Saturday, April 30, 2011

Insurance lobbyists celebrate passed version of SB 1274

Rafael del Castillo reported yesterday that "the health insurance lobbyists burst into applause and were high fiving and slapping each other on the back in the overcrowded conference room for several minutes" after the committee passed SB 1274.

While del Castillo was denied a copy of the bill, he writes that the jubulent reception by the health insurance lobbyists means "that the Baker bill that is going to the floor of each house for a vote repeals our consumer protections and segregates the health care consumer populations for experimentation."

Why are we allowing health insurance company lawyers anywhere near state legislation, let alone legislation that restricts civil rights by benefiting shareholders at the expense of policyholders? Evercare and Ohana get paid about $100 million a month by Hawaii. If the current state law is costing them millions of dollars in legal fees, they make a better profit if they can find a way to eliminate those costs.

How much of their monthly capitation income is being spent on legal fees? How much on actual services? Has anybody considered that if the companies would stop violating federal Medicaid regulations, their legal fees could be reduced substantially?

SB 1274 is literally going to be giving the insurance companies a license to kill.

Friday, April 29, 2011

How much of a raise did Hawaii give Evercare and Ohana?

Wellcare reported in their 2010 year-end SEC filing that the "Hawaii program rate increases, which we believe have improved the stability of the program, also were effective July 1, 2010."

The "also" referred to "net increases of approximately 2.5% to 3.0% in Florida effective September 1, 2010 and 1.5% to 2.0% in Georgia effective July 1, 2010."

The company directly blames its $254.3 million in litigation-related costs for 2010's net annual loss.

For the year ended December 31, 2010, the net loss was $53.4 million compared to $39.9 million of net income for the same period in 2009. Excluding investigation-related and litigation-resolution costs of $167.6 million and $86.7 million, net of tax, net income would have been $114.2 million and $126.6 million for the years ended December 31, 2010 and 2009, respectively.

Hawaii Senate Bill 1274, which is openly back by health insurance companies like Wellcare, UnitedHealthcare, HMSA and others, will help get Wellcare out from under some of those exhorbitant legal expenses.

My question is why are we allowing a state/federal contractor to divert $254,300,000 in taxpayer funds away from medical care to fighting federal allegations that the company is stealing from those same taxpayer funds?

It's taken since October 2007, but in March Florida finally issued federal indictments for Medicaid fraud against five former Wellcare employees. The investigation and indictments cover criminal fraudulent scheming and theft between 2003 and 2007.

According to the March 3, 2011 story from Associated Press in Florida, Wellcare, "which is one of the state's largest Medicaid providers, spent $2.4 million on political contributions in the 2004 and 2006 elections."

More than 95 percent of it went to Republicans, who pushed forward a nationally watched plan that funnels more state and federal Medicaid spending than ever through private companies, which profit most by providing the least care.

The fact the company still has legal expenses in the $254 million range would seem to imply other investigations are ongoing. Somewhere.

SB 1274 just keeps getting better for the health insurance companies

New amendments added to SB 1274 yesterday benefit the health insurance companies while segregating everyone currently receiving Medicaid into an experiment in civil rights.

According to Rafael del Castillo, who attended Thursday's brief meeting, "Senators Baker and Green have sent amendments to the House committee members proposing to segregate Medicaid members from the external review population with the supposed purpose of “studying” whether your welfare suffers if you are limited to the DHS process, in which you have to pay for the services you receive if you lose your case, and you will not get legal help unless you pay for it or qualify for legal aid."

As someone who has had personal experience with the "DHS process", I can say this logic is based on the mistaken assumption that DHS provides some sort of oversight over the health insurance companies.

CMS has been reviewing complaints for months that DHS is providing any sort of oversight at all. Twice I'm aware of State Medicaid Director Ken Fink has responded to these federally-filed complaints by writing the enrollee the insurance company has done no wrong.

The state has never acknowledged publicly that they had to place Evercare/UnitedHealthcare under a corrective action plan a year ago for on-going violations of federal Medicaid law. The families who were victimized were never notified.

The state has never acknowledged publicly that federal regulators recently began looking into potential Medicare fraud involving Evercare.

Evercare regularly refuses to authorize medications for my daughter, either new ones or ones that she has been taking for years. Complaints filed with Patti Bazin go nowhere. Every time, the only way I've been able to get Hannah's medications filled is by emailing CMS.

From my experience, DHS provides no oversight and in fact appears to collude in the health care insurance companies' strategy of essentially meaningless terrorism against families. The state gave the companies a premium increase last summer, so it is not for lack of funds.

I am one of so many families right now where a child or loved one is alive because of our current external review law.

SB 1274 needs to be killed. Please email the following representatives now to let them know they have to stand up against the insurance companies.

Friday, April 22, 2011

State is sweetening contracts with Evercare and Ohana with SB 1274

SB 1274 is the only way that Hawaii's Medicaid bureaucracy can help their insurance buddies get rid of a lot of nasty legal costs from people appealing their decisions.

Hawaii's external medical decision review panels are a mandated part of Hawaii's contract with CMS (the Centers for Medicare & Medicaid) for the 1115 waiver. As a result, they are also a mandated part of Hawaii's contracts with both UnitedHealth and Wellcare, the only companies who hold provider contracts under that waiver.

Presumably, the feds would never give Hawaii written permission to delete an entire section of the contract dealing with consumer appeal rights. The only way to get UnitedHealth and Wellcare out from under that burden would be a law that repeals the law creating the reviews in the first place:

S.B. 1274 is repealing H.R.S. 432E-6, the law that defines the external review process.

Rafael del Castillo has had thirty cases go through the insurance commission reviews over the past decade, and has eleven cases sitting there now. Ten of them are appeals against UnitedHealth. That seems to imply that the problem isn't the review system, it's UnitedHealth's medical decision making process.

There was a funny rumor going around in January that state employees were working on how to make the contracts with Evercare and Ohana "above federal law." Specific sections of the contract, dealing with appeals and grievances, were being focused on. I provided the information to CMS in mid-January.

Checking my notes, the rumor had to do with the same part of the contract that will be invalidated once SB 1274 goes through.

What a coincidence?

In fact, Evercare was put under a Corrective Action Plan by the state a year ago, for ongoing violations of federal regulations. By and large, these were federal regulations related to mandated procedures for appeals of insurance decisions, grievances, and complaints.

CMS has been receiving documentation of Evercare's ongoing violations of multiple federal regulations for months. CMS has also been receiving documentation of the state's failure to provide the required oversight of Evercare's operations. Letters from Dr. Ken Fink, Hawaii state Medicaid Director, just echo UnitedHealth's corporate line. I reported earlier that Fink's salary is more than twice that of his predecessor, and have not heard that Governor Abercrombie has taken any steps to reduce it.

The agreement between the state and CMS clearly gives federal regulators the ability to step in if the waiver program is no longer in the public interest or there is on-going non-compliance.

Both conditions seem met, which means only federal regulators or attorneys can step in to help us if SB 1274 is passed.

Thursday, April 21, 2011

Del Castillo says health plans gaining greater control over future of SB 1274

Insurance company meddling in Hawaii state law has worsened, according to patient rights attorney Rafael del Castillo. Castillo says he is "concerned because Sen. Roz Baker is doing the drafting and I believe she will enlist the assistance of the health plans lawyer, Ellen Carson, as she did once before on SB1274. Carson is going to see to it that our consumer protections are repealed. The health plans are ADAMANT that we shall lose those protections and rights."

We need to ask ourselves who benefits if SB 1274 is passed. The obvious answer is all the health insurers in Hawaii who provide Medicaid coverage to 264,000 people.

But who has the most to gain from the passage of SB 1274? The answer to that is the two for-profit companies that between them gobble up almost seventy percent of the state's Medicaid budget.

Passage of SB 1274 will allow Evercare (UnitedHealth Group) and Ohana (Wellcare) unfettered permission to make life and death medical decisions based on profit margin rather than medical need. The current "retroactive" clause in the bill will save UnitedHealth up to $500,000 by dismissing all the currently pending review cases. Speaking to the media on behalf of the bill, UnitedHealth attorney Dianne Brookins openly admitted these legal costs "just adds to the cost of healthcare."

Companies like UnitedHealth and Wellcare keep shareholders happy by keeping something called the MLR, or Medical Loss Ratio, as low as possible. When the government is paying them a guaranteed monthly fee for every Medicaid or Medicare enrollee, the MLR is kept low by not spending as much of that fee as possible. Across the country, over 13.5 million people are having their Medicaid decisions made by for-profit health insurers.

This video has been released by the opponents of SB 1274, to show the human toll when for-profit health insurers have life and death power over the families of Hawaii's disabled population.

Wednesday, April 20, 2011

Tuesday, April 19, 2011

UnitedHealth's News Comment on SB 1274

The local reporters here tried to break the embargo on Rafael del Castillo; he was interviewed on a piece that aired Friday night at 10pm on KITV.

I cannot find the story on their website, but luckily we were able to get a copy of it. The quote from UnitedHealth's attorney spokesperson, Dianne Brookins, is the most interesting part.

Ms. Brookins states the "existing process is expensive, time-consuming and burdensome... just adds to the cost of healthcare when we can ill-afford it."

Who is we? Is she speaking on behalf of Governor Abercrombie, whose office originated SB 1274? If so, then her referral to ill-affording the added cost would refer to the state.

Or is she talking about UnitedHealth? The same company that showed a net earnings increase between 2009 and 2010 of 21%? The same company that lowered its Medical Loss Ratio by two percent, to less than 80% in the fourth quarter of 2010?

If this corporation can "ill afford" the legal cost of these reviews, and considering Rafael del Castillo's comment that he wins about eighty percent of his cases, then perhaps UnitedHealth should stop putting their shareholders before their enrollees when making decisions about medical necessity.

I have met Ms. Brookins personally. She attended, on UnitedHealth's behalf, the "hit squad" attack at my home on February 18. If the company can "ill-afford" to fly her so many times to Kauai then perhaps it should stop violating federal regulations governing denials, appeals and grievances.

Arizona joins Florida and Hawaii in battles against patient rights

According to Disability Scoop, Arizona is considering state legislation that "would strip all of the state’s 32 health insurance requirements, including one mandating autism coverage."

Earlier this month, Governor Jan Brewer signed the state's 2012 budget, lauding its "reform" of Medicaid. "The reductions equal the amount cut over the previous two years. Many of those cuts make permanent changes to state law, meaning the programs they support will not return when state coffers are again flush with cash."

In Hawaii, for-profit Medicaid HMOs are openly supporting state legislation that would slash the patient rights of 264,000 people on Medicaid. In Florida, the state legislature is trying to completely rewrite Medicaid and force everyone into for-profit HMOs.

Action Alert for Opponents of SB 1274

Rafael del Castillo sent out an action alert this morning for opponents of SB 1274. People are being asked to email Congresswoman Colleen Hanabusa, who was a Hawaii State Senator when the current consumer protection law was enacted.

Del Castillo is suggesting the following text be included in your email:

Please help us stop Senate Bill 1274 HD3 which repeals longstanding and highly effective consumer protections against health insurance abuses.

Our Legislature and Governor Abercrombie have been unable to get assurances from the DHHS Center for Consumer Information and Insurance Oversight (CCIIO) that federal regulations do not require us to throw out our very successful consumer protection law, enacted while you served in the Hawaii Senate.

I ask you to intercede on our behalf with the CCIIO. If the CCIIO cannot give us an answer in the next 10 days while SB1274 is in conference committee, then we need a 1 year extension on the July 1, 2011 due date to resolve this issue without harming Hawaii consumers. The federal government has no legitimate interest in requiring us to repeal a law consumers strongly support and replacing it with one we strongly oppose.

Only the health insurers in Hawaii support SB1274, and that is because in its present form, it will destroy the considerable power Hawaii consumers now have to avoid and, when necessary, reverse bad and even selfish decisions by health plans in denying life-saving medical care, thank to the wisdom of your legislature in 1998.

Health insurers are using our $ and taxpayer subsidies to fight to repeal our rights and protections. Please help us defeat that effort.


I added some personal information into my email to the Congresswoman. If you are uncomfortable with her secure email system you can also fax her at (202) 225-0688.

You need to know the four-digit extension of your zip code to sign in on Congresswoman Hanabusa's website.

Monday, April 18, 2011

DHS backing "separate but equal" rights for Medicaid enrollees

With no apparent regard for the change in political party at the governor's level, Hawaii's Department of Human Services is openly backing the health plans' attack on patient rights via S.B. 1274.

According to the latest news released by Rafael del Castillo, "The Dept. of Human Services and the health plans, particularly Evercare and Ohana, are arguing that the Medicaid members will have equal rights even if they are separate. Those of you who are young may not remember, but many of your parents were opposed to the concept of “separate but equal” a generation ago, and the US Supreme Court finally realized that in a just society, if it was supposedly equal, there was no justification for it being separate."

So far, Speaker Calvin Say has assigned House members to the conference committee on SB1274, with Senate members not yet named. Opponents of SB 1274 are asked to please call or fax everyone on this list to let them know you want the bill killed.

Ryan Yamane (D), Phone 808-586-6150 Fax 808-586-6151
Robert Herkes (D), Phone 808-586-8400 Fax 808-586-8404
Gilbert Keith-Agaran (D), Phone 808-586-6210 Fax 808-586-6211
Marilyn B. Lee (D), Phone 808-586-9460 Fax 808-586-9466

John Mizuno (D), Phone 808-586-6050 Fax 808-586-6051
Dee Morikawa (D), Phone 808-586-6280 Fax 808-586-6281
Kymberly Marcos Pine (R), Phone 808-586-9730 Fax 808-586-9738

Transparency in government: UnitedHealth and S.B. 1274

Corporate health plan backing for S.B. 1274 became crystal clear on Friday. When the media needed a spokesperson on behalf of the bill, UnitedHealth offered up its local Honolulu lawyer.

UnitedHealth (or Evercare as they are known in Hawaii) could not have made their interest in the passage of S.B. 1274 clearer. The attorney they used is the same one who defends Evercare whenever a patient appeals to the external review panel the company's denial of medically necessary medications, treatments or services.

S.B. 1274 was recently amended to be retroactive to January 1, automatically dismissing all current cases. UnitedHealth is the defendant in eleven of twelve pending cases, so this amendment alone could be saving the company as much as $500,000.

The plaintiffs' attorney in all those cases is Honolulu lawyer Rafael del Castillo. Del Castillo only takes cases "on a contingency basis." That means he accepts no money from clients up front, even when actual hard costs are incurred for expert testimony. Del Castillo is only paid or reimbursed for the expert fees and other costs to the extent the Insurance Commissioner orders the health plan administrators to pay them.

Alston Hunt does not have to depend on the Insurance Commissioner for its fees. It gets paid no matter what, with our money. I wonder how many legal hours Alston Hunt got to bill UnitedHealth for strategizing how to be the best spokesperson for the bill?

Friday, April 15, 2011

State bills pending in Florida and Hawaii to increase for-profit Medicaid penetration while reducing patient rights

The state legislature in Florida has apparently decided to completely scrap the state's Medicaid program. Considering Medicaid fraud has been called the state sport, this is obviously necessary.

The problem is that the "new Medicaid" that Florida is trying to shape will essentially amount to giving more and more money to the same companies already caught or suspected in federal Medicaid fraud. A recent article calls it "the scariest part of scary Medicaid overhauls.

Isn't that like hiring Bonnie and Clyde as bank tellers?

On April 13, the Florida Tribune reported that "The House and Senate also have both agreed to use managed care as the main vehicle to lower costs and include requirements that long term care patients use managed care."

Back in June 2009, at least 56% of Florida's Medicaid enrollees were receiving their services through for-profit HMOs. In the summer of 2010, it was revealed that all eight for-profit subcontractors to one state Medicaid contract were cheating on the MLR (medical loss ratio, the percentage of each capitation payment spent on services for that specific individual). Amerigroup alone had to refund over $2 million to the state. Also last summer, there was talk of extending a minimum MLR to the state's other Medicaid contracts.

There's a battle going on in the Florida state legislature now between those in favor of establishing a 90% MLR, and those who want no MLR at all. Nobody is questioning turning the kitchen sink, water main and all, over to for-profit insurers.

If everyone ends up comprising on some "reasonable" MLR, it will still mean that state and federal funds are being diverted away from health services and into shareholder profits. Sean Hellein's whistleblower report demonstrated how casually insurance companies like Wellcare, Amerigroup and UnitedHealth (all named in the suit) treat the issue of committing Medicaid fraud, especially when it comes to falsifying MLR figures.

Between last summer's enthusiasm and the current Medicaid battle was the November election. Florida elected a new Governor who had been the CEO of a healthcare company holding the record for the country's biggest criminal Medicare fraud case. In Public Citizen's post-election night report on unregulated third party spending (subsequent to Citizens United v. Election Commission), Florida ranked second highest, with four congressional candidates splitting almost $2.9 million. One of those newly elected Congressmen dismisses any compassionate element of Medicaid (including, presumably, for children) as being evidence of a "bureaucratic nanny state" that can only be fixed with a "free enterprise solution."

Florida and Hawaii make two states where local legislative wars are being fought that have major repercussions for the future of Medicaid. These wars all have to do with the way states get their Medicaid money from the feds, and who they then give it to. Money for Health reform and stimulus funds is all channeled through different accounts. For instance, the federal DHHS report on stimulus funds paid out to states reported on March 31 2010 that the state of Florida had received $3 billion into thirty-seven different accounts. Each account is a possible contract to be bid out.

Every contract represents another opportunity to clear twenty percent in operating profit. With forty states reportedly considering (or in the process of) turning their ABD populations over to for-profit HMOs, the financial impact on the disability community could be overwhelming.

From our experience in Hawaii, when an ABD population is turned over to a for-profit HMO, that means the HMO now covers everything, including home attendants, medications, skilled nursing, home medical supplies, behavioral programs, durable medical equipment, even the cost of institutionalization. Hawaii's contracts with UnitedHealth and Wellcare clearly showed they received higher capitation payments for an individual if they were in institutional care than home care. Institutionalization therefore increases the premium while at the same time giving the insurer more power over how much of it has to be spent.

This is how the news of Florida Governor Scott's recently proposed cut in provider service reimbursement rates can relate to the MLR. Florida was already bidding out its ABD program to private HMOs like Amerigroup in early 2010. If ABD services are being channeled through new HMO providers, as they are done here, then reducing provider rates can be a back-door way of increasing corporate profit.

According to Amerigroup's 2010 annual SEC filing, the company's contract with the Florida Department of Elderly Affairs for Long-Term Care was renewed in September, they gained a new CHIP contract with the state in 2010 plus became a Medicare Advantage provider with Florida the same year. Overall, the company's net earnings were up 83%, helped along significantly by lowering the MLR by four percent.

Involved in the Florida legislative battle is SB 1972. On April 11, it was reported that Medicaid insurers, including the private HMOs, were backing an element of SB1972 that "would name them as agents of the state and give them the full protection of Florida's sovereign immunity, no matter how much damage they cause to an innocent disabled adult or child who has been entrusted to their care." As preposterous as it sounds, it is similar to an attempt here in Hawaii to assimilate child and protective services under the Medicaid ABD program. UnitedHealth and Wellcare employees suddenly had the right to threaten to remove a child from a family for abuse, if the family did not agree to the company's recommended reductions in Medicaid services.

Now we're putting Bonnie and Clyde in charge of the bank's vault.

Please sign our petition to get for-profit HMOs out of Medicaid and Medicare.

Wednesday, April 13, 2011

Hawaii health insurers back state bill attacking patient rights

There is a war going on against Hawaii's middle class, and between what appears to be a virtual media black-out on the subject and a public misinformation campaign, nobody seems to know a thing about it.

At least half a million people in Hawaii who have health insurance are going to lose the right to an effective external appeal of decisions made by their health insurance providers if Hawaii Senate Bill 1274 passes. Health insurance carriers have already admitted publicly to drafting companion legislation, and are increasingly open in their support of 1274.

SB 1274 will repeal HRS 432E-6, which created a state external review process that could intervene when a health insurance company denied medically necessary treatment or medication. The state law creates a local hearing process where both sides can present expert testimony, and decisions are issued by a panel rather than a lone individual.

According to Rafael del Castillo, a Honolulu attorney who specializes in representing clients appealing insurance company decisions under HRS 432E-6, the insurance companies have lost or given up in about eighty percent of these cases.

That means that in eighty percent of the cases, the insurance company denial had nothing to do with medical necessity, just saving the company money.

The Affordable Care Act may have also extended the coverage of HRS 432E-6 to most families with employer-paid health insurance. Del Castillo is seeking confirmation from the Department of Labor.

If Hawaii Senate Bill 1274 passes in any shape or form, the middle class is also going to lose any external review rights they just gained last fall.

SB 1274 came to life very unexpectedly in January, seeming to originate out of the office of the state's newly elected Democratic governor Neil Abercrombie. People were stunned since Abercrombie was assumed to be a pro-consumer rights politician.

At first it had a silent companion bill, S.B. 658, making patients responsible for insurance company legal fees if the patient lost the appeal. Attorneys for Wellcare, a for-profit HMO that makes about $600 million a year from its contract with Hawaii, admitted at a Senate hearing to having drafted the bill. S.B. 658 has been tabled indefinitely ever since.

The latest development is a clause that has been added to S.B. 1274 making it retroactive to January 1. All cases currently in the external review process would be dismissed, which could save the insurance companies as much as $500,000 in legal fees. According to del Castillo, the big winner in the bill going retroactive is UnitedHealth Group, operating in Hawaii as Evercare.

Every health insurance carrier operating in Hawaii is going to benefit if S.B. 1274 is signed: HMSA, Kaiser, HMAA, UHA, Aloha Care, Evercare (UnitedHealth) and Ohana (Wellcare) all benefit from repealing the law that gives their policyholders an effective way to challenge denials of treatment. That gives the insurance carriers free rein in making medical decisions based on operating profit rather than the policyholder's medical needs.

The mis-information campaign is claiming HRS 432E-6 violates new federal regulations and so MUST be repealed. Del Castillo has been working with federal authorities since January on how the existing law can meet new federal regulations with nothing more than a few tweeks, rather than a sledgehammer. According to del Castillo, Hawaii's health insurers continue to push hard to get 1274 passed and are refusing to accept any compromise that preserves the consumer protections we now have. Del Castillo has even received a letter threatening to sue him on behalf of unnamed insurers if he continues providing lawmakers with information about past external review cases consumers have won.

The media blackout on this (with the notable exception of HPR) is fascinating. It is easy for them to dismiss del Castillo's information campaign on 1274 on the basis he is the one to benefit if the current law stays in place. After all, he's the only local lawyer who is willing to represent health care consumers in this external review process. Since del Castillo finances these cases himself until the decision awards him costs, the retroactivity singles him and his clients out for special financial punishment.

Del Castillo says an editor told him years ago that one of the state's big insurance companies had threatened to pull advertising if his cases against them got any media coverage. It is obviously impossible to prove, but it is interesting that all of his advocacy work on behalf of patient rights is ignored, and even when he came in second in last year's Democratic primary race for Congress, never received a word of coverage in any of the major newspapers, TV or radio outlets.

A political candidate who gets 22,000 votes and is completely ignored by all the media is practically a story by itself.

Once upon a time, long ago, Hawaii was known as "the Health State". We had a state law that established a health patient's bill of rights, all the kids had insurance, and employers were required to provide health coverage. For a very short time, even President Obama was linked to his origins from "the Health State."

But about the time Obama came into office, Hawaii's Republican governor turned over seventy percent of the state Medicaid budget to two for-profit insurance carriers, the death rate among the elderly and people with disabilities increased, children had already lost their health coverage, and so the Health State was rather abruptly dismantled.

We can't let the Abercrombie Administration and this Legislature take away our right to an independent review panel when our health insurance company denies us medically necessary coverage. We can’t let lawmakers retroactively repeal rights people relied upon in incurring substantial costs and in seeking denied medical care. It doesn't matter if the company name on your insurance card is HMSA, HMAA, UHC , Kaiser, Aloha Care, Evercare or Ohana, you lose your health patient rights if SB 1274 gets passed.

We all lose.

Tuesday, April 12, 2011

A mom's letter opposing Hawaii Senate Bill 1274

A Hawaii mother has written the following letter, and sent it to Governor Abercrombie and Hawaii state legislators, regarding SB 1274.

My family and I are strongly opposed to Senate Bill 1274, which will unjustifiably and irreversibly damage health care consumer protection in Hawaii. Our external review law, H.R.S. § 432E-6, has served health care consumers well for over a decade. It gives health care consumers a more level playing field against powerful insurance companies. Consumers have access to experienced advocates to assist them with preparing and presenting their cases in a manner consistent with Hawaii’s medical necessity law. Decisions are made by a local expert panel, and consumers are able to present expert testimony and other evidence in a fair, but efficient, hearing process.

If this law passes, it will have a profound impact on my entire family. In addition to endangering my daughter, it could cost my family tens of thousands in unrecoverable attorney fees. When we exercised our right to appeal with the IC, we were not informed that the law could change in the process of appeals and that we could lose all of our rights retroactively. Basically the entire playing field changed with no warning. We--our daughter included--are being stripped of our current rights--this from insurance division and a Legislature that is supposed to be responsible for overseeing the safety of the Hawaii citizens they are sworn to protect. Furthermore, it appears that the retroactive application of the law, which was added by the Senate Committee on Ways and Means, punishes struggling families and benefits one, and only one, entity – rich and powerful UnitedHealthcare Insurance Company, known as “Evercare,” which would otherwise be required to pay those costs and expenses.

Please allow me to explain. We have a four-year old daughter who has a life-threatening seizure disorder known as Lennox Gastaut Syndrome. There are some days that she had had over 1,000 seizures per day. Despite these inhuman challenges, she struggles with all her might every day to learn to walk on her own and to communicate, and she is unfailingly appreciative of the help she receives. Our daughter has numerous physicians that provided her health care plan with prescriptions and letters of explanations for why she needs 24/7 skilled nursing care. It was reviewed by a physician on the health plans staff and denied. The part of this that is so concerning is the health care plans physician that provided the denial is not even a neurologist; nor has never seen our daughter as a patient; nor is this physician familiar with her care plan.

The health plans told us that, if our daughter needed 24/7 care, then the most “cost effective” place for her would be placement in an institutional setting. We feel strongly that such a move would be the most inhumane choice for
a four-year old child; it would amount to banning her to an institution away from her family forever, and depriving her once and for all of the hope of a meaningful and fulfilling life. We worry that such a move would send a horrible message to her brother—a message that family does not matter and that children can be thrown out like used Dixie cups.

Does institutionalizing a little girl who tries so hard to get better sound like something that constituents would support? The impossible part about this scenario is there is no facility in Hawaii to accomplish this “institutionalization.” Where did they want to send my medically fragile daughter? Were they thinking about taking our daughter from us and placing her on another island or, worse yet, sending her to another state? By doing this, they are putting Hannah in jail. If my daughter is placed in an institution, she won’t have her family or her right to a Free Appropriate Public Education. They will put her in a crib bed that is caged and not allow her to live her life. In essence, they would be putting her in a jail because of her disabilities. We treat our criminals better. What crime has my four year-old child committed that she deserves this fate?

I invite you to visit my child. While she has severe disabilities, she is a lovely and loving child. She works hard every day to master new skills. She is learning against great odds, and her quality of life is very high. So is the joy that she gives to us, her caretakers, and our friends.

We exercised our right to appeal what we think is a medically and morally bad decision, and so far, our daughter has the care she needs to remain with her family, school, and community. If you allow Senate Bill 1274 to take effect, it will be devastating to Hawaii families with disabled persons. I am begging you, please, don’t take away the only rights we have to help our disabled children and community. I ask you to look into your hearts—not just at budgets-- for the implications of these proposed bills. Please take the wise and humane course of action.

Very truly yours,
Kilauea, HI 96754

Privatizing Medicaid and Medicare is an attack on the middle class

There seems to be a general assumption that when people talk about cuts to Medicaid and Medicare, it has to do with poor people. In fact, the cuts affect middle class working families the hardest, by targeting anyone who isn't rich enough to pay for keeping a medically needy child or grandparent at home and out of an institution.

It is normal for about two-thirds of every state's Medicaid budget to go, not for people who qualify from poverty or unemployment, but to the medical care of children and adults with disabilities, whether from birth, accident, age or illness. These are middle class American families who make too much money to qualify for Medicaid; they are trying to care at home for a child, a grandmother, a sibling who qualifies for Medicaid on the basis of disability through what are called "waiver programs" (because family income/assets are "waived" in calculating eligibility).

That sixty-six to seventy percent of every state's Medicaid budget is what is up for grabs when companies like Wellcare gloat in their year-end reports that forty states are considering turning their ABD (aged, blind and disabled) population over to private contractors.

In Florida, for instance, the ABD population could be expected to account for somewhere between $12 and $14 billion, considering the $20 billion annual budget. Private contracts for ABD services were handed out to companies like Amerigroup last year. The newly elected governor of Florida, who vowed after the election to parcel out the state's entire Medicaid population to private contractors, recently announced he was filling a $174 million budget deficit by decreasing the rates paid to caregivers by 15%. Lowering reimbursement rates helps insurance companies decrease their Medical Loss Ratio thereby increasing profits. The family can either take another job to try to supplement the medical services lost, or put their family member in a hospital or institution. Again, it's the insurance company holding the state Medicaid contract for the ABD population and/or long term care who makes out.

Meanwhile Florida's state legislature is trying to rewrite Medicaid. One proposal would change the name of the Medically Needy program to the Medicaid Nonpoverty Medical Subsidy, while eliminating coverage of hospitals and medications.

What are adults with catastrophic illnesses supposed to do without medications?

Splitting up state Medicaid populations into "risk-based health maintenance organizations" will affect people who qualify because of poverty or unemployment, yes. But with two-thirds of any state's budget spent on the much smaller aged, blind and disabled population, the biggest impact is where the companies get the biggest bang for the buck saved. Capitation contracts are hard to come by, but I published Hawaii's a long time ago, verifying that individual budgets can go as high as $29,000 a month. This is not money spent on somebody because they are poor, it is money allocated to the home nursing care for someone who is so disabled they cannot live on their own.

Wasting up to twenty percent of our federal and state budgets for Medicaid and Medicare on CEO salaries and corporate profits is hurting millions of average middle class Americans whose only fault is wanting to keep their families, including their most vulnerable members, together.

Please visit this petition to put a stop to Wall Street's pillaging of Medicaid and Medicare. Every signature sends an email to Deputy Attorney General for Civil Rights Thomas Perez, Secretary Duncan of Education and Secretary Sebelius of DHHS to stop this attack on our civil and patient rights.

Monday, April 11, 2011

SB 1274 still alive, will be retroactive to January 1

The following announcement was distributed by Rafael Del Castillo:

It is time you understood something about S.B. 1274 as it goes into conference, and why it should be KILLED. It is a cruel trick on the poor and vulnerable and it is time we expressed our outrage about that.

Not only does S.B. 1274 EXCLUDE MEDICAID MEMBERS from the external review entirely, but our Senate Committee Ways and Means made the bill RETROACTIVE TO THE BEGINNING OF 2011. (only Sen. Slom voted “No”)

That means that the TWELVE cases (11 against Evercare) that are presently on file with the Insurance Division, and the EIGHT cases in internal appeals ARE DEAD THE DAY GOVERNOR ABERCROMBIE SIGNS THE BILL.

It means that pending motions on which consumers are entitled to over $40,000 in fees and costs incurred ARE ALSO DEAD.






Now that things are getting down to hand-to-hand, HOW ABOUT A FEW LETTERS TO THE EDITOR?

To get your message to the Governor, you can call Mike Ng, Governor’s Policy Analyst, at 808-586-0295 or email him at


I also apologize for all of the red ink (capital letters), but red ink is what this is about. The Administration’s original bill ignored the issue of pending cases, so our SENATE Committee on Ways and Means helpfully added language the HEALTH INSURANCE PLANS lobbied for. Let them know how you feel about that.

It is time they explained to you why they voted to retroactively deprive people of rights and property.
(I am giving you email addresses, but keep in mind that emails get ignored. Calls cannot be ignored so easily. Neither can faxes.)


David Y. Ige
Phone 808-586-6230 Fax 808-586-6231

Michelle Kidani
Phone 808-586-7100 Fax 808-586-7109

Suzanne Chun Oakland
Phone 808-586-6130 Fax 808-586-6131

Donovan M. Dela Cruz
Phone 808-586-6090 Fax 808-586-6091

J. Kalani English
Phone 808-587-7225 Fax 808-587-7230

Will Espero
Phone 808-586-6360 Fax 808-586-6361

Carol Fukunaga
Phone 808-586-6890 Fax 808-586-6899

Gilbert Kahele
Phone 808-586-6760 Fax 808-586-6689

Donna Mercado Kim
Phone 808-587-7200 Fax 808-587-7205

Ronald D. Kouchi
Phone 808-586-6030 Fax 808-586-6031

Pohai Ryan
Phone 808-587-8388 Fax 808-587-7240

Jill N. Tokuda
Phone 808-587-7215 Fax 808-587-7220

Glenn Wakai
Phone 808-586-8585 Fax 808-586-8588

The sole person you can send thank you’s for protecting your rights is Senator Slom, who voted “NO”
Sam Slom
Phone 808-586-8420 Fax 808-586-8426

Rep. Ryan Yamane, House Health Chair, and Sen. Josh Green, Senate Health Chair, are expected to be the subject matter experts on the conference committee.

Let them hear how you feel about depriving people of health care and property RETROACTIVELY.

Sen. Green
Phone 808-586-9385 Fax 808-586-9391

Rep. Yamane
Phone 808-586-6150 Fax 808-586-6151

Imua! Pass it on!
Rafael del Castillo

Friday, April 8, 2011

Death by Medicaid: the Republican dream of unbridled profit-taking at work in Florida and Hawaii

It's all about the privatization of Medicaid and Medicare. Along with CHIP, together they churned more than $887 billion in state and federal funds directly into the American economy in 2009, and private insurance companies saw a gold mine waiting to be exploited.

In 2010, just nine private health insurers reported getting their hands on more than $111 billion of it, up 35% over 2009. The companies have put together a self-serving body of research demonstrating how converting state Medicaid enrollees into privatized Medicaid contract policyholders saves the state money while proving better service. All of these plans are managed care.

The state and the insurer agree on a table of "risk" values and apply it to each policyholder. That amount, which can vary between $200 and $29,000 a month (based on individual medical needs), is called the capitation payment. Every Medicaid policyholder has an personal, individual budget that the contractor is paid monthly by the state, using a combination of local and federal funds.

How much of the capitation payment is spent on actual medical costs is called the Medical Loss Ratio (or Health Benefits Ratio). Private insurance companies make their money by not spending the money that they are paid in premiums.

If you are paying your private health insurer $250 a month for your coverage, you likely are not keeping track of how much of it is spent. If you suddenly develop a serious or life-threatening condition, you know the insurer will keep paying the costs (at least up to a point) regardless of how much it exceeds your $250 per month payment. The company is taking all the $250 per month payments from tens of millions of members, and there is always plenty left over to take care of higher needs here or there.

The perspective should be a little different, however, when the insurance company is being paid $29,000 a month to keep a medically fragile child at home with their family, anywhere from two-thirds to three-quarters of which are federal dollars.

Even if there were stringent regulations in place (which there are not) as to how much of these federal and state funds have to be spent on actual medical costs, it would make no difference. An FBI sting operation against health insurer Wellcare "videotaped a meeting of top executives in January 2007. Florida Medicaid officials had demanded an accounting of WellCare's behavioral health spending, and the company knew it was only about half of what the state believed. The solution: simply double every charge." The former Wellcare employee who wore video cameras and microphones to work every day estimated that the fraud against Florida Medicaid ranged in the $400 to $600 million range.

What somehow remained unmentioned was the fact that this type of Medicaid fraud, which Hellein's tapes show is openly shared between companies such as Wellcare, Amerigroup and UnitedHealth Group, is ongoing. Fines and Deferred Prosecution Agreements do not really seem to put a dent into it, in fact. Wellcare was paid $890 million by Florida for the same Medicaid contracts in 2010, and got a 2.5% to 3% rate increase in September. They claimed to spend 87% of that on actual medical costs, but Hellein's audiovisual evidence makes it clear these figures easily have little relation to reality.

Besides, they made around $600 million from their Hawaii contract, before getting a raise last summer. The Hawaii contract does not stipulate any minimum Medical Loss Ratio. The individual policyholders are all elderly, blind and/or disabled adults and children, so are not likely to be keeping track.

Hawaii, in fact, is an excellent example of how Republicans envision Medicaid functioning. Hawaii created two Medicaid populations: a small one of about 40,000 "aged, blind and disabled" adults and children who had special medical needs; and a bigger one for the other 267,000 people signed up for regular Medicaid. The small one gets more than seventy percent of the state's total $1.7 billion annual Medicaid budget, which is divided between two contract holders: UnitedHealth Group and Wellcare.

Former Republican Hawaii Governor Linda Lingle was responsible for moving the state's "aged, blind and disabled" population overnight from a fee-for-service system to a privatized managed care plan operated by two out-of-state for-profit corporations. Sworn testimony was videotaped last year stating this group had experienced a 36% increase in deaths within the first year after UnitedHealth and Wellcare took over.

While Wellcare's SEC filings bemoan the company's high Medical Loss Ratio, UnitedHealth celebrated its lowest rate in five years in the fourth quarter of 2010. Company wide, they got it down below 80%.

Apply that to their 2010 Medicaid premium earnings from Hawaii, also about $600,000,000, and it means $120,000,000 in operating profit was generated for the company. Wellcare would have cleared at least another $75,000,000, and there is no good reason to assume their MLR here would be as low as it is on contracts like Florida's where it has been stipulated.

For Wall Street, this was very good news. For the forty thousand or so elderly and children, as well as adults with disabilities, it was very bad news. Their service budgets were cut by that amount. Life-saving medications they had been taking for years were suddenly denied. Home nursing services were abruptly slashed.

To look at this another way, the State of Hawaii could hand over those two Medicaid contracts to local, non-profit corporations, keep services at the current level, and cut out the middleman profit of about $195 million a year. Sure, a portion would have to be paid out to hire back 200 - 300 state workers who have lost their jobs directly or indirectly from the privatization, but that would be funds going right back into the state economy.

But even with a new Democratic Governor, Hawaii's privatized Medicaid system for the "aged, blind and disabled" population is remaining privatized. UnitedHealth and Wellcare both have numerable complaints pending against them with federal regulators, and as recently as yesterday continue brazenly to violate federal regulations. The state is looking to save $100 million from Medicaid over the next two years. Why isn't even our Democratic governor trying to cut big business profiteering out of Medicaid?

In part, that seems to be because the national winds supporting Medicaid's privatization are so subtle.

Florida's new Republican Governor was the CEO of a healthcare corporation found guilty of the biggest Medicare fraud in US history. He is a strong believer in the privatization of Medicaid. In February, Governor Rick Scott announced a plan "to transfer Florida's Medicaid recipients into privately run managed-care programs. Doing so would save the state nearly $4 billion over the next two years, he says."

As of June 2009, almost a million Floridians already received their Medicaid from "privately run managed-care programs." These programs had earned the state a reputation as the "Medicaid fraud capital of the world", and FierceHealthIT said last summer that "Medicare and Medicaid fraud might as well be the state sport of Florida." In July the Florida Attorney General's office announced it had received permission to mine Medicaid claims to find fraud. Two months ago, Florida's Medicaid and Public Assistance Fraud Strike Force "estimated Medicaid fraud costs taxpayers more than $2 billion a year. That's about 10 percent of the $20 billion Medicaid budget, which happens to be the fastest growing segment of Florida's $70 billion budget."

If Florida has a $20 billion annual Medicaid budget, and two-thirds of it goes to help children, the elderly and people with disabilities (which is an approximate national average), and 56% of the Medicaid population is enrolled in privatized managed care run by for-profit corporations, and they are averaging an 85% Medical Loss Ratio, then somewhere around $1.1 billion is being skimmed off the top of the contracts as operating profit.

Governor Scott now says the state Disability Division is $174 million in the hole, and he's making it back by cutting home services to the state's disability population. Individuals are expected to see cuts ranging between fifteen percent and forty percent.

Profits to the big providers are not being touched, because that is not the "free enterprise" way. As Florida's recently elected Republican Congressman Allen West said, free enterprise is the solution to healthcare reform and what he calls "the bureaucratic nanny state."

Apparently taking money that is given away by the bureaucratic nanny state is OK, as long as it is not spent.

Please sign our petition to stop handing federal and state Medicaid dollars over to companies who won't spend it.

Tuesday, April 5, 2011

Tracking Wall Street's takeover of Medicaid and Medicare

I've been tracking nine companies expansion into Medicaid and Medicare since 2009, and some as far back as June 2008. The information is taken from their quarterly and annual SEC filings.

The nine companies tracked were Aetna, Amerigroup, Centene, Coventry, Humana, Molina, Wellcare, Wellpoint and UnitedHealth Group. Federal Medicare and State Medicaid contract business generated more than $111 billion in 2010 premium revenues to these nine companies.

A health Insurance company's standing on Wall Street and with its stockholders is based on keeping an important business indicator as low as possible. Called the Medical Loss Ratio (MLR), it stands for the percentage of each monthly insurance premium received that is spent on actual medical costs. These nine companies reported MLRs between 79.4% (Coventry) and 87.5% (Aetna). That means they saved shareholders almost $20 billion in operating profit from Medicaid and Medicare premiums.

State and federal contracts pay the companies based on intricate risk levels calculated for each individual "policyholder." They may be paid $5,000 a month for a senior citizen, $12,000 a month for my daughter, or as much as $29,000 a month for someone meeting the highest risk criteria.

When a state-operated Medicaid program that pays actual bills (called fee for service) is suddenly replaced by for-profit "managed care" plans, each "policyholder's" individual budget has to be cut by that 13% to 20% margin that now goes straight to company bank accounts.

Most Medicaid contracts either do not stipulate an MLR, or when they do, companies can easily defraud Medicaid by pumping expenses. The Affordable Care Act was supposed to be imposing an 85% MLR on Medicare and 80% or 85% on employer-paid policies. An Oppenheimer analyst calculated six companies alone (UnitedHealth, Aetna, Cigna, Coventry, Wellpoint and Humana) would have owed about $1.9 billion in rebates just to commercial and individual policyholders.

The Oppenheimer study looked at state insurance records as well as SEC filings. They found that average MLRs differed widely across the country: two different Wellpoint subsidiaries in Colorado spent only 33.2 percent and 53 percent respectively on actual patient care. A UnitedHealth program had an average MLR of about 63 percent.

A Florida investigation into a single Medicaid contract that actually stipulated an 80% MLR found all eight Medicaid HMO providers (including Wellcare, Amerigroup, and Humana) owed the state refunds.

The lower the MLR, the more medical services are cut.

Back in January, the Children's Disability Rights Education Association launched two surveys to gather information on how well states are following federal Medicaid regulations specifically directed to protecting children with disabilities. While the initial survey sample is small (41), its unanimity is glaring: all 41 respondents (forty of them family and caregivers), coming from 19 states, have been the victim of one illegal Medicaid action or another.

This is what happens when profit-based companies take over Medicaid contracts and have to slash services to please stockholders and Wall Street.

CDREA's article on the survey details the impact on family life that these anonymous financial decisions can have.

If you believe that life and death medical decisions for medically fragile children, the elderly, and adults with disabilities should not be made by for-profit health insurance companies, please sign our petition.

If you believe federal and state tax dollars destined to provide care for the elderly, and children as well as adults with disabilities should not be diverted to private corporate CEO salaries and profits, please sign our petition.

UnitedHealth, Wellcare and Hawaii Senate Bill 1274: a true Wall Street romance

Hawaii SB 1274 remains alive, along with its assault on the health care rights of almost everyone with employer-paid or Medicaid insurance. Raphael Del Castillo sent out this information at 4 am today:

I just came from the decision making by the House Comm on Finance, which passed SB1274 on with amendments. It was disappointing and frustrating. Health chair Ryan Yamane came to tell the committee that they were waiting for “language” to preserve the consumer protections in our existing law, but have not received any (my language recommendations don’t count – who knows, make up your own reasons). They are waiting on the Insurance Commissioner and the Abercrombie Administration. THERE ISN’T GOING TO BE ANY LANGUAGE FROM THE COMMISSIONER. IF HE DOES NOT SUBMIT ANY, THEY WILL PASS THE BILL AS IT STANDS, SO WHY WOULD HE SUBMIT ANY?



Del Castillo is asking for an immediate email campaign to President Obama.

sit down and send an email to the President, (with cc: to all of the addresses below) asking him the following two things: Why is the Obama Administration conspiring with health insurers

1. To DENY Hawaii consumers their long-established protections?
2. To DEPRIVE the poorest and most vulnerable of Hawaii’s people of the protections they now have against the richest health insurance company in the world?

Put this in the subject box: “NO ON SB 1274”

The petition distributed through has also been updated to include President Obama, as well as the governor and Hawaii State Senate.

Saturday, April 2, 2011

Death by Medicaid: Please sign our petition to take away Wall Street's license to kill

One death is already too many. Wall Street can no longer be allowed to make life-or-death health decisions for children, the elderly, and adults as well as children with disabilities.

Please sign our petition to stop federal Medicaid and Medicare dollars being paid to for-profit corporations.

Roughly one-seventh of the total federal outlay for Medicaid and Medicare was paid to companies that brag about spending as little as possible of each Medicaid or Medicare dollar on actual patient services. The 13.7 million Americans who now receive Medicaid through one of nine publicly trade corporations used to receive their services through state-run plans that paid the actual medical bills incurred, a system called "fee for service."

When a "fee for service" budget is handed over to a private insurer, the companies are under no legal obligation to pay out any minimum percentage in actual services. When a company such as UnitedHealth reports paying less than eighty cents out of every dollar, it means that the person with disabilities whose budget it is has had their medical costs cut by an average of twenty percent.

Long-term medications are suddenly denied payment. One young adult I know has had twenty-two medications denied payment since January and now requires dialysis.

Nursing services are abruptly cut, with no consideration to medical needs. UnitedHealth has mounted an offensive war against parents here in Hawaii, bullying and trying to coerce families into agreeing to cuts in home services. We're being accused of being bad parents somehow if we can't be professional nurses at the same time.

The $19.5 billion in off-the-top profit from Medicaid and Medicare managed care contracts received by nine companies I tracked could have been used to pay for more than just CEO salaries. For example, two companies that only offer federal Medicaid/Medicare programs, Amerigroup and Centene, paid out $5.5 million and $7.1 million respectively to their CEOs in 2009.

UnitedHealth tried to explain away 2010's skyrocketing profits by saying it was because people didn't have the money for copayments, so they weren't going to the doctor. But commercial premium revenue was up only one percent: the company's twenty-one percent increase in net earnings was tied more closely to the 24% increase in Medicaid and 12% increase in Medicare premium revenue, combined with a two percent reduction in the Medical Loss Ratio (MLR).

Every penny saved against that MLR, the percentage of the capitated fee received that is actually spent on medical services, exacts a human toll. These capitated fees are received to provide people whose special health care needs put them at risk of death or institutionalization with the services and medications they need to stay healthy and alive with their families.

The little boy that died here is not the first victim of Wall Street greed in the guise of Medicaid. Sworn testimony was presented to Hawaii State Senate leaders more than a year ago that the death rate among the elderly and disabled had gone up 36% in the first year after UnitedHealth and Wellcare took over the contracts. A list of names surfaced, and reportedly families were visited by either the FBI or DoJ.

But if he's not the first, he needs to be the last.

Please sign our petition, and forward to your friends.

Friday, April 1, 2011

News at hacked

The news and alerts pages were hacked and are down. I'm trying to figure out how to get them back up and apologize to anyone who came across the hacker's site.

Death by Medicaid: A child has died

A child has died but insurance company profits remain high.

Wall Street's pillaging of Medicaid and Medicare to the tune of over $111 billion in 2010 helped push net earnings for some companies 21% to 81% higher than 2009. Seven of the nine companies I've been tracking bragged in their 2010 SEC filings about the $19.5 billion saved off the top of federal and state Medicaid and Medicare contracts by lowering the amount of every dollar actually spent on costs.

What even The Wall Street Journal has failed to notice is that lowering costs (variously called the Medical Loss Ratio, Medical Benefits Ratio, Health Benefits Ratio, etc.) only happens when you cut services.

There is a human cost to these cuts in services. When life-saving medications are suddenly denied, thereby lowering the MLR, the company is taking a chance the patient will continue to live while the savings are realized.

A little boy has paid the price for this with his life, however, and no one is doing anything about it.

Different branches of the Federal government have been receiving complaints about Hawaii's Med-Quest program and providers UnitedHealth Group and Wellcare since August 2009. Federal Medicaid regulators from the Centers for Medicare & Medicaid Services (CMS) along with the DHHS Office for Civil Rights have been kept aware of a continuing pattern of Medicaid service cuts that persistently violate federal Medicaid regulations and civil rights.

My daughter is alive because I have learned how to play the insurance company game. They will suddenly deny one of Hannah's medications (or refuse to fill a new prescription), and I don't find out until I call to see if I can pick it up. Hannah's Medicaid provider, UnitedHealth, has told the pharmacy they won't pay for it, and then starts the back and forth over prior authorizations. New medical orders for Hannah's ketogenic diet, used to control her seizures, have still not been filled fifteen days after submission. I also have not received anything in writing from the insurance company. One prescription was finally filled on Tuesday after I emailed the president of the company and the state Medquest office.

But what about the families who don't know the insurance company is just playing a game with them?

How many federal investigations does it take before somebody sees the pattern and puts a stop to it?

A young man who is a double amputee and lost the use of both arms now requires dialysis after twenty-two different medications have been denied insurance payment. CMS and state Medicaid officials have been following the case since January. CMS has also been looking into potential Medicare fraud by UnitedHealth as a result of this case.

A five year old medically fragile child's home nursing hours were cut 33% while she was hospitalized for a worsening of her seizure condition. The cut was to go into effect immediately upon her return home, with the parents never to this day (it's been two weeks) receiving anything in writing from UnitedHealth. CMS and OCR have been following this case closely as well.

Medicaid "hit squads" have been terrorizing the families of medically fragile children here for months. A mother was verbally abused for not understanding medically technical language, and another mom was told she didn't spend enough time with her child. UnitedHealth later tried to trick a mom into agreeing with their proposed reduction in nursing hours by repeatedly asking, "it's reasonable, isn't it?" CMS, OCR and state Medicaid officials are following these cases as well.

Meanwhile, Medicaid insurance company Wellcare admitted to drafting anti-consumer state legislation in Hawaii that would have directly benefited the company as well as UnitedHealth. State legislation is still alive that will deprive everyone covered by UnitedHealth and Wellcare of any outside appeals by patients who don't agree with the companies' cuts in services to bolster stock prices. (It will also do away with the current independent review source for such profit-based decisions for people holding employer-paid health policies at HMSA, HMAA, Kaiser, UHA and other insurers).

A federal whistleblower complaint unsealed last summer, using information gathered during an eighteen-month cloak and dagger investigation, quoted Wellcare executives lauding the profitability of Medicaid contracts to provide care for the elderly and disabled. The head of "utilization management" (cost cutting from state and federal contracts) was quoted saying "we would prefer it if they would die because it's cheaper."

Our government has essentially given Wall Street a license to kill the weakest members of our society: the elderly, and children as well as adults with disabilities. The recession has ironically boosted corporate insurance profits tremendously, as states carve out new Medicaid and Medicare contracts that are put out to bid to private insurers. Between June 2008 and December 2010, UnitedHealth Group's Medicaid revenue skyrocketed by more than 640%. The company hit its lowest medical benefit ratio in five years in fourth quarter 2010, coming in at less than eighty cents on the dollar while annual after-tax profit was up 21%.

How does the life of a little boy figure into these types of calculations?

A federal employee told me yesterday that his death is not a civil rights issue, it is an issue instead for the regulators. This information has distressed me, as it belittles his life. Our children's lives should not be profit centers. Federal and state dollars spent on care for the elderly and people with disabilities should be used to pay for services, not CEO salaries (almost $9.5 million to UnitedHealth's CEO in 2009).

The practice of allowing profit making companies to pillage federal coffers under the guise of providing cost-effective "managed care" to the elderly and people with disabilities must be stopped.

No more children can be allowed to die.

About Me

My photo
I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.