Relevant and even prescient commentary on news, politics and the economy.

Why Do Rural Hospitals Close?

One of the serious issues with healthcare today is the lack of universal availability of it across the nation. In citified areas, the availability of it mostly meets the demand of the people requiring it and is in close proximity. If you travel one to two hours outside of the city, the availability of it begins to drop off until a person in need must travel hours to get to help. The resource in more rural areas begins to drop off in a precipitous manner. Not to make light of the healthcare situation, if you watch the move “Doc Hollywood,” small community with an aging doctor, a small clinic, staff nurse, a large number of patients, and a distant hospital. Dr. Ben Stone is on his way to LA in his 356 Cabriole (almost bought one in the eighties). The resources bypass rural America mostly for monetary reasons.

Here is a list of reasons:

  • States not expanding Medicaid: While Medicaid will not pay as much as commercial healthcare insurance or Medicare; without Medicaid, a hospital may be left with a larger debt. Hospitals located in communities with high numbers of uninsured residents are more susceptible to closures. According to the University of North Carolina’s Rural Health Research Program, the 17 states that did not expand Medicaid under the Affordable Care Act had the highest number of hospital closures. Texas lost the most hospitals (15), followed by Tennessee, Georgia, Alabama, Mississippi and North Carolina. Over half of the remaining rural hospitals in Texas and Tennessee and more than a third of hospitals in Oklahoma and Georgia are at risk of closing due to their weak financial position. These states are Republican led states and it is solely politics.

Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure in rural markets. The addition of  work requirements by states  will negate much of the Medicaid’s expansion gain.

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“Wow, that’s something,”

A presidential comment on New Mexico Governor Lujan Grisham concerns:

Grisham: “We’re seeing incredible spikes in the Navajo Nation, and this is going to be an issue where we’re going to have to figure that out and think about maybe testing and surveillance opportunities,

The rate of infection, at least on the New Mexico side — although we’ve got several Arizona residents in our hospitals — we’re seeing a much higher hospital rate, a much younger hospital rate, a much quicker go-right-to-the-vent rate for this population. And we’re seeing doubling in every day-and-a-half.

it could wipe out those tribal nations.”

Trump: “We’re gonna get you that hospital as quickly as we can,” while directing others in the Situation Room to look into the problem and rush work on the hospital. “Boy, that’s too bad for the Navajo nation – I’ve been hearing that.”

Maybe it is just the way he speaks or his mannerisms. I get the feeling he is smiling as he states his concern.

The Navajo Nation government declared a state of emergency on March 13. There were at least 128 cases and 2 deaths reported on the reservation, which has a population of over 250,000 and spans three states. Governor Grisham followed up on a request with President Trump, a request she made to the Department of Defense last Wednesday for a 248-bed U.S. Army combat support hospital (CSH) in Albuquerque, New Mexico. Grisham told Trump she had not yet received a response. from the Department of Defense yet.

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“Canceling Student Loans Now”

Alan Collinge of the Student Loan Justice Org. has a petition supporting the cancellation of Student Loan Debt.

If we can bail out corporations again, why not bailing out people with excessive student loan debt?

The student loan justice.org is counting on you and needs your help with President Trump: Cancel Student Loans NOW.”  Join student loan justice.org and the 116,064 signers of the petition calling for President Trump to cancel student loan debt.

President Trump is currently enacting economic stimulus measures in face of impending recession. He has no great options. The Fed Funds Rate is already close to zero. Taxes on corporations and the wealthy have already been cut to the bone. Suspending interest on student loans won’t hurt the economy, but won’t really help either. The measures that have been announced so far will add significantly to the national debt, or require an increase in taxes.

The president should immediately issue an executive order cancelling all of the loans that the federal government holds directly- about 85% of all student debt. This could be done without having to raise one dime in new tax revenue, or adding a penny to the national debt.

Angry Bear has posted Alan’s words over the years on Student Loans and the resulting Student Loan debt to which there is no bankruptcy relief; the same relief our president has enjoyed multiple times, abused by corporations who gambled on Wall Street and in every day business, unions, and ordinary citizens caught up in bad economies. There is a large economic potential in freeing them from the loan debt so as to be more productive.

Read it and if you can spare a signature, please add your name.

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Self Quarantine in Rhode Island Like it or Not

This came up on the radar this morning.

PROVIDENCE, R.I. (AP) – The American Civil Liberties Union of Rhode Island is questioning the constitutionality of Gov. Gina Raimondo’s directive allowing state police to stop vehicles with New York license plates to collect information from drivers and passengers in an effort to slow the spread of the coronavirus.

The Democratic governor on Thursday called the measure extreme but pointed out that the New York City area is the epicenter of the disease in the U.S.

While Raimondo has the authority to suspend some state laws and regulations to address a medical emergency, she cannot suspend the Constitution, ACLU of Rhode Island Executive Director Steven Brown said in a statement late Thursday.

“Under the Fourth Amendment, having a New York state license plate simply does not, and cannot, constitute ‘probable cause’ to allow police to stop a car and interrogate the driver, no matter how laudable the goal of the stop may be,” he said.

The governor’s directive is simply to ensure that travelers from New York staying in Rhode Island know they are required to self-quarantine for 14 days, Raimondo’s spokesman said.

Hat Tip CBS Boston, March 27,2020

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Patent Protection vs Orphan Drug Market Exclusivity

Massive Scandal or a Massive Misunderstanding of Regs and Laws for Orphan Drugs

Most of you know, I have been writing on healthcare for a long time and much of it has been negative about healthcare and the costs. I am not defending Gilead’s marketing of Remdesivir; but, a few articles (Common Dreams, The Intercept, etc.) written and the pundits amongst us appear to have misunderstood the issue for Remdesivir’s status.

I can understand why people would become excited and upset with the actions by the FDA to “designate” Remdesivir an orphan drug “candidate (note the quote notation).” In the past, I have found myself to be distracted by headlines (Intercept) which lead me to believe something bad was to come about only to find out it was not as serious as described in the headlined article. With all the issues we are faced with from COVID 19, the half attempt to mandate a lockdown of us in our homes, people “still” clustering, and our government led by a jackass; it is easy to get agitated.

Some thoughts; Given the pandemic, COVID 19 appears to be the exact opposite of a rare disease and describing a new drug for it as an orphan-drug does sound absurd.

A Little History

The seventies found incentives for profit-making drug companies not aligning with the needs of people having rare diseases. Drug Development of new drugs was expensive even 40 years ago. Companies concentrated on needed new therapies and pharmaceuticals potentially having high customer demand yielding increased profits rather than focusing  on those therapies and pharmaceuticals needed by a handful of patients. In 1983, the Orphan Drug Act was passed to encourage R&D for these drugs.

The FDA was given the power to grant a drug “orphan” status and to compounds without patent protection. If a company got its product “approved” as an orphan drug, it gained a period of market exclusivity of seven years. No one else was allowed to sell the same product to treat that specific disease. Additionally, the costs associated with developing that orphan drug including payroll for scientists, and miscellaneous costs were subject to a tax credit. Under the Orphan Drug Act, more than 800 orphan drugs and biologics have been approved by the FDA out of more than 5,300 applications. The Whys and Whats after the leap   .   .   .

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A Rehash, Stimuli Considered, And ACA Healthcare Insurance Assistance

I am sure by now many of you have read what the gov is and is not doing for us. The later is more prevalent as can be witnessed in the stimuli being offered. I am going to ask you to pay attention to the last item on ACA Healthcare Insurance. Whether you qualified or not in the past, you may be eligible for assistance now. I have broken this out into 4-points of which many of us might find ourselves. If you questions, PLEASE ASK, I will try to answer.

The Rundown

Goldman Sachs projects that after a 30% spike in jobless claims last week, to 281,000, new claims will hit 2.25 million this week — an unprecedented surge.

Treasury Secretary Steven Mnuchin warned Republican senators Tuesday morning that without action the coronavirus pandemic could drive up US unemployment to 20%, a Republican Senate source told CNN.

Mnuchin’s comments came as he urged Republican senators to act on economic stimulus measures totaling $1 trillion designed to avert that kind of worst case scenario. A 20% unemployment rate would be double the unemployment rate during the Great Recession, the highest in the US since the Great Depression, and it would leave more than 32 million Americans out of a job based on the current US labor force.

During the Great Recession of 2008 to 2009, approximately 9 million people lost their jobs. Losses this time around could far exceed that total if economic stimulus is not enacted.

I am not sure if it can get any worst than this; potentially lose your life, lose kin, lose your job, lose your healthcare, or lose whatever resource you might have.

Senate Republican Stimulus for People

– a direct payment to qualified Americans of up to $1,200. Married couples could get $2,400. Taxpayers who earn more than $75,000 annually will begin to see that payment reduced by $5 for every $100 they earn over the $75,000 threshold, with those who make more than $99,000 getting nothing. Families with children would get $500 per child.

While a Treasury Department outline circulated earlier in the week had called for two payments from the IRS — one each in April and May — the Senate GOP proposal only calls for one check at this time.

– The poorest families, those with no federal income tax liability, would see smaller benefits, though the minimum would be set at $600. About 22 million people earning under $40,000 a year would see no benefit under the GOP plan, according to an initial analysis by Ernie Tedeschi, a former Obama administration economist.

Business is the big winner under the Republican Senate Plan. I am waiting for a cohesive Democratic plan. Perhaps, I missed it?

ACA Healthcare Insurance

There are some things which will help people who lose their jobs and subsequently healthcare. Andrew Sprung at xpostfactoid also writes at Health Insurance Org. Today he wrote about “Uninsured in a pandemic? Seek help – it’s likely available.”

1. If you lose your job – and your employer-sponsored health insurance with it – you become eligible for a special enrollment period in the ACA marketplace. You can apply through HealthCare.gov if you’re in one of the 38 states that use the federal website. Twelve states and Washington D.C. run their own ACA exchanges. You can access those sites from this list. You can also get assistance from a licensed broker through this site.

2. If your estimated income for the year – including expected unemployment insurance – is below 400% of the federal poverty level ($49,960 for an individual, $67,640 for a couple, $103,000 for a family of four), you probably qualify for advanced premium tax credits – aka premium subsidies – a federal subsidy that picks up much or most of the monthly premium for plans offered on the exchange.

3. In the 36 states (and the District of Columbia) that have implemented the ACA Medicaid expansion, you should qualify for Medicaid if you lose your job – or you’re a freelancer who loses much of your income – and your monthly income going forward is below 138% of the federal poverty level ($1,468 for an individual, $3,013 for a family of four*). Apply through your state Medicaid office or website.

4. Important note for those whose income falls abruptly, e.g., to zero: While the ACA marketplace (HealthCare.gov for 38 states, state-based exchanges in 12 states and D.C.) calculates subsidy eligibility and Medicaid eligibility on the basis of yearly income, State Medicaid departments determine Medicaid eligibility on the basis of monthly income. Accordingly, if your earnings before layoff or loss of work were substantial, and your income going forward is zero or below the Medicaid threshold, you should apply for Medicaid through a state office or website, not through the ACA marketplace.

The main provider for healthcare insurance may be Medicaid. Pre-Medicaid expansion, rule of thumb was about 1 million Medicaid enrollment increase for every 1 point increase in unemployment rate. More than likely higher with many more parents and other adults potentially eligible in expansion states (Prof. Edwin Park, Georgetown).

Hopefully, the better souls and minds prevail in determining what stimuli is used to assist people. If you need some assistance in finding information, please ask and I will assist.

Sources of Information which will lead to other place:

Uninsured in a pandemic? Seek help – it’s likely available,” Health Insurance Org., Andrew Sprung, March 20, 2020

The ACA as recession insurance, revisited,” Xpostfactoid Blog, Andrew Sprung, March 20, 2020

CR’s Guide to the Coronavirus freebie informan

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FDA Approves Malaria Drugs for COVID-19 Treatment – Update 2

It is a start, maybe. Remdesivir is being touted as a potentially more effective drug.

The Chinese had reported there were several pharmaceuticals which appeared to work also and in particular drugs for malaria, Chloroquine and HydoxyChloroquine. I had mentioned this earlier in the week (or even earlier) in a post and then again in two separate comments.

One small clinical test (preliminary trial with 24 -36 patients) in France had positive results recently as reported March 17, 2020. HydoxyChloroquine Would Be Effective According to Professor Roault of the IHU in Marseille,” after the first limited Test as reported by EN24 on March 17, 2020. With the use of the antibiotic Azithromycin to treat pneumonia a bacterial infection resulting from the virus infection, the test results were ~75% positive.

Remdesivir appears to have worked in a limited number of cases also. An issue which we are missing is bacterial infection following viral infection. The Chinese followed up their treatment using Chloroquine and HydroxyChloroquine (decades old drug) with antibiotics for Strep. The French study instead uses Azithromycin for treatment of the resulting pneumonia, etc. Although the French clinical test had a success rate of 75%, they are calling for a larger load testing. For Italy, it may present an opportunity sooner than Remdesivir.

And today, Trump is back on the air: Malaria Drug for Coronavirus Has Been Approved by FDA (?)

President Donald Trump announced Thursday the Food and Drug Administration (FDA) has approved hydroxychloroquine—a drug used to treat malaria, rheumatic diseases and other conditions—for COVID-19.

As the COVID-19 pandemic spreads around the world, scientists are scrambling to identify treatments that may be effective against the disease. Hydroxychloroquine—a common derivative of chloroquine—is among those touted as most promising by some experts.

HydoxyChloroquine Would Be Effective According to Professor Roault of the IHU in Marseille after the first limited Test,” EN24, March 17, 2020

Donald Trump Says Malaria Drug for Coronavirus Has Been Approved by FDA, Newsweek, Aristos Georgiou, March 19, 2020

Update 3/19:  As Trump claimed HydoxyChloroquine was approved, FDA Head Steven Hahn countered Trump’s claim, stating the president had “directed the FDA to take a closer took” at whether the drug could help people with coronavirus. Indicating the FDA had not approved HydoxyChloroquine for use on a Coronaviral disease/disorder yet, Mr. Hahn called for large clinical trials to ascertain HydoxyChloroquine’s  effectiveness in treatment.

FDA contradicts Trump on status of potential coronavirus drug,” Financial Times, Demetri Sevastopulo (Washington) and Hannah Kuchler (New York), March 19, 2020

Update 3/20: Robert Waldman – “MDs can prescribe chloroquine and hydroxychloroquine for Covid 19 right now. The FDA doesn’t and can’t regulate off label prescriptions. Large trials (with young subjects) might be OK, but that does NOT mean Drs should wait for the results before prescribing hydroxychloroquine. It has known side effects which are mild except if it is taken continuously for years (anti malaria profilassi). I think the current evidence is enough that it should be given to everyone who is not in the trials’ control group. I am quite confident of this and know of no arguably valid argument against doing so.”

Robert’s Comment is true and something I did not think of while writing.

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CORONA VIRUS AND SOCIAL SECURITY, ANOTHER GRAND BARGAIN?

by Dale CoberlyCORONA VIRUS AND SOCIAL SECURITY, ANOTHER GRAND BARGAIN?

Republicans are showing what they are made of. After claiming that the Corona Virus was not serious, or was well contained, or was Democrat fake news; they are now admitting it is serious and calling it a Chinese virus.

Fox News explained to a reporter they don’t expect “turning the ship around” to cause any problem with their viewers. They did not say that is because their viewers will believe anything they tell them to believe. Nor did they tell the reason for their turnaround of their seeing how to make money out of the pandemic. Even more so, they have seen how to use it to destroy Social Security.

These guys are akin to inviting your boss to dinner and noticing he couldn’t take his eyes off of your teenage daughter. Well, you think, at least he has kept his hands off her. Then your daughter comes over and says, ”Dad, Mr Peterson has been telling me about his house on the beach. It sounds so cool. And guess what, he said I could come and spend the weekend there if I want to. Can I? Can I? Please.”

So Trump has said he will spend some money fighting the epidemic, but he wants to get the money from Social Security. He wants a “payroll tax holiday.” The government won’t collect the payroll tax, and people can keep the money and spend it to help stimulate the economy.

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