The novel coronavirus has been called “the great equalizer,” when in reality, it has only exacerbated health inequities that racial and ethnic minorities have experienced for decades.

As millions of Americans have lost their jobs, Congress is trying to figure out what to do to help those who have also lost their health insurance.; Credit: South_agency/Getty Images

Mayra Jimenez had just lost the job she loved — and the health insurance that went along with it.

The 35-year-old San Francisco server needed coverage. Jimenez has ulcerative colitis, a chronic condition. Just one of her medications costs $18,000 per year.

"I was just in panic mode, scrambling to get coverage," Jimenez said.

A recent estimate suggests the pandemic has cost more than 9 million Americans both their jobs and their health insurance.

"Those numbers are just going to go up," MIT economist Jon Gruber said. "We've never seen such a dramatic increase in such a short period of time."

House Democrats introduced a bill in mid-April to help the millions of people, like Jimenez, who find themselves unsure of where to turn.

The Worker Health Coverage Protection Act would fully fund the cost of COBRA, a program that allows workers who leave or lose a job to stay on their former employer's insurance plan. COBRA currently requires workers to pay for their entire premium, including their employer's share.

The Worker Health Coverage Protection Act is one bill being considered as Congress tries to figure out what to do about the very real health care gap for those millions who have lost their jobs. Sponsors of the COBRA legislation say they hope their plan gets rolled into the next relief bill. But it's unclear when, how and whether the problem will get addressed in upcoming coronavirus relief measures.

Jimenez learned COBRA would run her $426 a month.

"I was kind of shocked to hear the number," she said. "That's almost half my rent."

The idea of allowing laid-off workers to stick with their coverage at no cost in a pandemic has clear appeal, says Gruber.

But he warns, "COBRA is expensive, and for many employees, it won't be there."

Only workers who get insurance through their employer are eligible for COBRA, leaving out more than half of the 26 million who have lost jobs in the last few weeks. Many of the industries hit hardest by COVID-19, including retail and hospitality, are among those least likely to offer employees insurance.

And even if someone had insurance through work, the person loses COBRA coverage if the former employer goes out of business.

Funding COBRA costs, federal dollars also wouldn't go as far as they could. Unpublished Urban Institute estimates show that an employer plan costs, on average, about 25% more than a Gold plan on the Affordable Care Act exchanges.

"We need to be all hands on deck, spending whatever we can to help people," Gruber said. "But that doesn't mean we shouldn't be thinking about efficient ways to do it."

Congress has tried this move before. In response to the Great Recession, lawmakers tucked a similar COBRA subsidy into the massive stimulus bill a decade ago. That legislation paid for 65% of COBRA premiums, leaving laid-off workers to cover the rest.

A federally commissioned study found that COBRA enrollment increased by just 15%. Mathematica senior researcher and study co-author Jill Berk said workers skipped the subsidy for two main reasons.

First, only about 30% of eligible workers even knew the subsidy existed.

"For those that were aware," Berk said, "their overwhelming response was that COBRA was still too expensive."

At that time, the average premium for a single worker — even with the subsidy — ran about $400 per month for a worker with family coverage.

"When you're actually facing those choices, choosing between rent and food and other bills," Berk said, "that COBRA bill looks quite high."

Berk's team also discovered that people who reported using the subsidy were four times more likely to have a college degree and a higher income than those who passed on it. In other words, Berk found that the COBRA subsidy was least helpful to those with the greatest need.

Several economists, including Gruber, and some Democrats in Washington are kicking around alternatives to COBRA. Among their ideas is a plan to have the federal government pick up more of a person's premium and other expenses on the Affordable Care Act exchanges. Another proposal would extend ACA subsidies to people who earn too much to qualify for any aid and to lower-income people who live in states yet to expand Medicaid.

Compared with funding COBRA, beefing up ACA subsidies could potentially help millions more people, including the pool of laid-off workers who did not get health insurance from their employer.

The ACA ties subsidies to people's income, giving more help to those at the bottom end of the wage scale and spending less on those who are better off. In contrast, the current COBRA plan would cover 100% of COBRA for everyone, regardless of the person's income.

There are some downsides to this approach. Making ACA subsidies more generous could end up costing the federal government more overall, because it gives more help to a lot more people.

Chris Holt from the American Action Forum, a conservative think tank, points out that the ACA already increases federal support when people's earnings fall and questions how much more of the tab Washington should pick up.

"If that subsidy would have been good enough for someone six months ago, why is it not good enough now?" he asked.

Maybe the biggest challenge to building on the ACA: The 10-year-old law remains a political football.

"There's just so much both emotion and, frankly, bitterness tied up in debates," Holt said, adding that this makes it hard to move anything forward.

Holt notes that COBRA is not free of political hang-ups either. He expects a fight over whether subsidy money can be spent on employer plans that cover abortion services, for example.

Holt and Gruber agree that perhaps the easiest idea is to leave the ACA alone with one minor tweak: allow people to take the ACA subsidy they're already eligible for and use it on COBRA if they choose.

As for Jimenez, she did not have time to wait for Congress. She brought in too much from unemployment to qualify for Medicaid. And she couldn't afford COBRA, so she picked out a plan on the ACA exchange, where she's eligible for generous existing subsidies. It will cost her $79.17 per month, and she gets to keep her doctors. Not everyone does.

This is the first time she has ever purchased insurance on her own, rather than gotten it through work — and that has delivered one other unexpected benefit.

"Freedom," Jimenez said. "It feels so freeing to take charge of my health care and to know that no one can take this away from me. I don't have to rely on a job to give me what they want to give me. I can make my own choices."

Policymakers, providers, employers and health-industry executives have been fighting over whether the United States should tie insurance to work since the end of World War II.

Subsidizing COBRA preserves the status quo, while doubling down on the ACA might just start to drive a real wedge between work and health insurance.

As states begin reopening businesses, some laid-off workers will get back their jobs, as well as their insurance. But many will remain unemployed and uninsured. A decade ago, faced with the same challenge, Congress chose to subsidize COBRA. It proved to be a narrow solution with limited impact.

Lawmakers now have the ACA at their disposal, a tool that may be a better fit for this moment. Whether they choose to use it may be a choice grounded more in political realism than policy idealism.

Dan Gorenstein is the creator and co-host of the Tradeoffs podcast, and Leslie Walker is a producer on the show, which ran a version of this story on April 23.

This content is from Southern California Public Radio. View the original story at SCPR.org.

As the world turns to technology to track and contain the COVID-19 pandemic, could this spell the end of digital privacy rights?

The post Public health vs. personal privacy: Choose only one? appeared first on WeLiveSecurity

Source: Keith Schaefer for Streetwise Reports   04/28/2020

An entirely new—and highly profitable—industry is being borne out in 2020—TeleHealth.

CloudMD Software & Services Inc. (DOC:CSE; DOCRF:OTCQB; 6PH:FSE) is my favorite way to play teleHealth. It's growing quickly with over 100,000 patients registered on its app and over 3000 doctors in 8 provinces in its Electronic Medical Records—EMR—system. It has MULTIPLE revenue streams and it just moved into Canada's largest market—Ontario—setting up an even faster growth rate.

The recent spread of coronavirus is only accelerating this. COVID-19 has forever changed how we all will think about visiting a hospital or seeing our doctor. We really don't want to do that at all, if possible. It will have a very positive and long lasting impact on teleHealth.

teleHealth companies in Canada are getting paid more money for services than bricks-and-mortar clinics, and have a fraction of the costs. Doctors want more of it, patients want more of it, government wants more of it—and the Market REALLY wants more of it. Everybody wins here; there is no downside.

The rapid scale-up and profitability is key for investors.

The stock market is now recognizing this trend—in spades. You can see it in the stock chart of the U.S. leader in teleHealth, Teladoc Health Inc. (TDOC:NYSE).

While the market plummeted Teladoc's business and share price soared.

Now that a firm trend is in place—and teleHealth is one that makes a lot of sense—I'm looking for the junior with the best leverage to this new long term trade.

CloudMD is established, growing quickly and trading at a fraction of its peers.

The average multiple of competitors in the sector trade at 5-7x revenue, and CloudMD is trading way below that at 2.5x per revenue. I'll have more on those comps in a moment.

But realize that the Canadian use of telemedicine is still just a fraction of where it is in the U.S—so the quick, early upside is even bigger.

Literally the Canadian Version of Teladoc Health

The story with this stock is very simple. CloudMD is literally the Canadian version of Teladoc Health—just at an earlier stage in the growth curve.

The market desperately wants to own teleHealth right now (see also the stock charts of LVGO-NASD and CATS-NASD). I see CloudMD as the best way to do that in the junior sector (where the leverage is!).

For this stock to have a major run all that needs to happen is for institutional investors to wake up to the fact that the company exists. That's happening now with the company entering the province of Ontario—which has 14.5 million people, over one-third of Canada's population.

CloudMD is a fully integrated health care company—kind of like a hospital-in-the-sky. They do have five bricks-and-mortar clinics, but they also own their own EMR—Electronic Medical Records—system that operates in eight provinces and is used by over 3,000 doctors and is supported by an in-house 25 person development team. They have their own CloudMD app—which has over 100,000 registered patients already.

Folks, we really are in front of the institutions on this one. I don't have room in this article to even talk to you about the depth and credibility of CEO Dr. Essam Hamza, but after several conversations with him I can say that shareholders are in very good hands.

The EMR gives CloudMD a recurring monthly revenue stream, which The Street loves. The app gives them high margin fees from doctors, specialists and groups like massage therapists and counselors. These people are revenue, not costs. As I said, full hospital-in-the-sky. Multiple revenue sources with lower costs.

To schedule a virtual doctor's appointment all that a patient has to do is download the free CloudMD app and then arrange an appointment with one of the doctors. There is zero charge for the patient and they can see a doctor very quickly.

CloudMD can scale up the number of patients VERY quickly—and they are.

Every aspect of healthcare that's very fractured and disjointed will now be in the one CloudMD ecosystem.

Everyone wins with this system. Patients, doctors, the medical system, society, even investors. Everyone.

TeleHealth Is MUCH More Profitable Than Clinics

Doctors who have signed up with CloudMD work remotely from home or wherever they are (like their winter home down south). The rapid scale-up potential excites me. CloudMD can add in unlimited number of doctors and patients—so it has a virtually unlimited ability to scale quickly with little incremental cost.

Profit margins are wide and there is no cap on the number of customers that can be handled.

After a patient has an appointment, CloudMD bills the government directly just like every bricks-and-mortar clinic in Canada does. CloudMD records 100% of the revenue and gets to keep 30% of the billing for every patient that is seen through telemedicine, which is actually 10% more than what a bricks-and-mortar clinic receives. That is because the governments are trying to push teleHealth.

The doctor gets the other 70% and doesn't have to deal with any headaches of commuting or running a business.

Without the overhead of a bricks-and-mortar clinic, AND more revenue—CloudMD will be much more profitable than traditional health care stocks.

Faster scale, more cash flow. And they just entered Canada's largest market. This is the right stock in the right market at the right time.

When CloudMD goes from one doctor to 10 doctors to 100 doctors working at the same time, they don't have to build more clinics. They don't have to create more rooms for them or hire more staff. They just sign them on. That's it.

And we are not just talking about family doctors. They are also adding specialists and third party services like counseling and physiotherapists to the platform—and again, all these people are revenue, not costs.

That's the great thing about this business model. It's very scalable, very easy, and it grows very quickly.

CloudMD has been growing its recurring SAAS (Software-as-a-Service) revenue by 30% YoY with its EMR system. But this year the company is expecting that doctor growth to be much much higher—with a new full time sales team and the coronavirus pandemic. SaaS revenue is highly lucrative!

Consumer growth (patients) using the CloudMD app is growing even faster. And the recent COVID-19 situation will only turbocharge that.

Another Revenue Stream, Another Win-Win

There's another angle here—pharmacies. CloudMD says they will partner with more than 150 pharmacies in 2020 alone who are afraid of losing prescription business to Amazon (AMZN-NASD).

Those pharmacies are paying $500 a month for CloudMD kiosks to be in their pharmacies—where customers can get a prescription from a doctor on demand.

This keeps the customer in the pharmacy for their prescription—not out to see a doctor and then off to Costco to get it filled.

Pharmacies that don't see the writing on the wall will become the blockbusters of the industry and get left behind.

With the kiosk in the pharmacy, a person can just see a doctor right away, within 10 minutes, and walk the prescription back to the pharmacist.

Buy-outs Are Happening at High Valuations

We know that these businesses are worth.

Grocery giant Loblaws purchased QHR—another Canadian based EMR company—for $3.10/share or 7.5X revenue. Note that QHR's former Chairman Mark Kohler recently joined CloudMD's Board of Directors.

Teladoc bought a company out of Quebec just two months ago called InTouch for about US$600 million, which again is about 7.5X revenue. Teladoc itself trades at more than 10X revenue.

CloudMD trades at 2.5X revenue, less than a third of recent transactions. Meanwhile the company is poised to grow revenues at a high double digit rate for the foreseeable future.

TeleHealth is the future of how our healthcare is delivered.

Everyone has always expected that the growth would be just like what Netflix experienced with streaming, shaped like a hockey stick. The hockey stick shape is slow at the start as early adopters move and then straight up as the mainstream catches up with plot.

The demand for teleHealth from COVID-19 just took the flat part of that hockey stick out of the equation and instead took the industry directly to the exponential growth curve.

The jumping off point for teleHealth is here and I think CloudMD is the best pure-play teleHealth stock right now.

TeleHealth is to healthcare what streaming was to video rentals, and what Amazon was to retail. IT IS THE FUTURE.

Now is the time for investors to get on board, especially in Canada where virtual healthcare only accounts for 0.15% of the market and the growth curve will be much steeper.

And for me, that's CloudMD. It's the new normal. I'm long.

Keith Schaefer is editor and publisher of the Oil & Gas Investments Bulletin. He has a degree in journalism and has worked for several Canadian dailies but has spent over 15 years assisting public resource companies in raising exploration and expansion capital.

Disclosure:
1) Keith Schaefer: I, or members of my immediate household or family, own shares of the following companies mentioned in this article: CloudMD. I personally am, or members of my immediate household or family are, paid by the following companies mentioned in this article: CloudMD. My company has a financial relationship with the following companies mentioned in this article: None. Additional disclosures are listed below.
2) The following companies mentioned in this article are billboard sponsors of Streetwise Reports: None. Click here for important disclosures about sponsor fees. As of the date of this article, an affiliate of Streetwise Reports has a consulting relationship with CloudMD. Please click here for more information.
3) Statements and opinions expressed are the opinions of the author and not of Streetwise Reports or its officers. The author is wholly responsible for the validity of the statements. The author was not paid by Streetwise Reports for this article. Streetwise Reports was not paid by the author to publish or syndicate this article. The information provided above is for informational purposes only and is not a recommendation to buy or sell any security. Streetwise Reports requires contributing authors to disclose any shareholdings in, or economic relationships with, companies that they write about. Streetwise Reports relies upon the authors to accurately provide this information and Streetwise Reports has no means of verifying its accuracy.
4) This article does not constitute investment advice. Each reader is encouraged to consult with his or her individual financial professional and any action a reader takes as a result of information presented here is his or her own responsibility. By opening this page, each reader accepts and agrees to Streetwise Reports' terms of use and full legal disclaimer. This article is not a solicitation for investment. Streetwise Reports does not render general or specific investment advice and the information on Streetwise Reports should not be considered a recommendation to buy or sell any security. Streetwise Reports does not endorse or recommend the business, products, services or securities of any company mentioned on Streetwise Reports.
5) From time to time, Streetwise Reports LLC and its directors, officers, employees or members of their families, as well as persons interviewed for articles and interviews on the site, may have a long or short position in securities mentioned. Directors, officers, employees or members of their immediate families are prohibited from making purchases and/or sales of those securities in the open market or otherwise from the time of the interview or the decision to write an article until three business days after the publication of the interview or article. The foregoing prohibition does not apply to articles that in substance only restate previously published company releases. As of the date of this article, officers and/or employees of Streetwise Reports LLC (including members of their household) own securities of CloudMD, a company mentioned in this article.

Keith Schaefer Disclosures:

Charts provided by the author.

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Exposure to aircraft noise at night for more than 20 years could increase the risk of heart disease and stroke, according to research conducted around six European airports. Risk also increased for those constantly exposed to road traffic, but this may have been caused by air pollution rather than noise.

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To test the possible health impacts of human exposure to methylmercury through fish consumption, researchers fed mice a diet containing fish at levels that corresponded to a typical Western diet for humans. The mice suffered adverse health impacts after two months of being fed this diet, including reduced body growth rates and modified gene expression patterns.

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The health impacts of consuming food that has been grown using cadmium-contaminated fertilisers are an increasing concern. New Danish research has estimated that the annual monetary cost of these impacts is €15.53 per km2 of agricultural land treated with mineral fertilisers. This cost rises to €37.04 per km2 if pig manure is used.

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PM_2.5 air pollution can have a significant impact on human health, not only for local populations, but also in regions far from its source of emission, shows a new study. The study calculates ‘damage factors’ to human health of PM_2.5 and in different parts of the world.

Over 2500 tons of the air pollutants nitrogen oxides (NOx), sulphur dioxide (SO2) and particulate matter with a diameter of less than 2.5 micrometers (PM2.5) were released by cruise ships across the five busiest Greek cruise ports during 2013, a new study found. The researchers also examined the costs of the potential health impacts of this pollution, finding they could be as high as 24.3 million Euros.