Good News for People Who Love Bad News

And now for some more bad news via the New York Times reporting on the Centers for Disease Control:

One in 10 pregnant women in the continental United States with a confirmed Zika infection had a baby with brain damage or other serious birth defects, according to the most comprehensive report to date on American pregnancies during the Zika crisis….
Despite a C.D.C. recommendation that brain scans be performed on all babies born to women with possible Zika infection, only 25 percent of the babies in the study had brain imaging, so the actual number of impaired infants could be higher….

Birth defects, ranging from the condition of abnormally small heads, known as microcephaly, to neural tube defects and eye malformations, occurred in 5 percent, or 51, of those pregnancies, including 45 live births. Of the 250 cases where the presence of a Zika infection was confirmed with laboratory testing, 10 percent, or 24 pregnancies, resulted in birth defects, the report said.

All but eight of the 51 cases involved severe brain abnormalities such as microcephaly;

Why does this matter beyond the individual tragedy? Medicaid is the dominant payer for births in this country. Most Medicaid births are paid for by Legacy Medicaid funds where the states pay a significant portion of the cost. Almost all childhood Medicaid expenditures are also Legacy Medicaid expenditures where the states. We are having a policy debate that looks to significantly reduce Medicaid’s ability to respond to emerging public health crisises:

the current system where the Feds give the states an open ended funding stream that is a state specific multiple of the state contribution. The block grant removes the variability of the federal spending commitment. In the Ryan plans, it also shrinks in terms of real purchasing power over time so states either spend more money to maintain current level of enrollment and services or cuts to enrollment and services have to occur.

And here is where there is a problem. The capitated payments would be based on average expected costs in year 1 and then get weaker. States with disproportionate clustering of high cost conditions will be significantly worse off. Long run Zika neurological impairments will hit warmer states’ Medicaid budgets much harder and more dis-proportionally than Zika will hit cold weather states’ Medicaid budgets…. The block grant system fails unless there is a side payment of new federal funds. And given the political fights over natural disaster relief bills and the Zika bill, I have a hard time seeing Congress routinely providing multi-billion dollar cash infusions to a few states for new diseases or threatening epidemics.

Further more, the new CDC data indicates that severe birth defects are occurring more often than previously thought.

This is a case example of the problems with block granting with a shrinking real-dollar allocation. It can’t handle shocks.

32 replies
  1. 1
    WereBear says:

    They will kill us all for money, given the chance.

  2. 2
    TenguPhule says:

    Meanwhile the GOP will ban abortions for poor women, forcing them to give birth…..

  3. 3
    Mary G says:

    They want poor people to die, as a feature not a bug, then the rich have more room and don’t have to pay taxes for upkeep of what they see as useless people.

  4. 4
    jl says:

    Is there really a policy debate right now on Medicaid capitated block grants? Isn’t this just a provision that fades in and out of the various legislative fantasy vapor-ware that is bouncing around the GOP House caucus rooms?

    I mean, one could have an actual policy debate, but what is going on right now with the NObamacare deface and shift blame game among the GOPers is not a policy debate. It’s just random shit they are tossing into and removing from their proposals. Which news reports say are not stable enough to formalize into a document of any description.

  5. 5
    scav says:

    Lead poisoning,microcephaly, no school lunches . . . I,m sure many have noted their cunnong plan for continuing and invigorating their base.

  6. 6
    aimai says:

    I am so angry about this I can’t even tell you. I have been tracking this story because–hello! I’m a fucking human being and the enormous tragedy that Zika is going to be eclipses Ebola, to me. And yet the press, mysteriously, aren’t hammering the Trump administration on this. I wonder why?

    I have two daughters and dream some day of being a grandmother–how on earth can any Republican look their wives and daughters in the face with the way they are handling this health crisis. Are they so fucking stupid that they think their daughters can’t be bitten by a mosquito? Do they think this only happens to poor women? Or POC?

  7. 7
    Miss Bianca says:

    @aimai:

    Are they so fucking stupid that they think their daughters can’t be bitten by a mosquito? Do they think this only happens to poor women? Or POC?

    Yes. SATSQ. Or, rather – they have such a paucity of both imagination and empathy that they will simply refuse to entertain the possbility until it happens to one of their loved ones. Just like the people I saw when I was working at PP who sobbed, “but I never thought *I* would need an abortion! Mine is a special case!”

    Not to make light of that situation, either – but it was all I could do sometimes to say, “what the hell do you think ‘pro-choice’ means, anyway? It means that EVERYONE’s case is a special case, sunshine!”

  8. 8
    Mike J says:

    Just last week I saw somebody online asking about all that phoney zika stuff we heard before the olympics.

  9. 9
    Yarrow says:

    Long run Zika neurological impairments will hit warmer states’ Medicaid budgets much harder and more dis-proportionally than Zika will hit cold weather states’ Medicaid budgets….

    Good thing they keep voting for Republicans.

  10. 10
    Mnemosyne says:

    @aimai:

    Are they so fucking stupid that they think their daughters can’t be bitten by a mosquito? Do they think this only happens to poor women? Or POC?

    That’s exactly what they think. And, as Miss Bianca said, when it happens to them and their family, they will demand to be treated like a special case, unlike all those lesser people in the same boat.

    G says that the people who think like that and claim to be Christians believe in Velvet Rope Jesus. They think that they’re on the list and are going to be allowed to breeze past everyone else, because they’re just that important.

  11. 11
    aimai says:

    @Yarrow:
    Right, this is the problem with block granting or with a one size fits all approach to health insurance payouts –different regions have different mixes of needs and costs. Its absolutely possible for specific regions to have catastrophically high usage of the insurance pool because of natural causes, acts of god, or human evil (see, e.g. Flint).

  12. 12

    @Mnemosyne: I seem to recall Tim “dago wine” Ryan, who challenged Pelosi’s speakership from the heartland left, complaining that congress was wasting its time fighting about Zika funding when they could have been giving money to white people in Wisconsin.

  13. 13
    rikyrah says:

    this is so sad.

  14. 14
    aimai says:

    @Mnemosyne: Love this concept “Velvet Rope Jesus”

    –Jesus is my maitre d’!
    No waiting at the rope for me
    If I should die before I wake
    Jesus will my charge card take….

  15. 15
    jl says:

    @aimai: I remember Velvet Rope Jesus in the parable of the great banquet. IIRC all the good people were worried about appropriate protocol and asked to be put on a VIP list so they could RSVP. So Velvet Rope Jesus said the ‘hell with it’ and threw a house party for all the undeserving crumb bums and hobos.

  16. 16
    TenguPhule says:

    @aimai:

    how on earth can any Republican look their wives and daughters in the face with the way they are handling this health crisis.

    Its easy, they don’t. They look lower. The only bits that matter.

  17. 17
    Yarrow says:

    @Mnemosyne: LOVE Velvet Rope Jesus. Please thank G for coming up with the term. In the analogy does that make St. Peter the bouncer?

  18. 18
    amygdala says:

    It’s also worth pointing out that we’re still operating with an acting CDC Director. Not that she isn’t competent, but I don’t think Trump has even put forth a nominee. And heaven help us if it’s another anti-science wackmobile.

  19. 19
    The Moar You Know says:

    I have two daughters and dream some day of being a grandmother–how on earth can any Republican look their wives and daughters in the face with the way they are handling this health crisis.

    @aimai: The hardcore – like the jackass Albo below whose wife cut him off and hopefully has enough self-respect left to divorce the sack of woman-hating crap – look at the women in their lives and see house servants, pleasure holes, and baby incubators. They are not capable of viewing them or interacting with them as fellow human beings.

  20. 20
    A Ghost to Most says:

    I think in lieu of commenting on that, I would say thank you Zeus, for directing H.R. McMaster into a position to perhaps put the brakes on this ruinous train.

  21. 21
    mai naem mobile says:

    @amygdala: I heard Dolt 45 is looking at Dr.Laura,Dr Bill Cosby ,Dr.Huxtable and Dr.Doogie Howser.

  22. 22
    jl says:

    @A Ghost to Most: Yes, I saw something that said McMaster was trying to institute a ‘Scowcroft’ model. There is a lot to argue for and against such a model, but it is certainly better than the likes of Bannon. I also see in the news that some Trumpsters and Flynnites are already complaining their Great Cause is being betrayed. If only the Czar knew!

  23. 23
    jon says:

    @Mike J: Yep. I think on the Woo Site links various former friends on Facebook were screaming about as they reposted, the conspiracy involves (scary voice) MONSANTO!

  24. 24
    frosty says:

    @Mnemosyne:

    G says that the people who think like that and claim to be Christians believe in Velvet Rope Jesus.

    That’s just brilliant! Thanks, I’ll be stealing it.

  25. 25
    artem1s says:

    Lead poisoning, black lung, Zika, hillbilly herion, fentanyl overdoses… hep c on the rise, HIV and tuberculosis can’t be far behind. And we have to try and fight all this with an executive branch that doesn’t believe in science and does believe in eliminating NIH and HHS. We are so enormously fucked. And if what is left of the sane rational government reps and workers actually manages to save us before we descend back into the dark ages, the dumb rubes of Cult45 will still blame the people who are trying to save them. Morans. Fuck Mike Pence in particular. Evil Fucking Bastard.

  26. 26

    @mai naem mobile: I get the first three, but what did Doogie do to make this dubious list?

  27. 27
    J R in WV says:

    @Ben Cisco (onboard the Defiant):

    Doogie is fictitious, so he’s a safe choice, no matter what happens!

    I had almost forgotten Zika, until reminded by this post. Dammit!

    No CDC is necessary, ya’ll just go to church and prey on the help, OK?

    Bless yore littul pea-pickin’ hearts!!!

    Vaccine for birth defects? Whut if Gawd wants yore kid to have no brain? There’s a purpose there, to elect more Republicants~!!!!

    These monsters make me sick!!

  28. 28
    Ohio Mom says:

    Even if some of these babies appear unscathed, I wouldn’t be giving sighs of relief just yet. Subtle brain anomalies can take a while to show up.

    There are a couple of young women I know who were exposed to crack before birth. They seemed fine when they were little but as they grew up and the intellectual, social, emotional, and behavioral bars were raised…let’s just say they aren’t functioning very well as adults.

  29. 29
    mai naem mobile says:

    @Ben Cisco (onboard the Defiant): duh,it’s a distraction from the Russia treason story. Also current grown up Doogie Howser looks like a central casting doctor.

  30. 30
    Mnemosyne says:

    Now you guys are making me paranoid about my two mosquito bites. Fortunately, I am not pregnant and not likely to get pregnant now that I’m perimenopausal.

  31. 31
    Sab says:

    @Major Major Major Major: Tim Ryan ain’t all that left for anyone who isn’t a white male catholic.

  32. 32
    Gretchen says:

    @amygdala: I think we’re probably better off with an Obama-era holdover as acting director than the kind of person Trump picks, who wants to destroy the agency.

Comments are closed.