Top of the Funnel: Macro + Earnings.
CI. The company beat and raised but more interesting to us is the membership. For the last several years, the growth in commercially insured lives has been slow/no. Our Insured Medical Consumer model picked up a shift beginning in 2021 that appears to be, in part, employment rate and in part, more insured per employed.
CI’s commercial book has historically focused on the employer market. Generally, they are a low-cost option to Blues plans offered in most states. CI reported 9.6% increase in commercial lives which could be accounted for by their lower premium strategy. It is also, based on our data, a likely a result of a larger market in which to attract customers.
CONGRESS.
Ghost Networks. The debt ceiling remains the obsession but Senate Finance has started to take up the issue of ghost networks, otherwise known as outdated provider directories.
It is generally a problem with smaller and less robust plans that have trouble attracting members and use it as a way to mislead members into joining a plan.
THE WHITE HOUSE.
Walensky is Gone. The White House announced Dr. Rochelle Walensky is departing the Centers for Disease Control. The timing of today’s is at once both expected and interesting. The Public Health Emergency comes to a close next week and takes with it vaccine mandates. At the same time, CDC was expected to implement a reorganization to prepare for the “next pandemic,” so the loss of a leader midstream seems curious.
The White House announcement follows some pretty unbelievable statements from Dr. Anthony Fauci and American Federation of Teachers Union president Randi Weingarten about their (non) role in school closures. Testimony at House select subcommittees from long-standing evidence-based medicine advocate, Dr. Marty Makary, and others hammered home the failures of the public health system during COVID.
In short, opponents to pandemic policies of two White House administrations are gaining strength as its defenders retreat. Related I am sure are the poll numbers for Robert F. Kennedy Jr., which indicate he would take 19% of Democrats, and the politically catastrophic approval rating for President Biden of 37%.
Kennedy is an outspoke opponent of the pharmaceutical and defense industries and by his own account is running for president just so people will have to listen to him. As such he has the ability to present a counternarrative that is and will make Biden’s political advisors very nervous.
There is a lot of reason to “make it go away,” as we say in politics.
Vaccine Mandates. AMN (-) Consistent with the end of the Public Health Emergency on May 11th, the White House ended vaccine mandates this week for all CMS-certified health care facilities, which is to say, all facilities.
Surveys throughout the pandemic indicated the highest level of COVID vaccine hesitancy in men and women of childbearing years. That population would, of course, include nurses and other clinical staff and so it is safe to assume that their concerns about COVID vaccines may have kept them out of the health care workforce.
The last year or so it has been a lot of winking and nodding about compliance but to the extent mandates were being enforced, it kept health care workers at home or employed in other sectors.
With the end of the mandates, expect more slack in the health care labor market.
SNF Staffing Minimums. (ENSG (+) CMS has “formed a committee to settle the matter” as we say in the Presbyterian Church. Having already blown past its own deadline to impose staffing minimums on nursing homes, CMS reported this week that they are reviewing the results of a study on nursing home staffing.
The agency has not offered any timeline for a proposal not has it released the report it is said to be reviewing.
Other Stuff.
WHO Cares? The World Health Organization declared an end to the Global Health Emergency. The announcement is a bit of a turn around from a few months ago when the primary talking point was “we are still in a pandemic.”
The change is no doubt due to a number of factors from the genuine like increased population immunity to the reduced severity of circulating variants. The most probably cause, however, is the public’s waning interest and rising skepticism that the various interventions prescribed. (see above)
The WHO’s commitment to all things pandemic has not disappeared but given the clear lack of urgency around the world there is a lot of reason to press pause, at the very least.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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