Citizen Cartwright

Note to readers

I need to take a couple of weeks off to have some work done on my house. I’m expecting to be back with you sometime during the week of May 16.  

People with Medicare Advantage being denied medically necessary care, report says

Every year, tens of thousands of people enrolled in private Medicare Advantage health insurance plans are denied necessary care that should be covered under the program, according to a report by the Department of Health and Human Services’ inspector general.

 

The report calls for Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans. 

 

Medicare Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that frequently are less expensive and provide a wider range of benefits than traditional government-run Medicare.

Enrollment in Medicare Advantage plans has more than doubled over the last decade, and half of Medicare beneficiaries are expected to choose a private insurer over the traditional government program in the next few years, says The New York Times.

 

The industry’s main trade group says people choose Medicare Advantage because “it delivers better services, better access to care and better value.” 

 

Medicare Advantage insurers receive a flat monthly fee for every Medicare beneficiary they cover. Investigators say one of the concerns about this payment method “is the potential incentive for insurers to deny access to services and payment in an attempt to increase profits.” Under original Medicare, the federal government pays providers directly for each service or treatment Medicare covers.

 

The inspector general’s investigators reviewed pre-authorization denials from 15 Medicare Advantage organizations from the first week of June 2019. The investigators found that 13 percent of the services denied likely would have been paid for under original Medicare. They estimated that, based on their sample, nearly 85,000 pre-authorization requests would have been denied that year.

 

The report cites several examples of care being denied. In one case, a Medicare Advantage plan wouldn’t pay for an MRI to determine if an adrenal lesion was malignant. The plan said the lesion was too small and the patient would have to wait a year to get the test. The inspector general's physician panel that reviewed these cases said the MRI was necessary and the patient shouldn't have to wait. The insurer reversed its decision when it was appealed.

 

In many instances, the inspector general's report says, the Medicare Advantage plans substituted their clinical criteria for Medicare coverage rules. The report recommends that the Center for Medicare Services issue new, more specific guidance on when and how plans can use their own criteria to decide whether to pay for care. The inspector general also wants CMS to penalize plans that “are using more restrictive clinical criteria or requesting unnecessary documentation.”

 

The American Hospital Association says the findings “confirm — and provide data and real-life examples — of the harm that certain commercial insurer policies have on patients and the providers that care for them. The AHA continues to push back forcefully against MA plan policies that restrict or delay patient access to care, and add cost and burden to the health care system, while also contributing to health care worker burnout. We’ll continue to make the case that these commercial health plan abuses must be addressed to protect patients’ health and ensure that medical professionals — not the insurance industry — are making the key clinical decisions in patient care.”

Also in the news

Why Turkey, Saudi Arabia are working on improving their relationship

 

NATO says it's ready to back Ukraine for years in war against Russia

 

New natural gas pipeline between Bulgaria, Greece will help Europe ease its reliance on Russian supply

 

House passes, sends to Biden lend-lease legislation for Ukraine, on 417-10 vote

 

Biden asks Congress for $33 billion for Ukraine, seeks to use proceeds from sale of oligarchs’ assets for Ukrainian people

 

Why a law is needed for U.S. to sell oligarchs’ assets — and how it will help Justice Department’s ‘KleptoCapture’ task force 

 

IRS should develop more options for taxpayers to file for free, says Government Accountability Office report

 

Oklahoma House passes, sends to governor ban on abortion after about 6 weeks of pregnancy

 

AP: Algorithm being used by child welfare agencies raises concerns about racial disparities

 

Study in journal Science: 'Avoiding ocean mass extinction from climate warming’

 

Whistleblower Frances Haugen says Europe is making social media better without curtailing free speech; U.S. should, too.

 

Google expands ways to keep personal information private in searches

 

FDA issues proposal to ban menthol cigarettes, flavored cigars

 

Moderna seeks to be first with coronavirus vaccine for children under 6

Americans helping Afghan, Ukrainian refugees get settled here

In recent months, American military veterans, retired professors, pastors and hundreds of others have taken a leading role in resettling displaced Afghans, says The New Yorker. They’ve met planes from U.S. bases, found apartments, co-signed leases, and figured out public-assistance paperwork as part of a sponsor circle. 

 

More than 74,000 Afghan newcomers have been welcomed into communities across the United States, but thousands more still need help, says sponsorcircles.org.

 

The Sponsor Circle program started last fall as an emergency response to the arrival of Afghans. But Lucretia Keenan, a strategist for the program, tells The New Yorker it also was the culmination of efforts by organizers across the United States to ease conditions for refugees. 

 

The Sponsor Circle program is modeled on a successful, decades-long citizen-led resettlement effort in Canada, and a dozen other countries recently have started such programs, The New Yorker says. 

 

Meanwhile, the Biden administration this week has established a program to enable Americans to sponsor Ukrainian refugees and have them temporarily stay in the United States under a system known as humanitarian parole.

 

The program, called Uniting for Ukraine, is part of a larger initiative to temporarily resettle as many as 100,000 Ukrainian refugees, but migrants themselves can't directly apply, says The New York Times. Instead, a sponsor in the United States must apply on their behalf, and then migrants can complete the process after their sponsor is approved.

 

Here is more on the program, from the Department of Homeland Security.

Also in the news

U.N. moves to put veto users under global spotlight

 

Canada lawmakers vote unanimously to label as 'genocide' Russian acts in Ukraine

 

Central African Republic becomes second country to adopt bitcoin as an official currency

 

Senate confirms U.S. attorney, marshal nominees after Cotton lifts holds

 

Supreme Court seems divided in case over jurisdiction of Oklahoma's tribal lands

 

New York's highest court rejects congressional maps drawn by Democrats

 

Georgia governor signs bill empowering state’s investigations agency to probe accusations of voter fraud

 

KHN: Emergency contraception takes on new urgency in Texas after ban on nearly all abortions after about 6 weeks

 

WPost personal finance columnist: 'On college decision day, don’t sentence your child to decades of debt'

 

Fauci: U.S. is out of coronavirus ‘pandemic phase,’ into 'hopefully a more controlled phase and endemicity'

Tips for bridging our differences

I come from what might politely be described as an opinionated family. I found the resulting resentment and estrangement to be painful, but I didn’t know what to do about it.

 

Monica Guzman is director of digital and storytelling at Braver Angels, the country's largest cross-partisan grassroots organization working to depolarize America, according to U.C. Berkeley’s Greater Good Magazine.

 

"When we’re divided, politics feels like it’s exclusively about stopping the other side,” she says. "But at its core, politics is about how we coexist wisely, how we create societies that support us in all our different priorities and preferences.”

 

"The key is to focus on curiosity and understanding,” she says.

 

My family likely would have found this recommendation of Guzman’s to be shockingly heretical:

 

"Say 'I don’t know' when you don’t know. It’s wacky how rare this is! But nothing blocks the escalation of a bad kind of win/lose mode quite like admitting that, no, you don’t know everything (and neither does anybody else). A candid 'I don’t know' is a signal that you’re not in it to win it or to seem impressive. In that sense, I find 'I don’t know' to be the most critical honest answer to a question in a bridging conversation: It lets more curiosity flow from whoever wants to drop some knowledge."

Also in the news

In escalation, Russia says it’s shutting off natural gas to EU nations Poland, Bulgaria

AP explainer: How Moldova’s Trans-Dniester area is related to war in Ukraine

 

Defense Secretary Austin holds meeting of top military leaders from 40 countries on long-term aid to Ukraine

 

Youngest Guantánamo detainee Hassan bin Attash — held without charge since 2002 — is cleared for release

Biden takes his first actions on clemency, with 3 pardons and 75 commutations

 

Biden administration speeds up phaseout of incandescent light bulbs in favor of LEDs lasting up to 50 times longer

 

Senate confirms Lael Brainard to be Fed vice chair, on 52-43 vote

 

Harvard pledges $100 million to research, atone for ways it benefited from slavery, perpetuated racial inequality

 

New Firearm Life Plan tool can help gun owners, family plan for safe use, transfer in the event of disability or death

 

Study: More than half of Americans, three quarters of younger children have had coronavirus infections

 

What we know about new BA.2.12.1 omicron mutant

 

Biden administration to make coronavirus antiviral pill Paxlovid more widely available

 

FDA approves antiviral remdesivir as first coronavirus treatment for young children

 

Older adults who haven’t had heart attack or stroke shouldn't start a routine of daily aspirin, task force says

Eating to protect the planet

I’ve mentioned before that I appreciate the Nutrition Action newsletter published by the Center for Science in the Public Interest.

 

The April issue is titled “The Planet-Lover’s Plate.”

 

Food accounts for nearly a third of global greenhouse gas emissions, Nutrition Action says.

 

And one change can cut your diet’s carbon footprint in half: replacing beef with chicken or pork (even better would be a plant-based burger).

 

“Cattle are ruminants, so they expel a lot of methane as burps as they digest food,” says Walter Willett, a professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health. And more comes from their manure.

As a heat-trapping gas, methane is about 30 times more potent than carbon dioxide, and cattle live longer than other livestock.

“Chickens come to market in about six weeks, and pigs come to market in about six months,” Willett says.

“In contrast, cattle take about 1 to 1½ years to come to market if they’re grain fed and 2 to 2½ years if they’re grass fed,” he says. “And every day, they’re burping out methane and breathing out carbon dioxide.”

In addition, the fertilizers used to grow cattle feed release nitrous oxide, a greenhouse gas that’s 300 times more potent than carbon dioxide.

 

It also takes large quantities of fossil fuels to process and transport that feed.

Also in the news

Biden to nominate veteran diplomat Bridget Brink to be U.S. ambassador to Ukraine

 

Biden administration wants Congress to expand federal, state authority to counter drones in U.S.

 

Judge to block Biden administration plan to lift Title 42 coronavirus border restrictions for migrants

 

New York judge holds Trump in contempt of court, orders $10,000-a-day fine until he complies 

 

Supreme Court lets Thomas Jefferson High School's admissions policy stand

Kansas judge strikes down state’s Republican-drawn congressional map

 

Florida GOP Gov. DeSantis signs bill creating one of the nation’s only election police units

 

What’s next now that Twitter has agreed to Elon Musk’s takeover bid

 

How to help teens who are struggling with anxiety, depression

Vulnerable people vs. private equity

A friend who’s spent her career trying to help low-income people told me last week that she’s about to lose her job at a Pennsylvania medical facility owned by Prospect Medical Holdings, which is controlled by the private equity firm Leonard Green.

 

The closure of the unit where my friend works, along with the termination of other key medical services, is discussed here.

 

"The question of whether profits and good medical care can coexist is not a new one in the United States," says a 2020 ProPublica article. "But that tension is particularly acute in the case of Leonard Green and Prospect, where private equity has extracted hefty profits from a business that acquires struggling hospitals and relies on Medicaid and other government programs to pay the bills for its impoverished patients."

"It’s such a brutal case of unabashed greed," says Rosemary Batt, a professor at Cornell University’s School of Industrial and Labor Relations, who's studied private equity’s involvement in health care. "We’re talking here about safety-net hospitals that are serving the poor, the unemployed, disproportionately people of color. They’re just doing this immoral sucking out of resources. That is beyond the pale."