I get commentary (in my emails) from xpostfactoid who writes on healthcare issues and also does a yeoman’s function not found else in reconciling ACA signups, the differences between the penalty-mandate vs no penalty-mandate, Medicaid signups by state in both expansion and non-expansion states, and lately the impact on Medicaid due to the Covid-19 pandemic. The data and commentary by xpostfactoid for this particular summary by me can be found here; State Medicaid enrollment totals in light of CMS’s (lagging) reports, November 27, 2020

Why track Medicaid numbers? As you well know, unemployment has increased since the start of the Covid-19 pandemic as a result of the shutdowns of businesses and government facilities. The resulting layoffs have caused many people to lose not only their healthcare but also their healthcare insurance. Two ways to qualify for healthcare insurance is on the healthcare exchanges which will still look at annual income or through state Medicaid which looks at “current” income. If you are laid off and have no income (or less than 100% FPL [unless your state says differently] or 138% FPL in expansion states0, you can qualify for Medicaid CMS’s monthly totals of state-by-state Medicaid enrollment growth during 202 as impacted by Covid-19 in 2020 is currently posted Medicaid.Gov through July reflecting:

• five months of enrollment  as affected by the Covid-19 pandemic and
• four-plus months in which the suspension of disenrollment mandated by the Families First Act was in effect.

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"I guarantee you…" pic.twitter.com/HRjKjtrziV

— Bad COVID-19 Takes (@BadCOVID19Takes) November 23, 2020

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The good mayor of El Paso is at wit’s end. He is worrying himself into the grave. The City’s hospitals and morgues are overflowing. Seems that the people have to work to eat, and, if they work, they get the virus and get sick, and, too many die. Damned capitalism is as deadly as the virus; together they are a catastrophe. Maybe, if he would just step across the border into New Mexico, better yet, hop on a plane to San Francisco, better to get as far away from Texas as possible, we could explain the problem to him without being drowned out by the ignorant Texas dogma coming out of Austin; crapola he’s heard his whole life.

In a functioning state, there are dozens of examples, the government would have handed out masks and hand sanitizer, and free food as the need arose. It would have worked out a deal on the rents. The government would have mandated the changes needed to make the workplaces safe. If the government had done these things, had functioned, instead of blithering on about capitalism and the American way, the people could have kept on working without getting sick and dying by the droves; and, the economy could have kept on working. What our government didn’t do is killing us by the hundreds of thousands; destroying the nation.

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Coronavirus dashboard for November 20: North Dakota “leads” the world

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As you must know by now, I read the healthcare articles. One of my favored spots is MedPage Today where I pick up the less technical information on what is going on in healthcare.

November 22. 1963 is the day President John Kennedy was assassinated. My whereabouts were sitting in a high school study hall along with 100 other boys getting through my first year at Lane Technical H.S., an all boys school. November 22nd and the principal, who we called “froggie” because of the twangy noise from the school speakers pre-announcement, came across the school loud speaker announcing John F. Kennedy had been shot about the same time as the thought had passed through my head. Or at least, I remember it this way. It is hard to know what one would think at such an announcement or result at such an age. I wouldn’t till about 5 years later.

A medical question arises as to;

“How different might John Kennedy’s care be in 2020? Could modern medicine techniques have helped President Kennedy to survive if his shooting happened today?”

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Chronic Lymphocytic Leukemia is the most common kind of leukemia in adults. Current therapy is extremely unpleasant and often (usually) fails. There is a very large number of clinical trials of new therapies mostly immunotherapies. They are based on the fact that CLL cells are B-cells which express CD20.

One such trial is NCT03759184 Human IL-15 (rhIL-15) and Obinutuzumab for Relapsed and Refractory Chronic Lymphocyte Leukemia

This is a therapy which isn’t too horrible. The doctors are having some trouble recruiting patients (as noted above there are many trials attempting to treat people with relapsed and refractory CLL).

Complete disclosure: one of those doctors is my dad.

People with relapsed and refractory CLL who are interested in considering whether to enrol in the trial can

Contact: NCI Medical Oncology Referral Office (240) 760-6050 ncimo_referrals@mail.nih.gov

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Coronavirus Dashboard for November 16: raging out of control

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This update from XPOSTFACTOID showed up in my inbox. If Roberts and Kavanaugh continue on the same path they have started out on initially, it appears the case brought about by Texas may fail. Briefly, here are some points made.

November 10, 2020 in oral argument; California v. Texas  Roberts appears equally skeptical about this argument from intent. In oral argument yesterday, Kyle Hawkins, arguing for Texas, made the case:

“I think it’s critical that, in 2017, Congress could have excised the legislative findings in 18091 [the assertion of severability], but it chose not  to do so. It could have excised —

Roberts interjected:

Well, but I mean — I — I certainly agree with you about our job in interpreting the statute, but, under the severability question, where — we ask ourselves whether Congress would want the rest of the law to survive if an unconstitutional provision were severed. And, here, Congress left the rest of the law intact when it lowered the penalty to zero. That seems to be compelling evidence on the question.

In Roberts’ King v. Burwell decision: Congress repealed the individual mandate penalty, not the entire law.

Erwin Chemerinsky Explains Severability

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Coronavirus dashboard for November 9: Wow (and not in a good way)

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Guest Author at Angry Bear is Professor Joel Eissenberg. Dr. Joel Eissenberg is a professor of Biochemistry and Molecular Biology and is probably a good person to ask questions concerning pandemics and bringing new vaccines to market. Ask questions  .  .   .  I am sure he will answer the same as he has commented in the Comments section. He also reviewed my layman’s piece on Moderna’s mRNA. I am hoping he will contribute at Angry Bear on healthcare from time to time.

The Moderna trial has reached its enrollment goal of 30,000 subjects and at least 75% have already received both injections. This is not a challenge trial, but it is expected that many subjects in the vaccine and placebo arms will be infected and these will be tracked. Power calculations suggest that only a few dozen infections are necessary to determine whether there is a benefit to the vaccine over placebo. So far, the number of infected subjects is at or ahead of what they expected. The trial lasts two years, so there is plenty of time to collect data. There is, of course, understandable urgency to push out some vaccine ASAP.

I’m in the Moderna trial, which tests the efficacy of injecting the messenger RNA for the SARS-CoV-2 spike protein (the surface protein that gives coronaviruses their corona) directly into muscle. The protein is made in muscle cells and then (a) secreted and (b) presented to immune cells to stimulate the adaptive immune system. Technically, it is a double-blind trial, but so far, everyone in the vaccine arm experiences the short-term vaccine syndrome of headache, mild fever, muscle and joint ache after the booster. I did, and was able to get an antibody test confirming a robust response (IgG). I’ll continue to social distance and mask as before; I have no interest in testing just how effective the vaccine is or isn’t with my own body.

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