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Dentists Versus Insurers

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

Wednesday, April 29, the Senate Health Committee held a public hearing on SB 295, sponsored by Senator Paul Bussman (R-Cullman).

Sen. Bussman is a dentist. He said that SB295 simply says that if a health insurer develops a quality rating system for dentists, the cost of services would not be a factor.

Sen. Bussman said that Dentists are paid a certain fee for a service, but that does not mean the same service is equal. “I can order crowns from India for a very reduced fee or I can buy a crown in the United States that is of much better quality at a higher cost.”

Phillip Kennedy, representing the Alabama Dental Association, spoke in favor of the bill.  Kennedy says that this issue has not impacted Alabama yet, but is an emerging issue around the country. 

The cost of those services should not be a part of any rating system. “The bill does not say that insurers cannot do a rating system.”

Robin Stone, the Executive Director of Governmental Affairs for Blue Cross Blue Shield (BCBS) of Alabama, spoke against the legislation.  Stone said, “We agree that cost should not be the only factor in a rating system, but it should be a component in a rating system if an insurance company should choose to do that.”

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Stone said, “More people have dental insurance now than ever in the history of the State. We have over 1 million dental customers.  Dental care is more accessible now than ever. This bill would prohibit BCBS from using cost in a rating system.  Our concerns are that cost impacts our customers in a big way. This takes cost off the table. Our customers are always looking at the cost and quality of care. Cost is critically important to our company and to our customers. They are very concerned about their premiums, copays and deductibles going up. People are looking for greater value. People are Searching for economy. This has never been passed as a stand alone bill anywhere in the country.”

Stone said that when the time comes for the insurers to develop a rating plan for dentists, insurers should make that decision. “We don’t have one and don’t plan to put one in…Allow the insurance community to work with our providers…We are always happy to work with the dentists like we are with other providers.”

Sen. Bussman said, “First you said you had no plan then you said when the time comes you are contradicting yourself.”

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Stone said, “We do not have a current plan or idea to do this.”

Bussman asked, “Does your company pay the same across the State?”

Stone said “I think it is the same.”

Sen. Bussman asked, “Would you favor the bill if cost were only part of it?”

Stone said, “I don’t know that I would support it, but it would be a step in the right direction.”

Sen. Linda Coleman (D-Birmingham) said that she believes in capitalism and private enterprise and worried about too much regulation.

Stone said that BCBS has 2.1 million customers in Alabama and over a million dental customers. “Our customers and companies are constantly asking us how to reduce cost particularly in small groups.”

Sen. Coleman said, “I don’t think the legislature should be dictating to companies about cost. This seems to be more of an internal industry thing and I don’t know that this is something that the legislature should be involved in.  I am not necessarily for us always having to pass something so that we have to regulate something.  Maybe we should find another way rather than using a cannon to kill a gnat.

Business Council of Alabama President Billy Canary also spoke against the bill. Canary said that BCA opposes this bill philosophically. “We believe very strongly that possible mandate bills reduce the choice that companies have. Cost is a factor in dental care.”

Canary praised legislators as well intentioned individuals. Canary said that he wants to create a dialogue for an easier way to remedy these concerns. “We have a very active healthcare committee within the BCA structure that would be happy to work with this committee.”

Sen. Bussman amended the bill so that cost would not be the only factor in a rating system.

Sen. Billy Beasley (D) a pharmacist said that he is afraid the quality of healthcare is not well reported by ratings systems. “We have star ratings in pharmacy. If I don’t do what they want me to do, I lose a star. If do what they want me to do, I gain a star.  It has nothing to do with the practice of pharmacy.”

Sen. Bussman said all dentists do things differently. “The cleanliness of my office, the equipment I use, that I schedule patients so they don’t have to wait all provide value to my patients. 10:00 means 10:00 not like the legislature and they start at 10:15. Other people will stack people in a waiting room and will get to them as they get to them just to make sure there are bodies in the chair. There is a value for that. I use the best materials. This does not affect the insurer and it does not affect the business community in one shape or another.”

Sen. Harri Anne Smith (D) said, I would like to commend you for bringing this piece of legislation. To Canary, Smith said “It would be great to have more dialogue with you. I have not heard from you in 8 years.”

Senators Blackwell, Reed, Coleman, Wagner, Whatley, and Dial all voted against the bill.

Senators Melson, Stutts, Smith, Mcclendon, Ward, Busman, and Beasley voted for the bill.

SB295 received a favorable report from the committee 7 to 6.

Bussman also sponsored SB 296 which said that insurers can not set a fee for a service they don’t cover. Bussman said this does not cost the insurer, it does not affect the business community in any way. SB296 received a favorable report 7 to 2.

Brandon Moseley is a senior reporter with eight and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.

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Is “herd immunity” a reasonable strategy for Alabama? Evidence suggests it’s not

State Sen. Del Marsh suggested herd immunity may be the only strategy for Alabama going forward. The science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama Senate Pro Tem Del Marsh, R-Anniston, on Thursday caused an uproar when he told a reporter that he’d like to see more Alabamians get infected with COVID-19 so that we could “start reaching an immunity.” 

Marsh, a member of Gov. Kay Ivey’s COVID-19 task force, was speaking to a CBS 42 reporter about what’s called herd immunity, which means a percentage of a population gets a disease, gets over it and then has an immunity that prevents them from getting it again for a period of time.

Marsh’s suggestion that herd immunity may be the best, if not the only strategy, for dealing with COVID-19 is not new. It’s been a topic of discussion since the early days of the pandemic. Some countries have even attempted it. But the science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.

Reaching herd immunity essentially means that a population is generally protected from the worst of a disease because enough people have immunity. That can be achieved either through a vaccine or by allowing the virus to run its course until enough people have been infected. With more people infected and recovered, and with the assumption that fewer are susceptible to reinfection, transmission of the virus would slow significantly — only because there are fewer people to become infected.

Without a vaccine, herd immunity as a strategy would basically mean giving up on trying to contain the virus.

The topic of herd immunity has been brought up throughout the COVID-19 pandemic, but public health experts and scientists are quick to say they don’t yet fully understand the true strength of acquired immunity, and there have been some cases of people becoming infected with the virus more than once. 

But that doesn’t stop some from arguing perhaps we should give herd immunity a try. Sweden did, and it went terribly, as Alabama’s State Health Officer Dr. Scott Harris told a reporter when asked about the Alabama lawmaker’s statements on herd immunity. 

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Marsh followed his original statement with a caveat about protecting those with pre-existing conditions and the elderly, yet it’s not clear how an open society bent on getting as many younger people infected as possible would do such a thing.

“I’m not as concerned so much as the number of cases, in fact, quite honestly, I want to see more people because we start reaching an immunity as more people have it and get through it,” Marsh said to CBS 42’s Reshad Hudson on Thursday. “I don’t want any deaths, as few as possible. I get it. So those people who are susceptible to the disease, especially those with pre-existing conditions, elderly population, those folks we need to do all we can to protect them.”

In Sweden, where officials initially allowed the virus to run its course, they were not able to protect more vulnerable populations from infection despite efforts to do so. Vulnerable populations do not live in a vacuum, and despite their best efforts to limit exposure, long-term care facilities still have some contact with the outside world.

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It didn’t take long after Hudson tweeted out a video of Marsh’s statements for the backlash to set in. When asked by a CBS 42 reporter for his thoughts on herd immunity as a solution, Harris, the state health officer, said it would lead to many more unnecessary deaths. 

“There is absolutely no reason to think at this point that getting infected will give you any degree of immunity. We simply don’t know that,” Harris said, pointing to the fact that scientists have not reliably determined how long immunity lasts or how strong it is.

“We’ve looked at countries like Sweden, who have tried to actually generate herd immunity among their population, and it’s been disastrous. They’ve had increased numbers of deaths much higher than their neighbors, in trying to keep their economy open. It does not work well at all,” Harris said.

Marsh tried to walk back his controversial statement the next day — sort of — but he still landed back on herd immunity as an avenue Alabama might take. 

“It was a poor choice of words on my end, but ultimately what I was trying to say, and people can look at it, there are very few choices we have,” Marsh told WSFA on Friday.  “Ultimately if there’s no vaccine, herd immunity is the only one I can think of that’s eventually going to take place.” 

In Sweden, where they gave herd immunity a shot, deaths in the country have been eight times higher than in neighboring Denmark and 19 times higher than in Norway, according to The Washington Post. One study found that after months of infections and deaths, less than 10 percent of the population had developed antibodies.

In Denmark and Norway, along with most of the European Union, many restrictions have been lifted because governments there have been able to get the virus under control using testing and contact-tracing.

In Spain, one of the hardest-hit countries in Europe, just 5 percent of people had developed antibodies, according to another study in the journal Lancet. That means that at least 95 percent of the Spanish population would still be susceptible to the virus despite the country recording 28,000 deaths and 250,000 cases.

In New York City, where 32,000 people have died from COVID-19, the state tested some 28,419 people in an attempt to determine how many people had developed antibodies. That survey suggested that roughly 21.6 percent of New York City residents had antibodies. That’s in New York — widely viewed as the hardest-hit city in the world.

The science of herd immunity in a virus as new as COVID-19 is murky, because researchers still don’t know important details about how the coronavirus behaves, and every geographic location is different, with varying cultures and health outcomes, but since Marsh threw it out there, let’s see what getting to herd immunity would look like in Alabama. 

Dr. Michael Saag, an infectious disease expert at UAB and prominent HIV/AIDs researcher, told APR in May that to get the epidemic under control we’ll need at least 70 percent of the population to have immunity. Epidemiologists have estimated that between 60 percent to 80 percent of a population would need immunity before “herd immunity” is reached, and the virus can no longer spread widely in that community.

In Alabama, that would mean 3,340,000 people in total would have to become infected, and at our current approximate death rate of 2.2 percent, that would mean 75,460 Alabamians would likely die in the process. But 1,077 people have already died in Alabama from COVID-19, so to get to a theoretical herd immunity, 74,383 more people in the state would likely die from the virus. The death rate could spike if more infections happen at once, overwhelming the state’s health system.

Because we’ve got statistics on COVID-19 deaths in Alabama, we can look and see what that would mean for those yet to die. Of those 74,383 potential deaths, 58,762 would likely be 65 years of age and older. Those aged 50-64 would make up 12,654 of the deaths to come, while 2,975 would be between 25 and 49 years old, based on current death demographics.

Black people would likely continue to die in greater numbers per capita than white people. Although Black people make up just 27 percent of Alabama’s population, they make up 44 percent of all COVID-19 deaths.

It’s important to note that none of these estimates are reliable because researchers still don’t know for certain how long a person is immune after recovering from the virus — and how strong that immunity is. It’s also not clear how accurate or precise antibody tests are.

Columbia University virologist Dr. Angela Rasmussen told The New York Times that the “magical number of 60 percent for herd immunity” assumes that everyone infected has complete protection from a second infection.

“But what about people with partial protection?” she asked. “They may not get sick, but they can get infected and pass it along.”

The recent study in Spain published in The Lancet found that herd immunity with COVID-19 may be unachievable. The study, which looked at more than 61,000 people, found that 14 percent of those who tested positive for coronavirus antibodies, which means they had the virus and recovered, no longer tested positive for the antibodies in subsequent tests weeks later. 

“Immunity can be incomplete, it can be transitory, it can last for just a short time and then disappear,” said Raquel Yotti, the director of Spain’s Carlos III Health Institute and one of the authors of the study, according to Reuters.

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Alabama DHR announces grants providing temporary assistance for stabilizing child care

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The Alabama Department of Human Resources announced on Friday a new grant program to provide assistance to licensed child care providers in the wake of the COVID-19 pandemic.

The Temporary Assistance for Stabilizing Child Care, or TASCC, grant program’s purpose is to stabilize the number of child care providers that are open and providing services, as well as encourage providers to reopen.

DHR is now accepting applications for TASCC grants. The deadline to apply is August 7, 2020. The total grant amounts will be based on each provider’s daytime licensed capacity with a base rate of $300 per child.

To be eligible for a grant, licensed providers must be open or plan to reopen no later than August 17, 2020, and continue to remain open for a period of one year from the date of receiving the grant award. As of this week, 1,306 of Alabama’s 2,448 child care facilities were open in the state.

“We are proud to offer this program as a support and an incentive to an important sector of our economy. These grants will give the support many providers need to reopen and assist those already open,” said Alabama DHR Commissioner Nancy Buckner. “This program is going to be vital for our child care numbers to reach the level required to provide adequate services as parents return to work. We have already made significant strides in reopening facilities over the past several months; in April only 14 percent were open while now 53 percent are open.”

These grants will provide support for paying employees, purchasing classroom materials, providing meals, purchasing cleaning supplies, providing tuition relief for families, as well as other facility expenses.

DHR recommends child care providers read all guidance prior to submitting a TASCC application. Child care providers need to complete the application to determine the estimated grant amount. Grant applications will be processed as they are received and grants awarded once approved.

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An online fillable application is available for the TASCC grant at www.dhr.alabama.gov/child-care/. The application must include an Alabama STAARS Vendor Code in order to be processed. For questions regarding the application, please email DHR at [email protected].

 

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Gov. Ivey awards grant for new system to aid child abuse victims

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Gov. Kay Ivey delivers the 2019 state of the state address. (CHIP BROWNLEE/APR)

Gov. Kay Ivey has awarded a $375,000 grant to establish a statewide network that will ensure that victims of child abuse receive immediate and professional medical care and other assistance.

The grant will enable the Children’s of Alabama and the University of Alabama at Birmingham Department of Pediatrics to collaborate with the Alabama Network of Children Advocacy Centers in creating the Child Abuse Medical System.

 “Child abuse is a horrendous crime that robs children of their youth and can negatively affect their future if victims do not receive the proper professional assistance,” Ivey said. “I am thankful for this network that will ensure children get the professional attention they need and deserve.”

The medical system will be a coordinated statewide resource that includes pediatric physicians, nurse practitioners, nurses and other medical professionals along with specialized sexual assault nurse examiners.

The Alabama Department of Economic and Community Affairs is administering the grant.

“ADECA is pleased to join with Gov. Ivey and those dedicated people who are part of the Child Abuse Medical System to support these children at a time they need it most,” said ADECA Director Kenneth Boswell.

Ivey notified Tom Shufflebarger, CEO of Children’s of Alabama, that the grant had been approved.

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ADECA manages a range of programs that support law enforcement, economic development, recreation, energy conservation and water resource management.

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U.S. Attorney Jay Town announces resignation

Eddie Burkhalter

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U.S. Attorney Jay Town announced his resignation Friday. (WHNT)

Jay Town, the U.S. attorney for the Northern District of Alabama, on Friday announced his resignation and plans to work at a Huntsville defense contractor and cybersecurity solutions company. 

Town’s resignation will be effective Wednesday, July 15, according to a press release. 

“After much thoughtful prayer and great personal consideration, I have made the decision to resign as the United States Attorney of the Northern District of Alabama.  I have tendered my resignation to Attorney General William Barr. General Barr expressed his gratitude for my service to the Department of Justice and to the Northern District and, despite having hoped I would continue in my role, understood and respected my decision,” Town said in a statement. 

“I am extremely grateful to President Trump, to whom I also tendered a letter, for his special trust and confidence in me to serve as the U.S. Attorney. It was an honor to be a part of this Administration with an unrivaled class of United States Attorneys from around the nation.  I will forever remain thankful to those who supported my nomination and my tenure as the U.S. Attorney,” Town continued.

Town said his job with the unnamed Huntsville defense contractor and cybersecurity solutions company is to begin later this year, and the company is to announce his position “in a few weeks.” 

“The Attorney General of the United States will announce my replacement in the coming days or weeks,” Town said in the release.  

Town has served in his position since confirmation by the U.S. Senate in August 2017. Prior to that appointment, Town was a prosecutor in the Madison County District Attorney’s office from 2005 until 2017.

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Attorney General William Barr in a statement Friday offered gratitude for Town’s three years of service. 

“Jay’s leadership in his District has been immense.  His contributions to the Department of Justice have been extensive, especially his work on the China Initiative and most recently as a Working Group Chair on the President’s Commission on Law Enforcement and the Administration of Justice. I appreciate his service to our nation and to the Justice Department, and I wish him the very best,” Barr said in a statement.

The U.S. Justice Department in April 2019 notified Gov. Kay Ivey that the department’s lengthy investigation into the state’s prisons for men found systemic problems of violence, sexual assaults, drugs and corruption which are likely violations of the inmates’ Constitutional protections from cruel and unusual punishment. 

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Town’s office leads the discussions between the U.S Department of Justice and the state on the prison conditions. 

Problems with violence, deaths and drugs in Alabama’s overcrowded, understaffed prisons have not markedly improved in the year’s since the U.S. Department of Justice released its report.

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