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Ebola vs. PPACA: 3 effects

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New York City now has one patient — Dr. Craig Spencer — with confirmed Ebola, and three patients who are in quarantine as a result of their association with Spencer.

What do those cases mean for the agents and brokers already wrestling with the Patient Protection and Affordable Care Act (PPACA) provisions and programs that affect the commercial health insurance market?

The Spencer case already has disrupted the operations of a bowling alley Spencer visited and pushed a local public hospital, Bellevue Hospital, to care for Spencer in high-tech isolation, using the kinds of safeguards they might use if he were made out of cyanide gas.

New York City Mayor Bill de Blasio and New York Gov. Andrew Cuomo had to take the time to do a press conference in which they struggled to assure reporters, and the public, that the risk anyone would catch Ebola from Spencer was low.

Spencer reportedly became infected while volunteering for Doctors without Borders in Guinea, in West Africa. He was at unusually high risk for contracting the disease, due to his close work with patients in Guinea, and he kept careful track of his health once he returned to New York. Public health officials were quick to emphasize that they believe people Ebola can pass on the disease only after they begin experiencing obvious symptoms of the illness. 

But news of the Spencer case surfaced just half a day before the House Oversight & Government Reform Committee was about to hold a hearing on the Ebola crisis.

Meanwhile, within Africa, the public health officials in Mali reported that a woman had rescued a 2-year-old niece whose parents had died of Ebola in Guinea and brought her deep into Mali. Mali had not previously had a confirmed case of Ebola during the recent outbreak. The news of Ebola spreading to Mali has sparked fears that the outbreak might worsen and expand in West Africa, devastating the people in that region and increasing the chances that the outbreak could spread to other regions of the world.

A few hours earlier, many were mocking the alarm over the reports of three Ebola cases occurring in Dallas, including two cases of a patient infecting U.S. people in the United States. Alarm flared back up once national reporters realized that someone with confirmed Ebola was in a hospital a few blocks away.

The Spencer case may have sharply increased the odds that Ebola will have significant effects on PPACA program implementation, even if no one else in the United States gets Ebola. Because, even if Ebola flops, the flu is still out there.

Here’s a look at three ways Ebola could collide with PPACA. 

Frightened piggy bank


1. Money will be tighter.

Republicans in Congress have tried to tighten the flow of money to the U.S. Department of Health and Human Services (HHS), in part to block or slow the implementation of PPACA programs.

HHS has responded by shifting much of the operating funding it believes it can control to PPACA implementation. Some states may have taken similar steps, to use public health funding and other health agency money for PPACA programs.

Governmental PPACA programs may now face new competition from public health programs.

During the House hearing today, for example, Dr. Nicole Lurie, assistant secretary for preparedness and response HHS, testified about the billions of dollars Congress has already appropriated for medical countermeasures to chemical, biological, radiological or nuclear (CBRN) threats, including efforts to fund more than 80 countermeasure candidate products. Lurie said HHS hopes to include many of those countermeasure products in the Strategic National Stockpile.

Another witness, John Roth, inspector general at the Department of Homeland Security (DHS), noted that, in the past, that DHS has not done a great job at planning or acquiring pandemic preparedness supplies. The department spent $9.5 million on protective equipment in 2006 without doing much to analyze protective equipment needs, Roth said.

DHS has not kept good records on preparedness equipment purchases and is not sure what it has in stock, Roth said.

Meanwhile, hospitals that might have been thinking about investing in care coordination systems are shopping for Hazmat suits that cover the neck and wrists. 

List of CCIIO leaders that shows many acting chiefs and some vacancies.


2. The people who get things done will be even more scattered and harder to reach.

Due to time pressure, money problems and the complexity of the federal hiring process, the organizational chart of the Center for Consumer Information and Insurance Oversight (CCIIO) — the arm of HHS in charge of PPACA provisions and programs that affect commercial health insurance — shows many vacancies in important leadership positions.

CCIIO shows acting directors in other key posts, such as the director positions at the exchange policy and operations group and the insurance programs group.

The Ebola news has reportedly led HHS to transfer some of its people to Ebola jobs. 

Lurie noted today at the House hearing that HHS Secretary Sylvia Mathews Burwell has statutory authority to let states reassign federally funded personnel to declared public health emergency efforts. Dr. Karen DeSalvo, for example, is moving from a post as national coordinator for Health Information Technology to a post on the Ebola team.

That might be good for the Ebola response team but hard for efforts to get doctors and hospitals to move to the ICD-10 diagnostic coding system, or to get the health care system to converge on the use of electronic health reform systems that work better together.

Similarly, insurance companies may find that they have to devote more of the time of creative, resourceful executives to their own pandemic preparedness efforts. 

Hospital disaster drill


3. You, your clients and home-office workers will be even busier with non-core activities.

You, employer clients and many of your more affluent or more prominent individual clients already get asked to donate to this and volunteer for that — all while trying to figure out how to count employees for PPACA compliance efforts and understand exactly how to format a PPACA Summary of Benefits and Coverage notice.

Those projects were already taking time your clients could have been using to generate more personal income or company revenue, and it’s been taking time away from your core efforts to help people get covered and keep them covered.

Now, you may all have to spend more precious time wiping door knobs, thinking about pandemic preparedness plans and, possibly, volunteering for preparedness drills. Many of those efforts may be necessary efforts, but they may cost more of that spare time you don’t actually have to spare.