Archive for the ‘Healthcare’ Category
Sam Brownback’s experiment—running Kansas strictly on modern conservative principles—is not working out so well for the public. This latest development is tragic, but I get the sense that Gov. Brownback really doesn’t care about the disabled. Carl Gibson reports at ThinkProgress:
The conservative experiment in Gov. Sam Brownback’s Kansas has led to more suffering across the board — not just for the state’s economy, but for people with disabilities who are losing life-sustaining services.
At the time of his inauguration, Brownback was touted by fellow Republicans as a model example of what conservative governance nationwide could look like. While he promised to rejuvenate the state’s economy by slashing the state’s top income tax rate by 26 percent, his fiscal policy has instead blown an $800 million hole in the state budget, downgraded the state’s bond rating, and slowed job growth to a much lower rate than the national average. Brownback, once thought to be a strong contender for the 2016 Republican presidential nomination, now has just a 48 percent chance at being elected to a second term, and his tax cuts are the central issue of the campaign. These tax cuts have been devastating for Kansas’ disabled population.
Since Brownback’s inauguration, 1,414 Kansans with disabilities have been forced off of the Medicaid physical disability (PD) waiver. In January of 2013, Brownback became the first governor to fully privatize Medicaid services, claiming he would save the state $1 billion in 5 years without having to cut services, eligibility, or provider payments. Now, under Brownback’s “KanCare,” PD waiver cases are handled by for-profit, out-of-state, Fortune 500, publicly-traded managed care services. Kansas has contracts with three managed care profiteers — United Healthcare, Sunflower State Health Plan (owned by Centene Corporation), and AmeriGroup. Amerigroup and Centene each gave $2,000, Kansas’ maximum allowed contribution, to Brownback’s re-election campaign.
“They wanted to cut my full-time care hours by 76 percent, which all three of my doctors said was totally unrealistic,” said Finn Bullers, a disability rights advocate who suffers from muscular dystrophy, uses a wheelchair, has type 1 insulin-dependent diabetes, and requires a ventilator in his throat to breathe. “Essentially, they wanted three out of every four hours to go away.”
“Often, these are not optional services,” said Rocky Nichols, executive director of the Kansas Disability Rights Center. “These are life-sustaining services like properly caring for and cleaning out feeding tubes, colostomy bags, and other devices so people don’t die, transferring the person with a mobility impairment from the chair so they can toilet, assisting with the critical and life-sustaining activities of daily living that most of us take for granted. These are basic human needs, not optional wants.”
But Brownback’s claims of savings without risking patient eligibility is mere sleight of hand when taking a closer look at the numbers. When Kansas experienced a $217 million revenue shortfall in April of 2014, Brownback actually broke a promise made to the federal government as to how many people with disabilities would be served. When applying to launch the KanCare program, the Brownback administration originally promised the U.S. Department of Health and Human Services it would accommodate7,874 people on the PD waiver, according to numbers from the Kansas Department for Aging and Disability Services. After the first revenue shortfall, Brownback changed that number to 5900 – nearly a 25 percent cut in services amounting to $26 million.
Just before Brownback’s inauguration, Kansas served 6,752 people on the PD waiver. More than 2,000 people with disabilities were added just in the last decade as a result of more advanced healthcare and disabled people living longer lives. However, the gradual uptick in new enrollees stopped abruptly once Brownback took over. According to this chart, over 1,400 disabled Kansans were dropped from the waiver between 2010 and 2014, with a sharp decline in 2014, coinciding directly with the revenue shortfalls resulting from the recent tax cuts.
“It is mind-boggling to think that in 2004, just ten years ago, there were 4,527 people on the waiver… It grew to 6,752, and it’s been in a death spiral ever since then,” Nichols said. “That cannot be an accident. There is just no way you can have, year after year, for four years in a row, those types of reductions in the number of people served.”
According to one state elected official, the sudden drop-offs could easily be traced back to . . .
American government seems to be for sale these days. See next post.
Sometimes the drive to charge people for everything—particularly those who have fallen on hard times—is somewhat sickening.
Here are some examples:
That article explains the primary tactics and provides more detail under three headings:
1. Offering skimpy plans to workers that don’t cover all their needs.
2. Making drugs too expensive for sick patients to afford.
3. Forming narrow networks to discourage sick people from enrolling.
Of course, these things could be easily fixed were it not for the absolute opposition of the GOP, which does not want healthcare to work.
A Dallas Company Finds Profit in Video-Only Jail Visitations. The article begins:
There’s nothing nice about jail. The food stinks. There’s nothing to do. People are in a bad mood. The best you can hope for is to get out quickly with minimal hassle. One of the few things you have to look forward to is a visit from a friend or a loved one—a brief face-to-face connection to remind you that the world is waiting on the other side of the glass. But some Texas jails are eliminating in-person visitation and requiring instead the use of a video visitation system sold by Dallas-based Securus Technologies. Critics say it’s an outrageous profiteering scheme that has no policy rationale and could actually deteriorate security at jails.
Securus markets its video system as a cost-saver for jails and a convenience for family members who live far from their incarcerated loved ones. But the structure of the deals suggests there are powerful financial incentives for jails to curb or eliminate face-to-face visitation. Securus charges callers as much as a dollar a minute to use its video services, and jails get a 20 to 25 percent cut. For big-city jails, that could mean millions in extra money. . .
The article concludes:
. . . A report released this morning by Grassroots Leadership and the Texas Criminal Justice Coalition found that disciplinary infractions, assaults and contraband cases all increased within the year after the video-only policy was put in place. The report concedes that the trends may be an aberration or temporary but cites social science and long-standing prison policies holding that visitations improves jail security and lowers recidivism rates. One studyof 16,420 offenders commissioned by the Minnesota Department of Corrections, for example, found that “prison visitation can significantly improve the transition offenders make from the institution to the community.” Even one visit lowered the risk that a person would re-offend by 13 percent.
“Video-only visitation policies ignore best practices that call for face-to-face visits to foster family relationships,” the report argues. “They advance arguments about security that are dubious, not rooted in research, and may be counter-productive.”
Grassroots Leadership and the Texas Criminal Justice Coalition report found 10 counties in Texas that have already deployed video-only systems, with more considering the option.
Because cutting taxes means less money for government services, many police departments look for other sources of revenue, such as civil asset forfeiture in addition to things like the cash-up-front video-only visitation system. Indeed, Ferguson MO’s criminal justice system had a nice little racket going, constantly extorting money from the poor.
One excellent way to destroy public education is to turn it over to private, for-profit companies. It may start okay, but pretty quickly the drive to grow profits will result in cost-cutting, and the schools will go downhill, short of teachers, short of supplies, short of maintenance, and so on. The article at the link is worth reading, particularly if you will at some point have children that will attend schools. Take a look at the start of that Pacific Standard article by Marian Wang:
In late February, the North Carolina chapter of the Americans for Prosperity Foundation—a group co-founded by the libertarian billionaire Koch brothers—embarked on what it billed as a statewide tour of charter schools, a cornerstone of the group’s education agenda. The first—and it turns out, only—stop was Douglass Academy, a new charter school in downtown Wilmington.
Douglass Academy was an unusual choice. A few weeks before, the school had been warned by the state about low enrollment. It had just 35 students, roughly half the state’s minimum. And a month earlier, a local newspaper had reported that federal regulators were investigating the school’s operations.
But the school has other attributes that may have appealed to the Koch group. The school’s founder, a politically active North Carolina businessman named Baker Mitchell, shares the Kochs’ free-market ideals. His model for success embraces decreased government regulation, increased privatization, and, if all goes well, healthy corporate profits.
In that regard, Mitchell, 74, appears to be thriving. Every year, millions of public education dollars flow through Mitchell’s chain of four non-profit charter schools to for-profit companies he controls.
The schools buy or lease nearly everything from companies owned by Mitchell. Their desks. Their computers. The training they provide to teachers. Most of the land and buildings. Unlike with traditional school districts, at Mitchell’s charter schools there’s no competitive bidding. No evidence of haggling over rent or contracts.
The schools have all hired the same for-profit management company to run their day-to-day operations. The company, Roger Bacon Academy, is owned by Mitchell. It functions as the schools’ administrative arm, taking the lead in hiring and firing school staff. It handles most of the bookkeeping. The treasurer of the non-profit that controls the four schools is also the chief financial officer of Mitchell’s management company. The two organizations even share a bank account.
“This isn’t as if one of the board members happens to own a chalk company where they buy chalk from, and he recused himself from buying chalk. This is the entire management and operation of the school.”
Mitchell’s management company was chosen by the schools’ non-profit board, which Mitchell was on at the time—an arrangement that is illegal in many other states. . .
Brave New Films has a series Over-Criminalized, the first part of which is a look at defining mental illness as a crime worthy of prison time. Another film in the series looks at how homelessness is also a crime in much of the US. It’s as if the state and federal government and policymakers, have decided that the police are best equipped to deal with social problems, by locking people away, much as in international affairs the US relies mostly on its military to deal with the challenges of international relations. If your primary reflex is armed response, every problem looks like an enemy and every approach to solving it is treated as a war.
The first film in the series, shown below, is only 8 minutes long, and it’s worth watching. Their blurb:
Instead of helping the mentally ill, police often put them behind bars. Watch how one police department is making a positive difference.
It’s simple. Diversion programs work better than incarceration – for everyone. In cities like Seattle, San Antonio, and Salt Lake City, we see that successful solutions are a viable option to help end serious social problems. These services alter the course of people’s lives in a positive way and save taxpayers huge amounts of money. We cannot continue to isolate and imprison people who suffer from mental illness, substance abuse, or homelessness. We must treat them with compassion and care to better serve our communities and our pocketbooks.
It’s time we got serious about pulling our money out of incarceration and putting it into systems that foster healthy communities. Hundreds of thousands of people are locked up not because of any dangerous behavior, but because of problems like mental illness, substance use disorders, and homelessness, which should be dealt with outside the criminal justice system. Services like drug treatment and affordable housing cost less and can have a better record of success.
This summer, news stories from around the nation provided the American people with a litany of issues about how police officers respond to community members. By highlighting programs like Crisis Intervention Training (CIT), Law Enforcement Assisted Diversion (LEAD), and Housing First, OverCriminalized explores the possibility of ending incarceration for millions of Americans who, through successful intervention programs, can put their lives back on track.
OverCriminalized focuses on the people who find themselves being trafficked through this nation’s criminal justice system with little regard for their humanity and zero prospects for actual justice. They are victims of unwillingness to invest in solving major social problems, and the consequent handling off of that responsibility to the police, the courts, and the prisons. They are the mentally ill, the homeless, and the drug addicted. Sometimes they are all three.
Quick facts on over criminalization:
- Approximately 20 % of state prisoners and 21 % of local jail detainees have a “recent history” of a mental health condition.
- Approximately 26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders.
- In 2012, it was estimated that 23.1 million Americans needed treatment for problems that related to drugs or alcohol.
- Pew Research finds that 67% of Americans say that the government should focus more on providing treatment for those who use illegal drugs such as heroin or cocaine. Just 26% think the government’s focus should be on prosecuting users of such hard drugs.
Wal-Mart is using an Obamacare provision to stop paying for health insurance for employees working under 30 hours per week.
Totally sensible move for Wal-Mart: cut costs by externalizing the price of healthcare insurance—the workers without healthcare insurance from their employer can get health insurance from Obamacare, and in that income bracket, subsidies as well. Plus they have more coverage choices (the various plans). So it works out well for the employees, too.
Should this practice not be illegal?
“Best medical system in the world”: ER physicians are now independent contractors and do not accept insurance
The US developed a medical system that uses the free market to resolve problems, rather than socialistic single-payer system (as in, say, France). The US approach has some serious problems if you need to go to the ER. But probably the invisible hand of the market will fix that. /sarcasm
UPDATE: Kevin Drum has a good post on this.
Once they’ve collected your insurance premiums, health insurance companies are loathe to spend that money
Basically, insurance companies love having the money come in as premiums, but they hate paying out settlements and in general do everything in their power to stall and reduce payments. Now they have adopted a new tactic, reported by Charles Ornstein at ProPublica:
Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.
Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments. But according to an editorial to be published Thursday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.
The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments “non-preferred,” according to the editorial.
“It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,” the editorial says. “One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.”
I recently wrote about the confusion I faced with my infant son’s generic asthma and allergy medication, which switched cost tiers from one month to the next. Until then, I hadn’t known that my plan charged two different prices for generic drugs. If your health insurer does not use such a structure, odds are that it will before long.
The editorial comes several months after two advocacy groups filed a complaint with the Office of Civil Rights of the United States Department of Health and Human Servicesclaiming that several Florida health plans sold in the Affordable Care Act marketplace discriminated against H.I.V. patients by charging them more for drugs.
Specifically, the complaint contended that the plans placed all of their H.I.V. medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.
“It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,” said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Fla.
Turner said he feared a “race to the bottom,” in which plans don’t want to be seen as the most attractive for sick patients. “Plans do not want that reputation.”
In July, more than 300 patient groups, covering a range of diseases, wrote to Sylvia Mathews Burwell, the secretary of health and human services, saying they were worried that health plans were trying to skirt the spirit of the law, including how they handled co-pays for drugs.
Generics, which come to the market after a name-brand drug loses its patent protection, used to have one low price in many insurance plans, typically $5 or $10. But as their prices have increased, sometimes sharply, many insurers have split the drugs into two cost groupings, as they have long done with name-brand drugs. “Non-preferred” generic drugs have higher co-pays, though they are still cheaper than brand-name drugs.
With brand names, there’s usually at least one preferred option in each disease category. Not so for generics, the authors of the editorial found.
One of the authors, Gerry Oster, a vice president at the consulting firm Policy Analysis, said he stumbled upon the issue much as I did. He went to his pharmacy to pick up a medication he had been taking for a couple of years. The prior month it cost him $5, but this time it was $20.
As he looked into it, he came to the conclusion that this phenomenon was unknown even to health policy experts. “It’s completely stealth,” he said. . .
Obviously some laws and regulations will be needed to prevent this sort of discriminatory price.