Medical Debt Is Being Erased in Ohio and Illinois. Is Your Town Next?
In the next few weeks, tens of thousands of people in Cook County, Ill., will open their mailboxes to find a letter from the county government explaining that their medical debt has been paid off.
Officials in New Orleans and Toledo, Ohio, are finalizing contracts so that tens of thousands of residents can receive a similar letter in the coming year. In Pittsburgh on Dec. 19, the City Council approved a budget that would include $1 million for medical debt relief.
More local governments are likely to follow as county executives and city councils embrace a new strategy to address the high cost of health care. They are partnering with RIP Medical Debt, a nonprofit that aims to abolish medical debt by buying it from hospitals, health systems and collections agencies at a steep discount.
“What we need in this country is universal health care, clearly,” Toni Preckwinkle, the president of the Board of Commissioners in Cook County, said. “But we’re not there as a nation yet, and so those of us who are responsible for local units of government have to do everything we can to make health care available, accessible to people.”
About 18 percent of Americans have medical debt that has been turned over to a third party for collection, according to a report published in July 2021 in the medical journal JAMA. That figure does not account for medical debt that is carried on credit cards or all medical bills owed to providers. Research shows that people with medical debt are less likely to seek needed care and that medical debt can damage people’s credit and make it more difficult for them to secure employment.
Cook County plans to spend $12 million on medical debt relief and expects to erase debt for the first batch of beneficiaries by early January. In Lucas County, Ohio, and its largest city, Toledo, up to $240 million in medical debt could be paid off at a cost of $1.6 million. New Orleans is looking to spend $1.3 million to clear $130 million in medical debt. The $1 million in Pittsburgh’s budget could wipe out $115 million in debt, officials said.
These initiatives are all being funded by President Biden’s trillion-dollar American Rescue Plan, which infused local governments with cash to spend on infrastructure, public services and economic relief programs. Health policy experts say that while medical debt relief provides an immediate benefit to people, it does not address the root causes of medical debt, which is almost nonexistent outside the United States.
To be eligible for debt relief through RIP Medical Debt, people must have a household income up to 400 percent of the federal poverty level, or about $111,000 for a family of four, or have medical debts that exceed 5 percent of their annual income. People cannot apply to be considered for debt relief, and they do not pay taxes on the purchase of their debt. RIP Medical Debt analyzes debt portfolios to determine who qualifies.
Wendy Pestrue, the chief executive of the United Way of Greater Toledo, said debt relief could remove a source of economic stress for the 43 percent of families who either were living in poverty or were unable to afford housing, child care, food, transportation or health care in Toledo, which has a population of nearly 269,000.
“It puts some of this economic strength back in the hands of those who are having debt exonerated and really helps them plan for their stability,” she said.
Michele Grim, who joined Toledo’s City Council in January 2022, pushed for some of the city’s $180 million in American Rescue Plan funds to be used for medical debt relief after she read about the Cook County initiative.
“Here’s something so simple that local governments can do, maybe even state governments can do, to really help ease that burden on people, because we really need an overhaul in our system, and that’s going to take years,” said Ms. Grim, who is leaving the council at the end of the year because she was elected in November to be a Democratic state representative.
Toledo’s City Council voted 7-5 on Nov. 9 to provide $800,000 to pay off the debts. Its contribution was matched by Lucas County, resulting in $1.6 million for medical debt relief. The city, the county and RIP Medical Debt are now working out a contract.
One council member who opposed the plan was George Sarantou, who said that he voted against it because his top funding priority was public safety, including upgrading city fire stations and police vehicles. While Mr. Sarantou said he was not opposed to medical debt relief, he was concerned about state funding for cities and villages, which is expected to be 1.66 percent of Ohio’s 2022-23 budget. “Ohio has the money,” he said. “Toledo does not.”
Medical debt relief appears to be popular. A poll by Tulchin Research found that 71 percent of respondents supported it. Fifty percent supported relieving student loan debt, 65 percent supported “Medicare for all” and 68 percent supported expanding Medicaid. The national poll of 1,500 people was conducted online from Nov. 14 to 20, after the Toledo vote, and had a margin of sampling error of plus or minus three percentage points. (Ms. Grim’s husband works for the polling company.)
This debt relief comes as states change how medical debt is treated.
In November, Gov. Kathy Hochul of New York signed legislation that blocked health care providers from using property liens or garnishing wages to collect medical debt. The day before the Toledo City Council vote, 72 percent of Arizona voters chose to lower interest rates for medical debt and to increase protections for people who owe debt, though a judge has since halted part of the measure.
Wesley Yin, an associate professor of economics at the University of California, Los Angeles, said medical debt relief could be a “game changer” for some people, but governments should also be addressing the causes of medical debt, including high costs and limited access to good health insurance.
In partnership with RIP Medical Debt, Professor Yin is studying how the group’s work affects people’s livelihoods. “I believe there are some positive effects economically, but it might be more muted compared to the face value of the debt that is being forgiven,” he said.
Daniel Skinner, a health policy professor at Ohio University in Athens, said that debt relief was “low-hanging fruit,” considering that the mean amount of medical debt people carry is in the hundreds, not tens of thousands, of dollars.
“We need to get the cost of medicine under control, ultimately,” Professor Skinner said. “I’m all for what Toledo is doing, I’m all for what Cook County and now New Orleans are doing, but, ultimately, we can’t come back every couple of years and do this. It’s not good policy, it’s not efficient.”
Supporters of debt relief measures agree that there is more to be done.
RIP Medical Debt’s chief executive, Allison Sesso, said that a key part of the group’s work was to further discussions about changing the health care system.
In the past two years, RIP Medical Debt has placed more of an emphasis on buying debt directly from hospitals and health systems, before it reaches collectors. Ms. Sesso said that this gave the group a direct channel to talk with hospitals about how their own health repayment plans for low-income patients work. Some of the people whose debt RIP Medical Debt buys should have qualified for these programs in the first place, but they were not enrolled, she said.
“I do this job every day, and I appreciate that what we’re doing is really important and helpful for the individuals that we are helping and it’s resolving this problem for them,” Ms. Sesso said. “At the same time, I can’t help but wonder and question why my existence as an institution is needed in the first place.”
https://www.nytimes.com/2022/12/29/us/toledo-medical-debt-relief.html
ED Doctors Call Private Equity Staffing Practices Illegal and Seek to Ban Them
A group of emergency physicians and consumer advocates in multiple states are pushing for stiffer enforcement of decades-old statutes that prohibit the ownership of medical practices by corporations not owned by licensed doctors.
Thirty-three states plus the District of Columbia have rules on their books against the so-called corporate practice of medicine. But over the years, critics say, companies have successfully sidestepped bans on owning medical practices by buying or establishing local staffing groups that are nominally owned by doctors and restricting the physicians’ authority so they have no direct control.
These laws and regulations, which started appearing nearly a century ago, were meant to fight the commercialization of medicine, maintain the independence and authority of physicians, and prioritize the doctor-patient relationship over the interests of investors and shareholders.
Those campaigning for stiffer enforcement of the laws say that physician-staffing firms owned by private equity investors are the most egregious offenders. Private equity-backed staffing companies manage a quarter of the nation’s emergency rooms, according to a Raleigh, North Carolina-based doctor who runs a job site for ER physicians. The two largest are Nashville, Tennessee-based Envision Healthcare, owned by investment giant KKR & Co., and Knoxville, Tennessee-based TeamHealth, owned by Blackstone.
Court filings in multiple states, including California, Missouri, Texas, and Tennessee, have called out Envision and TeamHealth for allegedly using doctor groups as straw men to sidestep corporate practice laws. But those filings have typically been in financial cases involving wrongful termination, breach of contract, and overbilling.
Now, physicians and consumer advocates around the country are anticipating a California lawsuit against Envision, scheduled to start in January 2024 in federal court. The plaintiff in the case, Milwaukee-based American Academy of Emergency Medicine Physician Group, alleges that Envision uses shell business structures to retain de facto ownership of ER staffing groups, and it is asking the court to declare them illegal.
“We’re not asking them to pay money, and we will not accept being paid to drop the case,” said David Millstein, lead attorney for the plaintiff. “We are simply asking the court to ban this practice model.”
‘Possibility to Reverberate Throughout the Country’
The physician group believes a victory would lead to a prohibition of the practice across California — and not just in ERs, but for other staff provided by Envision and TeamHealth, including in anesthesiology and hospital medicine. The California Medical Association supports the lawsuit, saying it “will shape the boundaries of California’s prohibition on the corporate practice of medicine.”
The plaintiff — along with many doctors, nurses, and consumer advocates, as well as some lawmakers — hopes that success in the case will spur regulators and prosecutors in other states to take corporate medicine prohibitions more seriously. “Any decision anywhere in the country that says the corporate ownership of a medical practice is illegal has the possibility to reverberate throughout the country, absolutely — and I hope that it would,” said Julie Mayfield, a state senator in North Carolina.
But the push to reinvigorate laws restricting the corporate practice of medicine has plenty of skeptics, who view it as an effort to return to a golden era in medicine that is long gone or may never have existed to begin with. The genie is out of the bottle, they say, noting that the profit motive has penetrated every corner of health care and that nearly 70% of physicians in the U.S. are now employed by corporations and hospitals.
The corporate practice of medicine doctrine has “a very interesting and not a very flattering history,” said Barak Richman, a law professor at Duke University. “The medical profession was trying to assert its professional dominance that accrued a lot of benefits to itself in ways that were not terribly beneficial to patients or to the market.”
The California case involves Placentia-Linda Hospital in Orange County, where the plaintiff physician group lost its ER management contract to Envision. The complaint alleges that Envision uses the same business model at numerous hospitals around the state.
“Envision exercises profound and pervasive direct and indirect control and/or influence over the medical practice, making decisions which bear directly and indirectly on the practice of medicine, rendering physicians as mere employees, and diminishing physician independence and freedom from commercial interests,” according to the complaint.
Envision said the company is compliant with state laws and that its operating structure is common in the health care industry. “Legal challenges to that structure have proved meritless,” Envision wrote in an email. It added that “care decisions have and always will be between clinicians and patients.”
TeamHealth, an indirect target in the case, said its “world-class operating team” provides management services that “allow clinicians to focus on the practice of medicine and patient care through a structure commonly utilized by hospitals, health systems, and other providers across the country.”
State Rules Vary Widely
State laws and regulations governing the corporate practice of medicine vary widely on multiple factors, including whether there are exceptions for nonprofit organizations, how much of doctors’ revenue outside management firms can keep, who can own the equipment, and how violations are punished. New York, Texas, and California are considered to have among the toughest restrictions, while Florida and 16 other states have none.
Kirk Ogrosky, a partner at the law firm Goodwin Procter, said this kind of management structure predates the arrival of private equity in the industry. “I would be surprised if a company that is interested in investing in this space screwed up the formation documents; it would shock me,” Ogrosky said.
Private equity-backed firms have been attracted to emergency rooms in recent years because ERs are profitable and because they have been able to charge inflated amounts for out-of-network care — at least until a federal law cracked down on surprise billing. Envision and TeamHealth prioritize profits, critics say, by maximizing revenue, cutting costs, and consolidating smaller practices into ever-larger groups — to the point of regional dominance.
Envision and TeamHealth are privately owned, which makes it difficult to find reliable data on their finances and the extent of their market penetration.
Dr. Leon Adelman, co-founder and CEO of Ivy Clinicians, a Raleigh-based startup job site for emergency physicians, has spent 18 months piecing together data and found that private equity-backed staffing firms run 25% of the nation’s emergency rooms. TeamHealth and Envision have the two largest shares, with 8.6% and 8.3%, respectively, Adelman said.
Other estimates put private equity’s penetration of ERs at closer to 40%.
Doctors Push for Investigations
So far, efforts by emergency physicians and others to challenge private equity staffing firms over their alleged violations have yielded frustrating results.
An advocacy group called Take Medicine Back, formed last year by a handful of ER physicians, sent a letter in July to North Carolina Attorney General Josh Stein, asking him to investigate violations of the ban on the corporate practice of medicine. And because Stein holds a senior position at the National Association of Attorneys General, the letter also asked him to take the lead in persuading his fellow AGs to “launch a multi-state investigation into the widespread lack of enforcement” of corporate practice of medicine laws.
The group’s leader, Dr. Mitchell Li, said he was initially disappointed by the response he received from Stein’s office, which promised to review his request, saying it raised complex legal issues about the corporate practice of medicine in the state. But Li is now more hopeful, since he has secured a January appointment with officials in Stein’s office.
Dr. Robert McNamara, a co-founder of Li’s group and chair of emergency medicine at Temple University’s Lewis Katz School of Medicine, drafted complaints to the Texas Medical Board, along with Houston physician Dr. David Hoyer, asking the board to intervene against two doctors accused of fronting for professional entities controlled by Envision and TeamHealth. In both cases, the board declined to intervene.
McNamara, who serves as the chief medical officer of the physicians’ group in the California Envision case, also filed a complaint with Pennsylvania Attorney General Josh Shapiro, alleging that a group called Emergency Care Services of Pennsylvania PC, which was trying to contract with ER physicians of the Crozer Keystone Health System, was wholly owned by TeamHealth and serving as a shell to avoid scrutiny.
A senior official in Shapiro’s office responded, saying the complaint had been referred to two state agencies, but McNamara said he has heard nothing back in more than three years.
Differing Views on Private Equity’s Role
Proponents of private equity ownership say it has brought a lot of good to health care. Jamal Hagler, vice president of research at the American Investment Council, said private equity brings expertise to hospital systems, “whether it’s to hire new staff, grow and open up to new markets, integrate new technologies, or develop new technologies.”
But many physicians who have worked for private equity companies say their mission is not compatible with the best practice of medicine. They cite an emphasis on speed and high patient volume over safety; a preference for lesser-trained, cheaper medical providers; and treatment protocols unsuitable for certain patients.
Dr. Sean Jones, an emergency physician in Asheville, North Carolina, said his first full-time job was at a Florida hospital, where EmCare, a subsidiary of Envision, ran the emergency room. Jones said EmCare, in collaboration with the hospital’s owner, pushed doctors to meet performance goals related to wait times and treatments, which were not always good for patients.
For example, if a patient came in with abnormally high heart and respiratory rates — signs of sepsis — doctors were expected to give them large amounts of fluids and antibiotics within an hour, Jones said. But those symptoms could also be caused by a panic attack or heart failure.
“You don’t want to give a patient with heart failure 2 or 3 liters of fluid, and I would get emails saying, ‘You didn’t do this,’” he said. “Well, no, I didn’t, because the reason they couldn’t breathe was they had too much fluid in their lungs.”
Envision said the company’s 25,000 clinicians, “like all clinicians, exercise their independent judgment to provide quality, compassionate, clinically appropriate care.”
Jones felt otherwise. “We don’t need some MBAs telling us what to do,” he said.
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
Investigation: Many U.S. hospitals sue patients for debts or threaten their credit
by Noam Levey - Kaiser Health News - December 21, 2022
Despite growing evidence of the harm caused by medical debt, hundreds of U.S. hospitals maintain policies to aggressively pursue patients for unpaid bills, using tactics such as lawsuits, selling patient accounts to debt buyers, and reporting patients to credit rating agencies, a KHN investigation shows.
The collection practices are commonplace among all types of hospitals in all regions of the country, including public university systems, leading academic institutions, small community hospitals, for-profit chains, and nonprofit Catholic systems.
Individual hospital systems have come under scrutiny in recent years for suing patients. But the KHN analysis shows the practice is widespread, suggesting most of the nation's approximately 5,100 hospitals serving the general public have policies to use legal action or other aggressive tactics against patients.
And although industry officials say they are careful about how they target patients for unpaid bills, few institutions have renounced what federal rules call "extraordinary collection actions," even as medical debt forces millions of Americans to cut back on food and other essentials, drain retirement savings, and make other difficult sacrifices.
At the same time, a majority of hospitals scrutinized by KHN effectively shroud their collection activities, publicly posting incomplete or in many cases no information about what can happen to patients if they can't pay.
These are among the findings of an examination of billing and financial aid at a diverse sample of 528 hospitals across the country. Over the past year, KHN investigated each of these hospitals, reviewing thousands of pages of policies and other documents. The reporting also included thousands of telephone and email inquiries and interviews to obtain and clarify how hospitals handle patients with unpaid bills.
Some hospitals did not respond to multiple requests for information. But KHN was able to gather details about most. From them, a picture emerges of a minefield for patients where a trip to the hospital can not only produce jaw-dropping bills but also expose patients to legal risks that jeopardize their livelihood. Among the findings:
"People don't know what's going to happen to them. It can be terrifying," said Tracy Douglas, a consumer attorney at Bet Tzedek Legal Services in Los Angeles. Douglas described one older woman she worked with who was afraid to seek financial assistance from a hospital because she worried the hospital would seize her home if she couldn't pay.
'Taken aback by how callous they have been'
The impact of these collection practices can be devastating.
Across the U.S. health care system, medical debt is taking a fearsome toll on patients, forcing more than half of adults with health-related debt to make difficult sacrifices, including taking on extra work, changing their living situation, or delaying their education, a KFF poll conducted for this project found.
Basit Balogun was a freshman at Lafayette College in Pennsylvania when a heart attack caused by a previously undetected birth defect landed him in the hospital. Because his insurance had lapsed, Balogun, whose family is from Nigeria, was hit with bills amounting to tens of thousands of dollars.
When he couldn't pay, the hospital reported him to a credit agency, which he discovered only after he'd graduated and was trying to rent an apartment in New York City. "I kept getting rejected and rejected," Balogun recalled. "I was desperate."
Balogun, a prize-winning student, landed a job at banking giant Goldman Sachs and used his signing bonus to begin paying down the debt. Five years later, he's still making payments. Now Balogun said he thinks twice before going to the doctor.
Nick and Elizabeth Woodruff also had their faith shaken by hospital debt collectors. Nick was sued by Our Lady of Lourdes Memorial Hospital in Binghamton, New York, where he'd received care for a dangerous foot infection.
Despite having insurance through Nick's work at a truck dealership, the couple were buried in bills, forcing them to withdraw money from their retirement accounts and borrow from family. When they still couldn't make all the payments, the hospital, a Catholic institution owned by the Ascension chain, took them to court, and in 2018 they were ordered to pay more than $9,300.
"This hospital boasts Catholic values and states they take pride in their charity work," said Elizabeth, a social worker, "but I am taken aback by how callous they have been."
Ascension spokesperson Nick Ragone told KHN that the chain, America's second-largest Catholic system, "ceased taking legal action against patients for unpaid bills starting in October 2019." But New York court records show that Lourdes continued to file legal actions against patients until at least 2021.
Hospital spokesperson Lisa Donovan subsequently told KHN this was an "administrative oversight." "Lourdes is reviewing matters to ensure that all legal activities have been disposed/dismissed," she said in an email.
Holes in the charity care system
Many hospital officials say they are obligated to collect what patients owe. "We don't want to promote the concept that medical bills just go away, especially for those who are able to pay," said Michael Beyer, who oversees patient accounts at Sanford Health, a South Dakota-based nonprofit with clinics and hospitals across the U.S. and abroad.
Hospital leaders also stress the industry's commitment to helping low-income patients and others who can't pay their bills. "Hospitals are doing a lot," said Melinda Hatton, general counsel at the American Hospital Association. "Is it perfect out there? No. But I think they should get credit for trying pretty hard."
Charity care is offered at most U.S. hospitals. And nonprofit medical systems must provide financial aid as a condition of not paying taxes, a benefit that saves the industry billions of dollars annually.
At many medical centers, however, information about financial assistance is difficult or impossible to find. About 1 in 5 hospitals researched by KHN, including public university systems in five states, don't post aid policies online.
The University of Mississippi Medical Center disclosed its policy only after KHN filed a public records request. Many hospitals prominently place a link on their homepages for patients to pay a bill, but then require people to click through multiple pages to find information about financial aid.
Visitors to the website of Opelousas General Health System in Louisiana who click on the "Patient Resources" tab can learn that the Lil' General Café serves panini and pancakes, but they won't find any information about getting help with medical bills.
Applying for aid can also be extremely complicated, requiring patients to produce exhaustive amounts of personal financial information, KHN found. Standards vary widely, with aid at some hospitals limited to patients with income as low as $13,590 a year. At other hospitals, people making five or six times that much can get assistance.
About two-thirds of the hospitals researched by KHN require patients to report their assets, sometimes in great detail. Centura-St. Anthony Hospital, a Catholic medical center in suburban Denver, notes in its policy that in reviewing patient assets it may count crowdfunding or social media accounts patients have set up to help pay bills. Other hospitals ask patients to report the make, model, and year of cars they have.
"The system doesn't work," said Jared Walker, founder of Dollar For, a nonprofit that has helped thousands of people across the country apply for financial aid. "Patients can't find the information they need. Half the time, when they do apply for assistance, they never hear back. Basically, hospitals do what they want, and there is no accountability."
Sent to collections or sued
In many cases, patients who should qualify for assistance are instead targeted by bill collectors, whether by accident or by design.
"Every week or so we get a call from someone who should have qualified for aid, but they weren't enrolled," said Michele Johnson, executive director of the nonprofit Tennessee Justice Center.
A 2019 KHN analysis of hospital tax filings found that nearly half of nonprofit medical systems were billing patients with incomes low enough to qualify for charity care. Earlier this year, Washington state sued hospitals belonging to the nonprofit giant Providence after uncovering that the system trained its collectors to aggressively pursue even patients who should have qualified for aid.
In 2017, the state also successfully sued CHI Franciscan, another Catholic system that authorities found wasn't properly offering charity care. To settle that case, CHI Franciscan, now part of the mammoth CommonSpirit Health chain, provided more than $40 million in debt relief and refunds and helped patients repair their credit, according to the state attorney general's office.
But CommonSpirit hospitals still report patients to credit rating agencies, according to the chain's published policies.
Credit reporting, a threat that is supposed to induce patients to pay, is the most common collection tactic, KHN's analysis and other data shows. Fewer patients are actually taken to court.
But more than two-thirds of policies obtained by KHN allow hospitals to sue patients or take other legal actions against them, such as garnishing wages or placing liens on property.
This includes half the hospitals earning top spots on the U.S. News & World Report's annual scorecard — medical centers such as the Mayo Clinic, Cleveland Clinic, and Massachusetts General Hospital.
Patients at public university medical systems in at least 23 states, including Colorado, Georgia, Minnesota, Tennessee, and Wisconsin, can be sued. In several states, including North Carolina, Ohio, and New York, public university systems refer patients to other state agencies for legal action or withholding tax refunds.
Major nonprofit systems such as Kaiser Permanente, Trinity Health, and Northwell Health will also take legal action against patients, according to their policies or spokespeople. America's largest for-profit hospital chains — HCA Healthcare and Tenet Healthcare — don't post collection policies, but don't sue patients, according to spokespeople. Other investor-owned chains, such as Community Health Systems, will take patients to court.
Hospitals with policies allowing them to sue patients tend to have only slightly higher profits than those that don't sue, KHN found by comparing financial data that hospitals submit annually to the federal government.
The same is true of hospitals that sell patient accounts, a practice in which medical providers typically package a group of outstanding bills and sell them to a debt-buying company, usually for a small percentage of what is owed. Debt buyers then keep whatever they can collect.
Officials at many hospitals that sue say they rarely take that step. And spokespeople at several medical systems said they have effectively stopped taking patients to court even if their policies still allow it.
But in many cases, hospital policies haven't changed, leaving patients in legal jeopardy, as was the case at the Ascension hospital in New York that continued to file lawsuits against patients.
The effect of barring aggressive collections
A few hospitals have barred all aggressive collections, including two of California's leading academic medical centers at UCLA and Stanford University. So too have the University of Vermont Medical Center and Ochsner Health, a large New Orleans-based health system.
That can make a difference for patients, data suggests. A recent analysis by the Consumer Financial Protection Bureau found that while medical debt is widespread across the Appalachian region, one notable exception is western Pennsylvania.
Residents there have fewer past-due medical bills on their credit reports than the national average. This region is dominated by the Pittsburgh-based UPMC hospital system, which prohibits aggressive collection actions, including reporting patients to credit agencies.
In neighboring West Virginia, by contrast, the incidence of medical debt is more than 50% above the national average, the CFPB found. That state's largest hospital system — operated by West Virginia University — not only reports patients to credit agencies but will also sue patients, garnish their wages, and place liens on property.
Elected officials in some states have begun to put limits on hospital bill collecting. In 2021, Maryland barred hospitals from placing liens on patients' homes and protected low-income patients from wage garnishments. California recently restricted when hospitals could sell patient debt or report patients to credit bureaus.
But these states remain the exception. And hospitals that have voluntarily given up aggressive collections are in the minority: Just 19 of the 528 hospitals researched by KHN have publicly posted policies barring "extraordinary collection actions."
Mark Rukavina, who spent decades at the nonprofit Community Catalyst working to expand protections for patients with medical debt, said that is why federal action is needed to rein in hospitals and other medical providers everywhere.
"Nobody should be denied care because they have an outstanding medical bill," he said. "Nobody should have a lien on their home because they got sick."
Researchers who worked on this story include KHN writer Megan Kalata and Dr. Margaret Ferguson, Anna Back, and Amber Cole, who were students at the Milken Institute School of Public Health at George Washington University.
https://www.mainepublic.org/npr-news/2022-12-21/investigation-many-u-s-hospitals-sue-patients-for-debts-or-threaten-their-credit
Major Trustee, Please Prioritize’: How NYU’s E.R. Favors the Rich
by Sarah Kliff, Jessica Silver-Greenberg - NYT - December 22, 2022
In New York University’s busy Manhattan emergency department, Room 20 is special.
Steps away from the hospital’s ambulance bay, the room is outfitted with equipment to perform critical procedures or isolate those with highly infectious diseases.
Doctors say Room 20 is usually reserved for two types of patients: Those whose lives are on the line. And those who are V.I.P.s.
In September 2021, doctors were alerted that Kenneth G. Langone, whose donations to the university’s hospital system had led it to be renamed in his honor, was en route. The octogenarian had stomach pain, and Room 20 was kept empty for him, medical workers said. Upon his arrival, Mr. Langone was whisked into the room, treated for a bacterial infection and sent home.
The next spring, Senator Chuck Schumer accompanied his wife, who had a fever and was short of breath, to the emergency room. As sicker patients were treated in the hallway, the couple were ushered into Room 20, where they received expedited Covid-19 tests, according to workers who witnessed the scene. The tests came back negative.
NYU Langone denies putting V.I.P.s first, but 33 medical workers told The New York Times that they had seen such patients receive preferential treatment in Room 20, one of the largest private spaces in the department. One doctor was surprised to find an orthopedic specialist in the room awaiting a senior hospital executive’s mother with hip pain. Another described an older hospital trustee who was taken to Room 20 when he was short of breath after exercising.
The privileged treatment is part of a broader pattern, a Times investigation found. For years, NYU’s emergency room in Manhattan has secretly given priority to donors, trustees, politicians, celebrities, and their friends and family, according to 45 medical workers, internal hospital records and other confidential documents reviewed by The Times.
On hospital computers, electronic medical charts sometimes specify whether patients have donated to the hospital or how they are connected to executives, according to screenshots taken by frustrated doctors in recent years and shared with The Times.
“Major trustee, please prioritize,” said one from July 2020.
Dozens of doctors said they felt pressure to put V.I.P.s first. Many witnessed such patients jumping ahead of sicker people for CT scans and M.R.I.s. Some said medical specialists, often in short supply, were diverted from other cases to attend to mild complaints from high-priority patients.
Many hospitals offer exclusive concierge services to the rich. But emergency rooms are built around the premise of medical triage: that the sickest patients, regardless of their ability to pay, are treated first. Everyone else has to wait.
At NYU Langone, one of the country’s pre-eminent medical institutions, some doctors said that process had been upended.
“As emergency department doctors, we have two important skills: triage and resuscitation,” said Dr. Kimbia Arno, who worked in the emergency room in 2020 and 2021. “This system is in direct defiance of what we do and what we were trained to do.”
“The stress on providers is harmful,” said Dr. Anand Swaminathan, a physician in the emergency room from 2009 to 2018. “It’s the fact that I am getting multiple calls, from multiple people, asking me to drop everything to treat a V.I.P.”
Eleven doctors told The Times that they had resigned from the emergency department in part because they objected to favoring V.I.P.s.
Some residents — doctors in their first years of practice — complained to the national organization that accredits medical training programs. The frustrations included NYU’s “special treatment” of trustees, donors and their families, according to documents reviewed by The Times. The group’s subsequent investigation confirmed that some doctors “felt pressured to see V.I.P. patients first” and that they “experience a sense of fear and intimidation and retaliation for not expediting V.I.P. patient care.”
The Internal Revenue Service requires nonprofit hospitals like NYU, which avoids $250 million a year in taxes, to benefit their communities. A primary way to meet the requirement is to run an emergency room that is open to everyone.
But at NYU, poor people sometimes struggle to be seen. For example, ambulance workers said nurses in the emergency room routinely discouraged them from dropping off homeless or intoxicated patients. Instead, they were often shuttled to nearby Bellevue, a strained public hospital that primarily treats the poor.
A Times series this year has found that many nonprofit hospitals have strayed from their charitable roots to maximize profits. Giant hospital systems illegally sent exorbitant bills to Medicaid patients. They used hospitals in poor neighborhoods to qualify for steep drug discounts, funneling the proceeds into wealthier neighborhoods. Others cut staff to dangerously low levels.
NYU’s chief of hospital operations, Dr. Fritz François, denied that the hospital favored donors, trustees and other prominent patients. He said that patients received treatment based on how sick they were, regardless of their wealth or status, and that the emergency room treated many low-income and homeless patients.
“We do not have a V.I.P. program,” Dr. François wrote in a letter to The Times. “We do not have V.I.P. patients. We do not have V.I.P. floors. We do not have V.I.P. rooms. We do not have V.I.P. clinical teams. We do not offer V.I.P. care.”
Lisa Greiner, a spokeswoman for NYU Langone, confirmed that Mr. Langone had been treated in Room 20, which she said was “absolutely appropriate” based on his symptoms. She said the room served a variety of purposes, including privacy. She said no patient, including Mr. Langone, “has ever been treated in an isolated room at the expense of any other patient’s care.”
Mr. Langone said, “As a matter of personal integrity I have never asked for any special treatment at the hospital, and they have never offered.”
Angelo Roefaro, a spokesman for Mr. Schumer, said the protocol for the senator’s security detail was “to have the senator stay, whenever possible, in a secure location.”
Andrew C. Phillips, a lawyer for NYU, said some of the doctors who had spoken to The Times were motivated to disparage the hospital. Dr. Arno, for example, had been in a fellowship program and was passed over for a permanent job, he said. Mr. Phillips also said Dr. Swaminathan had never voiced concerns to hospital leaders about V.I.P.s.
Dr. François acknowledged that NYU’s electronic medical records sometimes included notations describing patients as “friends and family.” But he said these labels were available for all hospital employees — even the cousins of security guards and housekeepers — and enabled employees to pay courtesy visits to such patients.
“Our friends and family do not receive different or better medical care,” Dr. François wrote. He added, “Our friends and family don’t skip the triage process, don’t jump any lines, don’t get placed in any special rooms or floors and don’t get fed any differently.”
Dozens of doctors and other emergency room staff said that, when it came to many V.I.P.s, that was simply not true.
An E.R.’s Transformation
In 2007, the New York University Medical Center was in grave financial trouble.
Were it not for royalties from an arthritis drug developed by one of its researchers, the hospital would have lost $150 million that year. The patent’s expiration was looming.
A lifeline came from Mr. Langone, the founder of Home Depot and chairman of the hospital’s board of trustees. He and his wife donated $100 million in 2008, matching a contribution they had made eight years earlier. The medical center was renamed NYU Langone.
Mr. Langone became known not just for his own philanthropy — he donated another $100 million in 2019 — but also his ability to persuade other wealthy New Yorkers to donate. Over the ensuing years, he helped the hospital raise $3 billion.
In 2012, the run-down emergency room, on the East River in Midtown Manhattan, was destroyed by Hurricane Sandy. It reopened two years later with more space and a new name, the Ronald O. Perelman Center for Emergency Services, named for the billionaire who financed its construction.
The emergency department’s longtime chair, an outspoken champion of serving the needy, stepped down in 2015. Around then, several doctors said, they began receiving requests from administrators to give priority to V.I.P.s.
“Suddenly, we started getting these phone calls that X person is coming in, they are X relation to board member, and we were given the strong sense that you had to push them to the front of the line,” said Dr. Swaminathan, who worked in the emergency room at the time.
NYU was not the only prestigious nonprofit hospital system finding ways to cater to donors and other wealthy patients.
In San Francisco, the UCSF Medical Center rewarded donors with faster access to top cardiologists. Stanford Medical Center gave wealthy patients red blankets to distinguish them from everyone else. (Spokeswomen for those medical centers said they no longer provided such perks.)
Today, top New York hospitals like Mount Sinai and NewYork-Presbyterian/Weill Cornell offer luxury accommodations and personal concierge services to patients who can afford them.
And emergency room workers at several elite academic medical centers said in interviews that, as at NYU, administrators sometimes requested expedited treatment for well-connected patients.
“The hospitals are acting as businesses,” said Dr. Renee Hsia, a professor at the University of California, San Francisco, who researches emergency room care. “They can often garner much more revenue from these patients that are huge donors.”
‘Drop Everything’
The V.I.P. experience in NYU’s Manhattan emergency room starts before the patient arrives.
Trustees can use a dedicated phone number — the Trustee Access Line — to alert the hospital they are coming. Administrators then call, text and send messages notifying doctors that a high-priority patient is en route, according to 30 doctors. Doctors said that even when those messages did not explicitly seek priority treatment, that was how they were interpreted.
“Just a heads up that a VIP/trustee is coming to the ED per notification from the Dean’s office and to keep an eye out for her,” one doctor wrote in an electronic chat in August 2021, referring to the emergency department. The Times reviewed a screenshot of the exchange.
Ms. Greiner, the NYU spokeswoman, said the trustee line “does not entitle any member to better or prioritized care.” She said that the V.I.P. reference in the 2021 message was “colloquial and does not correspond with any special protocol at our hospital,” and that the sender did not “ask for or expect special care, line cutting or anything of the sort.”
Doctors said they were sometimes required to carry a hospital-issued iPhone that, among other things, was logged into an email chain that alerted them to incoming V.I.P.s.
“It didn’t matter how busy it was,” said Dr. Uché Blackstock, who worked in the emergency room from 2010 to 2019. “A V.I.P. was coming, and we had to drop everything.” She left NYU partly because of frustration with the preferential treatment, she said.
Ms. Greiner said that Dr. Blackstock had never complained to the hospital about improper prioritization of patients and that Dr. Blackstock had herself alerted colleagues on a few occasions when her family or friends were in the emergency room. In response, Dr. Blackstock said there was a distinction between what she had done and what she and others perceived as institutional pressure to swiftly treat V.I.P.s.
Some patients’ electronic medical charts included reminders about their V.I.P. status, according to screenshots captured by emergency room doctors and shared with The Times.
“NYUMC BOARD OF TRUSTEE AND IMMEDIATE FAMILY,” read one note.
Another: “She is a donor and a prospect for a planned gift.”
A third: “Escort Needed” and “Daughter of Trustee.” (Some V.I.P.s were assigned employees to stand by to transport them around the hospital, according to 13 medical workers. Ms. Greiner denied that.)
Two members of NYU Langone’s board of trustees said in interviews that they had received swift, excellent care at the emergency room. They believed everyone got such treatment.
“I didn’t have to wait around for long hours for someone to come talk to me as happens in other emergency rooms,” said Bernard Schwartz, who said he had donated more than $30 million to NYU Langone. “I think that’s for all patients.”
Mr. Schwartz said he did not think his medical record identified him as a trustee. But he presumed that doctors knew who he was.
“I would be upset if that were not true,” he said.
Delayed Resuscitations
NYU’s emergency room often has more than 100 patients at once but only 40 curtained beds, leaving many patients to be treated in the hallways.
None of the doctors The Times interviewed had ever seen that happen with a V.I.P.
One Thursday night in April 2018, workers in the emergency room got an alert that Mr. Langone would be arriving in about 20 minutes. They had to figure out where to put other patients to ensure that he could have a private room, according to two medical workers with direct knowledge of what happened. When he arrived with a two-centimeter cut on his thumb, doctors quickly stitched him up.
Ms. Greiner said no other patients were awaiting care during Mr. Langone’s visit. The two workers told The Times that the emergency room had been as busy as usual.
Emergency room workers said these arrangements for V.I.P.s sometimes delayed critical care for sicker patients.
In late 2019, doctors were racing to rescue a patient in cardiac arrest. One pushed the gurney toward one of the private rooms meant for life-or-death emergencies. Another sat atop the unconscious patient, performing chest compressions. When they arrived at the room, they could not enter — a V.I.P. occupied it. The patient survived, but two workers who witnessed the episode said the delay could have been deadly.
Ms. Greiner said, “Without the patient’s information, we cannot investigate this claim other than to say that at NYU Langone, there is one standard of care for all patients.”
The Times identified many similar examples.
For example, a relative of someone on the hospital’s leadership team went into the emergency room with chest pain and was promptly taken to a private room, even as a man experiencing a life-threatening emergency — a blockage of blood to one of his limbs — was put in the hallway, according to the accreditation group’s investigation.
Another time, at the instruction of a hospital administrator, a V.I.P. patient with asymptomatic Covid was seen by pulmonology and infectious-disease specialists who had to be pulled away from sicker patients, according to two medical workers with direct knowledge of the case.
Ms. Greiner said that The Times had not provided enough information for her to be able to respond definitively, but that the asymptomatic patient might have had an underlying illness.
Dr. Michelle Romeo, who was a resident in the emergency room from 2017 until 2021, recalled when a famous actor with a headache and low-grade fever jumped to the front of the line for a CT scan, cutting off a nursing home resident who had possible sepsis and had been waiting for three hours.
The actor requested a spinal tap, which Dr. Romeo believed was unnecessary. A supervisor instructed her to do it anyway, she said.
Both tests showed nothing wrong with the patient.
Mr. Phillips, the lawyer for NYU, said Dr. Romeo had an incentive to criticize the hospital because she had not been offered a full-time position after her residency. Dr. Romeo said she believed she had not been offered the job because she had been outspoken about issues including the treatment of V.I.P.s.
A Public Shaming
Over the years, doctors in NYU’s emergency room came to believe there could be career-threatening consequences if well-connected patients were dissatisfied with their treatment.
In October 2019, Dr. Joe Bennett was at the end of what’s known as a shift-change huddle, updating his colleagues on the patients he was handing off, when a frustrated V.I.P. approached him. The V.I.P. demanded that a family member immediately receive a CT scan, according to a doctor who witnessed the encounter and two others who were briefed on the matter.
Dr. Bennett explained that a sicker patient was the priority but that the family member would come next.
Soon after, Dr. Bennett was put on probation for what NYU said was a lack of professionalism, according to the three doctors. For months, the hospital required him to attend weekly meetings and write essays reflecting on how to provide professional treatment.
About a year later, in December 2020, Dr. Kristin Carmody, who oversaw the education of medical residents in the emergency department, was forced to resign after a patient complained about having not received the level of attention or treatment that she expected. Dr. Carmody later said in a wrongful-termination lawsuit that the patient had been designated as a V.I.P.
Ms. Greiner said that the patient’s medical record had not included a friends-and-family label and that Dr. Carmody had been pushed out because she falsely noted on a medical record that she had personally examined the patient. (Dr. Carmody denies that.)
But inside the emergency department, her ouster was widely regarded as punishment for not sufficiently catering to a V.I.P. patient.
At a heated staff meeting that month, a senior doctor said Dr. Carmody’s forced departure appeared to be the result of a complaint from “a V.I.P. person that was connected to higher-ups,” according to a recording of the meeting. The doctor added, “The clear message is anybody can be taken down.”
Around that time, top NYU officials commissioned an internal review of the culture of the emergency department, whose employees were burned out from the pandemic and unhappy with their pay.
The investigation documented concerns with V.I.P. care, according to a presentation that Dr. Robert Femia, the chairman of the emergency department, delivered to doctors.
Many doctors and nurses “dislike the current ‘V.I.P.’ process because they perceive it as disrupting ordinary work flows” in which staff triage patients based on their medical needs, one slide said. “They do not recognize that the true issue is that every patient is a ‘V.I.P.’ patient.”
‘An NYU Dump’
In the summer of 2021, a few months after Dr. Femia’s presentation, an ambulance dropped off a disheveled homeless patient at NYU’s emergency room. He had pain in both legs and was having trouble walking.
A worker checked the man’s vital signs. He was offered Tylenol and discharged, according to an email that a senior nurse later sent to more than 200 colleagues detailing what had happened.
About an hour later, the man was back. This time, he was seen in the waiting room by a social worker, who noted that it was hard for the man to lift his legs from his wheelchair. No one undressed the patient to examine his legs. He was discharged again.
It was not until later that day that the hospital admitted him. The man was diagnosed with acute kidney failure and rhabdomyolysis, a potentially fatal muscular condition.
Ms. Greiner said the case had been handled appropriately. But medical staff noted that NYU included it in an internal review process in which doctors try to learn from mistakes.
Doctors and nurses described a pattern in which homeless patients — surefire money losers for hospitals — sometimes received cursory care, even as privately insured patients with similar symptoms were admitted for urgent treatment.
For poor or homeless patients, “there is pressure to see them in the hallway or in the waiting room,” said Dr. Jeremy Branzetti, who ran NYU’s emergency-medicine residency program until last year. “I have never seen a V.I.P. patient in the hallway.” Mr. Phillips, the lawyer for NYU, said Dr. Branzetti had received a poor performance review and his contract was not renewed.
Some homeless people struggle to get into NYU’s emergency room in the first place.
Anthony Almojera, the vice president of a union that represents emergency services officers, said nurses at NYU reprimanded ambulance crews when they tried to drop off patients who appeared homeless or intoxicated.
“I had instances where the nurse’s first question wasn’t ‘What is wrong with the patient?’ but ‘How come this patient is being brought here?’” Mr. Almojera said.
Another ambulance worker, who requested anonymity because he still works with NYU, said that when he tried to drop off a drunk patient in October, a nurse demanded to know his badge number.
The pressure from nurses works: Paramedics who work on public ambulances said that instead of taking drunk or homeless patients to NYU, they routinely dropped them off at Bellevue, which is staffed in part by NYU residents.
NYU’s own fleet of ambulances, which handle some 911 calls, also take their unwanted patients to Bellevue, according to four nurses there.
“There isn’t a day that goes by that we don’t get an NYU dump,” said Kim Behrens, who has spent more than a decade as a nurse at Bellevue.
“We treat undomiciled persons every day and give every effort to do so with dignity, respect and compassion,” Ms. Greiner said. She also pointed to data showing that NYU treats thousands of Medicaid-eligible patients.
Accreditation in Jeopardy
By 2021, doctors had lost patience with the administration’s elevation of V.I.P.s, which they saw as unethical and dangerous to other patients. Some quit. Others complained to hospital administrators.
Then the Accreditation Council for Graduate Medical Education, which oversees medical training programs nationwide, received an anonymous complaint. One of the four allegations was that the V.I.P. system “teaches residents patient bias,” according to a letter the council sent to NYU in November 2021.
The accreditation council interviewed more than 50 doctors, who confirmed that V.I.P.s were regularly given priority. Citing Dr. Carmody’s ouster, they described being afraid of professional consequences if they did not give preferential treatment to well-connected patients.
The council said that climate of fear violated the group’s educational standards for medical residents. And the organization said it was unclear if NYU had taken steps to ensure that the V.I.P. process would not harm patients.
In August, the council put NYU’s emergency department on probation, jeopardizing the accreditation of its residency program. It was a rare move: Last year, of 12,740 residency programs, just 25 were placed on probation.
NYU has two years to address the council’s concerns. Losing the accreditation could cost the hospital millions of dollars a year in federal funds and doom the residency program, which the hospital relies on to keep its emergency room running.
Ms. Greiner accused the accreditation council of recycling “false” allegations about V.I.P. patients getting special treatment. The council said it stood by its findings.
Susan C. Beachy and Kitty Bennett contributed research.
https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html
Labor Leaders Provide Cover for Privatization of Medicare
by Ed Grystar - Portside - December 22, 2022
“Medicare is a pillar of the healthcare system”
– AFL-CIO June 13, 2022
Such a statement from the AFL-CIO would suggest that labor is
determined to protect Medicare and even support improving and expanding
it to all Americans. Additionally, President Biden and Democrats
regularly criticize Republican threats to reauthorize and voucherize
Medicare. Meanwhile, what’s left out of both the Democrat talking points
and the AFL-CIO’s 2022 national resolution on healthcare is any
acknowledgment that the real threat to Medicare and healthcare today is the decades-long tax-subsidized privatization supported by both major parties.
With major support from organized labor, including AFL-CIO President George Meany at the signing, Medicare was signed into law in 1965. Before Medicare, only 60% of those over 65 had insurance since it was unavailable or unaffordable via private insurance (seniors were charged 3x the rate of younger people). Not only economically beneficial to the working class, the passage of Medicare was a huge civil rights victory as payments to physicians, hospitals, and health care providers were conditional on desegregation.
While a big victory, Medicare did not provide full coverage for all services, and from its inception, there has been a drive to privatize and hand it over to profiteers. In fact, 2022 marks the 50th anniversary (1972) of Medicare permitting private insurance companies (HMOs) to participate in Medicare.
President Clinton finalized HMO participation with Congress in 1997, and in 2003, the Medicare Modernization Act, under President Bush, further boosted privatization. The year 2003 marks the beginning of Medicare Advantage plans: insurance companies essentially masquerading as Medicare.
HMOs and all the other private insurance companies introduced into Medicare after 1997 have not saved the government money, but instead, raised the cost to taxpayers much more than traditional Medicare beneficiaries. In 2005 the Government Accounting Office reported that “It is largely . . . excess payments, not managed care efficiencies, that enable plans to attract beneficiaries by offering a benefits package that is more comprehensive than the one available to FFS beneficiaries, while charging modest or no premiums. Nearly all of the 210 plans in our study received payments in 1998 that exceeded expected FFS costs….”
Under traditional Medicare, patients can go to any doctor or provider that accepts Medicare without prior authorization or restrictive networks. With privatization, profits ensue as additional restrictions are imposed, such as narrow networks, micro-managing physicians, and prior authorizations. Routine denials of care are also a common practice forcing patients into lengthy appeals with the insurers betting many will walk away. In NYC, retirees have had to file lawsuits to stop their own leaders from changing their coverage from traditional Medicare with a supplement to a Medicare Advantage plan.
These wasted tax dollars and huge profits for Medicare Advantage have skyrocketed over the years and contribute to draining the Medicare Trust Fund that supports all beneficiaries. While traditional Medicare has administrative costs of about 2%, the 10 private insurance companies that account for 80% of enrollees in Medicare Advantage have expenses of 15% including profits and advertising. The most recent Federal audits show that eight of the 10 largest Medicare Advantage companies have submitted inflated bills, and four out of five of the very largest have faced federal lawsuits with accusations of fraud. In 2020 alone, they exaggerated risk scores of patients and generated $12 billion in overpayments.
Labor Supports ACA – Vehicle For Privatization
With the passage of the ACA in 2010, the private insurance industry’s role as a taxpayer-subsidized vehicle for the healthcare delivery system was cemented and momentum for an alternative approach was stymied. Despite 600 union endorsements for Medicare for All Bill HR 676, union leaders joined Democrats to cheer the ACA as a resounding success.
Inserted into the passage of the ACA was language that created a new agency, the Center for Medicare and Medicaid Innovation under the Center for Medicare Services (CMS). Labeled as an office of “innovation,” it has been given the authority to establish “pilot projects” that hand traditional Medicare to corporations.
These “pilots,” established under the Trump administration and continued seamlessly by President Biden, accelerate the privatization and are even more insidious. Now called ACO REACH (Accountable Care Organizations, Reaching Equity, Access and Community Health), this program auto enrolls beneficiaries who have selected traditional Medicare into a privatized program without their consent. These programs can be eligible for profits of 25 to 40 percent. The aim of CMS is to put all beneficiaries into a privatized plan by 2030. Incredibly, it has no congressional oversight and little pushback by Congress.
Top Labor Complicit as Biden Continues to Privatize
Why Should the Rank-and-File Care?
Even as labor negotiations continue to be inhibited by rising healthcare costs, labor refuses to expose the corruption and waste within the ongoing privatization of Medicare, harming its members, reducing union credibility, and contributing to the downward spiral of health benefits for all. The promotion of an official AFL-CIO Medicare Advantage plan and a do-nothing attitude towards ACO REACH must end.
The Alliance for Retired Americans, the AFL-CIO’s national retiree organization, has refused to issue any statement against the privatization of traditional Medicare. Activists
around the country are reporting that they are being cautioned to not call for the cancellation of the ACO REACH privatization program.
What we are facing in 2022 is the destruction of Medicare by corporate privatization, supported by many top labor unions and their compromised “allies” in Washington. For comparison sake, take a look at labor in Canada where the top five healthcare unions are taking a stand to warn the public that the government in Ontario is intentionally creating a healthcare crisis to justify privatization, just like in the U.S.
What Kind of Labor Movement Will Lead This Fight?
There is ample reason for hope. A budding bottom-up movement has already garnered signatures from over 250 organizations in a letter sent to Health and Human Services Secretary Becerra asking him to end the ACO REACH privatization program. Included were the Alameda County, CA and Austin, TX Central Labor Councils plus the state AFL-CIOs in Vermont, Maine, Washington, and Kentucky and other labor groups. There have also been resolutions passed against ACO REACH by the Seattle City Council, West Virginia Democratic Party and the Texas State Democratic Executive Committee. Labor has the resources and organizational strength to lead this battle. It needs to multiply these actions tenfold to grow a real movement on behalf of working people everywhere. These efforts accompany a broader movement for healthcare justice spanning beyond retirees which include recent referendums in counties in rural Wisconsin and parts of Illinois calling for a national healthcare program as well as supermajority support in the US for Medicare for All.
We need to be clear that change cannot be achieved without a sea change in the ideological direction of labor. Discussions and debates inside labor unions and among workers about the best strategies and tactics to tackle the corporate assault on public need are necessary. It’s clear that the current approach is not working. People are looking for answers that protect and advance the public interest. For unions to assume their proper role they must discard the petty, bureaucratic, and ossified approach of business unionism: a losing strategy which at its core is the “partnership” with corporations and a futile lobbying approach tied to the Democrats. It cannot meet the possibilities and needs of the day.
Labor needs to stop providing cover for the privatization of Medicare and join the fight to end ACO REACH. We must mobilize a broad independent movement that unites all for the public interest. It’s only the power of the people that can win this.
[Ed Grystar has more than 40 years experience in the labor and healthcare justice movements. He is co-founder and current chair of the Western Pennsylvania Coalition for Single Payer Healthcare. Served as the President of the Butler County (PA) United Labor Council for 15 years. Has decades of experience organizing and negotiating contracts for health care employees with the Service Employees International Union and the Pennsylvania Association of Staff Nurses & Allied Professionals.]
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