The Advocate has had a series of articles about the failed and corrupt system of long term care in Louisiana.  One article explained how lobbyists and campaign contributions control the legislation passed by the politicians.

A team of government experts and industry stakeholders spent more than two years painstakingly crafting a plan that would have reduced Louisiana’s expensive and unpopular reliance on nursing homes to house the state’s most helpless residents.

But it took just one email from the head of the industry’s powerful Louisiana lobby to kill the reform even though estimates show the state could save more than $100 million a year while improving patient outcomes.  Months before he pulled the plug on the long-term care overhaul, Jindal received a pile of checks from nursing home interests in support of his quixotic presidential campaign. The stack added up to about $370,000 — roughly 5 percent of the total he raised. The industry had long been stuffing Jindal’s coffers: As governor, he had taken in nearly $800,000 from the industry.

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Over many decades, industry leaders have made themselves perhaps the state’s most powerful lobby, enjoying unfettered access to the state’s policymakers and protecting their profit margins even in the worst of budgetary climates. The Louisiana nursing home industry is a juggernaut in Louisiana’s political fundraising arena, with much of the muscle provided by three prominent owners: Ronnie Goux, Elton Beebe and Teddy Ray Price.

This year, the 259 nursing homes in Louisiana that accept Medicaid are slated to take in more than $1 billion in public funds. That’s roughly 4 percent of the overall state budget and about 10 percent of the state’s Medicaid budget — a bigger slice than any other sector, including hospitals and physicians.

House Republican passed Zombie TrumpCare with no hearings, no studies, no Congressional Budget Office analysis; not even the text of a bill circulated the day before the vote.

The bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class; waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits. It is stuffed with unpopular provisions — cuts to special education, elimination of funding for Planned Parenthood, threats to coverage for people who have employer-sponsored insurance.

According to studies of the last version of their bill, premiums in the individual market are projected to increase by 13 percent, and deductibles would rise by 60 percent. President Trump repeatedly vowed not to cut Medicaid, and has smashed that promise.

They are rushing a bill reorganizing one-fifth of the economy, without attempts to determine the consequences. Its budgetary impact and increase in deficit is unknown. Millions of Americans will lose access to medical care, and tens of thousands of them will die.

A website called EverythingZoomer had an interesting article on why violence persists in nursing homes. The author used the tragic case of James Acker as an example. Acker was viciously attacked by another resident with dementia at at St. Joseph’s Villa nursing home. The beating left him black and blue and bleeding from the head; his family was told he only had a 50 per cent chance of surviving.

A CNN study found that between 2013 and 2016, more than 1,000 nursing homes in the United States were cited for failing to report or mishandling allegations of rape, sexual abuse or sexual assault. According to the report, three-quarters of those cases involved residents abusing other residents.

 

Paul Bland from Public Justice wrote an article on the DailyKos about Trump’s plan to revoke the rule prohibiting mandatory pre-suit arbitration clauses in nursing home contracts. Bland wrote:

Some of the most heart-wrenching stories of abuse, mistreatment and neglect you’re likely to hear involve nursing homes. As America’s baby boomers age, and nursing home populations continue to grow, big corporations have, not surprisingly, started to take note. In fact, the vast majority of nursing homes in the United States – 70%, according to the Centers for Disease Control and Prevention – are run by for-profit corporations, and an increasing number of homes are being snapped up by Wall Street investment firms.

And that, in turn, can often mean that high quality care takes a backseat to high profits.

Increasingly, these giant corporations are using forced arbitration clauses — contract terms that say that people cannot sue them, no matter what laws they break, and instead people harmed by illegal acts can only bring cases before private arbitrators who are generally beholden to the corporations. These clauses make it far harder for the victims of mistreatment to hold a facility accountable where there’s abuse or serious negligence, and they minimize the incentive to provide the highest quality of care.  The secretive arbitration system also effectively lets homes sweep the facts about problems under the rug, so that the public and regulators never learn about widespread or egregious abuses.

That’s why, in 2016, the Centers for Medicare and Medicaid Services said nursing homes should no longer receive federal funding if they use arbitration clauses in their contracts. It was a commonsense proposal that would ensure families can hold nursing homes accountable for abuse and neglect. The government essentially said – and rightly so – that protecting desperately vulnerable people is more important than squeezing out an extra percentage of profit for hedge fund owners.

But that was 2016. Now, the Trump Administration appears to be gearing up to kill the proposal.

Senator Al Franken (D-MN), a fierce opponent of arbitration who has fought corporate lobbyists to protect Americans’ right to their day in court, said on Tuesday that “the Trump Administration is planning to lift the ban on nursing home arbitration clauses.”

So the White House, it appears, is ready to deliver another gift to hedge funds and banks – the corporate entities that increasingly control the nursing home industry – at the expense of the sick and elderly and their families.

It’s no wonder why corporate lobbyists working for the nursing home industry have made killing the CMS proposal a top priority: unlike the public court system (where trials are open to the public, press and regulators), nursing homes benefit enormously from the secretive system of arbitration, where the facts about abuses can be (and often are) buried. “Confidentiality” provisions – which really translate into gag orders – and non-transparent, non-public handling make it easier for systemic problems to stay hidden, and to continue.

If nursing homes are permitted to continue opting out of the civil justice system, we can expect to see lower levels of care, and higher numbers of preventable injuries and deaths. If they succeed in keeping families out of court, the potential savings to their bottom line are enormous when you consider that abuse is very widespread (according to the government’s own study).  Public Justice, our national public interest law firm and advocacy organization, set forth an extensive factual and legal case in support of the CMS proposal, where a great deal more background is available.

Consider just a handful of the plaintiffs who were able to successfully challenge nursing homes in court:

  • A 90-year-old woman allowed to languish with a festering pressure sore, acute appendicitis, and a urinary tract infection so severe it has entered her blood.
  • A diabetic patient injected with the incorrect dose of insulin, sending them into hypoglycemic shock and causing brain damage.
  • An 81-year-old man who was viciously beaten by a roommate who’d been involved in 30 assaults prior to moving in with the victim.
  • An 87-year-old woman whose calls for help were ignored after she fell and broke her hip.

Had any of those patients been subject to an arbitration clause – as no doubt many future cases would be if the Administration folds to pressure from for-profit homes – they likely would have never had a chance to have their case heard by a jury.

Nursing homes have complete control over some of the most vulnerable and fragile people in the entire country: people who are gravely ill, who are often cognitively impaired in ways that make it hard for them to protect themselves, are completely at the mercy of these institutions.

Now, rather than working to give those patients some small measure of protection and security, the Trump Administration is poised to give them the shaft. It’s unconscionable back-pedaling that would leave millions with little recourse when they, or their loved ones, are mistreated or abused.

McKnight’s reported that the Trump Administration is trying to roll back protections for nursing home residents by reversing a federal ban on pre-dispute arbitration agreements in nursing homes.   Sen. Al Franken (D-MN) said the proposal was a “misguided decision” on the part of the administration.

Until last year, many long-term care contracts were riddled with fine print that prevented residents and families who were wronged from seeking justice in court,” Franken, an outspoken opponent of arbitration agreements, said in a statement released last Thursday. “But now the Trump Administration is planning to lift the ban on nursing home arbitration clauses, which would be terrible for consumers,” Franken said.

He authored a bill introduced in March that would ban any arbitration agreements made before employment, consumer or civil rights disputes arise.

The nonpartisan Congressional Budget Office (CBO) “scoring” of the original American Health Care Act was clearly an important contributor to the bill’s steadily declining popularity in both Washington and around the country. In particular, Republican House members could all too easily imagine attack ads based on CBO’s finding that the bill would eliminate health coverage for 24 million Americans. CBO’s follow-up “scoring” of a tweaked version of the original bill made things worse, as it significantly reduced its estimate of deficit savings without changing the projection of lost health coverage.

So, instead House Republicans passed the legislation before the CBO was able to score the modified TrumpCare.  Previously, House Republicans refused to vote on repealing ObamaCare until Congress’s budget scorekeeper weighs in.

Republicans are clearly terrified of their Members and the American people seeing the full consequences of their plan to gut critical protections for Americans with pre-existing conditions,” Pelosi said in a statement.

What will CBO say about Zombie Trumpcare? The provisions allowing states to waive essential benefit and nondiscrimination provisions will make coverage losses even worse. And the last-minute subsidy boosts could also further erode deficit savings.

Eventually, of course, the CBO score will arrive, certainly before anything happens in the Senate. So, the House Republicans just threw Senate Republicans under the bus.

New York Magazine had an interesting article about “Zombie Trumpcare”. “Republicans say they’re on the verge of rounding up the votes to pass the American Health Care Act. They sounded the alarm before they headed home for Easter recess, and again before President Trump’s 100th day in office, but each time Zombie Trumpcare stumbled before it could eat the brains of the American health-care system.”

Republicans are relying on a process called reconciliation that will let them pass the bill with a simple majority, not 60 votes. That window closes when they wrap up the budget for fiscal year 2017, and on Sunday night Congress reached a bipartisan spending agreement that’s likely to pass this week. Despite reaching a compromise last week that House Freedom Caucus members actually like — though it would make the AHCA even worse for the poor, sick, and elderly – Republicans were unable to muster the support to hold a vote last week. Plus, as Politico notes:

The House is scheduled to leave town for a one-week recess on Thursday, and some senior Republicans worry that failing to get it done by then would fritter away critical momentum. Skittish Republicans would return home to face a barrage of pressure from Democrats and progressive outside groups.

“This is it,” an administration official told Politico. “We get it done now, or we don’t get it done ever.”

In a CNN interview, Representative Mo Brooks, an Alabama Republican, makes the case for Trumpcare: It will free healthy people from having to pay the cost of the sick. “It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” explained Brooks. “And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”

The idea that pre-existing conditions is related to morality is well-known conservative health-care thought. John Mackey wrote in a 2009 Wall Street Journal op-ed denouncing Obamacare:

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

The Republican plan expresses one of the core beliefs shared by movement conservatives, and utterly alien to people across the globe, right and left: that people who can’t afford the cost of their own medical care have nobody to blame but themselves.

Time reported that Trump promised TrumpCare would protect people with pre-existing medical conditions.  “Pre-existing conditions are in the bill,” Trump said on “Face the Nation” Sunday. “And I just watched another network than yours, and they were saying, pre-existing is not covered. Pre-existing conditions are in the bill. And I mandate it. I said has to be.”

House Speaker Paul Ryan argued that people with pre-existing conditions would be “better off” under the GOP bill.  But the most recent version of the legislation would leave them with higher costs and unpredictable coverage.  The Republican-drafted law would keep in place a federal regulation barring insurers from setting their rates based on the health of an individual enrollee, but it would allow states to opt out.

A number of nationwide patient organizations have spoken out against the change, saying it would gut protections for people who have serious medical conditions such as heart disease and epilepsy.

Premiums in high-risk pools were often 150% or even 200% higher than in the rest of the market. States had to raise significant funds to support the high-risk pools; in 2011, net losses for 25 state high-risk pools were over $1.2 billion for just 225,000 nationwide enrollees. Many states had long wait lists for coverage and funds often ran out, leaving patients unserved.

Ultimately, if the Republican plan were passed, the health care market for people with pre-existing conditions in 2020 would have a lot in common with the health care market in 2010. If you’re older and have had health problems in the past, your care would likely be worse — despite what Trump and Ryan have said.

KCMO reported the disturbing story of Mark Allen Keeney, the owner of a nursing home, accused of sexually abusing residents.   Keeney is charged with rape and sodomy in connection with a March 2015 incident in his long-term care home. Keeney has pleaded not guilty to the charges. The Sacramento Bee also ran an article on Keeney.

In March 2015, an authoritative knock stirred Keeney into answering the door to Room 6 of a motel in southeast Missouri. A sheriff’s deputy and police chief wanted to know who was with him. They found empty beer cans and two women, both described in a state health report as mentally ill and under the care of a guardian.

The women, in their mid-40s, also were residents of Keeney Country Homes, a state-licensed residential care facility that Keeney owned in the neighboring county.

Keeney had taken both women, along with their medications, from Keeney Country Homes. Keeney drove around looking for a motel room and picked up a 30-pack of beer. Both women took “several oxycodone pills,” and each had a history of drug or alcohol abuse. At the Leerjack Motel, Keeney had sexual intercourse with one and “made” each perform oral sex on him.

At a preliminary hearing in January, one of the women testified that she had sex with Keeney because she was afraid to say no.

One of the women he’d taken from Keeney Country Homes used Keeney’s credit card to check into the motel. Then, they overstayed the 11 a.m. check out.  Motel employee Tiffany Voyles dutifully called the phone number the woman had left at check-in. Instead of a cellphone, it turned out to be a business. But Voyles heard a familiar voice at the other end.

“Tiffany, this is Janet,” said a woman Voyles knew from church who happened to be at work — at Keeney Country Homes. Something was wrong. Voyles called the sheriff.

Donna Norviel, a nurse who worked at both of Keeney’s care facilities, at first assumed the resident had stolen Keeney’s card. The incident still haunts Donna Norviel, whose voice broke as she spoke about that day. “It’s been over two years, and it’s like it was just yesterday,” she said.

Missouri regulators reacted quickly and decisively to close Keeney Country Homes. In the Keeney Country Homes case, the state notified Keeney five days after the March 21, 2015, incident that it was revoking his license for the facility. A second notice revoking the license for his Maple Crest Residential Care Facility came five days after that. Keeney did not appeal.