A second letter from a mom to Governor Abercrombie about S.B. 1274

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This is the letter that Hannah M.'s mom brought yesterday for the Governor:

I am here today on behalf of my daughter—and, indeed, my entire family—to respectfully request that you veto Senate Bill 1274. 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 heart—not just at budgets-- for the implications of this proposed bill. Please take the wise and humane course of action.


If SB 1274 is not vetoed, it will have a profound impact on my entire family. By allowing SB 1274 to pass, you will be endangering my daughter’s life as well as the lives of many others like her in the state. Vetoing SB1274 will harm no one whatsoever. Allowing it to become law most certainly will. We--our daughter included--are being stripped of our current rights--this from an insurance division and a Legislature that are supposed to be responsible for overseeing the safety of the Hawaii citizens they are sworn to protect.

Please allow me to tell you about my daughter, Hannah. She is a five -year old girl who has a life-threatening seizure disorder known as Lennox Gastaut Syndrome. There are some days that she has had over 1,000 seizures per day. Despite these inhuman challenges, she struggles with all her might every day to learn to walk and to communicate, and she is unfailingly appreciative of the help she receives. Our daughter has numerous physicians who have provided her health care plan with prescriptions and letters of explanations for why she needs 24/7 skilled nursing care. Her health care plan was reviewed by a physician on the health plan’s staff and denied. The part of this that is so concerning is that the health care plan’s physician who provided the denial is not even a neurologist; nor has he ever 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 five -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.

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. Evercare seems so sure that you won’t veto SB1274 that they have decided again to cut my daughter’s life-saving nursing. They have conveniently chosen the date of July 1 to start the reduction, and that just happens to be the first day that we will lose our consumer rights. They know that we won’t have any recourse after June 30. Do you believe that Evercare is looking out for my daughter’s best interests by doing this or looking out for their pocket books? I need you, Mr. Governor, to help me to look out for my daughter’s—and other sons’ and daughters’--interests.


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 do 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? 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 five year-old child committed that she deserves this fate?


Senate Bill 1274 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.

While Hannah 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. Don't eliminate Hannah's rights and extinguish her joy. Please Veto SB1274.

My letter to the Governor why he needs to veto S.B. 1274

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Five children with multiple disabilities, along with their parents, siblings and nurses, attended yesterday's policy briefing on SB 1274. Many other parents came without their children. We did it because our children have no voices of their own, and we wanted Governor Abercrombie to see the faces of those who will be hardest hit if he does not veto this bill.

The governor was not concerned enough to show up. Instead he sent his health policy analyst, who stunned everyone by admitting the state still has not bothered to check with the feds if S.B. 1274 is even necessary. The bill says it is to meet requirements of the Affordable Care Act, but in six months nobody has bothered to find out from the source if that is true.

The parents and nurses I've spoken with since yesterday's meeting have been unanimous in their incredulity that the Governor's office is so unaware, and apparently uncaring, of the impact this bill will have on his state's most vulnerable citizens.

Parents who spoke of the bill's impact on the lives of their children were mocked twice for being overdramatic.

I can promise that none of us were. All five children had been the victims of life-threatening cuts in services by their Medicaid plans which were subsequently overturned directly (or indirectly in one case) thanks to the independent insurance appeals process.

I had prepared a letter to the Governor, and read it yesterday. I'm including it here.

To Governor Abercrombie:
Hawaii’s current insurance division appeals law is the only thing standing between my daughter’s life and the decisions her Medicaid provider makes on the basis of profit rather than what Hannah needs. No harm will come to anyone if you veto SB 1274.

If you do not veto SB 1274, Hannah’s only ability to challenge these decisions will be an Administrative Hearing at the Department of Human Services. The problem is DHS has no interest in protecting the rights of vulnerable children like our two Hannahs, or any of the other 260,000 people on Medicaid. If they did, Kenny Fink and Patti Bazin would not have sat back and allowed the state to get hit with a second wave of federal civil rights investigations, over the same cuts in the same services to the same two little girls by the same provider within fifteen months.

In April 2010, DHS acknowledged the health plans were committing federal regulatory violations when they instituted a so-called “corrective action plan” against at least one plan.

Since then, different families have been keeping CMS informed of ongoing regulatory violations. I’ve brought with me copies of my emails to CMS from the past six months documenting ongoing regulatory violations, and the emails back from CMS acknowledging a wide array of infractions.

As long as DHS continues to be unable or unwilling to provide oversight to the health plans, to make them comply with federal regulations, H.R.S. 432E-6 is the only thing that gives our families a level playing field when we’re trying to appeal life or death decisions made by our health plans. Going up against a multimillion dollar corporation is already making us David versus Goliath, but thanks to HRS 432E-6, we go into those battles over our children’s lives with professional advice, letters from our doctors, and the other evidence we wouldn’t know to get on our own. Our children’s doctors and therapists have a chance to testify on their behalf, supporting the prescriptions that have been denied, the necessary medical equipment like catheters and feeding tube extensions that have been denied, and the nursing services that keep our kids out of institutions denied.

If the insurance plans want to complain these appeals cases are costing too much, maybe the fact these bad medical decisions are bringing federal investigations down upon the state means the problem is with whoever is making those decisions. Not with our kids, and certainly not the law itself.

One of our families got chilling news from CMS. The bottom line is, we can all continue reporting the health plans’ violations of federal law, but as long as the state of Hawaii continues to refuse to do anything about it, CMS can’t protect our legal rights.

The only person right now who can is you, Governor. When you campaigned, you promised to protect our most vulnerable people. They are the people who will be hurt the deepest if you don’t veto SB 1274. Don’t take a chance with their lives. Do no harm. Please veto it for them.

Sincerely,
Summer Harrison

Hawaii Governor unaware or unconcerned of federal investigations of DHS

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Governor Abercrombie's health policy analyst Michael Ng admitted yesterday the governor is unaware of any of the ongoing federal investigations targeting DHS and its administration of Medicaid and Medicare.

One of two things has happened: either the state's Medicaid bureaucrats have hidden the information from the governor; or the governor has adopted an ostrich position of what he doesn't know about he doesn't have to do anything about.

Specific federal investigations Ng denied knowledge of included the following:

* six investigations by the Office for Civil Rights, including two opened in May;

* CMS investigation of potential Medicare fraud at DHS;

* on-going personal visits and phone calls from federal regulatory officials;

* on-going federal regulatory violations by the health plans about which DHS is doing nothing.

Documentation was provided to Ng. It will be interesting to see if that gets to the Governor's desk.

The information came out at a meeting yesterday between Ng and a group composed of lawyers, social workers, nurses, and the children with disabilities and their families who will be hardest hit if the governor does not veto SB 1274. Parents were literally pleading for their children's lives if access to the state's independent insurance division appeals process is denied them.

Abercrombie's campaign website is still up, and his campaign promises for healthcare, civil rights and human services are there. The difference between what he said and the message of his failure to veto SB 1274 is striking.

Monday is the deadline and the state still has not asked the feds if they really need to repeal H.R.S. 432E-6 in order to meet federal Affordable Care Act requirements.

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

Insurance lobbyists celebrate passed version of SB 1274

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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.

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

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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.

Action Alert for Opponents of SB 1274

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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.

Mahalo!

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.

Hawaii health insurers back state bill attacking patient rights

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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.

A mom's letter opposing Hawaii Senate Bill 1274

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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,
S.M.
Kilauea, HI 96754

SB 1274 still alive, will be retroactive to January 1

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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.

That means OVER $60,000 people have invested in appeals IS LOST, GONE, IF GOV. ABERCROMBIE SIGNS IT THANKS TO THE SENATE COMMITTEE ON WAYS AND MEANS’ HANDOUT TO HEALTH PLANS. WAY MEAN!

THE PEOPLE WHO HAVE APPEALS WILL NOT ONLY LOSE THEIR RIGHT TO CONTINUE THEIR APPEALS, WHICH WERE FILED UNDER THE LAW GOVERNING THEM, BUT THEY WILL NEVER RECOVER THOSE COSTS FROM THE HEALTH PLANS EVEN THOUGH THE LAW AT THE TIME THEY WERE INCURRED INDEMNIFIED THEM FOR ENFORCING THE LAW.

HOW IS THAT FOR EQUITY? HOW IS THAT FOR CONSUMER PROTECTION?

TO THOSE OF YOU WHO HAVE CASES PRESENTLY PENDING, I APOLOGIZE. I AM DOING EVERYTHING I CAN TO PROTECT YOUR RIGHTS BUT I NEED ALL THE HELP I CAN GET. YOU WILL LOSE YOUR CASES AND YOUR COSTS UNLESS YOU AND I CAN GET A LARGE NUMBER OF PEOPLE FIRED UP.

SO ARE YOU GOING TO LET YOUR LEGISLATURE AND THE NEW ADMINISTRATION YOU SENT TO WASHINGTON PLACE RUN OVER THE MOST VULNERABLE IN HAWAII FOR THE BENEFIT OF HEALTH PLANS? Or are you going to let them know you are outraged?

Now that things are getting down to hand-to-hand, HOW ABOUT A FEW LETTERS TO THE EDITOR?
HOW ABOUT A FEW PHONE CALLS TO LEGISLATORS AND THE GOVERNOR?

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

HOW ABOUT ASKING YOUR FRIENDS AND NEIGHBORS TO DO THE SAME?

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.)

COMMITTEE ON WAYS AND MEANS

David Y. Ige
Phone 808-586-6230 Fax 808-586-6231
E-Mail: sendige@Capitol.hawaii.gov

Michelle Kidani
Phone 808-586-7100 Fax 808-586-7109
E-Mail: senkidani@capitol.hawaii.gov

Suzanne Chun Oakland
Phone 808-586-6130 Fax 808-586-6131
E-Mail: senchunoakland@Capitol.hawaii.gov

Donovan M. Dela Cruz
Phone 808-586-6090 Fax 808-586-6091
E-Mail: sendelacruz@capitol.hawaii.gov

J. Kalani English
Phone 808-587-7225 Fax 808-587-7230
E-Mail: senenglish@Capitol.hawaii.gov

Will Espero
Phone 808-586-6360 Fax 808-586-6361
E-Mail: senespero@Capitol.hawaii.gov

Carol Fukunaga
Phone 808-586-6890 Fax 808-586-6899
E-Mail: senfukunaga@Capitol.hawaii.gov

Gilbert Kahele
Phone 808-586-6760 Fax 808-586-6689
E-Mail: senkahele@capitol.hawaii.gov

Donna Mercado Kim
Phone 808-587-7200 Fax 808-587-7205
E-Mail: senkim@Capitol.hawaii.gov

Ronald D. Kouchi
Phone 808-586-6030 Fax 808-586-6031
E-Mail: senkouchi@Capitol.hawaii.gov

Pohai Ryan
Phone 808-587-8388 Fax 808-587-7240
E-Mail: senryan@capitol.hawaii.gov

Jill N. Tokuda
Phone 808-587-7215 Fax 808-587-7220
E-Mail: sentokuda@Capitol.hawaii.gov

Glenn Wakai
Phone 808-586-8585 Fax 808-586-8588
E-Mail: senwakai@capitol.hawaii.gov

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
E-Mail: senslom@Capitol.hawaii.gov

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
E-Mail: sengreen@capitol.hawaii.gov

Rep. Yamane
Phone 808-586-6150 Fax 808-586-6151
E-Mail: repyamane@Capitol.hawaii.gov

Imua! Pass it on!
Rafael del Castillo

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

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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.

Death by Medicaid: A child has died

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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.

Hawaii Senate Bill 1274 is an attack on our health care rights

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The health care rights of almost everyone in Hawaii with health insurance are under attack.

 

For anyone with employer-paid or Medicaid health insurance through Kaiser, HMSA, HMAA, Aloha Care, Evercare or Ohana,  if you get cancer or some other serious disease and your insurance company denies coverage, you have the right to appeal that decision with an independent local hearing, with expert witnesses and attorneys on your side. 

 

If Hawaii State Senate Bill 1274 is passed on March 10, we will all lose that right.

 

Please sign our petition to stop this bill from passing.

Here is the text of the email that will be sent to Governor Abercrombie as well as all our state Senators.

Aloha,

My health care rights are under attack and I need your help to stop it.

Right now, if my health insurance company refuses to pay for treatment that my doctor says is necessary, I have the right to appeal that decision at an independent, local hearing. I am entitled to a lawyer, and the insurance company will be required to pay for my lawyer and any expert testimony I need to prove my case.

S.B. 1274 will repeal HRS 432E-6.

HRS 432E-6 gives everyone with HMSA, HMAA, Aloha Care, Kaiser, Evercare or Ohana health insurance, whether paid for by their employer or Medicaid, the legal right to those independent local hearings. If you allow S.B. 1274 to pass, that right will be taken away. Insurance company decisions on life or death treatment will be reviewed somewhere on the mainland depriving me of the right to attend, let alone present expert testimony that could save my life.

You need to put a stop to allowing state legislation to be drafted by companies that can pay their top executives almost $2 million in bonuses for 2010.

You also need to put a stop to allowing life and death health care decisions for our most vulnerable citizens to be made by a company that paid its CEO over $9.4 million in direct compensation in 2009. Why are you allowing valuable federal funding to be spent supporting these outrageous profits?

Please protect our rights, and vote no to S.B. 1274.

Please help us spread the word!

UnitedHealth under federal scrutiny in Hawaii over possible Medicare scam

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I reported on January 23 that a Kauai family claimed to have been duped by an employee of UnitedHealth into changing to the company's Medicare plan.

By February 8, federal Medicaid regulators from CMS were involved in the investigation.

This is only the latest in a long line of federal formal and informal audits, oversight and investigations plaguing Hawaii's Medicaid program since the fall of 2009.  In addition to CMS, the DHHS Office for Civil Rights, the FBI/DOJ and even the federal Office for Civil Rights of the Department of Education have all been involved.

I could understand why Lingle and Koller kept all this from the public.  They had built here in Hawaii a perfect Republican dream of how Medicaid should function under privatization, and small problems like deaths, let alone violations of federal laws, were just pesky details.

But where does our new Democratic governor stand with all this?  He seemed to promise an end to privatized Medicaid, but now is letting privatized Medicaid draft state legislation.

Meanwhile, life and death decisions continue to be made daily by people motivated more by profit than medical need.  

Governor Abercrombie, respectfully, you need to step in and put a stop to this before anyone else can be hurt.  Only you and the Feds can do that right now.  And you need to come clean with your voters about the state's dirty laundry and what you're going to do to wash it.

When the Medicaid Hit Squad comes calling

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UnitedHealth is sending "hit squads" out to the homes of medically fragile children. Their job is to bully and intimidate parents into agreeing to a reduction in the home medical services that keep their children alive. We are the families of children and adults whose disabilities are so complex and severe that the only alternative to institutionalization is for Medicaid to pay for providing nursing and care services in our homes.

Hawaii entered into its 2009 Medicaid contracts with UnitedHealth and Wellcare granting individual per person per month budgets ranging from $2,000 to $30,000. The purpose of the contract, and the higher monthly rates, is to pay for the nurses, personal aides, CNAs and other help that is medically necessary to keep each individual at home. Institutionalization costs more, not to mention the benefits of keeping someone home with their family, so the money is there to spend, so to speak, at least two-thirds of it federal in origin, without taking money from other programs.

Last summer, Evercare (UnitedHealth) and Ohana (Wellcare) once more got Hawaii to agree to raise the capitation fees. Did more money mean more medical services? No, not when the insurance company's profit depends on spending as little of that monthly per person fee as possible.

I had been hearing of these "hit squads" for several months but didn't experience one for myself until February 18. It's taken me since then to sort through the experience enough to isolate why it was so deeply disturbing. Under the guise of a standard quarterly nursing evaluation of Hannah's medical needs, my ability to be a good mom to my daughter was attacked. I was a bad mom if I couldn't provide the same level of professional medical care to my daughter that she gets from her nurses. The point was to get me to agree to taking over some of Hannah's nursing shift hours, thereby lowering UnitedHealth's "medical loss ratio" for my daughter and thus increasing company profits.

Unless you "live the life" so to speak, it can be hard to understand the daily stress of living with the potential your child could die at any minute, while surrounded by medical technology and treatments that you may or may not completely understand. Studies released in November 2009 showed the parents of kids with disabilities are prone to "shell shock", "battle fatigue", or PTSD as it's now known.

My daughter has seizures ninety percent of the time she is sleeping, and almost continuously when she is awake. She is at constant risk of death from something called SUDEP - Sudden Death in Epilepsy. Nurses are with her so that if any of those seizures start to escalate, it can be stopped before we reach the point of calling an ambulance. Every time her seizures have reached the point she needed to be flown to Kapiolani, it was when there wasn't a nurse home with her.

I've sat next to my little girl in an ambulance when she stopped breathing. There is a panic that sets in now if I'm alone with her and she starts seizing, to ensure she keeps breathing. That panic doesn't allow me to do the five other things that need to be going on simultaneously when she starts seizing: get the pulse oximeter hooked up, get the oxygen out and set up, get the diastat out and ready, cool her down if her body temp has gone over 99, all while keeping her in a position to minimize gagging since she's stopped swallowing.

Yet the rude, belligerent attack I experienced on February 18 was designed to make me feel I was a bad mom if I couldn't handle all this with the same skill and detachment as a professional nurse.

I am not the only one who has come away with similar impressions after visits from one of these "hit squads". Another mom was attacked with the accusation that she wasn't spending enough time with her child or she would know how to take care of her. A third family, for whom English was a second language, was belittled and intimidated for not understanding the technical medical terms for all their daughter's care.  Even taping the so-called evaluations did not inhibit the viciousness of these attacks on parents.

There is no doubt these attacks are designed to provide a justification for cutting home services. In December, UnitedHealth cut home services for a young man by sixty percent, on the basis he could use his hands and arms to move himself. The UnitedHealth employee who did the "evaluation" and recommended the cuts in services had spent the previous six years signing off on medical care reports for her previous employer, acknowledging he had no use of arms or hands. His medical situation had not changed overnight, only her employer had.

This is the same UnitedHealth that experienced a ten percent increase in earnings in fourth quarter 2010, "as the health insurer continued to benefit from people's relatively lighter use of medical services."  That Wall Street Journal article goes on to say

UnitedHealth's medical claims in relation to its revenue, a key statistic called the medical-loss ratio, were lower than financial analysts' views, and, according to analysts Leerink Swann, were the lowest in five years. The lower medical-loss ratio helped to boost per-share earnings beyond analysts' expectations.

For a company deriving forty-six percent of its $87.14 billion annual income from federal Medicare and state Medicaid "capitation" contracts, a lower medical loss ratio means the company has more likely cut services than mysteriously benefitted from "people's relatively lighter use of medical services." A simple read of UnitedHealth's SEC filings, along with the unsealed federal whistleblower complaint which includes taped conversations where Wellcare executives openly discuss strategies for committing Medicaid fraud, makes it clear these lower medical loss ratios are no accident.

It's what I've called "the new Medicaid Math", where sixteen to forty percent of state payments to private health insurers are being skimmed off the top by means of these lower "medical loss ratios". The Affordable Care Act tried to make health insurance companies responsible to their policy holders for how much of each monthly premium is spent on actual care. For private enrollees (i.e., non Medicaid or Medicare policyholders), the Act was trying to set a maximum twenty percent profit, and the insurer would have to rebate any difference to the policyholder at the end of the year. A financial analyst with Oppenheimer found that if that limit had been in place for 2009, private health insurance companies would have had to rebate over $1.9 billion back to policy holders.

But these limits do not apply to state Medicaid contracts. Florida recently found that all eight contractors for one specific Medicaid program were out of compliance with a required 80% medical loss ratio, with actual MLRs as low as 60%.

And so we've come back full circle to the Medicaid Hit Squads, whose ultimate purpose is to lower the company's "medical loss ratio" for adults and children like my daughter. They are targeting families where loved ones require what's called "total care" because we are where they get the biggest financial bang for the buck cut. If they're getting paid, say, $15,000 per month from the state to provide home medical services for a particular person, slashing those services by sixty percent puts more money into company coffers than cutting services to folks they get paid only a few hundred dollars a month for from the state.

I do not understand why neither state governments with health care deficits nor the disability rights community nor even the media have looked at the billions of federal Medicaid and Medicare dollars wasted on private corporate profits. The resulting levels of human misery being created in our caregiving families to support these outrageous profits isn't even being recognized.

Wellcare attorneys drafted Hawaii health care legislation

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In a State hearing yesterday, attorneys for Wellcare's Hawaii operation admitted to drafting S.B. 658. This is the proposed new law that would make consumers filing appeals against their health insurers responsible for insurance company legal fees even when the consumer wins the appeal.

S.B. 658 was deferred indefinitely yesterday, but the question remains why our new governor is sending out legislation written by health insurance company lawyers?

The story gets better. After the Ohana/Wellcare lawyers admitted writing the bill, they proposed an amendment that would had made it apply only to people insured under Medicaid. In other words, it would only have applied to their own members.

In my post on Thursday, I asked why Abercrombie was supporting legislation so blatantly anti-consumer. The question has now become why is he letting health insurance company lawyers write proposed legislation.

If you google "wellcare medicaid fraud", you may decide to share my incredulity that Abercrombie is even associating himself with these people.

Why did Hawaii's Governor introduce anti-health consumer legislation?

Right now in Hawaii, almost everyone with health insurance has a right to a local hearing process if their health insurance company doesn't agree with their doctor on what is "medically necessary." Whether you've got insurance through your employer or getting Medicaid through companies like UnitedHealth (Evercare) and Wellcare (Ohana), in most cases HRS 432E-6 gives you the right to a local hearing, complete with attorneys and witnesses, when your health insurer refuses to pay for something your doctor says you need. (Exceptions include federal health plan members, self-insured companies like Hawaiian Tel, Hawaii Pacific Health and a few others.)

The Hawaii Senate Ways and Means Committee is discussing today Senate bill (S.B. 1274) that would deprive all of us of that right. Its silent "companion" bill, S.B. 658, will effectively prohibit anyone from filing any sort of appeal against the decisions made by health insurers by making patients responsible for both their own legal fees and those of the insurance company, even if they win.

Last fall's federal case where Rafael Del Castillo was on one side of the aisle, lined up against fifteen or more lawyers (and staff) from the insurance companies on the other side, is a clear example of why no one will dare file for an appeal if HRS 432E-6 gets repealed. Who but the very richest could comprehend assuming financial responsibility for a $4,000 per day legal case, knowing they have to pay even if the insurance company is found wrong?

These bills, which came out of our new administration, are about as anti-health consumer as you can get. The only folks who are going to benefit are the insurance companies, particularly the two that get guaranteed monthly checks from DHS for $50 million or so, regardless of how much they actually spend on medical services.

Why would the new administration propose legislation that favors health insurance companies so blatantly? Or has no one else recently searched Ho'ohiki for Evercare, United Health and Wellcare?

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Who will step up to say our "less than perfect" children have any less a right to life than their "more normal" peers?

This is what is implied every time a politician says they have to cut Medicaid services.  Read the individual stories -- the biggest cuts are not affecting people who are poor or unemployed but the families caring for their children (of any age) with disabilities.

Our federal laws happen to give children and adults with disabilities the right not to be institutionalized. It is hard to imagine any set of laws more supportive of the basic values of the American family than one which ensures our children and our grandparents can continue to live at home.  It's a set of laws that recognizes that the government has a responsibility to keep families together, since none but the very richest could ever afford to pay for what it takes on their own.

When politicians start talking about cutting services to these children and grandparents, they are ripping apart the very core of the family, forcing agonizing decisions between the heightened risk of death versus institutionalization.

The unnecessary pain, delays in medically necessary treatment, stress and basic indignities that are forced upon families caring for their children or grandparents with disabilities is inhumane.  At the lowest level it involves an annual savings of $1500 in exchange for creating a bloody wound in a child's stomach twice a year.

At the highest level, children and, particularly, young adults with disabilities are being irretrievably harmed, and in some cases, killed.  Death can come from a lack of transportation to dialysis treatments, sepsis from a lack of dental care, or a simple refusal to fill a doctor-ordered prescription.  The worst deaths are the ones that come because families have tried so hard to avoid institutionalization, but simply can't match the intensity and type of care that has been taken away due to "budget cuts."

Too many of these "budget cuts" are resulting from the sixteen percent annual expansion in the privatization of Medicaid (and Medicare).  That's the rate at which states are turning over their Medicaid services to private contractors like UnitedHealth, Wellcare, Wellpoint, Aetna, Humana and others.  Instead of paying bills for actual services incurred, these plans make their profits off of getting paid a per capita rate from the state for every enrollee, and spending as little of it as possible.

In my opinion, the government waste of giving private Medicaid insurance companies more than $1.1 billion a month in profit is substantial and should be eliminated.  Shareholders are benefiting while children are harmed. 

Within the vast online community of parents caring for their children with disabilities, is is not uncommon to hear a mom talk of her child as a "blessing."  Our children teach us lessons in patience and the importance of the little things in life on a daily basis, and many of us celebrate the fact our children will never come to learn jealousy, hatred, greed or envy.  

So for all you politicians and health insurance executives who keep trying to cut Medicaid home services for my little girl and all the others like her: why won't you come out and tell me why you value their lives so little?  Are we a culture that "throws away" those who are too old to contribute financially, or whose disabilities, whether from birth or accident, prevent them from living alone? 

UnitedHealth testifies under oath losing money in Hawaii

David Heywood, Executive Director of UnitedHealth's Medicaid and Medicare operations in Hawaii, testified recently in federal court that the company "has been losing money."

Huh?

This is the same company whose Medicaid revenues exploded by 93% between June 2008 and September 2010, at the same time Medicaid membership only increased by 45%.

This is the same company that just reported fourth quarter 2010 profit up ten percent, and their annual profit for 2010 up 21%.

This is the same company that presumably received the state increase in capitation payments as Wellcare on July 1, 2010.

Perhaps UnitedHealth defines "losing money" differently than the rest of the world.

The federal court case in question had been narrowed down over time to the issue of whether or not UnitedHealth and Wellcare provided the elderly and people with disabilities with the same access to medical care as enjoyed by the rest of Hawaii's Medicaid program.  The two companies exclusively operate Hawaii's Medicaid program for the elderly and people with disabilities, called QExA.

The judge concluded his ruling with the comment that "plaintiffs have not established that the QExA program is in violation of any federal law."  Narrowing the focus of the case obviously had an impact on that issue, since it is well-known that UnitedHealth and Evercare, along with Hawaii's Medicaid office, have been under federal investigation for criminal fraud and violation of numerous federal laws since the fall of 2009.

What can you buy with $1.1 billion a month?

Six insurance carriers are profiting $1.1 billion a month from their state and federal contracts for Medicaid and Medicare.

If that money wasn't going for company profits, what else could it pay for?

For one thing, it would provide somewhere between 142 to 228 hours a month of personal assistance services to every one of the 370,000 people currently on waiting lists for Medicaid home services.

As of October 1, 2010, the Affordable Care Act has given states the ability to do away with their waiting lists completely for Medicaid services by implementing what is called a Section 1915i waiver.  The number refers to the section under Title XIX of the Social Security Act.

The problem is with corporate Medicaid taking over state contracts at an average growth rate of eleven percent in fifteen months, that $1.1 billion is just going to keep increasing, while the people on the waiting list continue waiting.

Do you think this is a good use of federal and state funds destined to help people with disabilities?  If you don't, please take our poll and let your voice be heard.