 99, according to Forbes’ recently released list.

The number of billionaires worldwide increased 32 percent to 2,755, or 660 more than a year ago, as many cashed in on a surging stock market. Beijing saw an uptick of 33 billionaires during the worldwide COVID catastrophe that began in China, while NYC’s roster increased by only seven.

“I personally know countless millionaires and billionaires who have left,” said Ronn Torossian, founder and CEO of 5W Public Relations, who is considering moving and relocating his 200 employees from Manhattan to Miami.

Manhattan supermarket magnate John Catsimatidis, worth a cool $3.3 billion, agreed: “New York is being destroyed. I was in Palm Beach last weekend, and I met more millionaires and billionaires who have moved recently than you have hair on your head. The key is they stay in Florida enough days each year to avoid New York taxes.”

He warned, “New York will continue to go downhill — and our billionaires and wealthiest will just get up and leave — unless the city improves.” While he continues to contemplate a run for governor, the Republican mogul told The Post he’s also mulling moving his official residence out of state to reduce his tax bill.

New York City’s superrich are seeing the benefits of living elsewhere.

Getty Images

“Billionaires can buy a new corporate jet and live in Florida, and easily fly back and forth between New York City and Miami with the money they can save by moving to lower-taxed states like Florida,” added Catsimatidis.

While Beijing eclipsed NYC billionaires in number, its supperrich fall far behind in net worth — city moguls are worth $550 billion to Beijing’s $490 billion. 

Zhang Yiming came in as Beijing’s wealthiest person.

Stringer – Imaginechina

Former Mayor Bloomberg was once again the city’s wealthiest person, and the world’s 20th richest, with $59 billion. TikTok titan Zhang Yiming, with a $35.6 billion fortune, was Beijing’s top billionaire, and 39th in global rankings.   

But higher taxes and dwindling quality of life could trigger an exodus from NYC.

“Wealthy people are now afraid to walk the streets in New York,” said Torossian. “A few of my hedge fund friends moved quietly to Palm Beach, and won’t return.”

Michael Hiller — founder and CEO of Talent Resources, a fast-growing digital “influencer” marketing agency which works with celebrities and brands like Dunkin’ Donuts — ditched his home in lower Manhattan six months ago and moved with his wife and 5-year-old son to London’s Notting Hill.

It could save him millions.

“I am not a billionaire today, but I could be someday,” said the former New Yorker.

The last time Gotham lost its No. 1 ranking was in 2016, when it slipped behind Beijing for a year.

https://nypost.com/2021/05/01/beijing-tops-nyc-in-number-of-billionaires-on-latest-forbes-list/

Pandemic forced many unprepared young adults to deal with parents’ estates

 There was no last will.

My husband and I knew that our work would be cut out for us. The death of my father-in-law in November 2020 was the sudden end of a long-term illness that he and his children were not ready for. He did not have Covid-19, but hospital pandemic-related restrictions excluded direct visits, making it difficult to understand his condition and manage care.

The day after we learned that his health was rapidly deteriorating, we bought a ticket for a flight to Florida. We thought he would land just before he was transferred to hospice care. There, my husband, Ryan, was able to visit his father. But he couldn’t get through that night.

The next day, I boarded as scheduled. What was supposed to be the last reunion became the mission of reconstruction. Ryan tried to sleep while making a list of what we needed to find, based on Google search results and AARP articles. The final will is the inventory of bank accounts, credit cards and retirement accounts. By the time we landed in the seaside town, road maps were scribbled on scrap paper.

But I didn’t know how much I was left behind. Not only was there no last will, but there was no inventory of assets. We didn’t even know where his wallet was. We had to start from scratch.

Ryan and I stayed for three weeks, stitching together what we could do from a confused file folder and an old invoice. His brother helped us from afar, and his mom jumped across the finish line to help us. His father’s death pushed Ryan, then 31 years old, into an unfamiliar world of unlisted assets and prosecution lawyers through a door that was expected to remain closed for much longer.

Another year, Ryan might have come to say goodbye. He and his father may have done a SAT together and discussed everything that followed. It may not have been closed, but at least it would have been clear.

But it wasn’t a normal year.

Many young adults face unexpected problems at this point in our lives after parents, grandparents, and other relatives have died in connection with Covid for several months. ..

Millions affected

The numbers have reached such an astonishing height and are almost impossible to conceptualize. According to the US Centers for Disease Control and Prevention, more than 570,000 Americans have died from the coronavirus and more than 32 million cases of US Covid-19.

Sadness is widespread. University of Southern California last summer analysis On average, each Covid-19 death was found to correspond to approximately nine individuals who lost their grandparents, parents, siblings, spouse, or children. At that time, an estimated 137,871 lives were lost, representing more than one million surviving Americans. Using today’s death toll, that number reaches over 5 million.

The authors of the study noted that young individuals are at increased risk of losing their parents and grandparents, who are classified in the age group with the highest documented case fatality rates.

Caitlin Moen is one of them.

The 25-year-old was working on a treatise at a graduate school in Mankato, Minnesota when her father died of Covid-19 last spring. Her father, then 64 years old,  was recently diagnosed with cancer.

For the past year, Moen has picked up his work. He has organized his home documents to find important documents, demanded a mortgage withholding, and is now selling his childhood home while trying to handle the loss.

“When everything started, I was 24. My dad intended to live until he was 80, but by then I thought I would be in my 40s,” she says. “I have a job after graduating from school and can take the time to handle everything.”

Barbara Schelhorn, Principal and Senior Client Advisor at SBSB Financial Advisors, states that betraying these expectations is one of the most difficult parts of making a family sad during a pandemic. “They aren’t given such extravagant time,” says Shellhorn, referring to both the younger generation and their lost loved ones. “We need to do a lot to make simple things easy. [family members] After passing, but without time and preparation in advance, it can be very overwhelming for survivors. “

Tough lessons

Moen’s dad, like my father-in-law, did not leave a will.

“He was one of them, like,’I’m going to live forever. Don’t worry now,’” says Moen. A few days after his death, she had to reverse engineer his understanding of assets and liabilities, access his PO Box, and organize everything in his home with his longtime friends. Moen says his friend “Marie Kondo edited everything”, organizing the documents by account and thinking about what to shred.

At the same time, Moen was called by the Inspector General to dispose of his father’s remains. There was no document showing what he wanted. She chose cremation. The service cost about $ 2,500 and couldn’t be obtained by Moen alone. She borrowed money from a close relative.

Moen worked with a prosecution lawyer to acquire his father’s assets, credit card debt, and shares in revolving invoices. It took several months to pass the Probate Court, which deals with the management of the deceased’s property. She completed the process last September and finally gained access to her father’s bank account.

“Overall, it was about $ 8,000,” she says — much more than she expected. She created a real estate bank account to cover the cost of improving the home while working to sell his home.

After his death until February 2021, Moen was able to withhold his father’s monthly mortgage payments and found a potential buyer, the daughter of his neighbor. However, she ran into problems due to her naivety.

Without the help of a realtor, she wouldn’t reveal in the purchase contract that the house was being sold as-is, Moen said. Therefore, to complete the sale, she spent $ 3,000 to replace the furnace, $ 1,600 to the radon mitigation system, about $ 1,000 to install the side grooves, and $ 600 to remove mold, but still patching the wall. there is.

She feels a twisted irony towards the impossible dreams of many in their mid-twenties for a limited time as a homeowner. “It’s my childhood home … and it’s a lot of hard work and I can’t keep it up,” she says. “Own a house is one of my fiancés and I really want what we can do, and now I got it in the worst of circumstances. “

After she finishes selling her home, disposes of the remaining debt and pays a lawyer, Moen thinks she may have about $ 10,000 left. But she doesn’t want to have hope.

“I have private student loans that pay $ 200 a month from undergraduates, so paying back those loans is my first thing,” she says.

The process didn’t expect her to deal with her for decades because she thought she and her father had enough time to sort out what would happen after he left. I gave her a short-term intensive course in terms of personal finances. When taking care of the real estate, Moen says he didn’t have time to mourn.

“Now I feel better equipped,” she says. “But it’s a shame I was forced to learn this way.”

https://newyorklatestnews.com/the-pandemic-has-forced-many-unprepared-young-adults-to-deal-with-their-parents-property/168449/

How the US can become the vaccine factory for the world

 Shout it from the rooftops and sometimes lots of other people will start shouting and then sometimes other people will listen!

The U.S. will begin sharing its entire pipeline of vaccine from AstraZeneca once the COVID-19 vaccine clears federal safety reviews, the White House told The Associated Press on Monday, with as many as 60 million doses expected to be available for export in the coming months.

The move greatly expands on the Biden administration’s action last month to share about 4 million doses of the vaccine with Mexico and Canada. The AstraZeneca vaccine is widely in use around the world but not yet authorized by the U.S. Food and Drug Administration.

…About 10 million doses of AstraZeneca vaccine have been produced but have yet to pass review by the FDA to “meet its expectations for product quality,” Zients said…That process could be completed in the next several weeks. About 50 million more doses are in various stages of production and could be available to ship in May and June pending FDA sign-off.

Let’s also get our J&J vaccine factories up and running and soon we will have Moderna and Novavax to export as well. Keep it coming! An American plan to vaccinate the world.

https://marginalrevolution.com/marginalrevolution/2021/04/shout-it-from-the-rooftops-sometimes-people-listen.html

Rasmussen on the controversy surrounding Russia’s Sputnik V Covid-19 vaccine

 By all accounts, the Covid-19 vaccine developed by Russia’s Gamaleya Institute, called Sputnik V, has looked really good. In a study published in The Lancet in February, the vaccine’s efficacy was 91.6%, putting it among the most effective vaccines for this pandemic in the world.

The technology used for Sputnik V is similar to the approach from Johnson & Johnson and AstraZeneca. It uses adenoviruses, essentially cold viruses, as vectors to ferry genetic instructions for the coronavirus-like protein to the body’s cells, causing the immune system to makes antibodies to this protein and thereby conferring protection.

Russia has emphasized that the vaccine costs less than $10 per dose and that it can be stored at 36-46 degrees Fahrenheit, making it easier to use around the world than the vaccines that have to be kept ultra cold. It says Sputnik V is already registered in more than 60 countries. But some regulators are now starting to ask questions about the vaccine. Brazil’s, in particular, this week rejected the vaccine, saying questions remained about its safety, manufacturing and development.

STAT sat down with Angela Rasmussen, a virologist and research scientist affiliated with the Georgetown Center for Global Health Science and Security and VIDO-InterVac at the University of Saskatchewan, to discuss.

So what is your understanding of why Brazil rejected Sputnik V?

So the Sputnik V vaccine is actually two vaccines. It’s what’s called a heterologous dosing regimen. They start off with ad26 vector vaccine, that’s similar to what the Johnson & Johnson vaccine is, and then they follow that up with a booster dose of a vaccine that’s vectored with adenovirus 5. What they determined was that with the adenovirus component the virus can actually replicate and potentially cause downstream complications. The vaccine itself is designed to be replication incompetent, meaning that the adenovirus vectors are not going to replicate beyond expressing the spike protein that you’re developing immunity to.

These are essentially cold viruses and if there were replicating vector there, wouldn’t lots of people have gotten really bad colds during the clinical trials of Sputnik V?

Well, in this case, it’s not being delivered via the respiratory tract, so you wouldn’t necessarily expect these viruses to cause a respiratory disease. These are being delivered intramuscularly, which is not the way that adenoviruses are normally transmitted. That means there could be potentially unpredictable results of what could happen, particularly in recipients who might be immune compromised or have some type of immune dysfunction. There’s still a lot that’s not known about this particular issue. But in the Phase 3 clinical trials, at least in the data that was reported in The Lancet paper describing those trials, there wasn’t evidence of replication-competent virus in those vaccine preparations and normally making sure that there’s no replication-competent virus there should be part of any good-quality control program for manufacturing a vaccine.

To that point, there have been quality-control questions raised in other parts of the world too, specifically in Slovakia where regulators said a batch didn’t match the ones reviewed by The Lancet. Do you think that’s the same issue? Or is there something else also going on here with quality control?

So the situation in Slovakia — I have only seen reported that they they declined to allow a batch of vaccine in because it wasn’t consistent with what was reported in The Lancet, but I don’t know what the specific issue was. In general, this certainly gives me less confidence in the quality-control processes of this product going forward. If you are not getting the vaccine that you think you’re getting, then that means that the process is what’s the problem, not the vaccine. The Gamaleya Institute certainly has a long history of developing vaccines, including adenovirus vectored vaccine, so I don’t think that this is an issue with design. It doesn’t mean that the vaccine itself is inherently bad, it means that there are discrepancies in the manufacturing process.

So this vaccine has been licensed in dozens of countries around the world, at least on an emergency basis. Should people in the countries where it’s being used be worried if they’ve taken the vaccine? 

It’s really hard to say right now because we just don’t have enough information about how commonly this is affecting all of the lots of vaccine that are being manufactured and distributed in those countries. This is definitely going to be something that the regulators in those countries are going to want to look into it. It is going to be really important to figure out what the risks are if somebody did get this vaccine that was replication competent and what that might mean in terms of vaccine safety.

For better or worse, global vaccine development has become a matter of soft power diplomacy between the U.S., China and Russia. How do you think the mounting concern about Sputnik V might affect geopolitics?

Well, I’m certainly a virologist and not a geopolitics expert, but you can imagine that Russia has presented the Sputnik V vaccine as something that they are doing out of altruism, and that’s their way of contributing to global health. And as you also know, there’s been a lot of discussion about the inequities in terms of rolling out vaccines globally. So this potentially deals a pretty serious blow, I would imagine, in terms of Russia taking a leadership role in making sure that vaccines are being distributed equitably to many countries around the world that desperately need them.

Speaking of Russia’s PR campaign around this vaccine, you’ve actually heard from the folks behind Sputnik V after you posted a detailed Twitter thread on what’s been found. What did they say? 

They told me to stop spreading fake news. As I mentioned before, the Gamaleya Institute has a great reputation and their scientists are excellent, so I don’t think that this was intentional. But that said, I don’t consider it fake news when a country’s regulatory agency presents data showing that, in fact, there is replication-competent virus in the lots that they evaluated. That’s not fake news. That is an observation and that directly contradicts what their statement says. So I think that it would be a good idea for Sputnik to be cooperative with these regulatory agencies, because I don’t think that you can just point to a statement and say, oh, this is fake news.

Do you think the fact that the Brazilian regulators are saying, hold up here, we see something that we need to look more into and that Slovakia flagged that bad batch — do you think that’s a sign of the regulatory system globally is working? And do you worry that in the many countries that have been using the vaccine, maybe they don’t have that those same kinds of safeguards in place and people are more vulnerable there? 

I think that’s definitely a possibility. It’s really hard in some cases to compare regulatory agencies around the world because apart from the WHO, which can make recommendations, there’s no such thing as a global regulatory agency. And certainly there are countries that really don’t have much in the way of a robust regulatory system. And in fact, you could argue that given that Russia authorized this vaccine before there was any type of clinical trial data, that that Russia might be among those countries. But I think overall, the WHO has said today that that they are still in the “back and forth phase” of evaluating the Sputnik V vaccine. I think that the WHO recommendation at least will carry a lot of weight.

I do think that this certainly shows that the Brazilian regulatory apparatus is intact at looking at this, I agree with everybody who said that the J&J pause was also evidence that the U.S. regulatory system is robust as well. I should add that those severe side effects observed with Johnson & Johnson, and perhaps also with AstraZeneca, aren’t necessarily the same problem with the Sputnik vaccine. This is a different issue. To my knowledge, there has never been an issue with J&J or AstraZeneca vaccines being given that were problematic in terms of their manufacturing or quality control. And in fact, the doses of Johnson & Johnson where there were quality control problems were discarded prior to those vaccines ever making it to market. Again, showing that our regulatory systems are robust and working.

https://www.statnews.com/2021/04/30/virologist-angela-rasmussen-on-the-controversy-surrounding-russias-sputnik-v-covid-19-vaccine/

The Disastrous J&J Pause

 We were told that the J&J pause was necessary to prevent vaccine hesitancy. I never understood the certainty people expressed on this point, even people who were relatively good on other issues. In anycase, as the excellent Daniel Bier argues, the best explanation for the data right now is that the J&J pause increased vaccine hesitancy.

Could the plunge timing have been a coincidence? Perhaps the eager had already gotten their vaccinations, leaving only the less eager and more hesitant. Maybe. But note that younger people were getting vaccinated rapidly before the pause and at increasing rates in line with the rates of the older people who had been vaccinated before them. But then the vaccination rates of the young plummeted, just as for the old. In other words, the plunge started in all age groups at the same time but at very different levels of vaccination. The similar timing across age groups is easy to explain if it was the J&J pause (everyone saw the pause at the same time) but it requires multiple coincidences to explain why every age group would reach their hesitancy point at different levels of vaccination but at the same time.

My view is that neither the CDC nor the FDA should be playing psychological games with the public. Just give it to us straight. In this case, since there was never much doubt that the J&J vaccine was much safer than COVID, a bulletin to physicians would have been appropriate to the circumstances. We don’t know for certain what would have happened under that counterfactual (although the data from Britain v. Europe on the AZ pause suggest a bulletin would not have generated the same hesitancy) but it would have been the right decision on the evidence.

https://marginalrevolution.com/marginalrevolution/2021/04/the-disastrous-jj-pause.html