CNN had an interesting article explaining how all of us have pre-existing conditions. CNN analyzed the top 10 most common conditions for Americans. People with these conditions come from all walks of life, but they each must cope with the illness they have or once had.

“As many as one in two Americans has some kind of illness or condition that was, at one time, considered a pre-existing condition by insurance companies before Obamacare. For older Americans, that percentage is even higher: About 86% of your aging parents and grandparents, Americans between the ages of 55 and 64, have one, according to government estimates.”

“But who are these people who live with these pre-existing conditions? Have they failed to “lead good lives,” as Alabama Republican Rep. Mo Brooks said in May of healthy people, who he believes should pay less for coverage? Will they really be able to buy a policy as Republicans are promising, or will the costs make coverage prohibitive?”

CNN lists out the ten most common pre-existing conditions, and the number of Americans with that condition.

The Atlanta Journal Constitution reported the tragic and preventable death of nursing home resident Dorothy Broome.  Police were dispatched to the area about 10 p.m. Aug. 25 after a man saw the woman’s wheelchair in the ditch on his way home from work.  Broome was found face down along South Main Street.

Broome was a wheelchair dependent resident at Gilmer Nursing Home who was found in a nearby ditch and later died after she fell while leaving the facility after a fire alarm was pulled, unlocking the doors.  Earlier that night, a fire alarm was pulled and Broome fell as she was leaving the building and sustained multiple injuries, the nursing home said in a statement to The Atlanta Journal-Constitution through its attorneys.

The Des Moines Register reported that Iowa’s Republican Senators have been silent as to their position on Trump’s plan to support unfair mandatory arbitration clauses against nursing home residents.  Despite claiming to support vulnerable adults access to courts and protect their constitutional right to a jury trial, neither has joined colleagues in the Senate who are attempting to prevent care facilities from limiting residents’ right to sue for abuse and neglect.

Last year, the federal Centers for Medicare and Medicaid Services notified all nursing homes that receive federal funding a new rule was being proposed to prevent them from including unfair mandatory arbitration clauses in their admissions contracts with residents. The rule would specifically prohibit the “the use of pre-dispute binding arbitration agreements” in care facilities funded by Medicare and Medicaid.

Advocates for consumers, seniors and the disabled have protested CMS’ about-face, arguing that arbitrators, often paid for by the industry itself, tend to side with industry.

Rob Weissman, president of the advocacy group Public Citizen, told the Los Angeles Times the switch to allow forced arbitration was “a heartless and vile act.”

On Aug. 7, 31 U.S. senators, all Democrats, wrote to CMS Administrator Seema Verma and said forced arbitration agreements “stack the deck against residents and their families who face a wide range of potential harms, including physical abuse and neglect, sexual assault and even wrongful death at the hands of those working in and managing long-term care facilities.

 “These clauses prevent many of our country’s most vulnerable individuals from seeking justice in a court of law, and instead funnel all types of legal claims, no matter how egregious, into a privatized dispute resolution system that is often biased toward the nursing home.”

Mandatory-arbitration clauses that prevent consumers from suing for poor quality service has ignited a fierce public debate.  Consumer advocates say they aren’t opposed to arbitration as a voluntary option, but residents shouldn’t be required to relinquish their right to sue to gain access to health care that’s paid for with public money through Medicare and Medicaid.

“The worst time for a vulnerable person or his or her family to decide the means to resolve future disputes is when the contract is being presented at the often-urgent time he or she is being admitted to a nursing home, a time of particular physical and/or emotional stress,” the attorneys general wrote.

“The practice of executing arbitration contracts during the nursing home admissions process raises valid concerns on a public policy level,” Judge Michael P. Mills of the U.S. District Court in Oxford, Miss., wrote, noting that “many residents and their relatives are ‘at wit’s end’ and prepared to sign anything to gain admission.”

Thirty-six advocacy groups, including the National Consumer Voice for Quality Long-Term Care, National Organization for Women and The Arc of the United States have also sent a letter to CMS encouraging adoption of the proposed rule.

Reuters had an article about a new study that indicates seniors living on their own may have a greater risk of fractures when they’re less mobile and less able to manage daily tasks without help, but in nursing homes the opposite may be true.  Among nursing home residents, risk factors for fracture included the ability to walk independently, wandering the halls, dementia and diabetes, the study found.

“In the community, individuals that need more assistance with mobility often have multiple health problems that place them at greatest risk for fracture,” said lead study author Dr. Sarah Berry of the Institute for Aging Research and Harvard Medical School in Boston.

“In the nursing home, all residents have health problems, but there is a tremendous variation in the ability of these residents to move independently,” Berry said by email. “Frail nursing home residents that are still mobile and independent have opportunity to fall, whereas residents that require extensive assistance have less opportunity to fall and fracture.”

Nearly 10 percent of hip fractures in the U.S. occur among nursing home residents, researchers note in The Journals of Gerontology: Series A. More than one-third of nursing home residents who fracture a hip will die within six months, and many others who were mobile before the fracture will become completely disabled.

Among residents who survive hip fractures, infections and pressure ulcers, or bed sores, are common, leading to functional decline and diminished quality of life.

Even if mobility might carry an increased fracture risk for nursing home residents, the fix isn’t staying in bed, said Dr. Joe Verghese, director of the Albert Einstein Jack and Pearl Resnick Gerontology Center in Bronx, New York.  That’s because being immobile is associated with an increased risk of blood clots, malnutrition and death for elderly people.

To prevent falls, bright lighting during the day and night lights after dark can help boost visibility, said Jean-Michel Brismee of Texas Tech University Health Sciences Center in Lubbock. Removing rugs that might slip, placing hand rails in showers and tubs, and keeping walkers and canes within easy reach can also help, Brismee said in an email.

New York Magazine had an article explaining four things in health care that Graham-Cassidy will make worse if it passes. Graham-Cassidy shifts the burden of crafting a health care system onto the states, and makes them do it with far less money.

1. Cut Protections for People With Preexisting Conditions.

Under Graham-Cassidy, insurers could not refuse to cover someone because of a preexisting condition, but they would be able to make coverage so exorbitantly expensive that sick people couldn’t afford it.

First, insurance companies could charge people higher premiums based on their health status. The Center for American Progress estimates that annual premiums would be tens of thousands of dollars higher for a 40-year-old with various medical conditions than for a completely health person.  Like previous GOP health plans, insurers would be allowed to charge older people five times as much as younger people, while the currently limit is three times as much.

The bill also allows states to waive Obamacare’s essential health benefits, which require insurance plans to cover basics like hospitalizations, maternity care, and laboratory tests.

2.  Gut Federal Funding for Health Care

Graham-Cassidy would eliminate both the employer and the individual mandate which would make health insurance more expensive, and lead to millions fewer being covered.  But Graham-Cassidy does something even more radical: eliminating federal funding for Obamacare marketplace subsidies and the Medicaid expansion, and replacing it with one block grant to the states.

As the Center on Budget and Policy Priorities explains, between 2020 and 2026, states would receive less money via block grants than they would under Obamacare, and that gap would get worse over time:

The block grant would equal $140 billion in 2020, which is $26 billion, or 16 percent, below projected federal spending for the Medicaid expansion and marketplace subsidies under current law. The block grant would increase annually by roughly 2 percent, to $158 billion in 2026. That wouldn’t even keep pace with general inflation, which the Congressional Budget Office (CBO) projects to equal 2.4 percent annually over that period, let alone with expected growth in per-beneficiary health care costs and enrollment. Thus, by 2026, block grant funding under the plan would be $83 billion, or 34 percent, below currently projected federal spending on the ACA’s major coverage expansions.

“I think this is a game,” said Senator Rand Paul, one of the few GOP senators openly opposing the bill. “I think this is a game of Republicans taking money from Democratic states. What happens if Democrats take power back?”

3.   Cut Medicaid Even Further

Graham-Cassidy destroy Medicaid with a per capita cap on federal funding for Medicaid. While the federal government currently pays a percentage of a state’s Medicaid costs, starting in 2020 it would pay a fixed amount for each Medicaid enrollee, regardless of what it actually costs to cover them.

States would have a number of other options — such as instituting work requirements and receiving part of their traditional Medicaid funding as a block grant — that would likely result in reducing eligibility and benefits for the poorest Americans. According to previous CBO estimates, non-expansion Medicaid funding would see a reduction of $39 billion, or 8 percent, by 2026.

 4.   Leave Millions Uninsured

The GOP’s plan to ram Graham-Cassidy through the Senate before Sept. 30 will not allow time for the CBO to score the bill.  The CBO previously estimated that a straight repeal of the Affordable Care Act would leave 32 million people uninsured and double premiums over the next decade. Graham-Cassidy gives states an even greater ability to cut preexisting-condition protections and tear apart Medicaid. So, presumably, the new projections will be even worse.

 

 

Over 1.3 million Americans reside in nursing homes according to  Jesse Slome, the director of the American Association for Long-Term Care Insurance (AALTCI). The majority were aged 65 and older. The HHS report reflected there were 15,600 nursing homes in the U.S. as of 2014.

According to the latest analysis of nursing home users in 2014, some 41.6 percent of nursing home residents were age 85 and older, Slome shared. Another 27.2 percent were between ages 75 and 84 and 16.1 percent were between 65 and 74.   66.8 percent of nursing home residents according to the data are women.

Alzheimer’s disease or other dementias was the leading cause for a nursing home stay. Over half (50.4 percent) of residents had that diagnosis. Depression and diabetes were two other leading diagnosis.

Jimmy Kimmel went off on Republican politician Bill Cassidy and Fox News pundit Brian Kilmeade.

“This guy, Bill Cassidy, just lied right to my face,” the late night host says in his opening monlogue.

“I don’t know what happened to Bill Cassidy,” Kimmel continued. “But when he was on this publicity tour, he listed his demands for a health care bill very clearly. These were his words. He said he wants coverage for all, no discrimination based on preexisting conditions, lower premiums for middle-class families and no lifetime caps. Guess what? The new bill does none of those things.”

“Stop using my name, because I don’t want my name on it,” he said. “There’s a new Jimmy Kimmel test for you, it’s called a lie detector test. You’re welcome to stop by the studio and take it anytime.”

Kimmel doubled down on his criticism of Senator Bill Cassidy on Wednesday night’s “Jimmy Kimmel Live,” after video from Tuesday’s show calling the politician out for “lying” to him about health care went viral. The late night host also called out those who said he didn’t understand the GOP’s latest attempt to replace Obamacare, ripping into senators and Fox News host Brian Kilmeade during his passionate, 10-minute long monologue.

After naming all the heath organizations that oppose the Cassidy-Lindsey Graham bill, Kimmel said Cassidy “either doesn’t understand his own bill, or lied to me.” He then joked, “or could it be that the problem is that I do understand and you got caught with your GOPenis out. Is that possible?”

“I don’t want to turn this into a Kanye-and-Taylor-Swift-type situation, but when Senator Cassidy was on my show in May, he told me that he believed that every American family regardless of income should be able to get quality health care,” Kimmel continued. “And I believed he was sincere. Sadly, the bill he unveiled last week with Senator Lindsey Graham indicates that he was not sincere. It is, by many accounts, the worst health care bill yet.”

The host then showed a clip of “Fox & Friends” host Brian Kilmeade criticizing Kimmel for being a member of the “Hollywood elite” on his show.

“This is a guy, Brian Kilmeade, kissing my ass like a little boy meeting Batman. Oh, he’s such a fan, I think he’s been on the show. He follows me on Twitter; he asked me to write a blurb for his book, which I did; he calls my agent looking for projects. He’s dying to be a member of the Hollywood elite,” a fired up Kimmel said. “The only reason he’s not a member of the Hollywood elite is because nobody will hire him to be one. And you know, the reason I’m talking about this is because my son had an open-heart surgery, then has to have two more, and because of that I learned that there are kids with no insurance in the same situation. I don’t get anything out of this, Brian, you phony little creep. Oh, I’ll pound you when I see you. That will be my blurb for your next book: ‘Brian Kilmeade is a phony little creep.'”

“There’s no way President Trump read this bill that he says is great. He just wants to get rid of it because Obama’s name is on it,” he said. “The Democrats should just rename it Ivankacare, guaranteed he gets on board. Can you imagine Donald Trump actually sitting down to read a health care bill? It’s like trying to imagine a dog doing your taxes. It just doesn’t compute, you know?”

See videos here and here.

Secretary of HHS Dr. Tom Price has no respect for taxpayer funds or ethical concerns. After President Donald Trump nominated him to be HHS secretary in January, it was discovered that he illegally made stock trades in health-care companies while serving on a House panel overseeing health issues.  His judgment and ethics are now being questioned for wasting taxpayer funds.  See Politico article.

In a sharp departure from his predecessors, Price last week took private jets on five separate flights for official business, at a cost of tens of thousands of dollars more than commercial travel.  He pretends to be a champion of fiscal efficiency, backing major spending reductions to agencies he oversees and legislation that would cut hundreds of billions of dollars from health programs including $6 billion cut to the National Institutes of Health, and an overall 18 percent spending cut to HHS included in Trump’s first budget proposal.

The travel by corporate-style jet comes at a time when other members of the Trump administration are under fire for travel expenditures, and breaks with the practices of Obama-era Secretaries Sylvia Mathews Burwell and Kathleen Sebelius, who flew commercially while in the continental United States.

 

An HHS spokesperson declined to answer questions on how many private charter flights Price has taken since being confirmed as secretary on Feb. 10.  Current and former staffers say Price has been taking private jets to travel domestically for months.

Ethics experts say the use of private charters by government officials, while legal, is highly dubious and in most cases a misuse of taxpayer funding.

“I can understand why the secretary might have to use a charter flight to get to a hurricane-devastated region, but Philadelphia is not one of those regions this year,” said Walter Shaub, who was director of the United States Office of Government Ethics until July. “I find it hard to believe he couldn’t find a suitable commercial flight to Philadelphia.”

“This wasteful conduct reflects disdain for the ethical principle of treating public service as a public trust,” said Shaub. “Public office isn’t supposed to come with frivolous perks at taxpayer expense.”

Shaub said that the trips violate the “spirit” of the Federal Travel Regulations, citing the express guidance contained in the regulations that “taxpayers should pay no more than necessary for your transportation . . .”

 

Market Watch reported the article by Betsy Rust who opines that “the confluence of a number of trends — demographics, competition from nursing home alternatives, federal and state health-care policy and even technology — will mean as many as 20% of nursing home beds will be eliminated in the next five years.”

She argues that many nursing homes face extinction based on economic realities. “Currently — and perhaps surprisingly — nursing homes are facing under-utilization. Occupancy rates have been steadily falling, save for a few quarterly spikes. The national utilization rate was about 86% in mid-2012; this year it is 81.8%.

“Nursing homes these days are populated mostly with residents in their 80s and older, those born, generally, in the 1920s and 1930s. So, maybe this is the calm before the storm, as the Depression-era recorded low birthrates, meaning the current cohort in nursing homes is unusually small, leaving beds unused.”

More alternatives exist nowadays. People try to delay their nursing home arrival as long as possible. Assisted-living facilities and home health-care, by large margins, are the leading growth areas.

NPR reported on the latest Republican attempt to repeal and replace the Affordable Care Act.  It is not a good plan.  The bill will result in millions of people losing their insurance coverage. Center on Budget and Policy Priorities says in its own analysis that Graham-Cassidy would lead to 32 million people losing coverage over 10 years. It would cut federal funding for health care by more than $400 billion over 10 years, the groups says.

The bill, introduced Sept. 13 by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., may actually come to a vote in the Senate in the coming days.

“The Graham-Cassidy plan would take health insurance coverage away from millions of people, eliminate critical public health funding, devastate the Medicaid program, increase out-of-pocket costs and weaken or eliminate protections for people living with pre-existing conditions,” says Georges Benjamin, executive director of the American Public Health Association, in a statement.

“Graham-Cassidy essentially deconstructs all of the major programs created by the Affordable Care Act, gathers up the money and hands it over to states to run their own health care programs.  It gets rid of both the subsidies that help people buy individual health insurance policies and the reimbursements to insurance companies for offering price breaks on copayments and deductibles to the lowest-income customers.”

It rolls back the popular and successful Medicaid expansion that was adopted by 31 states and Washington, D.C., and punishes those states that expanded Medicaid.  Basically, it is stealing from blue states to give to red states.  “In general, the legislation would over time move money away from states, predominantly Democratic, that have expanded Medicaid and aggressively pursued enrolling their lower income populations in Medicaid and exchange coverage,” Timothy Jost, a professor at Washington & Lee University School of Law who wrote a widely used textbook on health law, wrote in a Health Affairs blog post. “Money would move toward states, predominantly Republican, that have not expanded Medicaid.

Medicaid services or payments to nursing homes could be cut as states see federal funding decline.

There would be no guarantee of coverage for people with pre-existing conditions. Each state that accepts federal block grant funding could waive the ACA’s rules for covering the 10 essential health benefits and other consumer protections. Insurers could take health status into account and raise rates for people with pre-existing conditions in those states. Premiums for people with pre-existing conditions could rise by thousands of dollars because states could let insurers charge that population more.

The bill would offer a tax cut to wealthy people by making health savings accounts more generous. The bill boosts the amount people could deposit tax-free into an HSA and also would allow people to make tax advantaged catch-up contributions. These would benefit the wealthy more because they pay a higher tax rate.