Nebraska Getting $300G in Federal Money for Each Coronavirus Case While NY Gets $12G

[demmiblue]

Emergency relief for hospitals is being divvied up based on their Medicare billings and not how many coronavirus cases they have to handle.

It's likely few hospital systems need the emergency federal grants announced this week to handle the coronavirus crisis as badly as Florida’s Jackson Health does.

Miami, its base of operations, is the worst COVID-19 hot spots in one of the most severely hit states. Even in normal years, the system sometimes barely makes money. At least two of its staff members have died of the virus.

But in a scathing letter to policymakers, system CEO Carlos Migoya said the way Washington has handled the bailout “could jeopardize the very existence” of Jackson, one of the nation’s largest public health systems, and similar hospital groups.

“We are here for you right now,” Migoya, who has tested positive for COVID-19 himself, said in a Thursday letter to Alex Azar, secretary of Health and Human Services. “Please, be here for us right now.”

Migoya and executives at other beleaguered systems are blasting the government’s decision to take a one-size-fits-all approach to distributing the first $30 billion in emergency grants. HHS confirmed Friday it would give hospitals and doctors money according to their historical share of revenue from the Medicare program for seniors—not according to their coronavirus burden.

That method is “woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in ‘hot spot’ areas such as the New York City region,” Kenneth Raske, CEO of the Greater New York Hospital Association, said in a memo to association members.

States such as Minnesota, Nebraska and Montana, which the pandemic has touched relatively lightly, are getting more than $300,000 per reported COVID-19 case in the $30 billion, according to a Kaiser Health News analysis.

On the other hand, New York, the worst-hit state, would receive only $12,000 per case. Florida is getting $132,000 per case. KHN relied on an analysis by staff on the House Ways and Means Committee along with COVID-19 cases tabulated by The New York Times.

https://www.thedailybeast.com/nebraska-getting-dollar300000-in-federal-money-for-each-coronavirus-case-while-ny-gets-dollar12g

Link to tweet

[ProudMNDemocrat]

1. NY getting screwed because Gov. Cuomo has been honest...

In how Trump has been handling this pandemic. Trump cannot accept criticism.

[Igel]

5. Also because it's had so much more testing.

I'm trying to sort out how I'd distribute it. I don't assume that what I'm told by people who stand to receive a lot of money is completely unbiased. Or, if bias is inevitable, the best bias.

Nebraska must be getting about $200 million. NY, about $2.1 billion. Given what's in the OP and a few quick glances at 1point3acres and worldometer.

Seems less egregious put that way. Still, you never know.

My first thought is to toss the basis for the OP's outrage. # of reported cases is highly reliant on # of tests performed. Do more tests, get more reported cases, and NY (and N Jersey) have had nearly half of all reported positives--and more than 1/7 of all tests in the US were just in NY. It's a hotspot, but the bias in testing has to be big. Nebraska had had relatively few tests, but it was a zero sum game--NY got more tests so NE got fewer. So the OP's informants choose something biased towards them. Not unexpected. So I toss positives as a decent basis. It may be biased in the correct way, but it's still damned biased and part of me seriously hates bias.

Now I realize that paragraph is irrelevant. The basic premise of the OP's informants is the funding is to be based on # of positive tests. It's not. The funding is to reimburse hospitals for their expenses, not positive tests. There's even separate funding for testing. The entire "positive test" thing fails on both legal and practical grounds.

The covid tracking project helpfully adds that while they may have 175k or so positive tests, they've had 33k people hospitalized (those numbers are new!). That's a big difference. Don't have hospitalization numbers for Nebraska because the numbers are incomplete. That's a dead end for now, all the more so since it's not the number of admits, but the costs that matter. 4 young people cost less than 1 old person, on average. Still, you have to start somewhere.

I still suspect that the only reason to pick Nebraska is for the shocking but irrelevant number, based on the money doled out based on Medicare proportionality/# of reported cases. (Yes, the # of reported cases matters. But not for funding under this act of Congress--say otherwise, you're telling Pelosi and Schumer to screw off. I'm sure Schumer will weight in shortly, but in the end it's the text of the law that matters, and this isn't "the end". I know a lot of people who scream and stamp their feet for something. In the end they're convinced they got what they did because of the screaming and stamping. I find that amusing, but some people prefer to think instead of getting what they were due they got what they bullied the person into giving. Can't help that mindset and the ill-will and distrust behind it.)

The funding's ultimately is closer to the total number of hospitalizations, not those as of 4/10 or whenever, and the fat lady hasn't sung yet. NE's supposed to have its peak COVID-19 hospitalization rate around May 2, and spending all the money before they come to the party seems wrong. But this is only the first 30% of the funding, so that's not a big concern. Whatever's underfunded now, or overfunded, can be adjusted later. (And I'm sure that if you crunched numbers for hospitals in the boroughs versus, say, Watertown, NYC would still come off looking shortchanged--but better to pick NE than someplace else in NY.)

The other issue is how to dole the money out quickly. Asking hospitals to certify their hospitalizations and show that they're asking for reimbursement for just COVID cases is a nightmare. Not fast. "Hurry up and fill out this 30 page questionnaire, please include the necessary 35000 pages of documentation for review prior to issuing your reimbursement" sounds idiotic. It's how I'd like to do it, and expect it to be done before all's said and done, but I don't see how it could be fast. Since this is first-pass funding, we can leave that for the second cut, which is bigger, anyway.

HHS has reimbursement procedures and software in place for Medicaid and Medicare. So perhaps use that information for speed over accuracy? They're in place, and they're not quickly moving targets like cumulative hospitalizations would be. That money could be processed quickly. And it wouldn't flow through state coffers--it goes via channels that are federal to local. Albany can't say much about it.

Medicaid is uneven. If you're a state that's expanded Medicaid, you have more patients. Not necessarily more need, but more numbers. Might work, but that's a bias. Not all states are the same in how they administer the program. Granted, poverty isn't evenly distributed across the country, but it's a bias that's not subject to rigging like testing is. But there's still a bias. It's just fast.

Medicare. Are there state differences in Medicare? Dunno. Haven't heard of any, but no surprise there. But I do think Medicare is mostly for the elderly, and they're more at risk of being hospitalized, and more at risk of being in the ICU and racking up huge expenses. Even if the elderly aren't evenly distributed, it still roughly tracks the at risk population. (Noting that "at risk" doesn't mean "hospitalized".) Here the bias potentially tilts in the right direction, at least. It still doesn't quite match reality. So that's certainly going to be off, perhaps seriously. But it's still the first 30%.

The political appointee at HHS didn't come up with this. Some fairly high-level career staffer did.

I suspect that NYC's funding should work out to be more like $6-8 billion instead of $2.1 billion for this first tranche, but that would take time. And little of the money lost from NY is heading to NE, however much playing off blue-red or urban-rural enmity might work.


My #1 solution is go with hospitalization numbers as of 4/9 for the first 30%. It'd take a couple of days to get all the numbers from the hospitals, calculate the reimbursements, and then use the Medicare (or Medicaid) reimbursement mechanism. Okay, maybe a week. Depends on the complexity of the system they have and if the hospitals have that information to hand. Meanwhile, everybody would be screaming. They're going to scream anyway. Money's involved, and the ability to claim they're being wronged. (I've lived in the greater NY area.) But perhaps I should weight speed a bit more highly than lack of bias.

#2 would be distribute by Medicare #s. Because it's faster and the biases are more in not just a neutral direction but a risk-related direction. Other biases aren't so obvious.

#3 would be Medicaid. Yes, it's biased towards blue states, but the epidemic's been biased towards blue states, and usually the bluest portions of the blue states. Still, it's biased towards *youth* in blue states, and that's counter the risk this puppy of a virus poses. The money's not going to the states, remember, but to *hospitals*. So in PHX you'd expect more risk Sun City way, where there's higher income on average, but expanded Medicaid would weight hospitals in areas more like Glendale, a lot younger, more frequently Latino and poorer, families. The bias might be to the right states, but the wrong places inside those states.

Distributing by # of positive tests wouldn't even have occurred to me. It's like asking, "What do you want for dessert?" and responding, "There are three kinds of neutrinos." The only reason to pick that is to be explicitly biased towards a few states.

[There are probably bad edits in here, but as I went through I kept catching myself heading in ways that made no sense--towards more bias or demonstrating too much innumeracy for even a Saturday evening--and trashing parts. And finding that the covid tracking project is adding hospitalization numbers ... Score! Still, there's Koehler, Duvernoy and LaTour waiting.]

[bdamomma]

6. plus tRump

is of course being very vindictive and vengeful towards New Yorkers. They hate him.

[crickets]

2. K&R for visibility.

[Yo_Mama_Been_Loggin]

3. Kick

[smirkymonkey]

4. WTF?

This is outrageous! This is no time for political favoritism! It is a matter of life and death for people. The money needs to go where the need is greatest, not to where the local politicians kiss Trump's fat ass the most. It's infuriating!