Conservatives Are Using the Courts to Attack Health Care for All Americans

A doctor in Milton, Massachusetts, wheels his patient into his office, February 2018.

Conservative state officials, in conjunction with the Trump administration, have launched an all-out attack on health care in the United States. They have brought a suit to overturn the entirety of the Affordable Care Act (ACA), which would have serious consequences for nearly every American who has health coverage, whether through their employer, the individual market, Medicare, or Medicaid. And they found a partisan judge who, last Friday, proved willing to ignore the rule of law and help them advance their political agenda through the courts.

For now, the ACA remains the law of the land. But if the partisan decision in Texas v. United States is upheld, the consequences could be devastating. The Urban Institute estimates that overturning the ACA would result in 17 million more Americans being uninsured in 2019—in addition to coverage reductions that would occur due to the elimination of the individual mandate penalty. Millions of American families could be left without access to health care—and without the financial safety and peace of mind that health insurance provides. Overturning the law would also have serious negative effects on public health and drug development and would shorten the life of the Medicare trust fund. Moreover, it would provide a major tax break to the wealthiest Americans, insurance companies, and drug manufacturers.

Supporters of the decision have talked about this as an effort to end “Obamacare,” which may cause some people to mistakenly believe it only affects those who obtain coverage through the individual marketplace. Nothing could be further from the truth: Virtually no American’s health care coverage would be safe from the effects of this decision. Here are just some of the impacts that this decision, if upheld, would have.

Risks for people who obtain coverage through their employer

  • Lifetime and annual limits on coverage: Polling shows that without the ACA’s ban on lifetime and annual caps on benefits, firms would choose to reinstate limits on coverage. Tens of millions of workers and dependents could face annual or lifetime limits.
  • Loss of coverage for young adult children: The ACA requires employer plans that cover dependents to include young adults up to age 26. More than 2 million young adults have gained coverage under the ACA’s dependent coverage provision.
  • Loss of free preventive services, including contraception: The ACA requires preventive services—such as immunizations; screenings for cancer, diabetes, and depression; and well-child visits—to be available at no cost to the patient. Womensave about $250 annually thanks to the lack of cost sharing for contraception.
  • Elimination of rebates to cover excessively high premiums: The ACA requires insurers to provide rebates if they overprice premiums relative to actual medical costs. Under the ACA’s medical loss ratio provision, insurance companies paid back $344 million in 2016 to people with employer coverage.

Risks for people who receive coverage through Medicare

  • Increases in premiums and out-of-pocket costs: Elimination of the ACA would increase some beneficiaries’ premiums, deductibles, and copayments in Medicare Part A and Part B; overturning the law would eliminate Medicare savings, and premiums are based on program spending.
  • Cost sharing for preventive services such as mammograms: Under the ACA, Medicare provides preventive services and covers a yearly wellness visit at no cost to the patient.
  • Possibility of falling back into the prescription drug coverage gap: The ACA narrowed the Part D coverage gap and was on track to completely fill it by 2020. Without the ACA, many seniors could face higher costs for prescription medications.

Risks for people who receive coverage through Medicaid

  • Loss of coverage under the Medicaid expansion: About 12 million people are covered under the Medicaid expansion, which was funded mostly by the federal government under the ACA.
  • Higher costs for preventive services such as children’s vaccines: The ACA provided a financial incentive for states to provide preventive services to Medicaid beneficiaries free of charge, which a number of states currently utilize.
  • Fewer options to receive care in homes and communities: The ACA provided new options to states to allow elderly enrollees and enrollees with disabilities to receive care in their homes. If the law is overturned, more enrollees will be forced into institutional care.

Risks for people who buy insurance on their own

  • Loss of tax credits that make coverage affordable: Nearly 9 in 10 enrollees in the ACA marketplaces receive premium tax credits. Without the ACA, enrollees would lose financial assistance toward monthly premiums, as well as funding that helps lower deductibles and copayments.
  • Increased costs or denial of coverage due to pre-existing conditions: Without the ACA, individual market insurers would be allowed to charge more, exclude coverage benefits, or turn away people based on medical history. More than 133 millionAmericans with pre-existing conditions could be subject to discrimination if they ever needed individual market coverage.
  • Increased costs for older enrollees: The ACA limits how much more insurance companies can charge older people for coverage relative to younger ones. Without the ACA’s protections, the elderly and near-elderly would see their premiums rise

The legal reasoning behind the lower court’s decision to overturn the ACA is so poor that it has been decried by even some of the most strident conservative legal critics of the law—including those who have backed the previous efforts to overturn it through the courts. Congress has tried and failed to repeal the ACA, and voters in the midterm elections made it clear that they care about keeping protections for pre-existing conditions. Yet the court’s ruling has been approvingly cited by conservative political officials, including President Donald Trump. As such, the decision is best understood not as a legal opinion but instead as a policy preference pursued through the U.S. judiciary. That preference could not be clearer: to give the country’s wealthy and special interests massive taxes cuts—and pay for them with everyone else’s health care.




The health of 44M seniors is jeopardized by cuts to Medicare lab services

Image result for medicare lab cuts

The Protecting Access to Medicare Act (PAMA)

Congress passed the Protecting Access to Medicare Act (PAMA) in 2014 to help safeguard Medicare beneficiaries’ access to needed health services, including laboratory tests. Unfortunately, the U.S. Department of Health and Human Services (HHS) has taken a flawed and misguided approach to PAMA implementation. As a result of the Department’s actions, seniors will face an estimated $670 million in cuts to critical lab services this year alone, leaving the health of 57 million Medicare beneficiaries hanging in the balance.

PAMA cuts will be particularly burdensome to the most vulnerable seniors, such as those in skilled nursing facilities, those managing chronic conditions, and seniors living in medically underserved communities. The American Clinical Laboratory Association has raised significant concerns about the impact of Medicare lab cuts on seniors and their access to lifesaving diagnostics and lab services.

Learn more about the harm posed by these cuts on seniors here. Read the lawsuit ACLA has filed against HHS here.


In 2016, seniors enrolled in Medicare received an average of

16 individual lab tests per year

Test tubes


80% of seniors

have at least one chronic disease and 77% have at least two—successful disease monitoring and management requires reliable access to routine testing


1 million

seniors are living in assisted living or skilled nursing homes


3.5 million

homebound seniors
rely on skilled home health care services

Map pin

An estimated

10 million

seniors live in rural areas


can result in undiagnosed conditions, lack of treatment for sick patients, and the failure to monitor and treat chronic conditions before they become worse—
resulting in a decline in overall health and longevity.

The PAMA cuts will also have a broad impact on laboratories across the country. Those that will face the brunt of the cuts are the very labs and providers that are uniquely positioned to provide services—like house-calls, 24-hour emergency STAT testing, and in-facility services at skilled nursing facilities—that are particularly important to seniors who are more likely to be homebound, managing multiple chronic conditions, or living in rural areas that are medically underserved.






Editorial: Illinois’ home health care hustle

Image result for home health care fraud

For those who are ailing but hope to stay out of nursing homes or hospitals — and who wouldn’t? — there’s an increasingly popular alternative: home health care providers. These are doctors, nurses and other medical staffers who visit patients at home, with the goal of treating chronic conditions and keeping people healthy enough to avoid costly long-term stays in more intensive facilities. That saves patients, and the health care system, money.

But, as with all things in the health field, there are plenty of caveats for potential customers.

Illinois is a field of dreams for home health care fraud, the Tribune’s Michael J. Berens reports. Why? Because state public health regulators doled out too many home health licenses too fast in the past decade. The state allowed almost anyone with a $25 licensing fee to open a home health care business but fails to provide meaningful oversight on hundreds of operators. You can find Berens’ full report at

The upshot of lax oversight: In the last five years, area home health agencies have improperly collected at least $104 million in Medicare dollars, Berens reports. (Most patients in home health care are covered by Medicare.) Often the home health businesses did that by falsely certifying that Medicare patients were homebound and in need of nursing care.

But the problem here isn’t measured only in Medicare dollars wasted. It’s measured in patients at risk or harmed. Thousands of patients have been subjected to unwarranted procedures, therapies and tests; some were prescribed unneeded and powerful drugs, the Tribune analysis concludes.

So what can patients, and their families, do to protect themselves? How can someone in Illinois — or her family — shop smartly for a home health care provider? It’s not easy, but here are a few tips:

  • First, you can check a federal website that offers star ratings for home health providers at
  • Then, be vigilant. Make sure a home health care agency coordinates care with your existing primary physician. If a home health care company makes lots of visits but does little more than check your blood pressure, be wary.
  • Check your monthly Medicare statement to monitor services that a home health care company claims to have provided.

On average, some 10,000 Americans turn 65 every day. That means the market for home health will likely continue to surge, placing greater demands on regulators.

In 2013, the federal government banned Illinois from issuing new licenses. The feds said that fraud was rampant, driven by too many home health companies for too few patients. Still, Cook County has more home health companies than the entire state of New York.

Many companies provide excellent care for their customers. The industry’s trade association, the Illinois Homecare and Hospice Council, represents about 160 providers (among the 750 or so licensed in the state).

“We support the moratorium,” Executive Director Sara Ratcliffe told the Tribune. “We want more enforcement.”

So do we. This field of dreams needs to be weeded of fraudsters. At least 357 active home health companies in the Chicago area have been linked to potential financial fraud by federal investigators but never charged.

That’s a daunting fact for families and patients seeking home health care. The state could help prospective patients by posting disciplinary and enforcement actions on the web. More sunshine — readily available information on providers’ performance and disciplinary records — would help them make a wise choice.


Bipartisanship is Back: Congressional Cooperation Suggests Momentum is Growing for Aging Reforms

In a much-discussed early-morning vote on July 28, the U.S. Senate voted decisively to move in a different direction on health care, sending a clear signal that future reform efforts will likely have to be bipartisan. Affirmation came on August 1, when Sens. Lamar Alexander of Tennessee and Patty Murray of Washington, the Senate Health Committee’s top ranking Republican and Democrat, announced bipartisan hearings will begin this fall on possible policy solutions for American consumers and insurers participating in state exchanges.

Yet, beyond the fights over “repeal and replace,” a larger issue is looming: Our health care system is not prepared to care for the age wave—which will come with a surge in need for ongoing, daily assistance. Congressional representatives from both sides of the aisle must work together to plan for burgeoning numbers of  elders and individuals with disabilities, recognizing that there are diminishing numbers of family caregivers, and that the health services and delivery system as currently configured is poorly designed to meet  long-term care needs.

Combining Forces for Better Policy

Fortunately there are stirrings of interest and activity: Rep. Ileana Ros-Lehitnen of Florida, the most senior Republican woman in the House of Representatives, joined Rep. Michelle Lujan-Grisham, a Democrat who served as Aging Secretary in New Mexico before her election to Congress, to introduce the Care Corps Demonstration Act. HR 3494 is a thoughtful measure that is designed to galvanize communities by helping them train and deploy volunteers of all ages, whose mission would be to help aging neighbors, friends, colleagues, and family members thrive in their own homes. Rep. Ros-Lehitnen’s predecessor from the 27th District of Florida was one of Congress’ best-known champions of older adults, Rep. Claude Pepper. Rep. Ros-Lehitnen announced on April 30 that she would not be running for re-election, while Rep. Lujan-Grisham has said she will run for Governor of New Mexico in 2018. Before Reps. Ros-Lehitnen and Lujan-Grisham leave Congress, they are trying to recruit supporters from across the aisle and around the country for the Act, so that it can either find its way into a “must pass” bill, or attract widespread acceptance as a standalone measure.

Here’s what the Care Corps Demonstration Act would do:

  • Invite groups to apply for Care Corps grants and administer the program locally;
  • Train volunteers to support the achievement and maintenance of the highest level of independent living (but not provide professional medical services, administrative support services, or institutional care) and deploy them to communities in need; and
  • Award Corps members living allowances and benefits, including health insurance coverage, during their volunteer period, and offer tuition assistance or loan repayment after completion of their assignment.

“It’s clear that seniors want to remain in their homes and they want control over their own health care,” Rep. Lujan-Grisham noted on introduction. “Most of all, they want to remain as independent as they can, for as long as they can. The same is true for individuals with disabilities. Care Corps will allow them to keep that independence. Unfortunately,” she added, “we’re facing high costs, along with a shortage of direct-care workers, which results in the lack of access to these important services, especially for middle class families. A national Care Corps will help build the workforce, while building intergenerational relationships that allow seniors and young people to learn from each other.”

Addressing the looming shortage of direct care workers is exactly what Rep. Bobby Scott of Virginia’s third congressional district is setting out to do. Next month, the Virginia lawmaker will introduce the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act (or Direct CARE Opportunity Act), which will propose to give the Department of Labor funds to establish advanced care training and mentoring programs and establish career ladders and better job opportunities, for direct care workers in up to 15 parts of the country. Direct care workers are instrumental in supporting and assisting people across the country, particularly seniors and people with disabilities,” said Rep. Scott. “Moreover, if we invest in the direct care workforce, we invest in a rapidly growing and in-demand field. Growing the number of direct care workers is simply a win-win for investing in both the health of our communities and the jobs of tomorrow.”

PHI, a leading national organization representing and supporting direct care workers, is strongly backing Rep. Scott’s efforts: “Direct care workers are a critical part of delivering quality, person-centered long-term care, and we support this national effort to increase training, improve retention, and enhance the overall quality of jobs for this workforce,” noted Daniel R. Wilson, director of federal affairs.

Additionally, on July 27 Rep. Matt Cartwright of Pennsylvania’s 17th congressional district introduced the Improving Care for Vulnerable Older Citizens through Workforce Advancement Act. “This bill would improve both the quality of jobs for direct care workers nationwide, as well as the care they deliver, by helping to create expanded roles with sufficient training and compensation, and by helping them support people with increased complex conditions, such as Alzheimer’s and related dementias, congestive heart failure, diabetes, and other chronic conditions,”said PHI President Jodi M. Sturgeon.

Creating a System that Can Meet the Needs of Aging Americans

Together, these bills represent crucially needed investments in thinking through how to train more men and women who can serve on the frontlines of a multi-generational society in an era of mass longevity. With a majority of women now in the workforce and smaller and more scattered families quickly becoming the norm, the availability of traditional family caregivers—middle-aged women—is shrinking rapidly. This is giving rise to an urgent need to create a more flexible, community-focused workforce that is prepared to provide targeted supports in home settings on an as-needed basis to an increasing proportion of elders and individuals with disabilities.

Beyond the workforce, there is a need for more policy analysis and research to adapt and revamp existing social insurance programs that are still organized around delivering episodic medical services, and with financing protocols that are designed to pay providers and organizations without regard to the population’s need for ongoing services across a given geographic region or community. Making this shift—from provider-centric financing models to population health models—will also require tweaking payment rules to reward comprehensive, longitudinal services that include long-term care; adjusting performance metrics to emphasize population health and incorporate key social determinants of health factors; better information technology to foster communication across multiple providers and with individuals living at home and their family caregivers; and development of ways to accurately measure need, quality, and supply of services at a community level, with the help of local leaders and experts.

There are signs that lawmakers may rise to the challenge of helping to forge solutions to these issues. In the House, an ad hoc “problem solvers caucus” has surfaced with a set of initial ideas for fixing state exchanges, and the group of roughly 40 lawmakers may continue to hold discussions about other topics. There is solid bipartisan, bicameral work being done in the Assisting Caregivers Today (ACT) caucus on long-term care issues. Parallel caucuses focusing on Alzheimer’s and other types of cognitive impairment have already made excellent contributions to development of policy on “cure” and “care.” These and other budding efforts have the capability, if further developed, to begin contributing ideas necessary to address larger-scale systems challenges in ways that can inspire and complement the work of researchers, advocates, families, providers and stakeholders.

Between now and 2030, the U.S. will change profoundly as mass longevity becomes a central dynamic. To prepare, now is the time to invest and build for long-term care, not disinvest; to map existing assets and use current programs as platforms for improving and making more efficient; and to generally acknowledge gaps and focus work on addressing common goals in a long-lived society.

In summary, evidence-based, high-value health care reform is greatly aided by congressional bipartisanship, but more is needed. To create a value-based system requires the combined efforts of many. Now that bipartisanship is breaking out, let’s get to it!


Elderly Hospital Patients Arrive Sick, Often Leave Disabled

Elderly Hospital Patients Arrive Sick, Often Leave Disabled

Ron Schwarz, 79, was hospitalized after falling in the shower. Schwarz is a patient in a special ward at the San Francisco General Hospital known as the Acute Care for the Elderly unit, or ACE. (Heidi de Marco/KHN)

Not A Priority

Hospitals can be hazardous places for elderly patients, who are at increased risk of falling, drug-induced injury and confusion.

But as the nation’s senior population grows, many facilities are ill-equipped to address their unique needs.

Kaiser Health News visited hospitals around the country, reviewed data and interviewed dozens of patients, family members and health providers to document the extent of the problem and highlight possible solutions.

How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.

Startup device maker takes aim at hospital pressure ulcers

Startup device maker takes aim at hospital pressure ulcers

Device Held Up - 3.2 + _Reading_

3 Payer-Driven Strategies to Transform Care Models


Spectrum Health, a not-for-profit, integrated, managed care healthcare organization, is focused on redesigning care models to increase value. Its insurance arm has been key.