Pacific Alliance Medical Center in Los Angeles, which provided care for more than 150 years, closed Nov. 30.
The hospital, which was originally slated to close Dec. 11, cited the costs of retrofitting its facilities to meet California’s seismic standards as the reason for the closure. The hospital said it lacked a financially responsible way to make the required updates.
“PAMC does not own the land on which our hospital sits, and the owner is unwilling to sell the land to us,” the hospital said in a statement to Becker’s Hospital Review in October. “The hospital building does not meet current California seismic standards, and it is not economically viable for us to invest nearly $100 million to build a hospital on land that we would not own.”
A California Worker Adjustment and Retraining Notification Act notice dated Oct. 9 indicated all 638 of the hospital’s employees would be laid off when the hospital shut down. The hospital confirmed that number in its closure announcement.
In addition to the challenges related to the seismic requirements, Pacific Alliance Medical Center faced a few other major hurdles in the months leading up to its closure. In June, the hospital and its parent company agreed to pay $42 million to resolve allegations they violated the False Claims Act, Anti-Kickback Statute and Stark Law. The companies allegedly had improper financial relationships with certain physicians and billed Medicare and California’s Medicaid program for services provided to patients referred to Pacific Alliance Medical Center. In August, the hospital announced it was recovering from a ransomware attack that compromised the protected health information of 266,123 patients.
Fort Lauderdale, Fla.-based Broward Health’s ex-CEO Pauline Grant sued her former employer in December 2016. The health system fired back in a counter-suit filed Dec. 1, alleging Ms. Grant violated the Anti-Kickback Statute.
Here are five things to know about the litigation.
1. North Broward Hospital District, which does business as Broward Health, claims Ms. Grant violated the system’s code of conduct by serving as secretary of the board of directors of a long-term care provider that had contracts with Broward Health, according to the Sun Sentinel.
2. The health system alleges Ms. Grant’s position on the board violated the terms of a corporate integrity agreement the hospital district entered into with the federal government in 2015. The agreement was put into place after Broward Health paid $69.5 million in September 2015 to settle allegations it violated the False Claims Act by holding improper financial relationships with physicians.
3. Broward Health also claims Ms. Grant violated the Anti-Kickback Statute while she was CEO of Broward Health North in Deerfield Beach, Fla., one of the health system’s six hospitals.
4. Broward Health’s board voted 4-1 on Dec. 1, 2016, to fire Ms. Grant. The board voted to remove Ms. Grant from her position after an independent counsel review showed potential violations of the Anti-Kickback Statute. A subsequent independent investigation found Ms. Grant “ran afoul” of federal anti-kickback law when awarding emergency room contracts to orthopedic physicians seeking to participate in Broward Health North’s on-call emergency department rotation.
5. Following her ouster, Ms. Grant sued Broward Health, accusing the system’s general counsel and four board members of violating the Florida open-meetings law to bring about her termination.
Senate Republicans are trying yet again to repeal Obamacare, despite seemingly having all the political and substantive reasons in the world not to.
Like all the other bills, the newest one, sponsored by Sens. Lindsey Graham and Bill Cassidy, is horrendously unpopular, with only 24 percent support. The rushed and slipshod process around the bill means its consequences still aren’t well understood, but it’s clear enough that tens of millions of people would likely lose coverage if it passes, that several statesrepresented by Republican senators would lose billions of dollars in federal funding, and that the bill badly violates President Trump’s campaign promise not to cut Medicaid.
Instead of putting repeal to the side after its failure in the Senate in July, though, Republicans just keep coming back to it, and are pushing toward a Senate vote on Graham-Cassidy this week. They’re doing so in part because they feel obligated to fulfill a longtime campaign promise, and because they fear electoral consequences for being viewed as failures.
But one more crucial motivator explains a whole lot: Republican Party donors want it.
The evidence that the GOP is trying to please donors here is adding up. An anonymous Republican senator told Politico that McConnell might be returning to health care to show donors “that the Senate GOP tried again.” Senate Republicans were warned at a private meeting that fundraising was slow because donors were disappointed at their lack of accomplishments, per the New York Times. And in recent months, senators “faced an unrelenting barrage of confrontations with some of their closest supporters, donors and friends” over Obamacare repeal’s failure, according to the Washington Post.
This pressure seems to be able to move votes. One moderate senator, Dean Heller (R-NV), conspicuously switched from being a public critic of repeal efforts to a strong supporter of Graham-Cassidy. That came after he reportedly got an earful from Sheldon Adelson and Steve Wynn, two billionaire GOP donors in his state.
Steve Schmidt, who ran John McCain’s presidential campaign in 2008, told Vox recently that donor concerns seem to be dictating the GOP’s legislative strategy. “There’s not an actual human constituency for any aspect of the Republican Congressional agenda,” Schmidt says. “Instead it’s an inside game that is judged, win or lose, on the basis of which entrenched permanent interests gain advantage or disadvantage, and how that affects the endless fundraising process.”
“You’re voting to reorganize one-sixth of the economy without any sense of how much it costs, or who it’s gonna affect, and with 13 percent approval of it at a national level,” Schmidt continues. “The drivers of it are something other than the voters.”
And if you assume the goal of passing repeal is primarily to please donors and goose fundraising, a whole lot about congressional Republicans’ bizarre approach to repeal — particularly, their disinterest in policy details or in how restructuring the health system will impact their constituents — makes a lot more sense.
One interesting feature about this donor pressure Republicans are facing is that it does not appear to be coming from insurance companies or other health care industry stakeholders hoping to profit greatly from changes to the Affordable Care Act. (Health industry lobbyists in fact have been caught by surprise by the Graham-Cassidy boomlet.)
Instead, it appears to be a sentiment broadly shared among much of the GOP donor class. Paul Kane, who wrote a Washington Post report on pressure Republican senators faced after their initial failure on repeal, tweets that he’s heard “local Chamber types” or “longtime supporters” who’ve donated to them for years were particularly influential.
But super-wealthy donors are making their voices heard too. Doug Deason of Texas, who is part of the Koch brothers’ donor network, said earlier this year that his “piggy bank” would be closed until congressional Republicans “get some things done,” according to the Associated Press.
In trying to understand why these donors want Obamacare repeal so badly, I think it’s helpful to think of two somewhat overlapping sets of motivations.
The first is, essentially, a desire for their political “team” to win. These donors have been funding GOP candidates for years, and those candidates have been campaigning on repealing Obamacare. And while they may not care all that much about health policy, they care about broader matters like whether the Republican Party can get things done, or whether they feel their team is fighting for its principles.
Ken Vogel, who’s covered megadonors for years at Politico and now the New York Times, has said that he thinks a lot of them “treat this almost like a hobby” or game that they’re trying to win. “These folks have all this money, and they’re doing something they believe in. If they win, great; if they don’t win, they had fun doing it.”
In this case, the donors spent on the 2016 election, won, and now feel they’re owed a prize. If they don’t get a prize, then, well, they might not be so eager to open their wallets again. However, they don’t have particularly strong views or interests in the details of Obamacare repeal or how it should be replaced — so it makes sense that many Republican senators channeling their views would be similarly indifferent to what their bill actually does.
But a second set of donor motivations — that do help explain one major feature of nearly all the repeal bills we’ve seen — are ideological.
Across nearly every major version of Obamacare repeal that the House and Senate considered this year, there’s been one constant: hundreds of millions of dollars on cuts to government spending on health insurance. (Even the massive tax cuts for the wealthy in earlier versions of the bill were eventually scaled back to protect these spending cuts.)
The persistence of these cuts has been odd. If the GOP’s goal was simply to pass something, scaling back the cuts could have helped improve coverage numbers and win over wavering moderates. Furthermore, the bills’ deep cuts to traditional Medicaid go beyond merely rolling back Obamacare, as well as violating President Trump’s campaign promises not to cut that program.
These cuts make a whole lot more sense, though, when you view them as part of a long-term ideological project.
In addition to more traditional business and corporate donors, the GOP gets a great deal of its financial backing from megadonors with ideological motivations, like Charles and David Koch. These donors just don’t want to feel good by winning — they want to dramatically shrink the size of the federal government. And the way that’s done is by cutting spending.
In recent years, they’ve had little success. President George W. Bush found it to his political benefit to hike spending, and Donald Trump promised to protect entitlement programs. While an appealing slogan in the abstract, cutting spending usually proves to be difficult and unpopular in practice.
But Obamacare repeal is different, politically. It’s tied to the despised (on the right) figure of Barack Obama, it can be sold as a fix for the health system’s woes more generally, and the entire Republican Party (including the president) have campaigned on it for years. And it can be done through the budget reconciliation process.
As such, it’s clearly the Republican majority’s best chance for enacting deep spending cuts — and a fantastic Trojan horse if that is the true goal of some of their donors.
Now, as Republicans are facing a tough fight to hold onto Congress in 2018, they’re reportedly finding that fundraising is more difficult than they’d expected.
Sen. Cory Gardner (R-CO), who runs the Senate GOP’s fundraising arm, warned his colleagues at a lunch two weeks ago that their legislative failures, including on Obamacare repeal, were badly hurting fundraising. That’s according to a fascinating report by the New York Times’ Carl Hulse, who writes:
[Gardner] warned that donors of all stripes were refusing to contribute another penny until the struggling majority produced some concrete results.
“Donors are furious,” one person knowledgeable about the private meeting quoted Mr. Gardner as saying. “We haven’t kept our promise.”
Donor influence has been the most obvious in the case of Sen. Dean Heller.
Heller is facing a tough reelection fight in 2018. Hillary Clinton won his state, which also happens to have benefited greatly from Obamacare’s Medicaid expansion. Naturally, then, Heller was hesitant to support an Obamacare repeal bill that would gut Medicaid. So in June, he publicly announced his opposition to one version of the Senate health bill alongside Nevada’s popular moderate Republican Gov. Brian Sandoval.
What happened right afterward, according to a report by the New York Times’ Jonathan Martin and Kenneth Vogel, was that two Nevada billionaires and leading GOP donors let him know that they were very unhappy with him:
Mr. Adelson and Mr. Wynn, two of Las Vegas’s leading gambling titans, each contacted Mr. Heller at the request of the White House last week to complain about his opposition to the Republican-written health overhaul, according to multiple Republican officials.
One ally of Mr. Heller’s acknowledged that Mr. Adelson and Mr. Wynn were unhappy with the senator at the moment and that their relationship needed some repair work.
Soon after this, Heller’s approach to the issue changed dramatically. He stopped sticking his neck out with public opposition. And though he did vote no on two versions of the Senate’s bill in July, he was willing to vote yes when it really counted, on the “skinny repeal” bill. Then, to rebuild his conservative cred further, he added his name to the Graham-Cassidy repeal proposal.
Now, with Graham-Cassidy becoming essentially the Senate GOP’s main repeal plan, Heller doesn’t even seem to be considering a no vote — even though, like the version of the bill he opposed back in June, this bill would make deep cuts to Medicaid and is opposed by Gov. Sandoval.
Heller likely didn’t change his mind only because of annoyed billionaires. After all, in August, Nevada business executive Danny Tarkanian announced he would challenge Heller in the Republican primary, presenting a threat to his right. Since President Trump is still quite popular among GOP primary voters, defying him may have seemed increasingly dangerous after that.
But as Heller runs for reelection in what’s expected to be a hugely expensive race, it would certainly be nice if he had the backing of a pair of deep-pocketed billionaires who can donate unlimited amounts to outside groups who will run ads supporting his candidacy, both in the primary and the general. And his political logic seems to be shared by most of the Senate GOP.
In the past two days, we’ve outlined a number of concerns about news organizations, professional journalism organizations and academic institutions that are involved in health care journalism reporting or training while accepting sponsorship or funding from health care industry entities that are often subjects of what the journalists or trainees do or will write about. (Part one of series. Part two.) These practices may be good for corporate, organizational or academic institution coffers, but the sponsorship comes at a price – of potential damage to journalism’s integrity and to the public trust in journalism, news reports and news organizations.
We have touched on examples of our concerns involving:
Ben Bagdikian, journalist/educator/media critic, wrote to and about journalists:
“Never forget that your obligation is to the people. It is not, at heart, to those who pay you, or to your editor, or to your sources, or to your friends, or to the advancement of your career. It is to the public.”
In this final part of our three-part series, I talk about some of these issues in more depth, and from the perspective of my growing concerns over a 44-year career in health care journalism.
Perhaps few journalism organizations have tried harder to minimize conflicts of interest than the Association of Health Care Journalists (AHCJ), the leading professional organization for journalists who report on health care.
The two of us know AHCJ well, having been members almost since its launch 20 years ago. We’ve both served on AHCJ’s board, attended most of its 18 annual conferences, and served on many panels as speakers or moderators over the years. Gary wrote the AHCJ’s Statement of Principles, which was adopted by the Board in 2004.
AHCJ states that its educational arm, the Center for Excellence in Health Care Journalism, won’t take money from pharmaceutical companies, device makers, insurers or even most advocacy groups such as the American Cancer Society. That strict standard distinguishes AHCJ from some other journalism training organizations, which have no qualms about accepting money from companies that journalists routinely report on.
In fact, when AHCJ agreed to collaborate with the World Conference of Science Journalists (WCSJ), which meets in San Francisco this fall, it raised its own money for a health care track “because the broader funding of the conference includes funders that we would not take money from,” AHCJ Executive Director Len Bruzzese told us. As noted in part one of this series, WCSJ accepted $400,000 in support from drug company Johnson & Johnson and another $50,000 from drug company Bayer. Each of the funders that AHCJ lists for its track at WCSJ is a philanthropic foundation. Bruzzese added: “There is easier money out there if you’re willing to take it from other organizations that may want to have more influence than we believe they should have on journalists.”