The National  Memo Logo

Smart. Sharp. Funny. Fearless.

Monday, December 09, 2019 {{ new Date().getDay() }}

Tag: health care

Twelve GOP Senators Vote No On Care For Veterans Exposed To Toxic Chemicals

The Democratic-controlled Senate on Tuesday advanced a bill aimed at providing adequate medical care for veterans exposed to toxic chemicals during their service. But 12 Senate Republicans voted against even considering this bipartisan proposal.

By an 86-12 margin, the Senate voted for cloture on a motion to begin consideration of the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 — well more than the required 60-vote supermajority.

According to Senate Veterans' Affairs Committee Chair Jon Tester and Ranking Member Jerry Moran, the bill will expand the Department of Veterans Affairs health care eligibility to combat veterans who served after the Sept. 11, 2001, terrorist attacks, including more than 3.5 million veterans who were exposed to toxic chemicals during their service. The bill will also expand research on toxic exposure and expand coverage for those exposed to Agent Orange and burn pits.

"In addition to providing historic relief to all generations of toxic-exposed veterans, this legislation will improve claims processing to meet the immediate and future needs of every veteran it serves," wrote Tester (D-MT) and Moran (R-KS) after they reached an agreement on a Senate version of the bill on May 18. "Together, we will continue working until Congress delivers on its commitment to passing long-lasting solutions and comprehensive reforms for those who served our country."

Despite the Senate's broad bipartisan support for the bill, 12 Republicans voted against advancing it: Sens. Richard Burr (NC), Bill Cassidy (LA), John Kennedy (LA), James Lankford (OK), Mike Lee (UT), Cynthia Lummis (WY), Rand Paul (KY), Mitt Romney (UT), Dan Sullivan (AK), Thom Tillis (NC), Pat Toomey (PA), and Todd Young (IN).

None of the 12 senators immediately gave a reason for why they voted against the bill either on the Senate floor or on Twitter.

The issue has been a top priority for President Joe Biden and his administration.

In his March State of the Union address, Biden noted that his own son's fatal cancer might have been caused by toxic exposure during his service in Iraq.

"When they came home, many of the world's fittest and best-trained warriors were never the same. Headaches. Numbness. Dizziness. A cancer that would put them in a flag-draped coffin," he said of Iraq and Afghanistan veterans. "I know. One of those soldiers was my son, Major Beau Biden. We don't know for sure if a burn pit was the cause of his brain cancer or the diseases of so many of our troops. But I’m committed to finding out everything we can."

In April, the Biden administration announced administrative steps to allow those exposed to burn pit chemicals during their military service to get disability benefits if they contracted respiratory cancers.

The White House has also pushed Congress to enact broader legislation. In May, White House Press Secretary Karine Jean-Pierre said the Senate bill "will not only help deliver more timely access to benefits and services for veterans and their survivors, it will also ensure that the Department of Veterans Affairs can act more nimbly to add future presumptive conditions when the evidence warrants."

A similar bill passed the Democratic-controlled House of Representatives in March, 256-174. Though 34 Republicans backed that bill — along with every single Democratic representative — the vast majority of the GOP caucus voted no and argued that that $281.5 billion package was too expensive.

The Senate is now likely to approve its version of the bill and send it back to the House.

House Speaker Nancy Pelosi has already endorsed the Senate package as "an important victory for America’s veterans, their families and caregivers, and indeed for all of America," and promised to immediately move it through the House and to Biden's desk.

Reprinted with permission from American Independent.

'Promises Kept'? Eight Major Pledges That Trump Blew Off

Reprinted with permission from American Independent

Donald Trump made hundreds of promises as a candidate about what kind of president he would be. As his final days in office tick down, it is clear that he has broken most of the biggest ones.

Some were silly — like his vows never to call Iran's Ayatollah Ali Khamenei "Supreme Leader" ("I'll say, 'Hey baby, how ya doing?'") and never to break his leg in a bicycle race. Others were hyperbolic, like an April 2016 boast that if he won the election, "all of the bad things happening in the U.S. will be rapidly reversed!"

But many of his unkept promises were fundamental actions he had claimed were the reason he should be elected president, things he would do to "Make America Great Again."


Trump has claimed that he created the greatest economy in history. But even before the COVID-19 pandemic resulted in a massive economic downturn, the promises Trump made about what he'd do for the country's economy had not been fulfilled.

During a debate with Democratic presidential nominee Hillary Clinton not long before Election Day in 2016, Trump claimed that "we're bringing GDP from, really, one percent, which is what it is now, and if she got in, it will be less than zero. But we're bringing it from one percent up to four percent. And I actually think we can go higher than four percent. I think you can go to five percent or six percent."

But under Trump, growth of the country's gross domestic product never reached four percent in any quarter until the third quarter of 2020, and that was due to a partial rebound from a contraction of over 31 percent caused by the pandemic.

Rather than balance the budget and get rid of the national debt "fairly quickly," Trump's policies increased the debt by trillions of dollars, even before the 2020 pandemic relief bills.

His promised massive cuts to taxes paid by middle class Americans also never materialized, nor did the promised funding of massive infrastructure projects.


Dozens of times, Trump made a vague but firm pledge to "immediately" repeal and replace the Affordable Care Act, commonly known as Obamacare, with something "terrific" that would provide health insurance coverage to every American.

Trump never actually revealed this supposed secret plan. Instead, he endorsed what he described as a "mean" congressional repeal legislation proposal that he admitted lacked "heart." The House, then controlled by Republicans, passed a version of the bill, but the effort failed in the Senate.

Trump's pledges to stop the flow of illegal drugs into the country and solve the issues of cocaine and heroin abuse also did not come to fruition.


Trump's most famous 2016 campaign promise was that he would quickly build a massive wall along the entire southern border between the United States and Mexico, and that Mexico would pay for it. When Mexico refused to pay, Trump diverted billions of dollars appropriated for military families and construction to pay for it.

According to a fact check published by USA Today in September, only five miles of the wall built under the Trump administration are new construction; the rest of the 307 miles U.S. Customs and Border Protection said had been built as of Sept. 1 replaced or reinforcing existing fencing.


During his campaign for president, Trump vowed to "drain the swamp in Washington, D.C.," releasing a "Five-Point Plan for Ethics Reform" in government. He said he would completely disentangle himself from his financial holdings and have his kids take them over. He did neither, instead giving policy influence to donors, letting his children simultaneously take key roles in his business and political organizations, profiteering from his position, and running what the nonpartisan watchdog Citizens for Responsibility and Ethics in Washington called the "most unethical presidency" in U.S. history.

He also promised voters, "I will always tell you the truth." As of this September, the Washington Post reported, Trump had made more than 23,000 false or misleading statements while in office.

Focus On The Job

During the 2016 race, Trump claimed that as president he would behave differently than he had as a candidate. "And after I win, I will be so presidential that you won't even recognize me. You'll be falling asleep, you'll be so bored," he said during an interview with reporters Bob Woodward and Robert Costa. He also promised that if he was elected, he would stop tweeting.

"I would rarely leave the White House because there's so much work to be done," he said in 2015. "I would not be a president who took vacations. I would not be a president that takes time off."

Trump has made hundreds of trips to his own golf resorts and visited his properties on nearly a third the time he's been in office.


Trump promised that he would staff his administration with only the "best and most serious people." But he frequently fired his own appointees — sometimes via tweet — and often attacked them for being totally incompetent.

According to a report published by the Brookings Institution, 91% of Trump's "A Team" of positions within the executive office, not including Cabinet members, turned over at least once during his four years in the White House, breaking records for turnover.

Public Safety

Trump told Americans that he would bring an end to violent crime. "The crime rate is through the roof. People can't walk down the street without getting shot. I'll stop that," he said. In his inaugural address, Trump announced an end to crime and poverty in inner cities, saying, "This American carnage stops right here and stops right now."

While a decrease in violent crime that had been underway for decades mostly continued, the murder rate in many American cities shot up this year, possibly in connection with the coronavirus pandemic, experts speculate. Rather than highlight the incremental improvements, Trump actually made his failure to keep this promise a 2020 campaign talking point and frequently noted the increasing crime rates on his own watch.


While pushing climate denial, Trump framed himself as an environmentalist committed to "crystal clear, crystal clean" water and fresh air. "I will refocus the EPA on its core mission of ensuring clean air, and clean, safe drinking water for all Americans," he promised.

Instead, his administration rolled back environmental protections and slashed funding for water infrastructure. The level of dangerous particle pollution in the air is basically unchanged since 2016, as the EPA ignores scientists' calls to impose lower limits on the pollutants.

Despite all of these, Trump sought a second term with the slogan "Promises Kept."

"I didn't back down from my promises and I have kept every single one," he claimed in a video shown at the Republican National Convention in August.

With a popular vote defeat by a margin of more than six million votes and a 306-to-232 defeat in the Electoral College in the 2020 election, it does not appear the American people bought it.

Published with permission of The American Independent Foundation.

If Black Lives Matter, Racist Health System Must Be Priority

Reprinted with permission from ProPublica.

WASHINGTON — On Tuesday, when he decided to protest, William Smith, 27, used a red marker to write a message on the back of a flattened cardboard box: “Kill Racism, Not Me."

As he stood alone, somber, he thought about George Floyd, a fellow black man whom he'd watched die on video as a Minneapolis cop kneeled on his neck eight days earlier. “Seeing the life leave his body was finally the last straw that broke the camel's back for me," he said.

But he also thought about people he knew, a handful of them, who died after catching the new coronavirus. “They were living in impoverished areas. Couldn't get proper treatment. Lived in crowded conditions, so social distancing was hard to do. And they were still forced to go to work and be put in harm's way."

When speaking out against the loss of black lives, it is tough to separate those who die at the hands of police from those who die in a pandemic that has laid bare the structural racism baked into the American health system. Floyd himself had tested positive for the coronavirus. Eighteen black protesters interviewed by ProPublica were well aware that black lives were being lost to the virus at more than twice the rate of others, and that societal barriers have compounded for generations to put them at higher risk.

It was fueling their desire to protest and their anxiety about joining the crowd. But they flocked to the White House on Tuesday afternoon, one day after peaceful protesters there were tear-gassed so that President Donald Trump could hold up a bible for a photo op at St. John's Episcopal Church. There were tanks on the streets, along with a battalion of federal agents, military troops and police. Many of the protesters said they were willing to sacrifice their bodies, either to violence or the virus, to be heard.

In front of the White House stood Caleb Jordan, who turns 21 on Saturday. He showed up with an overstuffed backpack to make sure his 62-year-old grandmother, Carolyn Jackson, had enough water to drink and a hoodie to protect her arms in case of violence. “I don't know what I would do if anything happened to her," he said. Some people had on masks. Some did not. Some pulled their masks down to talk or breathe. “I'm not comfortable with that," he said. She's got a chronic lung condition, and he had been so worried about her catching the coronavirus in the past few months that he wouldn't hug her. But then she mentioned that she drove by the protests on Sunday, and immediately he asked, “Why didn't you take me?"

He had been losing sleep over what he was seeing in social media and on TV, having nightmares in which he was fighting a “real-Jim-Crow-looking white guy in a white button-down shirt, black tie, sleeves rolled up." His mom told him he was fighting racism. “It's like obstacle after obstacle," he said. “If it's not police beating us up, it's us dying in a hospital from the pandemic. I'm tired of being tired. I'm so tired, I can't sleep." It was something he continued thinking about until he couldn't help himself, sending a text at 3 a.m. asking his grandmother if they could attend together. “I thought about it and said, 'This is a teachable moment,' " she recalled.

So Jackson took the day off from her job as an accountant at a hospice organization and put on some peace sign earrings and a T-shirt from the 20th anniversary of the Million Man March. On the car ride into the city, her grandson asked about her struggles with race. She explained what it's like being a professional black woman with over 30 years experience who still feels overlooked for opportunities because of questions about her qualifications. Her awareness of being treated differently dates back to how her white paternal grandmother favored her lighter-skinned cousins. She found solace in her black maternal grandmother, who would comb her hair while she sat between her legs. Jackson wants her grandson to feel that kind of comfort from her.

That desire extends to her mission to help the black community understand palliative care is an option that can offer dignity and support at the end of life. “Because when people hear hospice, their hands go up and they say, 'I don't want to hear it.'" She's also heard that resistance when it comes to getting tested for the coronavirus; she has gotten tested twice and plans to get tested again. She feared being exposed on Tuesday, but being here with her grandson was too important to miss. “We internalized a lot with my generation," she said, “but I think it's important for him to see this."

N.W.A.'s “Fuck Tha Police" blared from a nearby speaker outside St. John's Episcopal Church until an interfaith group of men and women bowed their heads and began to pray. Among them was Timothy Freeman, pastor at Trinity African Methodist Episcopal Zion Church, who wore a brightly colored kente cloth-inspired mask, its vibrant yellows and reds standing in stark contrast to his ministerial black suit and white clerical collar.

Freeman, 42, knows eight people who have been diagnosed with the virus; one died. For two weeks, a sick friend had a fever and could barely move from fatigue but refused to get tested, running through all the scenarios of what might happen if he had it: What if he wound up isolated in an ICU with no one to advocate at his bedside? Another sick friend worried an ambulance would take him to a hospital that he didn't trust. These conversations, the pastor said, are always infused with an awareness of the medical system's record of neglect and abuse of black people, from dismissing their pain to using their bodies for research without consent. The virus has forced this all top of mind.

A licensed occupational therapist for 19 years who spent a decade managing a skilled rehab facility, Freeman said he has seen racial disparities in health care firsthand and that access to adequate insurance coverage is crucial. “I have seen diagnostic tests not performed … and hospitalizations cut extremely short — or not happen at all — because of insurance." COVID-19 is affecting black and brown people in disproportionate numbers, “and not just because we're black and brown, but because of the social and economic conditions people are forced to live in," he said.

“All of it comes together. What happened with George Floyd publicized to the world the experience that we live," he said. “It's a conglomeration of everything."

A block away from the prayer group, Elizabeth Tsehai, 53, drove slowly in her BMW SUV, honking her horn, as federal agents in riot gear began to march past the crowd just behind her. She had a Black Lives Matter T-shirt displayed on the dashboard and a bike rack on the top of her car that she joked made her look like the “caricature of a soccer mom."

She stopped her car on the road and remained there as protesters to her left took a knee. There was some heckling from the crowd but no one was in anybody's face. A Secret Service agent warned her to move. Her response: “Arrest me. I can't breathe!" Agents then pulled her from her car and to the ground and handcuffed her. “I didn't resist because I know they just arrest you for resisting arrest," she said. “But the minute they pulled me up on my feet, I was talking all kinds of trash."

Her car was left unlocked in the middle of the street, where it was protected by protesters. She was questioned and released. She said agents told her they were afraid she was going to hit protesters because people have been using their cars as weapons. They told her to move it and leave. The Secret Service did not respond to questions about this incident.

“Ordinarily, I would not get involved," Tsehai said. But George Floyd's death was enraging, as were “all of the things that came before it."

All of the things.

How a white nurse looked her up and down when she arrived at the hospital to give birth to her son and sneered, “Can we help you?"

How her brothers, who live in Minneapolis, recount being pulled over by police for driving while black.

How a black man couldn't watch birds in Central Park last week without having the police called on him.

“The pandemic is hitting black people hard and exposing these structural inequalities," she said. “Then on top of that, you get Amy Cooper … weaponizing her white privilege at a time when he might end up in jail, where infection is rife.

“But when they manhandled protesters who were peaceful, that was a bridge too far," said Tsehai, who grew up in Ethiopia under an authoritarian regime during a period known as Red Terror. She didn't know life without a curfew until she moved to the United States to attend Georgetown University 35 years ago.

“Moments like this are quite unusual," she said. They can also inspire change, a message she shared with her children, ages 12 and 14, when recounting her ordeal with them. “I want these children to live in a different world. It's not enough to read about it and get outraged and talk about it at the dinner table. Silence makes you complicit."

Report: Trump’s Health Care Failure May Hurt Him With Rust Belt Voters

President Donald Trump had a lot to say about health care when he gave his State of the Union speech on Tuesday, February 4, claiming that he was determined to protect coverage for preexisting health conditions and that “socialist” Democrats were trying to rob Americans of the health plans they love.

Problem: the Trump Administration is very much on board with a Republican lawsuit that seeks to abolish the protections of the Affordable Care Act of 2010, a.k.a. Obamacare — including coverage of preexisting conditions — and rip health insurance away from millions of Americans by arguing that the law is unconstitutional. And journalist Daniel McGraw points out in a February 10 article for The Bulwark that health care could be a major liability for Trump in the Rust Belt states that he needs to win in order to be reelected in November.

The Bulwark is not liberal or progressive. Founded by Never Trump conservatives Bill Kristol and Charlie Sykes in late 2018, The Bulwark has a right-wing point of view but is passionately anti-Trump. On the surface, it might seem strange that a conservative site would be sympathetic to Obamacare. But in fact, the elements of the ACA were greatly influenced by the “universal health care via the private sector” approach championed by President Richard Nixon, the Heritage Foundation and Mitt Romney (now a U.S. senator) in the past. Nixon never would have favored the type of Medicare-for-all proposal that Sen. Bernie Sanders is pushing for, but the health care overhaul he proposed in the early 1970s and worked on with the late Sen. Ted Kennedy was comparable to the ACA yet more aggressive.

Demonstrating why health care could be problematic for Trump in the 2020 election, McGraw cites the results of Baldwin Wallace University’s Great Lakes Poll (which was published on January 21). Only four states were included in the poll, all of them Rust Belt States that went from voting for President Barack Obama in 2008 and 2012 to favoring Trump over Democratic presidential nominee Hillary Clinton in 2016: Pennsylvania, Ohio, Michigan and Wisconsin.

McGraw explains, “One question in the poll was especially relevant to health care, and unlike the questions in most previous national polls, phrased very directly: ‘Do you approve or disapprove of the way Donald Trump is handling health care policy?’ The results show Trump and the Republicans have a big problem in these key states.”

Respondents who said they “somewhat” or “strongly” disapprove of how Trump has handled health care, McGraw notes, include 53 percent in Michigan, 56 percent in Wisconsin and 51 percent in Pennsylvania. Those figures include both men and woman; among women, the numbers increase to 59 percent in Michigan, 58 percent in Wisconsin and 53 percent in Pennsylvania.

“Exit polls in 2016 showed Trump lost to Hillary Clinton among women in each of those states: by 42-55 in Pennsylvania, 42-53 in Michigan and 43-53 in Wisconsin,” McGraw points out. “He can’t afford to lose even more ground.”

Robert Alexander, an Ohio State University political science professor and one of the people who oversaw the Great Lakes Poll, told The Bulwark that health care is a high priority among older votes in Rust Belt states.

“The aging population in these states is big in terms of numbers, and (health care) is a big issue for them,” Alexander explained. “These people in these states aren’t looking 20 years down the road on how they get health care; it is much more immediate for them. This is a very real issue, and instability doesn’t sell well. Trump’s policy seems to be based on more chaos, and while that might be appealing to some voters on other issues, it doesn’t seem to be that way for the people we polled.”

According to Lauren Copeland (a political science professor at Baldwin Wallace University in Ohio who worked on the Great Lakes Poll), public support for Obamacare has continued to grow.

“People are really skeptical of new policy changes that are imposed upon them,” Copeland told The Bulwark. “What seems to have happened is that the voters (still) saw Obamacare as a new policy in 2016, and were a little leery of it. But now, it is the standard in many ways — and most people don’t want to lose it now.”

If independent voters in the Rust Belt believe that Trump is hostile to their health care needs, McGraw explained, they might swing Democrat.

“Much will depend on who the Democratic candidate turns out to be, but whoever it is, Trump will need to get the independents on his side by at least the same margins as he did in 2016,” McGraw writes. “If health care is, as these independents say, their most important issue — and if they disapprove by large margins of Trump’s handling of health care —  his challenge is formidable.

Trump Claims To ‘Protect’ Healthcare Protections He Tried To Gut

Donald Trump falsely claimed on Monday that he “was the person who saved Pre-Existing Conditions in your Healthcare,” despite his well-documented push to eliminate the existing health care law barring insurance companies from denying coverage on that basis.

Trump made the claim while attacking Democratic presidential candidate and former New York City Mayor Michael Bloomberg.

“I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate,” he tweeted, adding that if “Republicans win in court and take back the House of Represenatives [sic], your healthcare, that I have now brought to the best place in many years, will become the best ever, by far.”

Trump concluded by stating that he “will always protect your Pre-Existing Conditions, the Dems will not!”

This claim flies in the face of Trump’s own record since taking office.

Prior to the enactment of the Affordable Care Act in 2010, it was legal for insurance companies to discriminate against patients who had preexisting medical conditions, such as a history of high blood pressure or even being a woman.

Despite unanimous Republican opposition, a Democratic Congress later passed the ACA and Barack Obama signed it into law in March 2010. The law both banned discrimination based on preexisting conditions and included mandates to make that workable for insurance companies.

Trump fiercely opposed the bill and vowed vaguely to “repeal and replace [it] with something terrific” during the 2016 election. He said this would happen “Immediately. Fast. Quick” if he were elected.

In 2017, after taking office, Trump pushed the Republican-controlled Congress to pass his Trumpcare legislation to repeal Obamacare and replace it with something that would leave tens of millions uninsured. While the legislation required insurers to offer some form of insurance to those with preexisting conditions, it did not prevent discrimination against them and did not include any system to make such coverage affordable for patients or insurers.

The bill failed after a handful of Senate Republicans joined every Senate Democrat in voting no.

That same year, Trump told his supporters to “not worry” about his failed bid to replace the ACA. “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE,” he tweeted in March 2017.

Since then, Trump has tried other tactics to implode the ACA. Last March, he endorsed a lawsuit by Republican state officials aimed at eliminating every word of Obamacare and replacing it with nothing. He has embraced allowing states to sell junk health insurance plans that exclude people with pre-existing conditions.

In the meantime, by repeatedly working to undermine Obamacare’s mandates, Trump has hurt the system that makes the law work. Last May, Politifact ruled Trump’s claim that he would “always protect patients with preexisting conditions, very importantly” to be false, stating that his administration’s trajectory would do “exactly the opposite.”

Rep. Bill Pascrell (D-NJ) slammed Trump’s dishonesty on Monday, calling his latest statements an “Orwellian lie even for him.”

“Trump is in court right now trying to destroy protections for preexisting conditions,” the longtime lawmaker tweeted, adding that the Trump administration asked the Supreme Court just last week to delay action until after the 2020 election “so he doesn’t get blamed for stealing your care.”

Published with permission of The American Independent Foundation.

Healthcare Costs Impacting Children Nationwide

As healthcare costs continue to climb into the new decade, many families are feeling the strain more than ever. Unlike other insurances like life insurance, which 60 percent of Americans have, health insurance is essential for people of all ages to have access to. This necessity puts a huge weight on parents’ shoulders. While some protections are in place to support those in need of assistance, gaps in coverage and certain restrictions can leave middle-class families and their children in a precarious position. The new year will undoubtedly be a notable year for American politics. With this in mind, only time will tell what the future holds for the nation’s healthcare.

Healthcare Access Limited, Harming Children

With healthcare costs climbing rapidly for both the insured and uninsured, many parents are being forced to make incredibly difficult decisions when it comes to the care and protection of their children. In some cases, parents are unable to afford basic healthcare costs for their children, veering into a state of neglect. Neglect was the top reason why Kentucky children were removed from their homes between 2010 and 2015, making up 68.6 percent of removals. However, this is not always due to genuine malintent on the part of the parents. In some cases, costs have simply spiraled out of control, and they’re no longer able to support their children as well as themselves.

The result is a young population with worsening healthcare. Children in lower-income communities often lack resources such as mental healthcare support, routine exams, and more. However, this lack of resources isn’t exclusively due to an increasingly high cost; some areas simply lack the staff to support these services.

Staffing Shortages Despite High Costs

While costs remain high, the funds aren’t always directed where they need to be in order to provide more support for struggling communities. Many areas, particularly when it comes to psychiatry and psychology, are critically understaffed. Some studies show there are about 7.2 million open healthcare positions available in the world today because of staffing shortages. Shortages tend to be particularly high in low-income communities, as the positions often pay less than the average salary for the job. This pushes doctors and medical professionals to wealthier communities, rather than to communities that are most in need of additional medical services.

Long-Term Impacts On Population

Over time, the lack of medical resources in necessary areas could lead to long-lasting consequences. Being healthy doesn’t just consist of eating nutritious food and going on hikes, a mile of which can burn over 500 calories. To have the best chances of living a healthy life, you need easy access to professional healthcare. Children who grow up in communities that lack vital health resources will likely be less healthy than their peers. The cycle tends to perpetuate itself, as those who are less healthy may struggle with maintaining long-term jobs or higher-paying careers.

In theory, various government-supported programs exist to interrupt this cycle. However, these programs often are difficult to access and can have vital gaps in coverage. The Americans with Disability Act provides that reasonable accommodations must be provided to individuals who have a qualifying disability, absent a hardship caused to the employer. However, not every disability will qualify, and assistance may not be available to those who make just enough to not meet financial assistance requirements.

As 2020 quickly approaches, it’s uncertain what the future of the nation’s healthcare holds. The upcoming year will be an important one for American politics, and the debate over healthcare will continue up to and beyond the next presidential election. With so many of the nation’s most vulnerable population riding on the healthcare debate, hopefully a solution to the dilemma will be reached soon.

McConnell Saved Big Money For Big Coal — And Let Us Pay Instead

Reprinted with permission from DCReport

Kentucky coal miners—along with the rest of us—will be paying the price to keep the government running next year. And we can thank Kentucky’s senior senator, Senate Majority Leader Mitch McConnell, for the sellout.

Buried in the giant $1.4 trillion government spending package that McConnell ushered through the Senate last week was a relatively modest $15 billion, 30-year payout to sustain the Black Lung Disability Trust Fund—a boon to the majority leader’s home state coal miners.  As many as one in five coal miners suffer from black lung.

But here’s the kicker: What McConnell had removed from the must-pass funding legislation. In order to keep the government running, McConnell threw out provisions that would have forced coal companies to commit to higher payments toward the health-care costs of their employees and retirees, nixing requirements to extend the commitment period and modestly increase the tax on coal mining companies that are supposed to support the trust fund.

McConnell threw out provisions that would have forced coal companies to commit to higher payments toward the health-care costs of their employees and retirees.

In short, McConnell let the coal industry skip out and leave the $15 billion black lung tab for everyone else to pay.

The move was mind-boggling, considering McConnell is already under scrutiny and criticism for partnering with a previously sanctioned Russian businessman, Oleg Deripaska, who McConnell voted to de-sanction. Deripaska, who owns Rusal, a Russian-owned coal company, joined McConnell in a project that his home state of Kentucky voted in 2017 to invest $15M of taxpayer money.

‘A Handout’

“This is a handout. This is a giveaway,” Jim Waters of the Bluegrass Institute for Public Policy Solutions, told WaPo in August. Waters reasoned that judgment might have been clouded by the possible thousands of area jobs that could be added. “I think the excitement of that overrode some of the due diligence.”

McConnell’s strange allegiances to influences domestic and foreign have clearly reached the grassroots level. As Mikaela Curry, a community organizer and member of Kentuckians for the Commonwealth, wrote in an op-ed in the Courier-Journal, Feb. 22, entitled, “Mitch McConnell is silent on coal while Kentucky miners suffer and die”:  “When McConnell speaks up for coal, it always seems to align with the people profiting in the fossil fuel industry and not the hard-working people he is supposed to represent.”

Disabled Miners

Most poignant are the call outs to McConnell from those suffering physically as well as financially from his unwillingness to make the coal companies own up to their responsibility to their current and retired workers and their families. Patty Amburgey, now secretary of the local black lung association in Letcher County, is the widow of a coal miner who died of Black Lung Disease after leaving mining, “blind, unable to feel his legs or arms, and constantly short of breath,” according to his obit.

“I’m asking [Mr. McConnell] to please remember that East Kentucky is a mining area,” his widow wrote in Kentuckians for the Commonwealth. “And we do have a lot of miners and the election is coming up. I want him to understand that.” Obviously, Mr. McConnell is betting his Appropriations Bill will heal these sores and smooth his way to re-election.

But that may not be so easy in practice. Instead of increasing the excise tax rate in effect in 2018, which sunset on Jan. 1, 2019, Congress failed to act, which allowed the tax for coal companies to reset to 1985 rates, lowering contributions by 55 percent (from $1.10 per ton of coal from subsurface mines to $.50 and from $0.55 per ton for coal from surface mines to just $0.25), which many in Congress had contested.

Companies Protected

After congressional wrangling, the 2020 tax rate will revert to 2018 rates of $1.10 and $0.55 per ton, respectively. But those prices will sunset again on Dec. 31, 2020, and if not renewed will revert to the 1978 rate of $0.50 and $0.25 per ton. The companies also are protected from market price rises by a ceiling cap on the tax of 4.4 percent of its coal selling price.

In June, the House Ways and Means Committee approved a 10-year extension as part of a broader package. Rep. Bobby Scott (D-VA) proposed the rate be renewed at a higher rate through 2029. He and co-sponsors want to see the Trust Fund fully funded with no sunsets.

While Moscow Mitch steers millions toward business ventures with oligarchs, many in Appalachia want lawmakers to realize that a hike in the excise tax of $0.14 per ton for surface-mined coal and $0.28 per ton for underground-mined coal would eliminate the debt in the Fund completely by 2050, according to the General Accounting Office.

Photo credit: Gage Skidmore

Blackstone Equity Firm Pursued Poor Over Medical Bills

Reprinted with permission from ProPublica.

MEMPHIS, Tenn. — After nine visits to the emergency room at Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she’d never heard of, Southeastern Emergency Physicians.

Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn’t have.

In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.

The case against Brooks is one of more than 4,800 lawsuits Southeastern has filed against patients in Shelby County General Sessions Court since 2017. In the first six months of this year, Southeastern filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare, Baptist and Regional One combined.

Lawsuits against poor patients over unpaid medical debts have received widespread media attention over the past few years. In almost all cases, the plaintiff has been a hospital system, often a nonprofit.

What sets the practices of Southeastern, and its parent, TeamHealth, apart is that it is a physician staffing firm that contracts with the doctors who treat patients in four of Baptist’s emergency rooms around the region. Physicians historically have avoided suing patients en masse, instead choosing to send unpaid bills to collections or writing them off as bad debt.

TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.

“There is this tension between being a health care provider and doing what’s best for their care … and being a profit-maximizing firm that aggressively goes after patients,” said Brian Shearer, legal director for Justice Catalyst Law, a New York-based social justice nonprofit, though he added that he wasn’t aware of any lawsuits by providers like Southeastern.

TeamHealth initially defended the lawsuits in an interview with MLK50 and ProPublica, saying they reserved legal action only for patients who’d made no attempt to pay.

But late last week, faced with additional questions by the news organizations, the company reversed course, issuing a statement saying it would no longer sue patients and wouldn’t pursue the lawsuits it has already filed. “It’s difficult to ensure that only patients with a strong ability to pay are ultimately impacted, so we’ve decided to eliminate it,” a TeamHealth spokesman said.

TeamHealth also had policies in place that made it difficult for patients to access charity care, a form of financial assistance for low-income patients. Two former TeamHealth employees told MLK50 and ProPublica that they were instructed not to mention the term charity care when patients called with questions about their bills.

After the company was asked about this, TeamHealth president and chief executive officer Leif Murphy announced a new discount policy for patients without insurance.

“Effective December 1, 2019, we are implementing discount policies for our uninsured population to reduce the cost of care by as much 90 percent, and up to 100 percent when necessary. We will proactively include eligibility criteria in our invoices to help promote participation rather than force patients to seek assistance,” Murphy wrote in a letter to employees.

TeamHealth’s abandonment of its lawsuits, as well as the implementation of a new financial assistance policy, marks the second time in five months that a major health care entity in Memphis has overhauled its practices amid questions from MLK50 and ProPublica. In July, Methodist, a nonprofit faith-based hospital system, announced it would curtail its lawsuits over unpaid debt against poor patients. It has since zeroed out the balances owed by more than 5,100 patients and reduced bills for more than 2,200 others, according to a hospital spokesperson.

TeamHealth declined to talk about the suits involving patients interviewed for this story, even though the patients gave the company permission to do so.

Mark Rukavina, business development manager at Community Catalyst’s Center for Consumer Engagement in Health Innovation, a national advocacy organization, said nonprofit hospitals shouldn’t work with physicians groups that aggressively pursue patients for medical debts.

“They could say, ‘If you’re going to provide services in our hospital, you’re going to comply with our financial assistance policy,’” Rukavina said.

The lawsuit from Southeastern was just a small part of Brooks’ debt, but learning that TeamHealth won’t pursue her case was good news, she said. Plus, she now has TennCare, the state’s version of Medicaid, which she hopes will spare her from other large medical bills.

She and her husband still “go from paycheck to paycheck,” she said, and with $60,000 in student loans and thousands more in credit card debt, she thinks bankruptcy – or a winning lottery ticket – is the most likely path out.

“It definitely helps though, that you’re not having that [doctor’s bill] hanging over your head,” she said.

From A Closet To National Leader

TeamHealth’s roots in Tennessee stretch back 40 years, to when emergency medicine was recognized as a specialty.

In 1979, a small group of ER doctors in Knoxville, Tennessee, landed contracts to operate two emergency rooms, including at the University of Tennessee Medical Center in Knoxville, where administrators allowed them to use a closet as their office, according to a company video. It was a step up from their makeshift workspace at Mrs. Winner’s, a fast-food restaurant.

Southeastern’s initial strategy was to focus on hospitals within a two-hour drive of Knoxville, said co-founder Dr. Lynn Massingale in the video. But his ambition to be the nation’s biggest staffing firm led him to expand that radius to a two-hour plane ride, he said in an interview posted on TeamHealth’s website, and, gradually, across the country.

Hospitals “needed reliable, 24-7 physician coverage in their emergency departments, but no one was ultimately responsible for making sure the shifts were covered,” wrote co-founder Dr. Randal Dabbs in a 2018 column in an industry publication.

Southeastern would take on that responsibility. “Our goals have never included conquest, but instead, true collaboration and servant leadership,” Dabbs wrote.

In 1994, Southeastern merged with three other doctors groups to become TeamHealth. It had 200 ER physicians at 27 hospitals in four states, according to a Modern Healthcare article published that year.

TeamHealth now has more than 16,000 physicians and clinicians, according to the company’s website. It provides medical professionals to 3,300 medical facilities and physician groups in 47 states.

“They provided great care in our emergency room, and because they provided great care, they continued to grow,” said Baptist Memorial Health Care’s president and chief executive officer Jason Little, who in 2003 signed the TeamHealth contract for Baptist Collierville’s emergency department.

Private Equity’s Rise in Health Care

With $554 billion in assets under management, the Blackstone Group is one of the world’s largest private equity firms.

Increasingly, health care is an attractive target for private equity, thanks to an aging population and a rise in chronic disease. The growth is highest in specialties where the need for a long-standing doctor-patient relationship is low, such as emergency medicine, anesthesia and care provided to patients when they are hospitalized (a medical specialty known as hospitalists).

The 2017 acquisition was Blackstone’s second investment in TeamHealth, after buying it in 2005, taking it public in 2009 and then selling its interest four years later.

Proponents of private equity argue that its profit-driven mission helps keep afloat sectors that serve the public good. At least 150 public pension funds invest in private equity, including Blackstone, with higher annual returns than other types of investments, according to a recent report produced by an industry lobbying firm.

But critics such as Eileen Appelbaum, co-director of the nonprofit Center for Economic and Policy Research, a left-leaning think tank based in Washington, D.C., lament its growing influence in health care.

“Private equity firms buy small competitors to add on to an initial acquisition, building national powerhouses without any antitrust supervision,” Appelbaum testified at a congressional committee hearing last week about private equity. She cited TeamHealth and its competitor Envision Healthcare as prime examples of how this practice harms consumers. “They use surprise medical bills, or the threat of such bills, to get much higher payments than other doctors receive, driving up health care costs.”

A New York Times investigationin 2016 found that after private equity firms took over ambulance companies, some response times slowed and billing practices became more aggressive. Soon after, the companies went bankrupt — leaving gaps in emergency response across the northeast. Citing that report, Rep. Maxine Waters, D-Calif., the chairwoman of the House Financial Services Committee, raised concerns in the hearing last week about private equity firms managing public services including health care.

In 2017, the year Blackstone acquired TeamHealth, the disclosed value of private equity health care deals exceeded $42 billion — the highest level since 2007 — according to a market research report. The following year, the private equity firm KKR acquired Envision, which operates Emcare, another physician staffing firm, for $9.9 billion.

In public filings, Emcare reported that it operated in 45 states in 2017, while TeamHealth said it had a presence in 47 states that year.

TeamHealth estimated that the market for emergency medicine was $12 billion, according to its filing with the U.S. Securities and Exchange Commission. It claimed a 17 percent share of that market, which in 2016 accounted for 57 percent of its revenue.

Appelbaum, like other experts interviewed for this story, had not heard of instances in which private equity-backed doctors groups sued patients.

In separate interviews before TeamHealth said it would stop suing patients, officials at TeamHealth and Baptist said Blackstone’s acquisition had no effect on collection efforts.

“Yes, we were acquired by Blackstone in 2017,” said Joe Carman, TeamHealth’s chief administrative officer. “But we have not had any change in practice as it relates to pursuing patients and legal strategies in that time.”

Baptist’s Little agreed. “We’ve not seen any changes,” he said.

But the lawsuits show something began to change about the same time.

From Zero To Hundreds Of Lawsuits

In 2011, Southeastern did not appear as a plaintiff in any lawsuit filed in Shelby County General Session Court. In 2013, there were just over 100 suits filed by Southeastern, and the next year, more than 600.

Both Little and Carman speculated that increased volumes of patients treated at Baptist’s emergency departments were partially to blame.

However, such an explanation is not borne out by the data.

Between fiscal 2016 and 2018, the number of visits to three of the ERs staffed by Southeastern doctors — Baptist Memphis, the suburban Baptist Collierville and Baptist DeSoto in Southaven, Mississippi, just over the state line — grew by 12 percent , according to figures provided by Baptist. But the number of Southeastern lawsuits grew by 132 percent — from 798 to 1,855 — from calendar year 2016 to 2018, according to Shelby County General Sessions Court records.

One of the defendants is Laurie Kimbrough, 62, who went to Baptist Memphis in March 2017 complaining of flu symptoms.

When the bill arrived, she tried to make payment plans with Baptist but said the representative she talked to wouldn’t agree to a payment she could afford.

The bill went to collections and this March, Baptist sued her for nearly $1,300, not including court costs and attorney’s fees.

By that time, she’d lost her job and had started a small lawn care business. When the weather is good, she manages to make a few hundred dollars per week, if the lawn mower and blower don’t need repairs.

Family friends gave her money to pay off the Baptist bill, but three weeks after Baptist sued her, she was sued by Southeastern.

Even though she owed around $400, Kimbrough said she didn’t have it. When a longtime friend learned she’d have to pay interest on the relatively small bill, he gave her the money and refused to let her pay him back.

Health care expenses have an oversized impact in Tennessee, where 1 in 4 residents has a medical debt on their credit report, the 10th highest rate in the nation, according to a report this year by the Sycamore Institute, a nonpartisan think tank.

Memphis is the second-poorest large metropolitan area in the United States, so the impact is even more acute here. Inside the city limits, more than a quarter of residents live below the poverty line, according to the most recent census figures. More than 40 percent of workers in the city earn less than $15 an hour, according to one economic development report.

Kimbrough’s current insurance plan covers just three primary care doctor visits per year, which she’s already used. She doesn’t have the $60 copay to see a neurologist for her ongoing leg pain, much less any other diagnostic tests the doctor might order.

In February 2018, Kimbrough went to Baptist’s emergency room again with flu symptoms. The bill was over $1,300, but she was able to negotiate the hospital down from the $100 per month payment it initially demanded.

“I said I’ll come up with the $55 a month, even if it means I have to eat Vienna sausages 7 days a week,” Kimbrough said.

Court records show that on Nov. 4, Southeastern sued Kimbrough again. She has yet to be served with the lawsuit.

Charity Care Elusive by Design?

Baptist, which started in 1912 with a single 150-bed hospital, is a faith-based institution whose mission is “in keeping with the three-fold ministry of Christ — Healing, Preaching and Teaching.” It now has 22 hospitals, dotted mostly in rural communities in eastern Arkansas, West Tennessee and Mississippi.

“If it weren’t for Baptist and our mission,” Little said, “there wouldn’t be hospitals in a number of communities around the three-state region that we serve.”

At Baptist, insured patients receive a partial discount for bills over $5,000 for a single visit, regardless of income. Uninsured patients with a household income less than 200 percent of the federal poverty guidelines are eligible for a 100 percent discount on hospital charges. Even patients making 400 percent of the federal poverty guidelines — or just over $85,000 for a family of three — would be eligible for an 80 percent discount.

Baptist prefers that all doctors groups that operate in its facilities apply the hospital’s financial assistance policy to patients, but Little said he couldn’t discuss whether the hospital’s contract with TeamHealth requires it to do so. TeamHealth did not respond to a request from Baptist to provide the system permission to discuss the contract, Little said.

In an interview before TeamHealth changed its policy, Carman said the company’s internal policy is to match Baptist’s charity care discount if a patient submits written proof of the financial assistance Baptist provided.

However, TeamHealth’s billing statements haven’t mentioned charity care. And the firm is not on Baptist’s list of providers that participate in the hospital’s financial assistance program.

In interviews, two former TeamHealth call center agents said they were instructed not to mention charity care unless patients did so first.

Between 2017 and 2018, Sharon Lovingood was one of about 100 employees fielding patients’ calls from a single-story TeamHealth office in Knoxville. “We were the first person they talked to for any issues,” she said. When she worked in the U.S. Department of Education’s student loan division between 2012 and 2017, managers encouraged her and her colleagues to find solutions for those who called in.

But not at TeamHealth.

“A lot of times, a patient would call in and say, ‘Hey, can you give us a discount?’ But we had to say, ‘No, I can’t do that,’ because we weren’t allowed to say, ‘Well, did you apply for charity care at the hospital?’” Lovingood said. “They didn’t want us doing that.”

She asked her supervisors why and said she was told that the hospitals and billing groups TeamHealth had contracts with didn’t want call center workers bringing it up. Lovingood said she left the job in February 2018 because she could not stomach the restrictions that stopped her from helping people. “I was miserable working there.”

Sherry Breitung, who worked as a national patient service representative in Knoxville from 2014 to 2018, also said she asked for an explanation about the policy but didn’t get one. One thing was clear, though: “We weren’t allowed to mention charity care to the patients.”

Since all of their calls were monitored and reviewed by supervisors, Breitung and Lovingood, who don’t know each other, each said they devised their own work arounds — such as asking patients, “Did the hospital help you?” But the four minutes allotted per phone call wasn’t enough to help patients understand their options, they said.

Carman, on the other hand, said he thought call center agents were instructed to bring up charity care. “We are attempting always to try to understand their circumstance, and we’re trying to understand charity care.”

After additional questions, TeamHealth CEO Murphy said in his letter to employees that effective Dec. 1, the company would begin including eligibility criteria for charity care in patients’ invoices to make it easier to find.

After a reporter asked Kimbrough if the ER doctors had offered her charity care, she called TeamHealth to inquire.

“I said, ‘I need to talk to someone in your charity division,’” Kimbrough recalled, “and they said ‘What?’”

She said she was put on hold and then transferred to another call center agent, who asked her if she wanted to set up a payment plan.

“I said, ‘I want to know if I can’t pay, if you have a charity division,’” Kimbrough said.

The representative then told her that if she’d gotten a charity care discount from Baptist, she could send proof to TeamHealth and they’d consider her for the same discount.

But Kimbrough is uneasy with the idea of getting financial assistance. “I feel like if I pursue charity, there’s somebody who won’t get it who needs it worse than me.”

“Some way it’ll all work out,” Kimbrough said. “If it doesn’t, I’m lucky that if I lost everything I could go and live with my mom.”

Hospitals are abdicating their responsibility to protect patients from financial harm when they hide behind firms to which they’ve outsourced services, said Michele Johnson, executive director of the Tennessee Justice Center, which advocates for expanded health care access.

“Particularly with hospitals that have a mission that is aligned with treating low-income folks with fairness … it’s unfortunate that they’re not having people who intersect with their patients follow that same charitable mission,” Johnson said.

Health care is a necessary and often unavoidable expense, Johnson said. “These are not designer jeans. These are not video games. This is a whole different thing.”

Questions Remain For Hospital, Patients

TeamHealth declined to answer questions about its timeline for dropping existing lawsuits or whether its decision will apply to lawsuits that have already resulted in judgments, saying in a statement, “TeamHealth will not file additional cases naming patients as defendants and will not appear in any pending case.”

After MLK50-ProPublica’s investigation into Methodist Le Bonheur Healthcare’s debt collection practices, the nonprofit hospital dropped hundreds of lawsuits for unpaid medical bills and expanded its financial assistance policy to cover families making up to 250 percent of the federal poverty guideline, which will cover more than half of Memphis-area households. It has not filed any lawsuits since July 3.

It’s unclear whether TeamHealth’s change will shift the responsibility of unpaid bills from patients to Baptist.

In his letter to employees, TeamHealth’s CEO pointed the finger at insurance companies, noting that the share of insured patients with deductibles of more than $1,000 has risen sharply over the last five years. (In most cases, patients must pay deductibles out of pocket before their insurance coverage kicks in.)

The typical contract with a physician staffing firm calls for the hospital to guarantee enough business to at least break even, Little said.

“If they can’t do that on their own billing and collection, then they, generally speaking, look to the hospital for a subsidy to make them whole,” Little said.

He said he hasn’t spoken with TeamHealth since its statement was issued but doesn’t anticipate any changes. “We have a contract and it’s in place.”

Little was cautiously optimistic about the end of TeamHealth’s lawsuits for unpaid ER doctors’ bills. “It sounds like it’s going to be a benefit for patients, so I’m anxious to study it,” he said.

Through a spokesperson, Blackstone said it was not involved in “these specific practices at the company, which we understand are quite common in the broader industry. However, we fully agreed with and support TeamHealth’s determination to discontinue it.”

TeamHealth’s decision comes just in time for Loretta Baxter, who went to court Friday to keep Southeastern from garnishing her paycheck.

Baxter, 33, didn’t have insurance when she visited a Baptist ER in 2017 for stomach pain and couldn’t afford the $1,111 doctor’s bill.

In April, Southeastern sued her, and on Thursday, her employer told her that it had received a garnishment attempt that could take up to 25 percent of her paycheck.

That would leave her with $250 less to cover her rent, car note, insurance and expenses for her three children. She makes about $11 an hour as a caregiver at a social service organization for people with disabilities.

Baxter left court with paperwork to take to her employer that would postpone the garnishment until a Dec. 2 hearing. “I try not to let things stress me out because stress can kill,” Baxter said at court.

When a reporter asked TeamHealth how its decision would impact patients like Baxter, TeamHealth said that the outside collection agency “is sending a release to remove the garnishment and will be working with the court system to process it as soon as possible.”