Health Care Reform Articles - June 13, 2020

Editor's Note -

David Belk, M.D. has written an important new book titled "The Great American Health Care Scam".  It should be a must read for all Americans wondering what is going on with the prices of healthcare in America. Here is a link to a talk he gave recently about the findings of his decade long study of American healthcare prices.  It's well worth the expenditure of about an hour of your time.

 Here's the link:

https://www.youtube.com/watch?v=rhlwJeeDWZA

 - SPC

Hospitals Got Bailouts and Furloughed Thousands While Paying C.E.O.s Millions

Dozens of top recipients of government aid have laid off, furloughed or cut the pay of tens of thousands of employees.

By Jessica Silver-Greenberg, Jesse Drucker and David Enrich - NYT - June 8, 2020

HCA Healthcare is one of the world’s wealthiest hospital chains. It earned more than $7 billion in profits over the past two years. It is worth $36 billion. It paid its chief executive $26 million in 2019.

But as the coronavirus swept the country, employees at HCA repeatedly complained that the company was not providing adequate protective gear to nurses, medical technicians and cleaning staff. Last month, HCA executives warned that they would lay off thousands of nurses if they didn’t agree to wage freezes and other concessions.

A few weeks earlier, HCA had received about $1 billion in bailout funds from the federal government, part of an effort to stabilize hospitals during the pandemic.

HCA is among a long list of deep-pocketed health care companies that have received billions of dollars in taxpayer funds but are laying off or cutting the pay of tens of thousands of doctors, nurses and lower-paid workers. Many have continued to pay their top executives millions, although some executives have taken modest pay cuts.

The New York Times analyzed tax and securities filings by 60 of the country’s largest hospital chains, which have received a total of more than $15 billion in emergency funds through the economic stimulus package in the federal CARES Act.

The hospitals — including publicly traded juggernauts like HCA and Tenet Healthcare, elite nonprofits like the Mayo Clinic, and regional chains with thousands of beds and billions in cash — are collectively sitting on tens of billions of dollars of cash reserves that are supposed to help them weather an unanticipated storm. They awarded their five highest-paid officials about $874 million in the most recent year for which they have disclosed their finances.

At least 36 of those hospital chains have laid off, furloughed or reduced the pay of employees as they try to save money during the pandemic.

Industry officials argue that furloughs and pay reductions allow hospitals to keep providing essential services at a time when the pandemic has gutted their revenue.

But more than a dozen workers at the wealthy hospitals said in interviews that their employers had put the heaviest financial burdens on front-line staff, including low-paid cafeteria workers, janitors and nursing assistants. They said pay cuts and furloughs made it even harder for members of the medical staff to do their jobs, forcing them to treat more patients in less time.

Even before the coronavirus swept America, forcing hospitals to stop providing lucrative nonessential surgery and other services, many smaller hospitals were on the financial brink. In March, lawmakers sought to address that with a vast federal economic stimulus package that included $175 billion for the Department of Health and Human Services to hand out in grants to hospitals.

But the formulas to determine how much money hospitals receive were based largely on their revenue, not their financial needs. As a result, hospitals serving wealthier patients have received far more funding than those that treat low-income patients, according to a study by the Kaiser Family Foundation.

One of the bailout’s goals was to avoid job losses in health care, said Zack Cooper, an associate professor of health policy and economics at Yale University who is a critic of the formulas used to determine the payouts. “However, when you see hospitals laying off or furloughing staff, it’s pretty good evidence the way they designed the policy is not optimal,” he added.

The Mayo Clinic, with more than eight months of cash in reserve, received about $170 million in bailout funds, according to data compiled by Good Jobs First, which researches government subsidies of companies. The Mayo Clinic is furloughing or reducing the working hours of about 23,000 employees, according to a spokeswoman, who was among those who went on furlough. A second spokeswoman said that Mayo Clinic executives have had their pay cut.

Seven chains that together received more than $1.5 billion in bailout funds — Trinity Health, Beaumont Health and the Henry Ford Health System in Michigan; SSM Health and Mercy in St. Louis; Fairview Health in Minneapolis; and Prisma Health in South Carolina — have furloughed or laid off more than 30,000 workers, according to company officials and local news reports.

The bailout money, which hospitals received from the Health and Human Services Department without having to apply for it, came with few strings attached.

Katherine McKeogh, a department spokeswoman, said it “encourages providers to use these funds to maintain delivery capacity by paying and protecting doctors, nurses and other health care workers.” The legislation restricts hospitals’ ability to use the bailout funds to pay top executives, although it doesn’t stop recipients from continuing to award large bonuses.

The hospitals generally declined to comment on how much they are paying their top executives this year, although they have reported previous years’ compensation in public filings. But some hospitals furloughing front-line staff or cutting their salaries have trumpeted their top executives’ decisions to take voluntary pay cuts or to contribute portions of their salary to help their employees.

The for-profit hospital giant Tenet Healthcare, which has received $345 million in taxpayer assistance since April, has furloughed roughly 11,000 workers, citing the financial pressures from the pandemic. The company’s chief executive, Ron Rittenmeyer, told analysts in May that he would donate half of his salary for six months to a fund set up to assist those furloughed workers.

But Mr. Rittenmeyer’s salary last year was a small fraction of his $24 million pay package, which consists largely of stock options and bonuses, securities filings show. In total, he will wind up donating roughly $375,000 to the fund — equivalent to about 1.5 percent of his total pay last year.

A Tenet spokeswoman declined to comment on the precise figures.

The chief executive at HCA, Samuel Hazen, has donated two months of his salary to a fund to help HCA’s workers. Based on his pay last year, that donation would amount to about $237,000 — or less than 1 percent — of his $26 million compensation.

“The leadership cadre of these organizations are going to need to make sacrifices that are commensurate with the sacrifices of their work force, not token sacrifices,” said Jeff Goldsmith, the president of Health Futures, an industry consulting firm.

Many large nonprofit hospital chains also pay their senior executives well into the millions of dollars a year.

Dr. Rod Hochman, the chief executive of the Providence Health System, for instance, was paid more than $10 million in 2018, the most recent year for which records are available. Providence received at least $509 million in federal bailout funds.

A spokeswoman, Melissa Tizon, said Dr. Hochman would take a voluntary pay cut of 50 percent for the rest of 2020. But that applies only to his base salary, which in 2018 was less than 20 percent of his total compensation.

Some of Providence’s physicians and nurses have been told to prepare for pay cuts of at least 10 percent beginning in July. That includes employees treating coronavirus patients.

Stanford University’s health system collected more than $100 million in federal bailout grants, adding to its pile of $2.4 billion of cash that it can use for any purpose.

Stanford is temporarily cutting the hours of nursing staff, nursing assistants, janitorial workers and others at its two hospitals. Julie Greicius, a spokeswoman for Stanford, said the reduction in hours was intended “to keep everyone employed and our staff at full wages with benefits intact.”

Ms. Greicius said David Entwistle, the chief executive of Stanford’s health system, had the choice of reducing his pay by 20 percent or taking time off, and chose to reduce his working hours but “is maintaining his earning level by using paid time off.” In 2018, the latest year for which Stanford has disclosed his compensation, Mr. Entwistle earned about $2.8 million. Ms. Greicius said the majority of employees made the same choice as Mr. Entwistle.

HCA’s $1 billion in federal grants appears to make it the largest beneficiary of health care bailout funds. But its medical workers have a long list of complaints about what they see as penny-pinching practices.

Since the pandemic began, medical workers at 19 HCA hospitals have filed complaints with the Occupational Safety and Health Administration about the lack of respirator masks and being forced to reuse medical gowns, according to copies of the complaints reviewed by The Times.

Ed Fishbough, an HCA spokesman, said that despite a global shortage of masks and other protective gear, the company had “provided appropriate P.P.E., including a universal masking policy implemented in March requiring all staff in all areas to wear masks, including N95s, in line with C.D.C. guidance.”

Celia Yap-Banago, a nurse at an HCA hospital in Kansas City, Mo., died from the virus in April, a month after her colleagues complained to OSHA that she had to treat a patient without wearing protective gear. The next month, Rosa Luna, who cleaned patient rooms at HCA’s hospital in Riverside, Calif., also died of the virus; her colleagues had warned executives in emails that workers, especially those cleaning hospital rooms, weren’t provided proper masks.

Around the time of Ms. Luna’s death, HCA executives delivered a warning to officials at the Service Employees International Union and National Nurses United, which represent many HCA employees. The company would lay off up to 10 percent of their members, unless the unionized workers amended their contracts to incorporate wage freezes and the elimination of company contributions to workers’ retirement plans, among other concessions.

Nurses responded by staging protests in front of more than a dozen HCA hospitals.

“We don’t work in a jelly bean factory, where it’s OK if we make a blue jelly bean instead of a red one,” said Kathy Montanino, a nurse treating Covid-19 patients at HCA’s Riverside hospital. “We are dealing with people’s lives, and this company puts their profits over patients and their staff.”

Mr. Fishbough, the spokesman, said HCA “has not laid off or furloughed a single caregiver due to the pandemic.” He said the company had been paying medical workers 70 percent of their base pay, even if they were not working. Mr. Fishbough said that executives had taken pay cuts, but that the unions had refused to take similar steps.

“While we hope to continue to avoid layoffs, the unions’ decisions have made that more difficult for our facilities that are unionized,” he said. The dispute continues.

Apparently anticipating a strike, a unit of HCA recently created “a new line of business focused on staffing strike-related labor shortages,” according to an email that an HCA recruiter sent to nurses.

The email, reviewed by The Times, said nurses who joined the venture would earn more than they did in their current jobs: up to $980 per shift, plus a $150 “Show Up” bonus and a continental breakfast.

https://www.nytimes.com/2020/06/08/business/hospitals-bailouts-ceo-pay.html?action=click&module=RelatedLinks&pgtype=Article 

Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers

Twenty large chains received more than $5 billion in federal grants even while sitting on more than $100 billion in cash.

By Jesse Drucker, Jessica Silver-Greenberg and Sarah Kliff - NYT  - May 25, 2020

A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms like the Carlyle Group.
But it is not just another deep-pocketed investor hunting for high returns. It is the Providence Health System, one of the country’s largest and richest hospital chains. It is sitting on nearly $12 billion in cash, which it invests, Wall Street-style, in a good year generating more than $1 billion in profits.
And this spring, Providence received at least $509 million in government funds, one of many wealthy beneficiaries of a federal program that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.
With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled. The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.

So far, the riches are flowing in large part to hospitals that had already built up deep financial reserves to help them withstand an economic storm. Smaller, poorer hospitals are receiving tiny amounts of federal aid by comparison.
Twenty large recipients, including Providence, have received a total of more than $5 billion in recent weeks, according to an analysis of federal data by Good Jobs First, a research group. Those hospital chains were already sitting on more than $108 billion in cash, according to regulatory filings and the bond-rating firms S&P Global and Fitch. A Providence spokeswoman said the grants helped make up for losses from the coronavirus.
Those cash piles come from a mix of sources: no-strings-attached private donations, income from investments with hedge funds and private equity firms, and any profits from treating patients. Some chains, like Providence, also run their own venture-capital firms to invest their cash in cutting-edge start-ups. The investment portfolios often generate billions of dollars in annual profits, dwarfing what the hospitals earn from serving patients.
Many of these hospital groups, including Providence, are set up as nonprofits, which generally don’t have to pay federal taxes on their billions of dollars of income.
By contrast, hospitals that serve low-income patients often have only enough cash on hand to finance a few weeks of their operations.

After the CARES Act was passed in March, hospital industry lobbyists reached out to senior Health and Human Services officials to discuss how the money would be distributed.
Representatives of the American Hospital Association, a lobbying group for the country’s largest hospitals, communicated with Alex M. Azar II, the department secretary, and Eric Hargan, the deputy secretary overseeing the funds, said Tom Nickels, a lobbyist for the group. Chip Kahn, president of the Federation of American Hospitals, which lobbies on behalf of for-profit hospitals, said he, too, had frequent discussions with the agency.
The department then devised formulas to quickly dispense tens of billions of dollars to thousands of hospitals — and those formulas favored large, wealthy institutions.

One formula based allotments on how much money a hospital collected from Medicare last year. Another was based on a hospital’s revenue. While Health and Human Services also created separate pots of funding for rural hospitals and those hit especially hard by the coronavirus, the department did not take into account each hospital’s existing financial resources.
“This simple formula used the data we had on hand at that time to get relief funds to the largest number of health care facilities and providers as quickly as possible,” said Caitlin B. Oakley, a spokeswoman for the department. “While other approaches were considered, these would have taken much longer to implement.”
Hospitals that serve a greater proportion of wealthier, privately insured patients got twice as much relief as those focused on low-income patients with Medicaid or no coverage at all, according to a study this month by the Kaiser Family Foundation.

“If you ever hear a hospital complaining they don’t have enough money, see if they have a venture fund,” said Niall Brennan, president of the nonprofit Health Care Cost Institute and a former senior Medicare official. “If you’ve got play money, you’re fine.”
In a letter this month to the Department of Health and Human Services, two House committee chairmen said the Trump administration appeared to be disregarding Congress’s intent in how it was distributing the aid.
“The level of funding appears to be completely disconnected from need,” wrote the two Democrats, Representatives Frank Pallone Jr. of New Jersey and Richard E. Neal of Massachusetts.
It is the latest instance in which enormous and hastily enacted federal bailout programs have benefited those who don’t appear to need the money. A package of $170 billion in federal tax breaks, for example, will go overwhelmingly to many of the country’s richest people and biggest companies. A program to rescue small businesses initially directed hundreds of millions of dollars in loans to publicly traded companies while many smaller firms were frozen out.
That pattern is repeating in the hospital rescue program.
For example, HCA Healthcare and Tenet Healthcare — publicly traded chains with billions of dollars in reserves and large credit lines from banks — together received more than $1.5 billion in federal funds.
An HCA spokesman said the aid didn’t cover the expected lost revenue and higher expenses caused by the coronavirus, while a Tenet spokeswoman said the pandemic had suppressed the company’s profits.

The Cleveland Clinic got $199 million. Last year it had so much money on hand — its $7 billion in cash helped generate $1.2 billion in investment profits — that it paid investment advisers $28 million to manage the fortune.

Angela Kiska, a Cleveland Clinic spokeswoman, said the federal grants had “helped to partially offset the significant losses in operating revenue due to Covid-19, while we continue to provide care to patients in our communities.” The Cleveland Clinic sent caregivers to hospitals in Detroit and New York as they were flooded with coronavirus patients, she added.
The St. Louis-based Ascension Health, which operates 150 hospitals nationwide, has received at least $211 million from Health and Human Services. The company, with $15.5 billion in cash, operates a venture capital fund and an investment advisory firm that helps other companies manage their money.
Even if Ascension stopped generating any revenue whatsoever — a doomsday scenario — it would have enough cash to fully operate for nearly eight months.
https://www.nytimes.com/2020/05/25/business/coronavirus-hospitals-bailout.html?action=click&module=RelatedLinks&pgtype=Article

We’re in a pandemic. Why have we stopped talking about Medicare-for-all?

By Helaine Olen - The Washington Post - May 28,  2020

Until quite recently, it seemed almost certain that Medicare-for-all would be a major issue in the presidential election. It came up at every Democratic presidential debate. President Trump turned it into a talking point to be used against a future challenger. And when the novel coronavirus pandemic hit, it all but made the case. Contagious viruses, after all, don’t check insurance status before striking.

Now it’s crickets. Unless, that is, you count Joe Biden’s insistence that he is still not a fan. “I do not support Medicare-for-all. I will not support Medicare-for-all,” he announced last week on CNBC. Instead, Biden supports lowering the age of eligibility for Medicare to 60, improvements to the Affordable Care Act and a public option.
No doubt part of the explanation for the suddenly lowered profile of Medicare-for-all lies in the multifaceted crisis our nation is facing. The pandemic is not simply a medical crisis, it’s also an economic catastrophe. More than 40 million Americans have filed for unemployment since March. Millions of children are going hungry. When you are concerned about keeping a roof over your head, other concerns fade in importance.
It’s also quite possible that Medicare-for-all is quiescent because many people are forgoing medical services, fearful of contracting covid-19 at the doctor’s office or hospital. Visits to primary care doctors are down by at least 50 percent. Knee and hip replacements are postponed. So too are cancer surgeries and chemotherapy. While there are certainly major health consequences to this in the long run, in the short run people aren’t racking up as many medical expenses as in the past. Out of sight, out of mind, as the saying goes.
And, of course, Medicare-for-all champion Sen. Bernie Sanders (I-Vt.) was defeated by Biden in the Democratic primary. Neither Biden or Trump support it. From the perspective of horse race media coverage, there isn’t much of a race here to cover.
But don’t let all that fool you into thinking the battle over Medicare-for-all is over. It most certainly is not. Voters in the Democratic primary — even as they pulled levers for Biden — told exit pollsters they supported the idea. And there is no reason to believe the issue won’t make a reappearance as the country takes steps toward reopening. Not only do the problems that led to support for major health-care reform remain in place, they have only increased over the past several months.
Legislation putting a stop to surprise medical bills is stalled out, caught in a spat between Democratic legislators — one group supporting a bill that favors the financial interests of the insurance industry and another that gives greater consideration to the bottom line of medical practitioners (and the private equity interests that own medical practices). At the same time, insurers are dropping doctors from their networks, increasing the likelihood a patient will need to pay unexpected charges.
There’s little action on bringing the cost of medications down. Yes, earlier this week Trump announced an agreement that would ensure almost all people on Medicare will pay no more than $35 a month out of their own pocket for insulin. But that’s only one drug, and the action does nothing for the millions of Americans who are insured either through their employer or Affordable Care Act exchanges.
And, finally, there is the issue of insurance itself. Millions of Americans have lost or will soon lose their workplace-based health insurance. (The Kaiser Family Foundation put the number at 27 million at the beginning of May). It’s all but certain many of them will decide to go without in an attempt to save money. Legislation introduced earlier this month by Sanders and Rep. Pramila Jayapal (D-Wash.) to expand Medicare to cover all Americans who lack health insurance is receiving little attention. Instead, the Heroes Act, passed by the House, contains provisions subsidizing COBRA — that is, what someone would pay to continue their employer-based health insurance after losing or leaving a job. Not only won’t expanded COBRA not help people who didn’t have workplace insurance, it does nothing to solve the issues of high copays, deductibles and surprise bills — the very things that are driving support for Medicare-for-all.
No matter whether Biden or Trump emerges victorious in the November election, expect to hear more heartbreaking news about people in their twenties who die because they can’t afford insulin, are refused organ transplants because they lack five-figure savings accounts and who eschew desperately needed emergency medical treatment because they can’t afford it. As a result, the struggle for universal and easily affordable health-care coverage will continue.
https://www.washingtonpost.com/opinions/2020/05/28/were-pandemic-why-have-we-stopped-talking-about-medicare-for-all/

Trump administration revokes health protection for transgender Americans

The White House has finalized a regulation that overturns Obama-era protections for transgender people against sex discrimination in health care. 

By RICARDO ALONSO-ZALDIVAR - Associated Press - June 13, 2020

WASHINGTON — In a move applauded by President Trump’s conservative religious base, his administration on Friday finalized a rule that overturns Obama-era protections for transgender people against sex discrimination in health care.
The Department of Health and Human Services said it will enforce sex discrimination protections “according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.” This rewrites an Obama-era regulation that sought a broader understanding shaped by a person’s internal sense of being male, female, neither or a combination.
LGBTQ groups say explicit protections are needed for people seeking sex-reassignment treatment, and even for transgender people who need care for common illnesses such as diabetes or heart problems.
But conservatives say the Obama administration exceeded its legal authority in broadly interpreting gender.
The reversal comes in the middle of LGBTQ Pride Month. Activists and Democratic lawmakers noted that Friday was also the four-year anniversary of the mass shooting at the Pulse gay nightclub in Orlando, Florida, in which 49 people were killed.
Behind the dispute over legal rights is a medically recognized condition called “gender dysphoria” — discomfort or distress caused by a discrepancy between the gender that a person identifies as and the gender at birth. Consequences can include severe depression. Treatment can range from sex-reassignment surgery and hormones to people changing their outward appearance by adopting a different hairstyle or clothing.
Many social conservatives disagree with the concept.
“Under the old Obama rule, medical professionals could have been forced to facilitate gender reassignment surgeries and abortions — even if they believed this was a violation of their conscience or believed it harmful to the patient,” said Mary Beth Waddell of the religious conservative Family Research Council.
But House Speaker Nancy Pelosi said, “Religious freedom is no justification for hatred or bigotry, and every American has the right to seek and receive care without intimidation or fear.”
The American Medical Association strongly criticized the Trump administration’s action.
“The federal government should never make it more difficult for individuals to access health care — during a pandemic or any other time,” said Dr. Susan Bailey, the group’s president.
Under the Obama-era rule, a hospital could be required to perform gender-transition procedures such as hysterectomies if the facility provided that kind of treatment for other medical conditions. The rule was meant to carry out the anti-discrimination section of the Affordable Care Act, which bars sex discrimination in health care but does not use the term “gender identity.”
Women’s groups say the new regulations also undermine access to abortion, which is a legal medical procedure.
“No one should fear being turned away by a medical provider because of who they are or the personal health decisions they have made,” said Fatima Goss Graves, president of the National Women’s Law Center.
The ACLU says it has already moved to try to prevent the rollback of protections for transgender people. The LGBTQ civil rights group Lambda Legal said it will sue.
More than 1.5 million Americans identify as transgender, according to the Williams Institute, a think tank focusing on LGBT policy at the UCLA School of Law. A bigger number — 4.5% of the population— identify as lesbian, gay, bisexual or transgender, according to Gallup.
Roger Severino, head of the HHS unit that enforces civil rights laws, said transgender people continue to be protected by other statutes that bar discrimination in health care on account of race, color, national origin, age, disability and other factors.
“Everyone deserves to be treated with respect and according to the law,” said Severino. “Our dedication to our civil rights laws is as strong as ever.” He cited recent actions to safeguard access to treatment for disabled people in the coronavirus pandemic.
For the Trump administration it’s the latest in a series of steps to revoke newly won protections for LGBTQ people in areas ranging from the military to housing and education.
The administration also has moved to restrict military service by transgender men and women, proposed allowing certain homeless shelters to take gender identity into account in offering someone a bed for the night, and concluded in a 2017 Justice Department memo that federal civil rights law does not protect transgender people from discrimination at work.
The new rule would also affect the notices that millions of patients get in multiple languages about their rights to translation services. Such notices often come with insurer “explanation of benefits” forms. The Trump administration says the notice requirement has become a needless burden on health care providers, requiring billions of paper notices to be mailed annually at an estimated five-year cost of $2.9 billion.
https://www.pressherald.com/2020/06/13/trump-administration-revokes-health-protection-for-transgender-americans/