Category: Health Care

Policy in the Pandemic: Housing Security Policies Reduce U.S. COVID-19 Infection Rates

As the impact of COVID-19 grows in the United States, the lack of vaccines or effective treatment, coupled with anticipated subsequent outbreaks, has made it necessary to adopt unprecedented policy interventions across many aspects of daily life. Now many people are facing financial challenges resulting from these interventions and are struggling to pay housing and utility costs.

In response, many jurisdictions have temporarily halted evictions, suspended foreclosures, and granted relief from utility shutoffs. For example, the federal CARES Act placed a 120-day moratorium on evictions for properties that participate in government programs or that have a federally backed mortgage loan. In addition, many state and local governments issued orders that electric and water utilities continue service even when customers were unable to pay their bills. These protections have been essential for stabilizing people who have lost jobs or experienced income reductions. But they are beginning to expire just as many states are seeing increasing numbers of COVID-19 cases.

Given these evolving circumstances, we decided to look at how housing security interventions have affected infection rates. In our analysis, we evaluate the impacts of:

  1. locally implemented policies targeting housing security (specifically, policies designed to prevent eviction or shutoff of water and/or electricity),1
  2. federal policy implemented through the CARES Act,2 and
  3. orders that restrict movement (i.e., “stay-at-home orders”).3

Our data constitute a panel of daily observations of the confirmed infections in each of 3,141 U.S. counties from March 1 to May 31.4 We calculate the growth rate in infections5 and use county-level fixed effects to adjust for county-level characteristics that do not change over our sample period (i.e., age, race, income, education, housing security, health indicators, environmental indicators, institutional living, transportation use, and percent of the workforce employed by an essential business). We also use fixed effects that vary by week and state to account for changing access to testing. Finally, we include a flexible time trend and account for the duration that each policy has been in effect.

Figure 1
Figure 1

The scenarios presented below illustrate the impacts of these housing security policies on daily coronavirus case growth rates and the degree to which they may matter for managing the pandemic. We found that the CARES Act and eviction, water, and utility moratoria significantly reduced daily infection growth rates as compared to a simulation of the growth rate if no policies were implemented.

Figure 1 illustrates the combined effect of all three policy categories as they were actually implemented in the U.S., or the average growth rate across all counties at each point in time, combined with a simulated growth rate showing the result if none of the policies had been adopted. If we assume no policies had been adopted, the predicted average growth rate per day is 7.2%, while the actual growth rate is 4.7%. Thus, at the end of the sample on day 91, the predicted growth rate of an average county where no policies were in effect is 8.7% whereas that of an average county in reality is 2.3%, suggesting that the set of policies has reduced the growth rate by 6.4%.

Figure 2
Figure 2

Figure 2 breaks down the role of eviction and utility moratoria in those reductions. The evictions moratoria and water and utility moratoria show the average daily growth rate if every county in the U.S. had implemented these policies throughout the duration of the sample period. These are again compared to a predicted average daily growth rate for no policies of 7.2%. If a state or local eviction moratorium were in place, the average growth rate per day decreases to 2.7%; if the water and utility shutoff moratoria are in place, the average growth rate per day decreases to 4.6%. This shows that the eviction moratoria reduce the average growth rate by 4.5% and water and utility shutoff moratoria reduce the average growth rate by 2.6%.

In Figure 3, we turn to the effects of federal housing policy through the CARES Act and stay-at-home orders, relative to a “no policy” daily growth rate. On average, while the CARES Act is in place, the predicted growth rate per day is 5.0%, reducing the average growth rate by 2.2%. If a stay-at-home order is in place, the predicted growth rate per day is 7.0%, which results in a 0.2% reduction in the average log growth rate.

Figure 3
Figure 3

Our analysis shows that eviction, electricity, and water utility moratoria have played an important role in containing the COVID-19 pandemic and one that should be carefully considered as these moratoria are lifted. We are engaged in continuing to analyze these policies and their effects at mitigating the spread of COVID-19. Simultaneously, these policies also have impacts on landlords and utilities, the implications of which are not well understood either. A deeper understanding of how these moratoria affect both the spread of COVID-19 and those who supply housing, water, and electricity will better inform policy decisions during this public health crisis.

Kay Jowers is a senior policy associate with the State Policy Program at Duke University’s Nicholas Institute for Environmental Policy Solutions. Christopher Timmins is a professor in the Department of Economics at Duke University. Nrupen Bhavsar is an assistant professor in medicine at Duke University School of Medicine.

The Big Questions

To continue the conversation on this week’s topic, here are a few questions for further consideration and study:

  1. How will phasing out moratoria on evictions and essential service disconnects affect people of color and low-income/low-wealth people who are already suffering disproportionally from the COVID-19 pandemic?
  2. Should decision makers extend moratoria on evictions and water and electricity disconnections?
  3. What effects are eviction, electricity, and water utility moratoria having on landlords and utilities?

What to Know for This Week

  • preliminary data snapshot released by the Centers for Medicare & Medicaid Services (CMS) pointed to income and race/ethnicity as critical predictors of COVID-19 infection and hospitalization rates among older Americans. Based on a study of billing records through mid-May, low-income individuals enrolled in both Medicare and Medicaid were four times more likely to be infected or hospitalized for the virus than people on Medicare alone. The data snapshot also found Black Americans on Medicare were hospitalized at a rate nearly four times higher than whites.
  • The International Energy Agency (IEA) has argued that post-COVID recovery policies can ensure that 2019 was the “definitive peak” for global emissions. The IEA frames its proposed series of measures as a “once-in-a-lifetime opportunity” to pour investment into clean energy and create millions of new jobs.
  • For sub-Saharan Africa, 2019 power sector investment levels were already just one third the level needed to support full, sustainable electrification by 2030. But the IEA’s latest projections on 2020 investments are downright scary for many developing countries struggling with access. Globally, grid investments and renewable generation investments are projected to fall 9% and 10% respectively in 2020, however that impact will be more acute in Africa and other markets reliant on state-owned utility financing. As utilities face climbing non-payment from customers suffering financial stress during the pandemic, many cash-strapped national governments already facing higher borrowing costs and increasing sovereign debt risks will be forced to further intervene to support utility finances.
  • Habitat destruction and the wildlife trade create conditions favorable for viruses such as COVID-19 to jump from animals to humans. In an April commentary in Issues in Science and Technology, Leah R. Gerber, director of the Center for Biodiversity Outcomes at Arizona State University, calls for a new global body with “scientific heft and enforcement teeth” to spotlight what drives zoonotic leaps of disease and to work to minimize these risks. Gerber outlines three immediate tasks that the body should address: support and speak for basic science, become a global governance regime with regulatory clout, and transform the global economy and markets to avoid these risks.
  • An editorial essay in The International Journal of Protected Areas and Conservation explores the negative impacts that COVID-19 is having on protected and conserved areas, including management capacity, budgets, and effectiveness, as well as on communities in and around these areas. Effectively and equitably managed systems of protected and conserved areas can be part of a response to the pandemic that both lessens the chance of a recurrence of similar events and builds a more sustainable future for people and nature, the authors write.

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Missouri Policies Allow Consumers to Be Overcharged for Drugs

Jefferson City — Believe it or not, generic medicines can be less expensive than co-pays, making them cheaper to buy outright than with insurance – but your pharmacist may be banned from telling you that. The cost difference doesn’t go to the pharmacist, it doesn’t go to the drug manufacturer, it goes to the middleman: the drug benefit manager. That payback is called a clawback.

Clawbacks can range from $2 to $30 a prescription, boosting profits while unfairly charging consumers.

Patients shouldn’t have to pay more than a drug costs. Many states are moving to block the “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash rather than using their health insurance. Missouri should be the next state to join that list.

HB 1542 sponsored by Representative Lynn Morris, prohibits clawbacks and eliminates gag clauses in Missouri. This bill will allow your pharmacist to tell you the least expensive way to pay for your drugs and will save Missourians money.

“With the costs of drugs skyrocketing in this country, consumers should be enabled to make informed decisions.” says Cara Spencer of the Consumers Council of Missouri. “Policies that prohibit a pharmacist from communicating pricing information to a patient should have no place in our state. HB 1542 deserves to be heard.”

Please contact our state leadership and let them know that the cost of drugs is important to Missouri consumers and we shouldn’t have to pay more unknowingly.

MO Speaker of the House Todd Richardson:  573-751-4039,
Majority Floor Leader Rob Vescovo: 573-751-3607,

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Report Card: 2018 MO Health Insurance Increases

Consumers Council of Missouri has completed a formal review of proposed 2018 health insurance rates in the state of Missouri. This marks the first year the Missouri Department of Insurance has the authority to review rates and CCM is calling for the Department to deem each of the rates hikes “unreasonable.”

Three companies will be offering insurance on the exchange in Missouri in 2018: Cigna, Healthy Alliance (Anthem) and Celtic (Centene, new to the MO exchange). Proposed rate increases are estimated to affect hundreds of thousands of Missourians and increases vary from 17% to 73% for individual plans. This will have a significant impact on consumers ability to afford insurance throughout the state.

In summary, the filings include several unreasonable assumptions as well as a redaction of much of the data needed to properly analyze the findings. Therefore, Consumers Council of Missouri urges the Department to exercise its authority under Mo. Rev. Stat. § 376.465.10(4) and deem rates proposed by both Cigna and Healthy Alliance  unreasonable absent further justification.

CCM’s full report of Cigna’s rate filing can be downloaded here and our full report for Healthy Alliance can be downloaded here and with our letter to the Department which summarizes both may be viewed here.

Join us in commenting to the Department of insurance. Instructions for filing comments can be found here and a sample letter to the Department can be downloaded here.

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The MO Exchange: Steep Rate Hikes Expected

Proposed rates for the 2018 Missouri health insurance exchange were released on Friday by the Missouri Department of Insurance.

While the Department and our state’s carriers both deserve credit for ensuring that all counties in MO have ACA coverage, this comes at significant cost. Requested increases average between 35 and 42% according to a review by the Department and as reported here.

What makes these increases even worse is that they come with compromised transparency to the general public, allowing carriers to hide critical elements they are relying on to justify significant increases. While many states allow no redactions at all, Missouri insurance companies routinely omit reasons for increases from public documents. You can read CCM’s request and legal argument for more transparency here.

Join Consumers Council of Missouri as we weigh in on these proposed rates. By federal law, the public has 30 days to comment. Contact us if you’d like guidance on submitting comment.

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Health Insurance Rate Increases: Transparency Please!

Under Governor Greitens, the state has launched an initiative to increase transparency and within that framework, Consumers Council of Missouri submits a formal argument that the Department’s regulation 20 CSR § 10-2.400, on the redaction of trade secrets, should be updated to reflect what is required by law and that nothing that isn’t a trade secret should be withheld from the public.
Insurance companies routinely designate a substantial amount of information in their rate filings as confidential which makes it virtually impossible for consumers to weigh in during federally mandated public comment periods. If we really want to increase transparency as a state, we should add transparency, we should start with the rising costs of health care.
Download the entire submission here:

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Public Access to Health Insurance Rates Postponed in MO

The annual review of health insurance rates helps to protect consumers from insurance companies unjustly increasing rates on premiums. Federal regulations specify that 2018 health insurance rates must be made public by August 1 to facilitate this review process but the Missouri Department of Insurance has postponed public access of these filings in our state to September 1, 2017.

With all the activity on the national level regarding the future of subsidies and the last-minute addition of Centene to the MO marketplace, it is no surprise that the Department has postponed the date. But the delay will hurt the ability of consumers and advocates to review health insurance rate increases for 2018.

This makes our work even more important. Consumers Council of Missouri and our rate review legal team will be ready to go come September 1. Stay tuned for what’s in store for MO health insurance consumers.

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The ACA void has been filled in MO

The MO Director of Insurance joins consumer advocates at CCM in cheering Centene for filling the ACA void in our state. While we would like to see more choice in MO, 1 choice is certainly better than no choice.

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Centene to now offer Obama Care in MO In 2018

With a large part of MO at risk of having no insurer next year, Centene decides to sell Obamacare plans in MO. Read more here.

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Concentration in the health care market

The effects of concentration within the Health Care Market cannot be overstated. Join @SLU_HealthLaw this Friday!

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Exit would be disastrous for MO

The potential exit of Anthem from ACA in Missouri would be disastrous for Missourians ACA choice. And highlights the importance of reviewing rate increases by consumer watchdog like CCM.

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