November 1st, 2021
The Out-of-Pocket Health News Digest
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Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.
This compilation is produced by the HPSA Education Committee: Brynna Thigpen, Christopher Whitlock, Easheta Shah, Hannah Lane, Hassan Kourani, Jourdan Clements, and Lizzy Peppercorn
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Long Term Effects of COVID-19 in Children
by Lizzy Peppercorn
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A recent study in Germany collected data on post-acute sequelae, also known as long covid, in both adults and children. For a condition to be considered long covied the patient must have multiple health issues that have no origin to illness besides COVID-19, are present three or more months from symptom onset or when the individual tested positive, and must last for two or more months.
The study analyzed healthcare data from multiple health insurance providers looking for evidence of higher rates of illness three months after a diagnosis of COVID-19 in over 157.000 individuals of ranging ages. Some of the patients had experienced originally mild or asymptomatic cases of COVID-19. The data was from the Post-Covid-19 Monitoring in Routine Health Insurance.
The study found that the incidence rate of any given health outcome, mental or physical, was 30% higher in the COVID-19 group compared to the control groups. In adults, it was found that all outcomes were present at higher rates in the COVID-19 group whole for children, the outcomes were only at higher rates in 10/13 of the cases.
The most significantly raised outcome among children and adolescents were malaise and persistent tiredness, cough, throat pain, chest pain. These symptoms were twice as prominent in the COVID-19 group than the control. Adjustment orders, somatization disorder, headache, fever, anxiety, depression, and abdominal pain also increased by over 50%. In adult cases, dysgeusia, fever, and cough were 3-6 times more prominent in the COVID-19 group whereas chest/throat pain, breathing insufficiency, hair loss, malaise, dysphagia and headache were more than doubled in incidence.
This study stands out because it uses documented new-onset illness data from physician records and health care use. Overall, the magnitude of long covid is significantly lower in children than adults due to the difference in COVID-19 rates. There is a need for more research in the area of children long covid cases.
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Wyoming Files to Expand Medicaid
by Brynna Thigpen
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One provision of the Affordable Care Act, commonly known as Obamacare, allowed individual states to decide whether or not to expand eligibility criteria for Medicaid to include more people in their state. This was known as “Medicaid expansion.” Under Medicaid expansion, the federal government covers the vast majority of expansion costs in the first several years, with the cost sharing gradually approaching a more even split as time goes on.
Not all states approached this offer the same way. Dozens of states took up this option immediately, the earliest among them making expansion for their constituents effective on January 1, 2014. However, many legislatures in mostly-conservative states pushed back, citing higher cost sharing and a fundamental rejection of entitlement programs (also commonly known as social safety net programs). Ultimately, however, voters and advocacy groups in these so-called “non-expansion states'' observed the outcomes in their peer states. In recent years, these non-expansion state voters have overcome their legislatures’ objections and expanded Medicaid through voter-promoted ballot measures. Today, only 12 states have held out against Medicaid expansion: Wyoming, South Dakota, Wisconsin, Kansas, Texas, Tennessee, Mississippi, Alabama, South Carolina, North Carolina, Georgia, and Florida. All other states and territories have expanded.
The most recent state to consider expansion has been Wyoming, where a Medicaid expansion bill (the “Medical Treatment Opportunity Act”) was filed in the state legislature this month (following a failed proposal in March of this year). The current bill estimated that around 25,000 people would gain insurance coverage, mostly the working poor and women. An American Cancer Society survey found that 58% of Wyoming Republicans support Medicaid expansion, garnering support from a full two-thirds of all Wyomingites.
However, despite the support of voters of all kinds, health benefits, and federal financial incentives, the most recent bill proposal has been killed in the Wyoming legislature, with the Senate voting against bringing it to the floor. This proposal has been brought to Wyoming representatives every year in recent years, and political pressure is mounting to expand Medicaid. It will remain to be seen if the resistance to expansion continues here and in the 11 other remaining holdout states.
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Lung Cancer Screening Rates in the US are Far Below Projected Goals
by Jourdan Clements
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Preventative care measures such as lung cancer screening have been shown to reduce mortality rates, but patient adherence to screening intervals is largely a problem in the United States. Lung cancer screening can effectively reduce patient mortality when complemented with follow-up recommendations standardized by the Lung CT Screening Reporting & Data Systems (Lung-RADS), but patient compliance with adhering to these recommended screening intervals is suboptimal across clinical lung cancer screening programs in the US.
Lung cancer screening can clinically identify tumors at the preclinical stage of disease when the cancer is more treatable. Successful screening detection programs can extend the lead time of disease diagnosis, which is the interval by which the time of diagnosis is advanced by screening and early detection compared to usual time of diagnosis. The National Lung Screening Trial (NLST) has shown that for lung cancer, low-dose chest CT screening relative to chest radiography provides a 20% reduction in lung cancer mortality due to earlier detection. Current Lung-RADS guidelines for lung cancer screening were developed from this NLST study.
A recent meta-analysis of adherence to Lung-RADS recommended screening intervals showed that patients in lower risk Lung-RADS categories were less likely to adhere to recommended screening intervals than those in higher risk Lung-RADS categories. Researchers hypothesize that this could be due to patient characteristics, insurance coverage, and interventions to ensure adherence, among other factors.
A potential method to combat this disparity may be to tailor interventions based on Lung-RADS categories, but this would take more time and research to instate. Short-term solutions should revolve around increased education on screening methods, as it is necessary that patients and providers understand that screening is most effective when conducted regularly. In order to most effectively catch and treat lung cancer, the healthcare system must meet lung cancer screening rate goals for patients in all Lung-RADS categories.
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Exercise: Recent studies have found that obsessive tracking of ones exercise may cause negative mindsets and worse outcomes as people get more enjoyment out of tracking themselves than the exercise itself. (CNN)
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Climate Change and Health: British Prime Minister Boris Johnson states that modern civilization may crumble like Ancient Rome if world leaders don’t act soon to combat climate change. (US News)
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COVID-19 Spread Video: Watch this time lapse data visualization on the spread of COVID-19 across the U.S. in 60 seconds. (Reddit/New York Times)
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COVID-19 Child Vaccination Efforts: Children ages 5 to 11 may be eligible for the COVID vaccine as soon as next week, but the timeline before release is a little more complex than you might think. (NPR)
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