IHA Daily Briefing: May 14

Tuesday, May 14, 2019
Reps Asks House Leaders for Medicaid DSH Cut Delay
Register for July SANE Training  
CDC: Pregnancy-Related Deaths are Avoidable
KFF: Record Number of Premium Rebates Expected
NCHS Report Shows Health Insurance Coverage
Briefly Noted

Reps Asks House for Medicaid DSH Cut Delay
An overwhelming majority of the U.S. House - including 12 members of the Illinois delegation - cosigned a letter to House Speaker Nancy Pelosi and House Republican Leader Kevin McCarthy asking Congress to take action to delay $4 billion in cuts to the Medicaid Disproportionate Share Hospital (DSH) program in fiscal year (FY) 2020, and another $8 billion in FY 2021.

“We urge you to take action to delay these cuts for at least two years. In 1985, President Ronald Reagan and Congress created the Medicaid DSH payments to sustain hospitals that serve a disproportionate number of low-income and uninsured patients. In treating those who have nowhere else to turn, these hospitals incur uncompensated costs. Furthermore, these same hospitals typically operate on very narrow, or even negative, margins… Medicaid DSH payments not only support hospitals in cities across the country, these payments are also especially important to rural hospitals, which often face added financial burdens,” read the letter.

Illinois members signing the letter are: Reps. Bobby Rush (IL-1), Robin Kelly (IL-2), Daniel Lipinski (IL-3), Chuy Garcia (IL-4), Mike Quigley (IL-5), Sean Casten (IL-6), Danny Davis (IL-7), Raja Krishnamoorthi (IL-8), Jan Schakowsky (IL-9), Brad Schneider (IL-10), Bill Foster (IL-11), and Cheri Bustos (IL-17).

Register for July SANE Training
The Illinois Office of the Attorney General (OAG) is offering Pediatric/Adolescent Sexual Assault Nurse Examiner (SANE) training July 16-18 from 8 a.m. – 6 p.m. at Loyola University of Chicago’s Marcella Niehoff School of Nursing in Maywood.  
Applicants must have a license in good standing, have a minimum of one year of clinical experience, acknowledge the requirements of the training including submitting a recent resume, and complete 14 hours of online training and homework by July 11.
This training does count toward SANE certification. More details can be found in an OAG memo. The application deadline is June 11.
Illinois Public Act 100-0775 amended the Sexual Assault Survivors Emergency Treatment Act (SASETA) with numerous new requirements for treatment hospitals, effective Jan. 1. For complete details, see IHA's memo.

For additional information or to be added to the email distribution list for upcoming SANE trainings, please contact Jaclyn Rodriguez, BSN, BS, RN, SANE-A, SANE Coordinator, OAG, at sane@atg.state.il.us.

CDC: Pregnancy-Related Deaths are Avoidable
The Centers for Disease Control and Prevention (CDC) studied pregnancy mortality data from 13 states from 2011-2015 to analyze pregnancy-related complications and deaths. During that timeframe, there were more than 3,400 pregnancy-related deaths in the U.S.

The majority of deaths occurred during pregnancy (31.3%), followed by 1-6 days postpartum (18.6%); 7-42 days postpartum (21.4%); day of delivery (16.9%) and 43-365 days postpartum (11.7%). The CDC said that nearly three in five pregnancy-related deaths (60%) were preventable.

About 33% of the deaths were due to cardiovascular conditions—cardiomyopathy (10.8%), other cardiovascular conditions (15.1%) and cerebrovascular accidents (7.6%). Other complications included: non-cardiovascular medical conditions (14.3%); infection (12.5%); and obstetric hemorrhage (11.2%). A cause of death could not be determined in 6.7% of these pregnancy-related deaths.

During the time frame analyzed, Black women had the highest rate of pregnancy-related deaths (42.8%) followed by American Indian/Alaska Native women (32.5%).

Maternal mortality review committees identified three community strategies to reduce pregnancy-related complications:

  • Expanding clinical office hours and the number of providers who accept Medicaid;
  • Prioritizing pregnant and postpartum women for temporary housing programs, and
  • Improving access to transportation.

KFF: Record Number of Premium Rebates Expected
A Kaiser Family Foundation (KFF) analysis revealed that Individual market insurers are expecting to return to consumers a record total of about $800 million in excess premiums for 2018, a year in which the insurance companies posted their best annual financial performance under the Affordable Care Act (ACA) to date.

The rebates to more than 3 million eligible individual market consumers, based on preliminary estimates by insurers, must be issued by Sept. 30. They are the result of the insurance companies not meeting the ACA’s medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues on healthcare claims or quality improvement activities.

On average, monthly premiums per enrollee in the individual market grew 26% from 2017 to 2018, to $559, while per person claims grew only 7%, to $392. The analysis finds insurance companies posted their strongest performance in the individual market under the ACA to date using two different financial indicators:

  • The average share of health premiums paid out in claims (or loss ratio) fell to 70% in 2018, down from 82% in 2017, 96% in 2016 and 103% in 2015; and
  • Average premiums collected in excess of claims (or gross margins) reached $167 per enrollee per month, up from comparable figures of $79 in 2017, $14 in 2016 and -$9 in 2015.

KFF says that financial results for 2018 suggest that insurers in the individual market are generally returning to or exceeding profitability levels seen before 2014, when ACA insurance market rules took effect, including the requirement to cover people with pre-existing conditions.

NCHS Report Shows Health Insurance Coverage
Early released findings from the National Center for Health Statistics (NCHS) 2018 National Health Interview Survey (NHIS) data show that:

  • 30.4 million people of all ages were uninsured at the time of the interview in 2018, slightly up from 29.3 million in 2017;
  • 13.3% of adults 18-64 years old were uninsured at the time of the interview; 68% had private health insurance and 19.4% had public coverage;
  • The uninsured rate for 45-64 year olds increased from 9.3% in 2017 to 10.3% in 2018;
  • People between ages 25-34 years old were the most likely to lack health insurance—17%—when compared with the other age groups; and
  • The percentage of people with high-deductible private health insurance plans increased from 43.7% in 2017 to 45.8% in 2018.

The NCHS updates this report quarterly based on data available from the NHIS website.

Briefly Noted
A National Institutes of Health-funded study of more than 21,000 people finds that training emergency medical services agencies to implement pre-hospital guidelines for traumatic brain injury may help improve survival in patients with severe head trauma. The findings were published in JAMA Surgery.