Time Magazine reported that more than 12.2 million people have signed up for coverage nationwide this year under the Obama-era health care law.  AP’s analysis showed that a clear majority of those enrolled — nearly 64 percent — live in states that Trump carried in November.

The federal Health and Human Services Department reported last week that 9.2 million people signed up in the 39 states served by the HealthCare.gov website, which offers subsidized private health insurance to people who don’t have job-based coverage.  AP checked with the remaining 11 states, and Washington, D.C., and found an additional 3 million enrolled, for a national total of 12.2 million.

Under the health care law, the nation’s uninsured rate has fallen to a historic low of about 9 percent, with some 20 million people gaining coverage since its passage in 2010. In addition to the subsidized private plans available through HealthCare.gov and state marketplaces, the law offers states the option of extending Medicaid to cover more low-income adults.

“These numbers demonstrate that there’s a demand for this insurance, and that people see value in the financial protection that comes from health insurance and the access it gives you to health care,” she said.

The Columbus Dispatch reported that Harry E. Yruegas, caregiver at the Heinzerling Developmental Center on the West Side admitted to raping a 47-year-old, severely disabled female patient at the nursing facility.  Yruegas pleaded guilty to one count each of rape and sexual battery for the assault, which was witnessed by another employee who walked into the patient’s room.  The co-worker told police that she walked into the woman’s room and saw Yruegas on the woman’s bed “with his penis exposed”.  Three employees of Heinzerling reported inappropriate behavior by Yruegas with the patient on three other dates.

The victim has “profound mental retardation” and other debilitating conditions and is unable to walk or speak, Assistant Prosecutor Jennifer Rausch told the judge.

In an interview with police, Yruegas referred to the patient as “super cute” and admitted that he had fondled her before the other employee walked in.  He also told officers that he had engaged in sexual conduct with the patient on several other occasions.

 Yruegas was indicted for eight counts of rape and eight counts of sexual battery, with most of the counts based on his interview with police.

 

 

Vanity Fair reported a rift emerging within the Republican Party over how to dismantle President Obama’s signature health-care law without suffering the consequences at the ballot box.  With public support for Obamacare at an all-time high, Republicans are struggling to craft an alternative that reconciles a number of extensive promises Donald Trump has made—that no one will lose coverage under his plan; people with pre-existing conditions won’t be denied coverage; that the Medicaid expansion under the A.C.A. won’t be rolled back—with classic conservative principles, namely lower taxes and smaller government. But these challenges may prove intractable. And as Republicans’ simple “repeal and replace” narrative has grown more complicated, some conservatives are beginning to worry that the window of opportunity to kill Obamacare is closing.

Hard line conservative Republicans want a repeal without any replacement.  While Paul Ryan’s “plan” would utilize the budget reconciliation process to pair repeal with several stop-gap replacement provisions, members of the Freedom Caucus are advocating a pure repeal bill—similar to one that passed both houses in Congress in 2015—creating a sort of “Obamacare cliff” that would leave lawmakers with little choice but to come up with a quick alternative.  A few reasonable Republicans understand that would be political suicide.

At the root of the growing divide G.O.P. divide is the fact that, despite having railed against the Affordable Care Act for seven years, the party is no closer to rallying around a replacement plan.

“If we just passed what we did in 2015? Nobody is seriously proposing that because it doesn’t have any replacement,” Lamar Alexander, the Senate Health Education, Labor, and Pensions chairman, told Politico, highlighting the greatest source of tension that has emerged between congressional Republicans and constituents. The G.O.P.’s failure to identify an alternative to the A.C.A. has put the party on the defensive, as uncertainty over the future of the $3 trillion health-care industry has gripped the country.

KSPR reported on a proposal to keep residents safe, and to deter theft, fraud, and abuse, by allowing video cameras in Missouri nursing homes.  Under the proposed law, families can choose to put a camera in their patient’s room, at their own expense and would be able to view the cameras at any time.

Supportive lawmakers say families could monitor how much and how often medications are given and how their loved one is being taken care of overall. Rep. Andrew McDaniel backs the bill after his staff says they received hundreds of complaints about abuse, neglect, rape and fraud.

Nursing home lobbyists claim they are concerned about patients’ privacy, and their lobbyists have killed similar bills in past legislative sessions. However, McDaniel says the camera can be turned off during baths or if a patient is exposed.

 

Arbitration clauses in nursing home agreements attempt to include wrongful death but the majority of states do not hold that the beneficiaries are bound by the agreement.  The Pennsylvania Supreme Court has recently addressed this issue in Taylor v. Extendicare Health Facilities, Inc., 147 A.3d 490 (Pa. 2016). In that case, the resident’s family members sued the nursing home for the wrongful death of their loved one and as representatives of the resident’s estate.

In the wrongful death action, the plaintiffs sought compensation for the emotional harm they sustained from losing their loved one prematurely. The survival suit relates to the resident’s compensation for pain and suffering and other harms sustained from the neglect.

The agreement between the resident and the nursing home contained an  arbitration clause that covered any resident’s suit against the nursing home. However, this clause applies to the survival action only, but not to the wrongful death suit filed by the nonparties to the agreement.

The wrongful death action must go to court. The survival action goes to arbitration.

The Court reasoned that –

“We recognize that Rule 213(e) is a procedural mechanism to control case flow, and does not substantively target arbitration. However, the Supreme Court directed in Concepcion that state courts may not rely upon principles of general law when reviewing an arbitration agreement if that law undermines the enforcement of arbitration agreements. We cannot require a procedure that defeats an otherwise valid arbitration agreement, contrary to the FAA, even if it is desirable for the arbitration-neutral goal of judicial efficiency. See Concepcion, 563 U.S. at 351, 131 S.Ct. 1740 (“States cannot require a procedure that is inconsistent with the FAA, even if it is desirable for unrelated reasons.”). Declining to bifurcate the wrongful death and survival actions against Extendicare in the interest of efficiency would nullify the ADR Agreement, a result not permitted by the Supreme Court’s FAA jurisprudence. …. Collectively, Moses H. Cone, Dean Witter and KPMG instruct that the prospect of inefficient, piecemeal litigation proceeding in separate forums is no impediment to the arbitration of arbitrable claims. Indeed, where a plaintiff has multiple disputes with separate defendants arising from the same incident, and only one of those claims is subject to an arbitration agreement, the Court requires, as a matter of law, adjudication in separate forums.”

 

Contribution from freelance writer, Jessica Walter:

Living at home alone can sometimes be unnerving, especially for seniors as falls could cause trips to the emergency room. Knowing how to make your home safer is easy, and can bring peace of mind to all. Where there are hazards, there is the risk of injury, but there is something you or a family member can do to help lower the chances.

  1. Bathrooms: You should make sure that tubs and showers have non-slip surfaces, and shower doors should be made of safety glass or plastic.
  2. Staircases: They need to be clear of obstructions and lit well so that each step is clear to see. A secure handrail should be installed at every staircase.
  3. Kitchens: A working fire extinguisher is necessary. A sturdy stool with a handrail should be used to reach higher cabinets.

To find out more about making your home safer, take a look at this Home Safety Checklist for the Elderly.

The Star-Tribune had an article about one family’s fight for justice for their neglected dad.  Gerald Seeger was a resident of an assisted living facility, Lighthouse of Columbia Heights.  The facility failed to respond promptly when Seeger, repeatedly vomited and screamed for help while pointing to his badly swollen stomach. After hours of suffering, Seeger died of complications related to a common hernia. State investigators later cited the facility for failing to provide timely medical care.

In 2014 when Joan Maurer arrived at her father’s room at Lighthouse. She was shocked by what she found. Her father, a florist who just a week earlier had been laughing and stomping his foot to old-time music, had turned ashen and was vomiting in plastic cups, she said. Photographs from that day show that his stomach had swollen like a balloon.  Despite Seeger’s visible suffering, the staff had not called for emergency help.

“I knelt by his side, grabbed his hand and said, ‘Dad, I’ll get you to a hospital.”  Maurer called 911, and on the ambulance ride to the hospital, Seeger rated his pain as a “10 out of 10” on the pain scale, state records show. “I was horrified,” Maurer said. “I never want to see another human being in that much pain for as long as I live.”

Investigators from the state Department of Health later found multiple lapses in Seeger’s care. Despite a history of hernia problems, staff at the senior home failed to follow a physician’s instructions and notify medical professionals immediately if he had any pain or tenderness in the groin area, state records show. On the evening and overnight shift before he died, Seeger complained of stomach pain and vomited; but such symptoms were not promptly reported to a nurse, state investigators found.

His daughter had a strong legal case so she sued over the sudden death of her father.  But Maurer is still fighting for a chance to hold Lighthouse accountable in court. Attorneys for the facility claim that she forfeited the constitutional right to sue when she signed a densely worded contract that forced the family into private arbitration if a dispute arose, even one involving a wrongful death claim.

I never believed they would arbitrate my father’s life like he’s a piece of paper, and not a living, breathing human being,” said Maurer.

Over mounting objections from consumer groups and regulators, arbitration agreements like the one Maurer signed are proliferating in the senior care industry. Hundreds of Minnesota nursing homes and assisted-living centers now request that elderly people sign arbitration clauses on admission. The clauses require them to forfeit their right to a court hearing and, instead, lock elderly residents into a secretive process for resolving claims. Even in cases of extreme neglect and death, nursing homes use the clauses to block residents and their families from pursuing lawsuits.

 In Minnesota and nationally, more attorneys are seeking to throw out arbitration clauses, particularly in cases where there is evidence that elderly residents were coerced into signing the contracts. In a recent case, the Kentucky Supreme Court refused to enforce arbitration agreements in three wrongful-death cases, ruling that legal representatives of nursing-home residents lack the authority to waive another’s “God-given right” to a jury trial.

McKnight’s reported that the Trump Administration will continue the Obama Administration’s policy of discovering and punishing waste, fraud, and abuse in the nursing home industry.  However, based on Trump’s history of fraud himself, and the fact that he chose Tom Price as Secretary of DHHS, it does not appear that discovering and punishing health care fraud is on the top of the agenda.

Attorneys and former DOJ officials interviewed by Bloomberg BNA predicted that the new administration is likely to preserve several Obama-era policies in place. Those include the use of data analysis in fraud investigations, and the Yates plan to prosecute more individuals.

The department’s efforts to combat fraud in post-acute care will also likely remain a top priority, said Zane David Memeger, an attorney with Morgan, Lewis & Bockius. That may include the the DOJ’s regional nursing home task forces, launched last year to target “grossly substandard” facilities.

“We have an aging population, and nursing homes and home health, they’re vulnerable to fraud,” Memeger said.

He also indicated that fraud in the pharmaceutical and medical device industries will continue to receive DOJ scrutiny.

Vox reported on recent polling about ObamaCare and Americans’ confusion regarding the terms “Affordable Care Act” and “ObamaCare”.  Thirty-five percent either think Obamacare and the Affordable Care Act are different policies or aren’t sure whether they’re different policies. The confusion is worst among young people and those making less than $50,000, and it’s magnified when you begin asking about the consequences of repeal:

When respondents were asked what would happen if Obamacare were repealed, even more people were stumped. Approximately 45 percent did not know that the A.C.A. would be repealed — 12 percent of Americans said the A.C.A. would not be repealed, and 32 percent said they didn’t know.

The pollsters dug into more specific consequences of repeal, too. Among Republicans, only 47 percent knew that the Medicaid expansion and insurance subsidies would be rolled back — 29 percent said Medicaid and the subsidies would be unaffected, and another 24 percent weren’t sure. So fully 53 percent don’t know or don’t believe that repealing Obamacare would repeal its coverage expansion, too.

The basic message of this poll — that there’s a lot of confusion around what the Affordable Care Act actually is and does — is consistent with past surveys. The Kaiser Family Foundation, for instance, polled Trump voters on the Affordable Care Act, and found the Medicaid expansion, Medicare taxes, and out-of-pocket limits are popular even among Trump supporters:

 Kaiser Family Foundation

Republicans know they’ve benefited from voter confusion on this issue. It’s why Donald Trump’s health care policy could literally be to repeal Obamacare and replace it with “something terrific.” They also know that begins to end as soon as they release a real plan, and it really ends if they pass something into law. Which is why congressional Republicans are in disarray over their replacement strategy, Trump has begun making impossible promises about what will come next, and even Medicaid’s most committed opponents are admitting that slashing it is harder than they thought.

Vanity Fair had an interesting article about Republicans continued failure to repeal and replace ObamaCare.  Republicans are awakening to the treacherous reality of rewriting the nation’s health-care policy. The majority of Republicans in Congress acknowledge that the Affordable Care Act may never be completely unwound. First, Republicans dramatically pushed back their timetable for replacing President Obama’s health care law, settling on a strategy for an immediate, partial repeal followed by a multiyear replacement process. Now, CNN reports, Republicans are quietly beginning to add a third “R” word to their political lexicon: repair. The suggestion that Trump is considering saving certain aspects of the Affordable Care Act is a definite shift in the narrative after the Republican party has campaigned on repealing the law in its entirety for years.

With public support for universal health care in the United States at an all-time high and Trump insisting that his inchoate replacement plan will provide “insurance for everyone”, G.O.P. lawmakers are scrambling to craft an Obamacare replacement that won’t rattle insurance markets or tank their chances of re-election.”

Trump has made sweeping promises that nobody will lose coverage under his plan; that people with pre-existing conditions won’t be denied coverage; and that the A.C.A.’s Medicaid expansion won’t be rolled back—all of which are expensive. As the law currently stands, the Affordable Care Act is funded through taxes levied on insurers, medical device companies, high-income households, and employers with expensive health-care plans—all of which are on the chopping block. Republicans are racking their brains to devise a magic bullet, but health care experts are skeptical that any market-based solution exists.

Republicans are also reportedly still searching for a mechanism to prevent people with pre-existing conditions from only buying insurance coverage when they get sick. Obamacare relies on the individual mandate and its accompanying tax penalty, both of which Republicans swore to repeal.

Politico reports that tensions are rising within the G.O.P. as lawmakers struggle to identify an alternative to the mandate that isn’t at conflict with Republican “principles” and wouldn’t result in a spike in the uninsured rate.