SB 1274 Action Alert: Veto demonstration re-scheduled for Friday June 3

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The following update was received from Rafael del Castillo this morning.

One of the key organizations urging the Governor to VETO SB1274 has asked for more time to get together a veto demonstration, so we are looking at Friday, June 3, to make sure there is enough time and there are enough people. Please email me at countmein@we-are1.com whether you (and friends and family) can make it to the Capitol that afternoon (6/3/11). A lot of camaraderie will be had by all!

BTW, I do have a correction about the hearings I referred to in my previous post. CCIIO (Center for Consumer Information and Insurance Oversight, which has charge over compliance) is not holding hearings about individual state laws. However, I believe that CCIIO must have a formal process which involves a 2-way discussion of the points and, as I previously said, not go hunting squirrels with an elephant gun.

On that note, the promise that I would get an audience for substantive discussions with CCIIO has NOT BEEN KEPT, and it is Wednesday. Tomorrow will be a full week.

I am urging our Congressional delegation to help ensure that the promise is made good.

I have tried hard, as you know, to reach accommodations. Those efforts have thus far been met with disdain. SB1274 is a sad chapter in legislation that should never have made it out of committee. We must bring all of our resources to bear on the Governor to do the right thing.

SB 1274: Action alert for Friday

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Last night, Honolulu patient rights attorney Rafael del Castillo released his first post-trip announcement on the status of SB 1274.

There are no indications that Governor Abercrombie ever sent the letter that CCIIO asked for on May 18, last Wednesday. Evercare has already slash home nursing services for a medically fragile little girl on Kauai, in anticipation of the Governor's signature, to the point where the child is threatened with re-institutionalization.

As a result, del Castillo has called for a Veto Demonstration at the State Capitol on Friday afternoon, May 27. Anyone interested in attending should email him at countmein@we-are1.com

Here is the full text of last night's release.

Great things are happening. Please forgive me for not sending out an update, but I did not want to jump the gun. Besides, I wound up spending 24 hours in LAX.

CCIIO has yet to make good on the conference it agreed to thanks to the facilitation of FamiliesUSA. I am pursuing it, and hope it was not just to get me to return to Hawaii. I did not want them to bank on my returning, so I said nothing about it. In fact, I have oral argument tomorrow and have been jamming on an opening brief in an appeal I am attempting to have expedited because Evercare is slashing services – why not when you expect the consumer protections to be repealed, right?

You ask, “What about the letter from Governor Abercrombie to the CCIIO?” We have not gotten any indication that the Governor sent a letter.

So, I owe you a report on the conversation with CCIIO. If it does not happen, I will go back to DC and camp out on their doorstep.

But great things are happening. In the last couple of days, more influential organizations in Hawaii are calling for a veto, and the organizations who recognized that SB1274 was a bad piece of legislation, and unnecessary, are increasing their efforts to persuade Governor Abercrombie to veto. It is time to join hands, link arms, and make an appearance at the Capitol where the veto will be secured:

This is a call to action for a VETO DEMONSTRATION at the State Capitol. Details are being worked out, but prepare to come to the Capitol and demonstrate with all of the people who are in this fight to preserve Hawaii’s nation-leading consumer protections and rights. Look for the date and time to be announced tomorrow after I work out details with representatives of the organizations calling for a VETO. We will also let the Governor’s office know about our plans and that only a veto will call off our demonstration (signing SB1274 will not stop us). Due to the holiday coming up, plan on Friday afternoon, May 27, but I will confirm that.

In the meantime, please email me at countmein@we-are1.com if you will be at the Capitol Friday so that I can start getting a head count (for refreshments, etc.). It is BYOS (bring your own sign). I am really looking forward to this.

I want to make sure you know that great things happened in DC too. I learned from a very good source (not CCIIO because they were declining to discuss) that the CCIIO has been holding hearings with the states whose external review laws do not meet the consumer protections. This fact is unsurprising because applying temporary federal regulations to preempt a state’s duly enacted law(s) raises substantial sovereignty issues. This news is important for two reasons, as I am sure you realize: Has Hawaii law been slated for a hearing? Not that anyone in the Administration has been told. Also, that there will be hearings also provides certain important assurances. Of course, I still have to confirm this information.

I also strengthened past connections with the most influential consumer advocacy organizations with our first face-to-face meetings, and getting assurances of support, the legal analysis I was provided strongly supported our position that the preemption argument was a straw man. I was reminded of the rule that you don’t take an elephant gun squirrel hunting. That rule applies to conflicting federal and state law.

Of course, in this case, we don’t have conflicting federal and state law, we have temporary federal regs which the Legislature alleged were preemptive. But the principle is the important thing: Even if there was a conflict, the precise provision of state law that conflict are preempted, not the entire state statute, which is what our Legislature did. Thus even if Hawaii law had a conflicting provision, repealing Hawaii’s law is OVERKILL. Of course, the overkill was carried out by a faction in the Legislature because of a particular agenda.

I also had discussions with representatives from Sen. Inouye’s and Sen. Akaka’s offices and believe they will both help at the federal level, and got further support from Colleen Hanabusa’s office. I requested assistance from Congresswoman Hirono, but received none thus far.

BTW, Ed Case broadcast an email invitation for some party he was having in DC the same time I was there, and invited emails, so I emailed him to give him a chance to provide whatever help he could get for us from the connections his email said he was renewing ties with. No response. Thought you should know.

Rejuvenated and looking forward to seeing you at the Capitol.

Rafael

Update from D.C. on SB 1274

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Here is Rafael's update from last night.

It was an eventful day. I met with staff at Families USA first thing this morning and learned a surprising thing (keep in mind I have yet to confirm this directly with the CCIIO). Cheryl Fish-Parcham at FamiliesUSA believes that CCIIO has had hearings for one or more states where they had serious concerns about compliance. She also believes that DOL ESBA participates and that these hearings are operated by the OPM. As soon as I can confirm those facts, I will let you know, but it does appear that there is a formal process for 1) determining compliance, 2) notifying the state of the CCIIO’s determination (and possibly DOL), and 3) providing a hearing for the state to make its case. All of this suggests a number of things. For one, I would argue that any preemption (this is really not quite the right concept, so I am using the term because that is the label that has been used in our State) would be confined to the items of noncompliance instead of an across the board overthrow of the state’s external review law. That would be well grounded in preemption jurisprudence concerning cases in which Congress has expressly provided that State law is primary unless it fails to comply with federal law. Enough legal theory. This will be interesting to pursue.

You hopefully had time to listen to my report on The Conversation with Beth Ann Koslovich at 8 or download the podcast from http://hawaiiconversation.org.

I provided more information to Sen. Inouye’s office, including the HMA’s letter to Governor Abercrombie urging him to veto SB1274, for a hoped-for letter to the CCIIO and DOL.

I spoke with Joe Shapiro, investigative reporter at NPR thanks to facilitation by Summer Harrison. Joe has done a series on developments in Medicaid care for the aged, blind, and disabled. He will be investigating if other states have specifically excluded Medicaid managed care members from external review. Because the plans are purchased, I am considering whether the specific exclusion could be a violation of the ACA.

Then I heard from Cheryl Fish-Parcham that Ellen Kuhn at CCIIO had agreed to a conference with me and Commissioner Ito. I contacted Commr Ito and he is substituting Lloyd Lim because he will be away. We will be going through Hawaii law in detail with Ms. Kuhn. That means CCIIO has done some work on our law at least.

I also received some helpful suggestions from Rep. Della Bellati, and I hope I already told you that Rep. Karl Rhoads has been very helpful and supportive.

I connected with Erika Moritsugu at Sen. Akaka’s office, thanks to help from Mary Osorio – thank you, Mary!. She has substantial experience in health policy matters and was in Hawaii for a while during the time SB1274 was in the Legislature, but had not known its fate. I provided her with the information I had provided to Lt. Col. Maureen Charles in Sen. Inouye’s office.

Meanwhile, I received Rep. Cynthia Thielen’s compelling letter to Governor Abercrombie urging him to veto SB1274 if he is able to establish that it complies with the minimum protections. Rep. Thielen has been opposed to the repeal of Hawaii’s consumer protections since the bills were first heard in this Legislative session. Rep. Thielen concluded her letter: “With your leadership, we can continue to be a national role model in this area.” Thank you, Rep. Thielen for taking time out of your busy schedule to send a great letter!

Hope you are following my peripatetic tweets.
Thanks to all for your support and assistance. G`nite

Rafael

Action Alert on SB 1274: The feds won't see del Castillo without a letter from Abercrombie

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According to Rafael del Castillo's morning report from Washington, D.C., the people who need to issue the decision that will determine the fate of SB 1274 will not do so until they get a written request from Governor Abercrombie.

I have heard nothing on my call to Sadena Thevarajah, unfortunately. Dr. Anthony Rodgers, chief of Strategic Planning for the Centers for Medicare and Medicaid Services was very helpful in trying to get me an appointment with the CCIIO. He positively identified Karen Pollitz as the person to see outside of the Director, Steve Larsen, and spoke with her, but she has declined to see me. She is insisting that CCIIO will do nothing without a letter of inquiry from Gov. Abercrombie. My email from Mike Ng – go to DC – is not enough.

Haw. Med. Assn went to see Mike yesterday and copied me on an email to him confirming their request that the Governor send such a letter. HMA also sent the Governor a lengthy letter urging him to veto SB1274.

Join HMA in urging the Governor to send a letter to Karen Pollitz requesting that the CCIIO confirm that our EXISTING law already provides the 16 minimum consumer protections, so he can VETO SB1274!

ACTION ALERT

Please contact Governor Abercrombie's office and ask him to write the letter to Karen Pollitz.

You can call him at (808) 586-0034. Or you can go to his online contact form here.

The subject could be:

Please send a letter to CCIIO asking for their decision now.

The message could be:

Dear Governor Abercrombie,

Please send a letter to Karen Pollitz requesting that the CCIIO confirm that our EXISTING law already provides the 16 minimum consumer protections, so you can VETO SB 1274!

Hawaii Medical Association Asks Governor to Veto SB 1274

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The Hawaii Medical Association has issued a strong letter to Governor Abercrombie, asking him to veto SB 1274.

How to Follow Rafael and SB 1274 in D.C.

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Follow Rafael on his Twitter page here.

Support his efforts to save Hawaii's health insurance rights by visiting President Obama's website, and sending him a message like the following:

Dear Mr. President:

Greetings from your home state of Hawaii. I am writing to urge you to avoid an ironic turn of events which is potentially very embarrassing for the Affordable Care Act.

Hawaii is poised to repeal its best-in-the-nation consumer protections because your CCIIO staffers refuse to say whether Hawaii law complies with the ACA regulations. Wouldn’t it be ironic if the ACA is reported to be responsible for the repeal of the law in the State that was a model for universal health care?

Rafael “Del” del Castillo and many others have tried for months to get an answer from the CCIIO staff, but they refuse. Hawaii’s health plans have spent tens of thousands trying to persuade lawmakers that they should repeal our law, so Del decided to fly to Washington DC this week to meet face-to-face with the CCIIO decisionmakers.

He needs your help to get an appointment. Governor Abercrombie’s office has asked Del to bring back all of the information he can obtain to prevent the unnecessary loss of our consumer protection law. It is a no-win proposition for Governor Abercrombie if he acts to destroy our consumer protections without the information he needs. What a shame it would be to stick Governor Abercrombie with responsibility for destroying our consumer protections just because the CCIIO policymakers refuse to meet with Del for a few minutes.

Your office can reach Del at 808-782-1262. Please help him get an appointment.

Thank you for your kokua!

SB 1274 on hold while del Castillo heads to DC for answers

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Rafael del Castillo arrived this morning in Washington D.C. The purpose of his trip is to get the definitive answer on whether or not Hawaii has to dump its previous healthcare laws in order to meet a July 1, 2011 deadline imposed under the Affordable Care Act.

To understand this issue, I'm going to quote huge blocks from emails from del Castillo. As a healthcare rights attorney, I don't want to even try to re-write it.

Back on March 4, del Castillo reported

Having been lead counsel for all but two or three of the consumers who have requested external review under our present law during the past ten years, I consider myself one of the most knowledgeable persons in the State on this topic. I interrupted work on a letter to Steve Larsen, Director of the Center for Consumer Information and Insurance Oversight at DHHS, which has the assignment under the health care reform act (Patient Protection and Affordable Care Act) to review each state’s external review law and decide whether it meets all of the 16 minimum consumer protections in the interim federal regulations. After July 1, 2011, health insurance issuers will be required by the CCIIO to comply with the federal external review law in any state in which the CCIIO determines the law does not meet those minimum protections, effectively preempting the state law until it is brought into compliance. This is apparently not a well-understood concept in Hawaii. (CCIIO staff explained to me that this passive preemption is due to the fact that the PPACA is part of HIPAA (Health Insurance Portability and Accountability Act).) In any event, on February 17, Prof. Richard Miller and I had a lengthy conversation with the CCIIO staff about our situation, and we were invited to submit a letter to Mr. Larsen explaining why we believe that Hawaii law meets all of the 16 consumer protections (with one minor exception that requires a technical correction). The one element that will be in question is whether the federal minimum requiring that consumer complaints be sent to an independent review organization (IRO) is met by Hawaii’s hearing process before a local panel of three persons, including a physician, plan administrator from a competing plan, and a DCCA lawyer. We believe that is superior to an IRO and has proven to be so, but a minor amendment to our existing law could offer consumers a choice of going to an IRO or a hearing.

The problem is that by today, SB 1274 has been passed by the legislature and sits on the Governor's desk, without yet hearing back from the CCIIO. They have proved resistant to being rushed.

Governor Abercrombie has agreed to wait and see if del Castillo can get the necessary sign off on our current review system before deciding if he will sign SB 1274 into law.

Del Castillo has gone to Washington without having appointments to see the people he needs to see. On Sunday when he announced his trip, he asked supporters to email President Obama from his website to help get these appointments made and decisions reached.

I am not expecting open arms – they have their hands full with the pushback on the Affordable Care Act. Nonetheless, we are from the President’s home State. It will be a sad day if his push to expand Hawaii’s genius in health coverage to the nation results in substantial loss of rights in Hawaii.

You can urge the President to help us get an answer by contacting the White House using the form on this webpage: http://www.whitehouse.gov/contact

Sample message:

Dear Mr. President:
Greetings from your home state of Hawaii. I am writing to urge you to avoid an ironic turn of events which is potentially very embarrassing for the Affordable Care Act. Hawaii is poised to repeal its best-in-the-nation consumer protections because your CCIIO staffers refuse to say whether Hawaii law complies with the ACA regulations. Wouldn’t it be ironic if the ACA is reported to be responsible for the repeal of the law in the State that was a model for universal health care? Rafael “Del” del Castillo and many others have tried for months to get an answer from the CCIIO staff, but they refuse. Hawaii’s health plans have spent tens of thousands trying to persuade lawmakers that they should repeal our law, so Del decided to fly to Washington DC this week to meet face-to-face with the CCIIO decisionmakers.

He needs your help to get an appointment. Governor Abercrombie’s office has asked Del to bring back all of the information he can obtain to prevent the unnecessary loss of our consumer protection law. It is a no-win proposition for Governor Abercrombie if he acts to destroy our consumer protections without the information he needs. What a shame it would be to stick Governor Abercrombie with responsibility for destroying our consumer protections just because the CCIIO policymakers refuse to meet with Del for a few minutes.

Your office can reach Del at 808-782-1262. Please help him get an appointment.

Thank you for your kokua!

You can use the same page (and message) to ask the First Lady (except it is the President’s home state) if she will help (separate message, of course).

I will also appreciate anything you can do to encourage DHHS and DOL regulators to meet with me. You can email or call officials, but should do so Monday and Tuesday. I will let you know the shape of things Tuesday and what additional help I may need.

Hon. Kathleen Sebelius, Secretary, DHHS: Kathleen.Sebelius@hhs.gov Toll Free: 1-877-696-6775
Another person you can email in DHHS asking for help for me is Sadena Thevarajah because she is known for advocating for greater protections: sadena.thevarajah@hhs.gov

You can also contact the public affairs office for DHHS in this subject (a fax would be good):
Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration)
Phone: (202) 690-6145
Fax: (202) 690-7159

Sample message:

Dear ________________,

Greetings from our President’s home state of Hawaii. I have written the President, but I am also writing (calling) you to urge you to help Rafael “Del” del Castillo, who has flown from Hawaii to Washington DC this week solely to get a face-to-face meeting with the administrators in the CCIIO.

The Governor’s office has asked Del to bring back all of the information he can obtain to prevent wrong action on consumer protections. Del and others in Hawaii have tried for months without success to get an answer from the CCIIO, and we are distressed at their refusal to answer the question. Of course they are busy and we are only a small state, but we are the President’s home state, we were the model for the ACA, and wouldn’t it be ironic (and helpful to ACA opponents) if the ACA was responsible for destroying Hawaii’s best-in-the-nation consumer protections? Don’t you agree we are entitled to a meeting out of simple fairness?

Del can be reached at (808) 782-1262. Please call him and set up an appointment with the decisionmakers at CCIIO.


Hon. Hilda L. Solis, Secretary, DOL: solis@dol.gov Not toll free: (202) 693-6000
Another person you can contact is the Senior Advisor for Communications and Public Affairs Carl Fillichio, at (202) 693-4676 or
Public affairs Senior Managing Director Jaime Zapata, (202) 693-4676
The guy I really want to see is Deputy Assistant Secretary Michael L. Davis (202) 693-8300, Employee Benefits Security Administration (EBSA)

Public affairs offices are the way into the Federal agencies and they can be telephoned or faxed :

Office of Public Affairs
U.S. Department of Labor
200 Constitution Ave. NW, Room S-1032
Washington, D.C. 20210
(202) 693-4676

I will send a fax # when I get one Monday

Sample message:

Dear ________________,

Greetings from our President’s home state of Hawaii. I have written the President, but I am also writing (calling) you to urge you to help Rafael “Del” del Castillo, who has flown from Hawaii to Washington DC this week solely to get a face-to-face meeting with the administrators in the DOL EBSA.

The Governor’s office has asked Del to bring back all of the information he can obtain to prevent wrong action on consumer protections. Del and others in Hawaii have tried for weeks without success to get an answer from the ESBA, and we are distressed at their refusal to answer the question, or to even meet with Del. Of course they are busy and we are only a small state, but we are the President’s home state, we were the model for the ACA, and wouldn’t it be ironic (and helpful to ACA opponents) if the ACA was responsible for destroying Hawaii’s best-in-the-nation consumer protections? Don’t you agree we are entitled to a meeting out of simple fairness?

Del can be reached at (808) 782-1262. Please call him and set up an appointment with ESBA policymakers.

Aloha,
Rafael

Just after 5am local time, Rafael sent in his first email update.

I am here (Washington DC). Think POSITIVE thoughts! I intend to see the regulators at the CCIIO and DOL ESBA about preserving Hawaii’s existing external review law. Please let the Governor know that you appreciate his holding SB1274 until I can put our case to the Federal regulators.

If you think going to DC says “commitment” hold on to your seats. I signed up for twitter for this trip so you could follow me. I am a beginner, so have patience with me. Look for me at @Del4Hawaii

I arrived at O’Hare at 5:05 a.m. local time and left there at 6:25 bound for Reagan National Airport, where I arrived at 9:30 am local time. I immediately called Sadena Thevarajah of DHHS External Affairs, but had to leave a message on her answering machine – meetings, no doubt.

My shuttle took me over the bridge through the Capitol Mall. You can see the Washington Monument for miles around so you would have to work at it to lose your bearings in DC. With the Monument to my left, I looked up the Mall to the right, and saw the Capitol Building less than a mile away. The route to the Henley Park on Massachusetts Ave. took me across Pennsylvania at the 1400 block, but I did not see the White House. A few blocks from the Mall, less than 15 minutes from Reagan, I was dropped off at the Henley Park, my headquarters while I am staying here. I am glad I have a GPS in my phone to help me make get around quickly.

No time to spare. Follow me on Twitter (I hope) and listen to “The Conversation” with Beth Ann Koslovich on Hawaii public radio.

I just received an email from Anthony Rodgers, M.D., head of Strategic Planning for CMS. He understands the reason I am here and asked me to call. Good beginning!

Please support Rafael's efforts. I admit that I am biased and he has helped my daughter. But he also helped every other family I know of that has gone to him.

You can follow him on Twitter here.

SB 1274 and the Governor's attitude towards insurance companies

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Civil Beat this morning published an interview they did with Governor Abercrombie on Friday. Abercrombie is somewhat fixated on AARP, and threatens to "roll over" them if they try to oppose his pension tax proposal next time. His biggest beef with the association is that they are just a front for insurance companies.

I responded, and since it has to do with SB 1274, I want to put my questions out to the public.

I'm floored by the incredible irony of Abercrombie's statement about AARP, that "This is when your special interest becomes a private interest at the expense of the public interest." AARP is bad because they are an insurance company, but that attitude apparently doesn't spare him from playing nicey-nice with actual insurance companies like Unitedhealth and Wellcare.

The governor is putting business with crooks ahead of the public interest. Florida is trying to recover millions in stolen Medicaid funds destined for children's programs from both companies.

But SB 1974 will accomplish nothing other than saving these two corporations potentially millions of dollars in legal fees. With no outside challenges to their medical decisions, they save the money on the services as well as the fees. When it looked like SB 1274 was going to be made retroactive, Rafael del Castillo calculated it would save Unitedhealth about $500,000 in legal fees, just for five months of case work.

The Office for Civil Rights at DHHS just opened at least its fifth investigation in Hawaii since February 2010. All five have been over Medicaid cuts in services to children with disabilities, cuts that put these children at risk of institutionalization. Two cases were closed with decisions in favor the children last summer. All of the cases involved either Evercare/Unitedhealth or Ohana/Wellcare.

Of course, the way Hawaii's contracts with Evercare and Ohana are written, they get a bigger capitation payment every month if the child is institutionalized.

Given Hawaii's role in the recent federal Medicaid fraud settlement with Wellcare, the Governor owes the public an explanation of how his office could support legislation that helps companies that hurt children. That, too, seems to exemplify "when your special interest becomes a private interest at the expense of the public interest."

Would you hire a pedophile as a babysitter? Why do we hire companies who hurt children and their families to provide them with this kind of care?

Hawaii's role in federal fraud settlement reveals possible double-dealing behind SB 1274

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On April 26, 2011, Hawaii was one of nine states signing a settlement agreement between Wellcare Health Plans and the Office of Inspector General of DHHS, Civil Divisions of the US Attorney's office, and every state where Wellcare currently does business.

According to the company's first quarter SEC filing, Wellcare gets their federal slate wiped clean in exchange for the $137 million settlement.

The United States and the Settling States agree to release us from any civil or administrative monetary claim under the False Claims Act and certain other legal theories for certain conduct that was at issue in their inquiries and the qui tam complaints. Likewise, in consideration of the obligations in the Federal Settlement Agreement and the Corporate Integrity Agreement (as described below under United States Department of Health and Human Services), OIG-HHS agrees to release and refrain from instituting, directing or maintaining any administrative action seeking to exclude us from Medicare, Medicaid and other federal health care programs.

When did anyone plan on telling the people in Hawaii that their Medicaid health insurer, the same one that benefits from segregating everyone on Medicaid into a guinea pig herd with no access to outside second opinions, is paying the state millions in exchange for not being convicted of criminal Medicaid fraud?

In practical terms, this means that Hawaii Governor Abercrombie has been negotiating silently for the past several months for Hawaii's share of a settlement deriving from accusations of criminal Medicaid fraud. SB 1274 came out of his office unexpectedly in January. At one time, Wellcare lawyers admitted to state legislators they had personally drafted a silent companion bill.

How much of a fraud settlement is Hawaii getting? An article out of Florida expects that state to receive $23 million.

While Wellcare reported their percentage rate increases in Florida and Georgia, they did not disclose the figure for Hawaii and New York premium increases.

The nine states that settled with Wellcare over criminal Medicaid fraud allegations are Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio. Wellcare currently operates Medicaid programs in all but two of those states, Connecticut and Indiana.

Also announced in the quarterly report,

On May 4, 2011, the Federal Court entered an order (the “Approval Order”) approving the Stipulation Agreement. As required by the Stipulation Agreement, in March 2011 the Company paid $52,500 into an escrow account for the benefit of the class. The Stipulation Agreement also provides, among other things, that the Company will make an additional cash payment to the class of $35,000 by July 31, 2011 (the “July 2011 Payment”). It also requires, among other things, that the Company issue to the class tradable unsecured subordinated notes having an aggregate face value of $112,500, with a fixed coupon of 6% and a maturity date of December 31, 2016. Additionally, the Company will be required to pay to the class an additional $25,000 if the Company experiences a change in control at a share price of $30 or more within three years of the date of the Stipulation Agreement.

Meanwhile, Wellcare's premium income in the first quarter (almost $1.5 billion, all of it federal/state Medicaid or Medicare funding) was up nine percent over the first quarter of 2010.

Yesterday's Hawaii Medicaid briefing featured wrong information about SB 1274

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During yesterday's state wide hearing on upcoming changes in Hawaii's Medicaid program, a question was asked regarding Senate Bill 1274, which was passed by our legislature and currently sits on the governor's desk awaiting signature. The bill is strongly opposed by healthcare advocates, and has only been pushed by healthcare industry lobbyists.

Dr. Kenneth Fink, Hawaii state Medicaid director, responded to the question. He stated, extremely clearly, that "to the best of his knowledge" there was only one case that had made its way through the external review process and been found against the health insurer. "Only one" was stated more than once.

I asked Rafael del Castillo about Fink's statement, since he is one of the people in the best position to know how accurate Fink's number is. Here is his response:

I was unable to attend yesterday's conference concerning the future of Medicaid. I understand that Administrator Fink responded to questions concerning SB1274 and the exclusion of Medicaid members from the protections of Hawaii's external review statute that, to the best of his knowledge, there had been only one case by a Medicaid member decided in the external review, and it was decided against the patient.

As usual, intentional or not, Fink's statement is patently false and constitutes an abuse of his office in light of the fact that he is a public servant believed to be knowledgeable about the facts, whose comments are given extraordinary weight. I have no doubt that Fink provided similar false information to legislators in lobbying for SB1274 to the detriment of the people he is charged with protecting. In fact, although he has told officials he wants to know about cases involving problems with Evercare, he also declines to discuss or assist in cases and his people are actively engaged in holding services over the heads of members to persuade them to dismiss their cases.

The facts are these: There have been an unprecedented number of cases in the external review by Medicaid members, more than against any other provider, many decided, and many pending. The score is as follows:

Decisions:
Patients 3, HMSA QUEST 0. 1 case pending, heard this month.

Patients 1, Alohacare 0 - settled when filed.

Patients 1, Kaiser QUEST 0 - resolved without a hearing

Patients 2, Ohana 0 - one decided, one settled, none presently pending but several resolved before request for review filed.

Patients 1, Evercare 2 - both on appeal (1 split decision with hearing officer voting against Evercare, one failure to heed expert opinion); two cases resolved without a hearing; two will be dismissed, one because DHS immediately reversed Evercare's ridiculous decision, one because patient pre-deceased hearing; several cases filed, will be heard before June 30.

These are verifiable facts. I can provide details about each and every case, and the Medicaid members involved will be only too happy to confirm those facts.

Rafael del Castillo

After the insurance celebrating is over.....

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