In April, a prescient column in The Atlantic explored the challenge of COVID-19 long-haulers from a relevant, if not particularly politic, angle — cost. Billions, or perhaps trillions of dollars, have poured into the health care system from the federal treasury to buttress acute care during the crisis. However, we’re just beginning to get a glimpse of what the health effects of the disease are in the long term.
A growing body of evidence suggests that some individuals will continue to suffer physical or mental health conditions beyond the acute phase of COVID-19. The syndrome, which can vary widely, is known as “long COVID” and the sufferers are often called “COVID long-haulers.” It is too early to know whether these individuals will suffer from long-term chronic conditions or whether they will resolve. Studies suggest that even asymptomatic individuals can have long-term damage. The implications are huge for our health care system.
The Atlantic article relied on a study from the Kaiser Family Foundation that projected the “cost of treating just COVID-19 cases for the uninsured would range from $13.9 billion to $41.8 billion.” These costs were based on 2% to 7% of the uninsured population requiring hospitalization. That’s a huge cost to the health care system for a small segment of the population. And, that is the acute care treatment cost.
In Missouri, 11% of the population are uninsured. More than 1 million Missourians are presently eligible for Medicaid — a number that will grow with expansion — and 1.2 million are enrolled in Medicare. The balance have insurance through their employer or purchase coverage independently.
The short-term costs of caring for the uninsured will be offset, at least in part, by federal COVID-19 spending. In the long term, the cost of the pandemic results in significant uncompensated care costs, increased spending in Medicare and Medicaid, and higher premiums for commercial insurance. Assuming again that these are chronic conditions, managing them throughout a patient’s lifetime — especially if they are conditions that require hospitalization — will be very expensive.
There’s little to be done to change the health status of individuals who contracted COVID-19 before vaccines were available. Early evidence suggests that vaccines may help reduce some of the acute challenges of long COVID. Unfortunately, even asymptomatic cases can end up with long-COVID health issues, according to very early research. This may signal damage that could result in chronic health conditions.
Vaccination, and avoiding the infection entirely, are the best options for maintaining health. Unfortunately, Missouri has one of the lowest vaccination rates in the nation and recent spikes in positive cases and hospitalizations could result in Missouri being overrepresented among COVID-19 long-haulers nationwide.
Earlier this week, President Biden announced that he would support efforts to protect Americans suffering from the long-term effects of the illness from discrimination. Federal agencies have started to release guidance for inclusion of COVID-19 protections in the Americans with Disabilities Act. This could result in costs to both the health care system and the larger safety-net.
On the front lines, hospitals continue to see the significant toll in COVID-19 mortality. Talking about costs may be unseemly when patients are being hospitalized at record levels in some Missouri communities and the COVID-19 death toll continues. However, for those who can’t recognize the value of a shot in their arm, they may understand one to their wallet.
We know that vaccination is the way out of the pandemic. The faster we get there, the lower the costs in lives and treasure.
P.S. — Medicare and Medicaid were established on this day in 1965. Since that day 56 years ago, the programs have become essential to the fabric of our health care system, providing coverage for seniors, low-income Americans and those with disabilities. And, it all started here. The bill was signed in Independence, Mo., with former President Truman — an early supporter of a national system to address gaps in coverage — on hand.
In This Issue
DCI Releases Proposed Health Insurance Rates For 2022
CMS Releases FY 2022 Final Payment And Policy Updates For IRF, SNF, IPF And Hospice
CMS Releases CMP Guidance
MLN Connects Provider eNews Available
SAMHSA Awards $250 Million To 100 Certified Community Behavioral Health Centers
Rural Energy For America Program Improvement Grants And Guaranteed Loans Available
Transition To Value Educational Video Series Available
CFPB Offer Resources For Renters And Landlords
The Missouri Department of Commerce and Insurance released proposed health insurance rates for the 2022 individual market. For 2022, nine carriers will be offering individual market health plans. Open enrollment for the 2022 plan year begins Monday, Nov. 1 and ends Jan. 15, 2022. DCI is encouraging purchasers of coverage to assess and compare rates. DCI Director Chlora Lindley-Myers stated, “the health insurance market in our state and our country continues to be challenging, however, I’m pleased by the significant increase in competition we’ve seen in Missouri this year. Nearly half of our counties in Missouri now have three or more health insurers competing for business in the individual market.”
The Centers for Medicare & Medicaid Services released the FY 2022 Medicare payment and policy updates for the inpatient rehabilitation facility, skilled nursing facility, inpatient psychiatric facility and hospice prospective payment systems. CMS is estimating that Medicare IRF payments will increase 1.5% or $130 million, SNF payments will increase $410 million, IPF payments will increase 2.1% or $80 million, and hospice payments will increase 2% or $480 million. MHA published an issue brief for hospice and IRF with additional details. MHA soon will release issue briefs for SNF and IPF.
The Centers for Medicare & Medicaid Services released new guidance that they will reinstate monetary penalties for prior noncompliance on a per-day basis. This guidance applies to nursing homes and is on a discretionary basis. Since 2017, the agency was solely imposing civil monetary penalties on a per-instance basis for previous noncompliance. The revised policy was effective July 16.
The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.
Price transparency stakeholder webinar – August 11
In the effort to address the behavioral health needs of Americans, the Substance Abuse and Mental Health Services Administration awarded 100 grants to certified community behavioral health centers. CCBHCs are key to providing improved treatment services in the community. U.S. Health and Human Services Secretary, Xavier Becerra, stated that “as we continue to confront the impact of the pandemic, increased support for mental and substance use treatment can be a critical lifeline to communities across the country.”
The 100 grants comprise $115 million in COVID relief funds, $77 million in American Rescue Plan funds and $58 million in annual appropriations. Grant recipients are given the opportunity to increase access to CCBHCs and improve the quality of community mental health and substance use disorder treatment services by establishing services in new facilities and creating more robust services at existing facilities.
The Rural Energy for America Program provides financial assistance to small business owners to purchase, install and construct renewable energy systems or energy efficiency improvements. Additional information can be found on the USDA Rural Development webpage. An example of a potential project may be the installation of solar panels for hospitals or clinics to improve energy costs. Applications are due Monday, Nov. 1.
The National Rural Health Resource Center is offering an educational video series to provide mid-level leaders with foundational knowledge and strategies to lead their team and influence others as they navigate the shift to value-based payment and population health. The series is formatted to allow for self study and additional information can be found on the website.
Some forms of federal support for renters will end soon, and a wave of evictions could lead to an increase in homelessness. The Consumer Financial Protection Bureau has resources available to support renters and landlords, including state, county and city-specific links to where local help is available. Housing is an important social determinant of health.
