The Atlantic had a good article explaining the six signs that show how Trump will sabotage the Affordable Care Act.

  1.  Withdraw the appeal of the lawsuit that allows cost sharing reduction subsidies to insurers. The ACA subsidies at the center of the suit—otherwise known as cost-sharing reductions, which are different than the ACA tax credits for premiums—limit out-of-pocket costs for the 6 million people who both bought insurance through the ACA exchanges and who earn up to 250 percent of the federal poverty level. If insurers do not receive these funds, they may leave the exchanges altogether—ending coverage for customers.
  2. Refuse to enforce the individual mandate which is a Conservative idea to insure personal responsibility and accountability is designed to ensure healthier and therefore more stable insurance pools. The second major test to determine whether the President is choosing sabotage over governing will be if he directs his administration not to enforce the current individual-mandate provisions within the ACA.
  3. Refusing to advertise enrollment and shortening the time to enroll.  If the Trump administration reduces, it will be a clear indication that it is choosing sabotage over governing.
  4. Limiting risk corridors—a piece of the ACA designed to help health plans adjusting to new, unpredictable marketplaces. Additional funding is critical to ensuring stability in these relatively new marketplaces.  The program also lowers premiums for even non-subsidized enrollees who have been exposed to the highest premium hikes. Whether the Trump administration supports or opposes efforts to stabilize insurance markets, then, offers another crucial test.
  5. Whether Trump uses tweets, cell-phone calls, or White House meetings, investing time and political capital in to spur major health-care players to constructively participate in the ACA or conversely, to fear that if they do they will be on Trump’s black list, will be his fifth test.
  6. Will he issue regulations that weaken insurance? The hardest thing may be to detect an administration that avoids the most blatant acts of sabotage, but looks to kill the ACA with a thousand cuts. If the overwhelming number of health experts and consumer groups like the National Association of Insurance Commissioners, Kaiser Family Foundation, the American Cancer Society, AARP, and the Georgetown University Center on Health Insurance Reforms conclude it is an attack on the stability of the ACA—it should raise red flag that it is indeed a concerted effort to weaken the ACA.

Health-care experts agree with the Congressional Budget Office and S&P that the ACA is mostly stable—and as The New York Time’s Margot Sanger-Katz recently put it, “Obamacare is not on the verge of explosion.

Will he follow the law as his Constitutional oath requires or allows his supporters to lose health care?

The Buffalo News reported the disturbing tale of Thomas Moore who spent more than 20 years in prison for sexually abusing hospitalized women who were elderly, disabled or incapacitated.  But when time came to release him last year, he was accepted at Waterfront Rehabilitation and Healthcare Center in Buffalo – where he lived surrounded by elderly, disabled and incapacitated women. State law required Waterfront to be notified of Moore’s status as a level 3 “sexually violent and predicate sex offender” when he was released to its care, according to the state Department of Corrections and Community Services.

Barely a month after he moved into Waterfront, Moore was arrested and charged with sexually abusing a fellow resident in her bed.  Authorities accused Moore of entering the room of another Waterfront resident at about midnight on Jan. 3, pulling off her blanket and molesting her. Police arrested Moore nine days later, charging him with sexual abuse of a person incapable of giving consent and with endangering the welfare of a physically disabled person.

“It was like throwing the fox in the hen house,” said Dr. Charles P. Ewing of the University at Buffalo, an attorney and forensic psychologist who has studied sex offenders and the law. Ewing said that any facility responsible for the safety of others, whether they are young, elderly or infirm, has a higher level of obligation to stay informed if it agrees to hire or house someone on the sex offender registry.

The police report’s description of the January assault are similar to Moore’s first two convictions for sex crimes. In both cases, he assaulted women who were disabled or incapacitated.

Moore’s first sex offense conviction came in July 1996. Moore targeted a 79-year-old woman – a patient in a Manhattan hospital. Convicted of the sexual abuse of a person who was physically helpless, he spent four years in prison and was released in 2000.

By August 2001, Moore assaulted two female patients at Beth Israel Medical Center. First he pulled the sheet off a 58-year-old woman who had come out of surgery. Then a nurse spotted him on a bed with a semi-conscious 93-year-old woman.

Federal regulations require nursing homes to make every effort to protect their residents from abuse. Those rules “not only specify that these facilities may only admit residents they can appropriately care for, but they must also identify residents whose personal histories put them at risk for abusing other residents,” according to the state Department of Health.

“Staff must work diligently to prevent such occurrences by monitoring behavior of these residents and regularly reviewing their internal strategies for the prevention of abuse,” according to its statement to The News.

A 2015 study led by Cornell researchers found that more than 20 percent of nursing home residents are victims of some type of resident-on-resident abuse in the course of any given month, with the abuse ranging from cursing and threats, theft of personal items, inappropriate touching or hitting, all the way up to homicide.


The Chicago Sun Times reported the $875,000 settlement for the family of a man who choked to death at the facility in 2012.  Antonio Mares died after a nursing assistant at the Center Home for Hispanic Elderly fed him food that was not safe; failed comply with his physician’s diet orders; and violated the resident’s care plan.  He choked while eating without proper supervision.

The Levin & Perconti law firm announced the settlement. The family’s attorneys faulted understaffing and improper training for Mares’ death. Mares’ daughter, Isela Mares, says she hopes “needed changes” will be made at the nursing home.

A certified nursing assistant who was assigned to assist Mares with his evening meal set up the food tray on his table, positioned him to begin eating then stepped away from the area. Mares ate the food unsupervised and began to choke.

After realizing that Mares was choking, the nursing assistant unsuccessfully attempted to perform the Heimlich maneuver. He also used the call light to ask for help, but no one responded. Mares was later pronounced dead after further life-saving efforts also proved unsuccessful.

“Our family was robbed of the opportunity to properly say goodbye to my father, and while no sum of money will ever make up for our loss, we are hopeful that this settlement will incentivize the nursing home to make some needed changes,” Mares’ daughter, Isela Mares, said in the statement.


Buzzfeed had an article about Secretary Tom Price’s refusal to acknowledge his Constitutional duty to follow the law of the land as it pertains to regulations in the ACA.  Price is the man in charge of either fixing Obamacare, or neglecting Obamacare but he refuses to disclose what he will do after Republicans failed to pass a bill repealing the law.  Price avoided giving direct answers about whether he will try to strengthen or weaken Affordable Care Act regulations when he appeared before the House Appropriations Committee last week.

He could make changes that independent experts, insurers, and health care providers are calling for to stabilize markets and bring down prices. Or, as Trump proposed, he could do nothing and cause some markets to fail.

Larry Levitt of the Kaiser Family Foundation told BuzzFeed News the best thing the Trump administration could do for markets is clear up this uncertainty.

“The single most important thing the Trump administration could do right now is to assure insurance companies that it intends to run the program effectively,” said Levitt.

“That would include things like continuing outreach, enforcing the individual mandate, making the cost-sharing subsidy payments to insurers, and settling the lawsuit over the risk corridor program and making those payments.”

The administration could significantly bring down premiums by supporting these programs and enforcing the individual mandate, Andy Slavitt, an administrator at the Centers for Medicare and Medicaid Services, argued in a recent op-ed.

The New York Times reported that the Congressional Budget Office said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place.

The Republican bill would actually result in more people being uninsured than if Obamacare were simply repealed. Getting rid of the major coverage provisions and regulations of Obamacare would cost 23 million Americans their health insurance, according to another recent C.B.O. report. In other words, one million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to C.B.O. estimates.

The people who would end up without health insurance are slightly different in the two cases. The current bill would cause more people to lose employer insurance, while a straight repeal bill would most likely cause more people who buy their own coverage to become uninsured. A simple repeal would be worse for Americans with pre-existing conditions, but the current bill would be worse for older Americans who are relatively healthy. Both approaches would lead to major reductions in the number of Americans covered by Medicaid.

The C.B.O. estimated what would happen after a simple repeal when it considered a bill that Congress passed last year. But the similarity of the two estimates highlights some of the difficulties of the current proposal, both for Democrats, who are strongly criticizing potential coverage losses, and for the repeal-or-die crowd, who hate the structure of this new bill.

The kind of full repeal that some Republicans are calling for would, of course, be hard to pass. Even if every member of their caucus supported the approach, most experts believe that repealing Obamacare’s major insurance provisions would require a type of legislation that would be vulnerable to a Senate filibuster, and would thus require at least eight Democratic votes.

All of the Republican approaches would result in meaningful reductions in the number of Americans with health coverage.

Healthcare Finance News reported that The Medicare Payment Advisory Commission (MedPAC) is recommending 5 percent payment cuts to home health agencies and inpatient rehabilitation facilities and no increases next year for long-term care hospitals, hospices, ambulatory surgical centers and skilled nursing facilities.

The bipartisan, 17-member commission recommends freezing skilled nursing facility payment rates for two years while the payment system is revised.

MedPAC said in its report to Congress that payment changes would ideally bring all types of post-acute care into a unified payment system.

“For years, the commission has noted that PAC (post-acute care) payment systems do not encourage efficient care and are not equitable across different patient stays,” the report said.


They also recommended requiring ambulatory surgical centers to submit cost data, eliminating therapy visits as a factor in payment, and expanding the inpatient rehabilitation facility outlier pool for high-cost enrollees.

In 2015, fee-for-service program spending on post-acute care services totaled $60 billion, according to the report.

Implementing its recommendations would reduce fee-for-service program spending by over $30 billion over the next 10 years, the report said.

If Congress had implemented the commission’s 2008 recommendations for skilled nursing facilities and home health agencies, spending would have been reduced by about $11 billion between 2009 and 2016, it said.


In 2016, MA enrollment increased by 5 percent to 17.5 million beneficiaries or 31 percent of all Medicare enrollees. The average beneficiary was able to choose from 18 Medicare Advantage plans in 2017.

The Augusta Chronicle reported the settlement between Amara Health Care, also known as Salem Nursing and Rehab, and its chief executive officer Douglas Mittleider and Norma Manning on the eve of trial.  The terms of settlements are often confidential with no admission of liability.

Manning filed the 2013 lawsuit over the death of her husband of 18 years, Patrick Manning.  Patrick Manning suffered a stroke in 2011. He remained communicative and ambulatory but needed rehab services. He was sent to Amara. Five months later, he could no longer walk to the bathroom. In 16 months, Manning was dead. He had gangrenous pressure sores, dehydration, malnutrition and severe contracture, a condition in which a person’s limbs remained clutched close to the body.

“All I can say is that it was resolved to the satisfaction of the parties,” said attorney Caleb Connor, whose firm represented Manning.

Amara, or Salem, has been sued a number of times in the past 10 years over its care of patients. It also consistently rated below average in the nursing home inspection rating system of the Centers for Medicare and Medicaid.

The 213-bed facility went into bankruptcy and was purchased at a bankruptcy auction in May by University Hospital for $3.7 million, according to an earlier report in The Augusta Chronicle.

Miami’s News7 reported the abuse of a 93 year old nursing home resident.  The victim’s family made the disturbing discovery after installing a nanny camera in her room. Loved ones were horrified to see how their great-grandmother was being treated at the Boston area facility.  The video, set up by her family in her room at Wingate at Sharon, shows two women toss the elderly resident into her wheelchair. The resident, whose family, has identified her only as Dorothy, then struggles to maintain her balance.  See video on Fox25 here.

“They actually pull her hair and her neck is catapulted back, and she can’t catch her balance,” said the victim’s granddaughter Kristin.

The video from March 5 begins with Dorothy, who has dementia, swearing at and exchanging swipes with the pair. She threatens to break one certified nursing assistant (CNA)’s nose and says she will call police.

“She can’t really hurt you. She’s 98 pounds. They were picking her up and whipping her around,” Kristen said. “It’s awful. We haven’t even slept nights with the images in our head of what was taken place, and we weren’t there to help her.”

Since the incident, officials say both employees, Domingas Teixeira and Leonide Jean Paul Bien-Aime, are now facing charges. The 93-year-old has since been removed from the home. The workers now face charges of assault and battery on a person over the age of 60.

In an effort to protect her own grandparent and others, Kristen has been sending letters to lawmakers urging them to reconsider an electronic monitoring bill that was never passed but was proposed more than 15 years ago to allow residents of nursing homes to keep a camera rolling in their room.


Dear Friend,

Next Wednesday, March 29, the House of Representatives will consider legislation that, if passed, will arbitrarily devalue human life and will make it much more difficult to hold abortionists and birth control drug manufacturers accountable in American courts.  As a friend and fellow supporter of the pro-life cause, I urge you to contact your state’s congressmen and tell them to vote NO on this offensive effort to devalue human life and undermine Americans’ right to hold abortionists and birth control drug manufacturers accountable for the harms they have caused.

H.R. 1215, the “Protecting Access to Care Act,” would limit recovery for families who have lost their ability to have children due to preventable medical errors.  The bill would place a maximum value of $250,000 in non-economic damages no matter how egregious the conduct, even in cases where a doctor intentionally sterilizes a man or woman against his or her will.  Depriving someone of the ability to have children can never be adequately compensated, but capping the value of their suffering is just plain offensive.  For this reason alone, H.R. 1215 must be opposed.

The bill, however, would have other anti-life effects.  For example, H.R. 1215 devalues the life of children, mothers, and the elderly.  By imposing caps on non-economic damages, H.R. 1215 devalues human life without regard for the facts of any particular case.  Because children, the elderly, and stay at home moms usually have significantly reduced economic earning potentials (and thus economic damages), the vast majority of damages in their cases come from loss of life, pain and suffering, and other hedonic damages.  By arbitrarily capping these types of damages, Congress is devaluing the worth of our children, mothers, and grandparents’ lives.

     Furthermore, H.R. 1215 immunizes abortionists and birth control drug manufacturers.  When abortionists prescribe life-ending drugs like Mifepristone and Misoprostol to terminate healthy pregnancies, they should be held accountable when even more devastating injuries occur. H.R. 1215 would immunize the negligence of abortionists and shield defective birth control drug manufacturers from liability.  When providers and prescribers can’t be held responsible for the defects in abortifacients, they are more likely to be prescribed.

In short, this legislation seeks to attack pro-life policies by way of restricting citizens’ ability to hold bad actors accountable.  To be clear, the American citizens did not ask for this legislation – well-connected and well-funded special interests did.  It is reprehensible that this Congress is considering legislation that would promote anti-life policies through the backdoor of “civil justice reform”.  I ask that you contact your state’s congressmen and tell them to fight this arbitrary devaluation of human life, protect the rights of Americans to hold abortionists and birth control drug manufacturers accountable in court, and vote NO on this anti-life legislation.

With kindest personal regards, we remain



When CNN published a report revealing widespread sexual abuse and assault in nursing homes, many people asked the same question: Why isn’t more being done to stop it?

The multi-part investigation revealed disturbing cases of rape and sexual abuse by nursing assistants and found that more than 1,000 nursing homes had been cited for mishandling suspected cases of sexual abuse.
In response, the National Association of Health Care Assistants pledged to take action. The organization said it was “saddened and sickened by the CNN investigative report” and that it planned to immediately ramp up its education and training efforts. It said it especially wants to ensure that nursing assistants know how to spot potential abuse and report it promptly.
But federal legislation introduced two days after CNN’s investigation was published could make it far more difficult to hold problematic nursing homes accountable for abuse, according to elder abuse attorneys. The bill, submitted by Rep. Steve King, R-Iowa, would limit the legal liability of nursing homes, among a wide variety of other doctors, medical facilities and companies.