NC indefinitely suspends tailored Medicaid plans

Plus: Another Blue restructures and no the price transparency data is not currently lowering costs

Jul 14, 2023

Good morning and happy Friday. Welcome to the Friday Pulse Check from FLATLINING.net.

In the news:

North Carolina indefinitely suspends special needs Medicaid plans

After pushing back the effective date for months, the NC Department of Health and Human Services says they will become effective at a future undetermined date rather than 1 October. NCDHHS says they are concerned about the future of the state budget; they are also probably concerned with having too small of a network. Only 160,000 individuals with special needs in North Carolina would be eligible for these plans. Read more in Becker’s Payer Issues.

Horizon BlueCross BlueShield joins other plans in restructuring

After a New Jersey court struck down a challenge by a nurses union and from a non-profit, that state’s non-profit BlueCross BlueShield plan will be joining BCBS NC in restructuring. Both of these organizations say it is to level the playing field with other for profit insurers like UnitedHealthcare (UNH 0.00%↑) and Aetna (CVS 0.00%↑). The changes mean both companies can own physician practices or pharmacy benefit manager organizations. Read more in Becker’s Payer Issues.

California Watch: Excessive drinking during the pandemic lead to a spike in liver disease death rates

Analysis from KFF Health News also found that excessive drinking in California led to more deaths than car accidents or breast cancer in that state. The research also found that death rates were higher in the rural mountains and foothills areas; the lowest death rates were in the San Francisco Bay Area. Read more from KFF Health News.

Who is Perry Johnson?

Michigan businessman and self-declared “quality guru” Perry Johnson has been running for president in Iowa with little to no one taking notice outside that state. Except for us obviously.

Since we did a deep dive into the campaign of fringe Democratic candidate Robert F. Kennedy, Jr., I thought it made sense to do an equally fringe candidate on the Republican side. Now, I want to point out here that fringe does not necessarily mean un-electable.

In RFK’s case, fringe does mean un-electable, despite what certain commentators on SiriusXM’s POTUS seem to think. His theories on vaccines, COVID-19, and the war in Ukraine, among other things, make him distasteful to mainstream Democratic voters. I’m not saying they’re excited about voting for Joe Biden again, just that RFK is not the guy they want to replace him.

Perry Johnson kicks off his campaign at CPAC 2023 and Robert F Kennedy Jr participates in a NewsNation townhall

Perry Johnson, on the other hand, is a very electable candidate if only he were more well-known outside of Michigan and where he is campaigning in Iowa. Unlike RFK, he doesn’t think vaccines cause autism, he says Trump lost the last election but he’d vote for him if he were the nominee, and he has fairly mainstream views for his party.

His strategy, I believe is to do well enough in the Iowa caucus to get some mainstream media attention. Outside of what we have done, some local news interviews in Iowa, one twenty-minute interview with Forbes YouTube channel, and his weekly thirty-minute infomercial on NEWSMAX, he has not been getting much attention. If he does well enough to come in even fourth or fifth place, he has a real shot at getting some traction. Remember, the last few nominees did not do well in Iowa including Biden and Trump.

Campaign analysis aside, Johnson was the topic of our newest edition of Pulse Check on the Candidates where we break down their healthcare policy (if they have one) and discuss the other healthcare and economic implications of their other policies. Check it out now wherever you listen to podcasts and be sure to share it with your friends.

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Ukraine

Five-hundred days have now passed since Russia invaded Ukraine and international aid agencies are hard at work trying to get food and supplies to the war-torn nation that has seen countless attacks on its medical infrastructure. This week, the United Nations International Children’s Emergency Fund (UNICEF) put out a new video detailing what they are doing in the country including providing primary care.

Final Thought

We are still waiting (at the time of this writing) for a decision in the Texas Medical Association cases against the Biden Administration regarding the No Surprises Act. Judge Kernodle has everything he needs and we think a response could be given in a matter of days. Until we hear from him, life goes on.

Becker’s Payer Issues this week published a summary of an article with the headline: “Payer price transparency data has been available for a year. Is it lowering costs?” Before anyone gets their hopes up that it might be lowering costs, I have to burst your bubble: the payer data is trash, so of course its not lowering costs.

The summary is from an article published by Georgetown University's Center for Health Insurance Reforms and as those research correctly point out (but Becker’s neglects to include) it requires a small supercomputer to process and actually access the data from the payers in a format that is comprehensible to humans. We’ve looked at this data at Fulcrum Strategies; it is cells within cells within cells within cells within… you get the idea. It is nearly impossible to read with a regular computer.

So the idea that it might be lowering costs is absurd. Now, Becker’s is a news aggregate and they’re simply linking their readers to the main article so I don’t fault them for not having an understanding of just how difficult the payers have made their data to access. Trust me when I say it will take years before the data (in the format it is currently in) can have an effect on patient costs.

Read the post from Georgetown University's Center for Health Insurance Reforms.

Have a good weekend,

Matthew