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The Abstract
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> By Stephanie Getman, Arnold Ventures
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Happy Friday! I’m welcoming the end to another week of our coronavirus reality, one in which we’ve seen some incremental but encouraging movement on issues like eliminating fines and fees and reducing incarcerated populations amid COVID-19. But the reforms are sporadic, not systemic — let's hope more substantial and widespread policy change is on the horizon.
We at Arnold Ventures have colleagues spread out all over the country — Houston, D.C., New York City, and beyond — and many have spouses and loved ones working on the front lines of this pandemic. I've been touched by news reports from New York about the nightly 7 p.m. cheering for these essential workers. Last night some New Yorkers upped the ante with a citywide singalong to “New York, New York.” Silver linings, folks. That’s what I'm looking for every day.
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Debunking Myths:
Surprise Billing Edition
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President Trump announced last week that hospitals receiving COVID-19 bailout funds could not engage in surprise billing of coronavirus patients. While it’s encouraging to see some action on a practice that has long harmed American families (while lining the pockets of private equity firms), it simply is not enough — questions remain about implementation, and it doesn’t protect all patients.
So what can be done? Congress needs to enact legislation that prohibits all providers from directly billing insured patients and limits what providers are paid for surprise bills by insurers. A benchmark approach requiring insurers to pay providers a local, market-based rate is already included in several bipartisan bills that advanced out of House and Senate committees, but as my colleagues Erica Socker, Alexandra Spratt, and Mark Miller report in the best explainer I’ve read on the subject, opponents have spun a number of myths about this solution. They’re easily debunked.
Myth: Insurance companies stand to benefit from the windfall in savings that would result from a locally-based market rate for out-of-network care.
Reality: The savings arising from a benchmark approach would lead to lower premiums for consumers and employers, higher wages for American families, and savings to taxpayers.
Bottom line: Surprise billing hurts everyone. It has inflated premiums by more than 3 percent, roughly a $40 billion increase in health care costs annually, according to research by Yale’s Zack Cooper and colleagues, and the relationship between premiums and wages has been well-established. Private equity firms exploiting this market failure reap so much from surprise billing that they funded a $53 million lobbying and ad campaign to stop Congressional action.
Keep reading >
Related: Why didn’t Congress act on surprise medical bills? The answer, as The Daily Beast writes, is a story as old as Washington.
Related: A bombshell of an article from the New Yorker on how private equity firms have perpetuated surprise billing practices at the expense of American consumers.
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Logging On, Falling Behind
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Like many of you, I’m now homeschooling my children, and the abrupt switch to online learning has been a challenge — and an eye-opener. Their (amazing) teachers are providing video lessons and Zoom meetings to replicate the face-to-face interactions that come from being in a classroom, and while it’s a good substitute, it can never replace the real thing. (When will school start again?)
In the world of higher education, this shift comes with questionable long-term impacts for students.
The situation: Arnold Ventures-funded research shows that outcomes for students who learn online are not good, and this is especially worrisome for those with fewer resources and who are already academically vulnerable — it puts them at greater risk of dropping out or falling behind.
What's next: Already, students are questioning whether they will get a return on their investment, with some signing petitions for tuition reductions or even threatening to withhold tuition payments altogether. “I do not feel like I am getting the same education that I would have otherwise. The sort of enrichment and learning that I would have in the classroom isn’t there,” University of Chicago student Arica Kincheloe tells Inside Higher Ed.
Related: "A perfect storm is brewing for a rip-off revival" benefiting predatory for-profit colleges, write Aaron Ament and Debbie Cochrane in Hechinger Report. It may be left to states to defend students.
Related: Short-term Pell grants may be short-sighted, for both students and taxpayers. New America delves into the issue.
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Reducing corrections populations and compassionately releasing some individuals is good for public health, safety, and the economy amid COVID-19. At Arkansas’ Cummins Unit, almost all of the men in one housing barracks tested positive for the coronavirus. In the federal system, more than a dozen prisoners have died and more than 700 prisoners and staff are infected. Riverside County saw a startling jump in cases. The infection rate at Chicago’s Cook County jail is the highest in the country. And there’s Louisiana, and Texas, and the list goes on.
There are jurisdictions taking the smart steps of releasing some offenders, but bolder action is needed. Our Prisons Team explains why:
#1 A large percentage of people in jails and prisons are older and/or medically vulnerable — making them automatically higher risk for serious illness or death.
On average, imprisoned people are physiologically 10 to 15 years older than their community counterparts of the same age.
#2 COVID-19 containment measures are impossible in jails and prisons due to their design, operation, and often overcrowded, unsanitary conditions.
Social distancing is impossible, and incarcerated people have limited access to soap and water, must pay for personal hygiene products, and are often prohibited from possessing sanitizing supplies such as bleach and hand sanitizer.
Keep Reading 5 Reasons Why >
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Nick Turner, whose 'serendipitous' start at Vera Institute has become his life's work. His story is one of those classic American tales: the intern who rose through the ranks to become president of the organization. He calls his start there “a nice reminder that, in some respects, life kind of happens by accident, not by planning.” And with the pandemic throwing any and all planning out of the window, Vera has had to rethink how it pursues its mission. That means focusing on the life or death task of keeping people out of prisons and jails and considering what post-pandemic criminal justice reform looks like. (“Will people care less?”) He also talks about the surprising appetite from corrections leaders to reimagine prisons, why New Orleans is a critical city for reform, and what he would do with two extra hours a day. (Don’t tell his wife and kids — or maybe, do).
Read the Q&A >
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The surprising decision to base CARE Act grants for hospitals and doctors fighting the coronavirus on past Medicare business rather than COVID hot spots. Minimally impacted states, such as Minnesota and Montana, are getting more than $300,000 per COVID-19 case while New York, the worst-hit state, is getting just $12,000, reports KHN.
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Sens. Chuck Grassley and Bill Cassidy writing in the Daily Caller about why now more than ever reforms are needed to rein in soaring drug prices.
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This must-read from The Atlantic about America’s Other Epidemic. It highlights problems with access to medication-assisted treatment — the gold standard in treating opioid use disorder — as well as the devastating toll of the crisis in rural America. "Medications to treat opioid-use disorder are far more tightly regulated than the painkillers that have gotten people hooked in the first place."
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How our nation’s patent process was not built for pandemics, via the Washington Examiner. “We need to rethink our default policy for innovation.”
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A sobering look from Axios on how the economic crisis is heading for states, cities, and towns, with many saying K-12 education will be the first to suffer.
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Probation and parole executives and associations offering stark guidance on how to limit the spread of the coronavirus, including fewer office visits, suspending or limiting technical violations, and rethinking who is placed under community supervision entirely. This was good policy before COVID-19 and even more critical now.
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This fascinating New Yorker profile of Anthony Fauci and his work leading the National Institute of Allergy and Infectious Diseases through six presidential administrations. “You stay completely apolitical and non-ideological, and you stick to what it is that you do.” Oh, and you can buy his bobblehead, if you’re into that kind of thing.
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This big win for the Project on Predatory Student Lending and the students who will finally get debt relief after being defrauded by now-defunct chains Corinthian Colleges and ITT Technical Institutes. It pairs nicely with this landmark decision by a second U.S. Court of Appeals affirming the rights of states and individual borrowers to sue loan servicers for deceptive conduct.
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A good follow-up from our talk of hydroxychloroquine in the last newsletter that discusses the importance of transparency in clinical trials.
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New America’s take on how the next package of coronavirus legislation should address the needs of higher education.
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This victory for Voters Not Politicians after the U.S. 6th Circuit Court of Appeals ruling that rejects efforts to delay implementation of Michigan’s redistricting commission.
For more on gerrymandering, listen to our Co-Founder Laura Arnold’s podcast interview with Katie Fahey, the group’s founder (her movement started with a simple Facebook post) and Paul Smith of Campaign Legal Center.
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How a spur-of-the-moment decision led to the Internet's go-to source for data on the coronavirus. (1 billion page views a day!) It's the story behind that viral Johns Hopkins University dashboard, via Nature Index.
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Philadelphia has become an epicenter of the nation's opioid epidemic, and nowhere is the crisis more evident than Kensington, a neighborhood in east Philadelphia that has been called the largest open air drug market on the East Coast. Now COVID-19 has shuttered businesses, changed the way policing is done in the neighborhood, and left an already vulnerable and unsheltered community even more vulnerable. How do you manage one public health crisis on top of another? On The Why podcast, Annette John-Hall of WHYY talks to Mike Newall of The Philadelphia Inquirer, who went to Kensington to explore how the pandemic is unfolding there.
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Lies, Damned Lies, and Statistics
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By Stuart Buck, Arnold Ventures Vice President of Research
At a time when we need good evidence on COVID-19, bad studies are proliferating and getting attention in the press and on social media. The past week alone provides the following examples:
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A widely publicized paper argued that smoking might actually protect against COVID-19, because the rate of smoking among COVID-19 patients is lower than in the general population. But a geneticist emailed the authors, one of whom admitted that the smoking rate was low because “many patients cannot answer questions about whether [they] smoke because of their older age and serious illness.” Obviously this isn’t a good reason to conclude that the smoking rate is low, let alone that smoking protects against COVID-19.
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We’ve all heard about staying 6 feet away from others in public. A recent “study” from Europe claimed that runners/joggers actually need to stay 10 meters (or about 30 feet) away from others, which is difficult in many situations (such as a sidewalk). But this wasn’t an actual paper at all, just an interview with a Belgian newspaper about some computer simulations that provided zero evidence of how real-world runners emit droplets, let alone showing that any actual case of COVID-19 could be transmitted by runners passing each other at a distance of, say, 15 feet.
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Perhaps most alarmingly, the New England Journal of Medicine published an article on treating COVID-19 with remdesivir, concluding that “clinical improvement was observed in 36 of 53 patients (68%).” Journalists wrote up this study as a “hopeful” sign. But as one critic pointed out, the study had at least 11 serious flaws, including the lack of a control group, cherrypicking of patients and outcomes, and much more.
Now more than ever, we need to look at hastily-published studies with a skeptical eye.
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Nothing might be more calming in these times than listening to Italian tenor Andrea Bocelli’s soaring vocals resonate through the empty halls of the Duomo di Milano. If you were not one of the 22 million who watched his live-streamed performance Sunday on YouTube, I suggest you take the 20 minutes to meditate on it. I’ll leave the full review to expert ears, since this listener might have shed some real tears seeing him perform in concert in the past. (It’s truly an overwhelming experience, no matter what the critics say.)
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Have an evidence-based week,
– Stephanie
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Stephanie Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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