VA Progress Under Trump

 

Finally there is progress at the Veteran’s Administration. It’s now over three years since the scandalous revelations of 2014 when veterans were dying while waiting for appointments to see a doctor.

The Coburn Report

Senator Tom Coburn (R – OK) investigated the VA scandal and released a report called “Friendly Fire: Death, Delay, and Dismay at the VA.The tragic consequences of this scandal of mismanagement are highlighted in the report:

  • The report identifies $20 Billion in waste and mismanagement that could have been better spent providing health care to veterans.
  • More than 1,000 veterans may have died as a result of VA misconduct over the past decade.
  • The federal government has paid out $845 million for VA medical malpractice since 2001.
  • Most VA construction projects are over budget and behind schedule, inflating costs by billions of dollars.

 

During the Obama administration little progress was made in solving the many problems and reversing the perverse culture that contributes to the dilemma. But recent signs reveal the Trump administration is having better success.

According to David A. Patten, writing in Newsmax, Trump started working on the problems even before he was inaugurated. In December last year Trump convened a group of highly respected healthcare officials at his Mar-a -Lago estate in Florida. The group was put together by highly respected Dr. Bruce Moskowitz and included Mayo Clinic CEO John H. Noseworthy, Paul Rothman of Johns Hopkins Medical Center, Dr. David Torchiana of Partners Healthcare and Dr. Toby Cosgrove of The Cleveland Clinic.

As a result of that meeting, many ideas were put forth on how to fix the VA. The right leader was needed to implement these changes and President Trump appointed Dr. David J. Shulkin as the new Secretary of Veterans Affairs. Shulkin was the former president and CEO of New York’s Beth Israel Medical Center. He won Senate confirmation with the only 100 – 0 vote.

Shulkin recognized immediately that he needed the power to hold VA officials accountable who were not performing well. The result was an executive order by Trump to establish the VA Office of Accountability and Whistleblower Protection. He also authorized the VA secretary to use “all available authorities to discipline or terminate any VA manager or employee who has violated the public’s trust.”

Shulkin has instituted an aggressive series of reforms:

  • Stop Fraud, Waste and Abuse” campaign to save millions of taxpayers’ dollars
  • New electronic record keeping system to replace old paper-based system. The new system is the same as already exists in the Department of Defense which makes the two systems compatible to share records.
  • Wait times for appointments posted online to increase transparency
  • Free mental health services to all veterans, regardless of service records. This is a serious attempt to lower the suicide rate currently at 20/day.
  • Decision Ready Claims – electronic claims process to process the backlog of 90,000 disability claims.
  • Choice program enhanced – to allow veterans to seek private care outside the VA system. Over 500,000 community providers are participating.
  • Low-rated medical centers being investigated. Fourteen identified centers are currently under investigation.

 

Problems Persist

Despite all this good news, there are still problems due to the federal bureaucracy that is deeply entrenched. The case of Brian Hawkins is a good example, which was reported by The Wall Street Journal.

Hawkins was director of the Veterans Affairs Medical Center in Washington, D. C. until April when he was fired after the Inspector General, Michael Missel, issued an emergency report on his facility. His report found 18 of 25 sterile storage areas for supplies at the D.C. facility were dirty.

The hospital had no effective inventory system, so doctors and nurses had to routinely cancel or delay procedures for lack of supplies; they used recalled or expired products on patients. The facility had run up 194 official reports of safety incidents involving patients since 2014 – and those were merely the incidents reported. Vendors removed equipment because the hospital failed to pay its bills.

Hawkins was dismissed on July 28 for having “failed to provide effective leadership at the medical center.” Hawkins claims he was wrongly terminated and appealed to the Merit Systems Protection Board, which was established in 1979 to protect federal employees from abusive treatment. Unfortunately it has become a union-supported shop dedicated to protect employees from discipline. The board issued an immediate stay on his removal, meaning the VA must continue to employ Hawkins while he fights dismissal.

Secretary Shulkin plans to use the Hawkins case to test the VA Accountability Act’s new powers of removal. He will fire Hawkins again, under the new law, which bars him from appealing to the Merit Board. He will then have 21 days to appeal the firing to an internal board made up of fellow senior executives or go to court.

Hopefully this case will set a precedent that will give the VA Secretary the powers he needs to hold his employees accountable. Veterans’ lives are at stake.

To Bailout ObamaCare or Not to Bailout?

 

When is a bailout not a bailout? That’s the big question facing Congress now.

In an earlier post I described the peculiar language that Congress uses to describe things so they are considered political correct, or incorrect, as it suits their agenda. (see The Misleading Language of Healthcare Reform) The latest word in this peculiar language is bailout.

Now that Democrats have successfully prevented Republicans from making the changes in ObamaCare they promised, it’s time to deal with an unpleasant issue. Cost-Sharing Reductions subsidies (CSRs) are payments by the government to the insurers to subsidize deductibles and co-pays for lower-income individuals – those below 250 percent of the Federal Poverty Level – who purchase coverage on ObamaCare’s exchanges.

Although these payments must be appropriated by Congress, the Obama administration made the payments without approval anyway. The result is a lawsuit called House of Representatives v. Price (the current HHS Secretary). This lawsuit was originally filed in 2015 against the Obama administration and a federal judge ruled in favor of the House. The judge initially slammed the Obama administration with an injunction to prevent further payments. However, the injunction was later stayed at Congress’ request, putting the legality and existence of CSRs in limbo.

President Trump had opposed what he calls “bailouts of insurance companies.” Insurers and Democrats are pressuring the White House to approve the payments to lower the cost of health insurance for low-income Americans.

Are these actually bailouts or not? Who is being bailed out?

Republicans call these bailouts of the insurance companies. Democrats call these necessary subsidies for low-income Americans. Insurers call these cost-sharing reductions.

Avik Roy, writing in Forbes, calls these payments “a bailout of ObamaCare’s sloppy authors.” He blames the authors for creating a healthcare system that is so overloaded with government regulations that it drives up the cost of insurance and makes these payments necessary.

The Congressional Budget Office (CBO) as usual has weighed into the fray with their opinion which Democrats routinely pounce on to justify their position. The CBO predicts 20% premium increases in 2018 if the Trump administration fails to make the CSR payments. They also say the higher subsidies mean that the increased spending on tax cuts will add $194 billion to the deficit through 2026, according to The Wall Street Journal. Ending the subsidies would add $6 billion to the deficit next year.

However, there is some good news. The CBO says that failure to make the payments would produce no significant change in the number of insured individuals, at least not any time soon. Analyst Charles Blahous says the report shows that killing the subsidies could lower costs for some consumers, especially the near-elderly, whose premiums would rise very little while they would be able to afford gold plans that are worth more.

Roy says the prudent thing to do is to pass a short-term, one-year funding package for ObamaCare’s CSRs, in exchange for real reforms of the individual insurance market.

 

Real Reforms

The suggested real reforms include the following:

  • Repeal of the Individual Mandate – to give people freedom not to purchase insurance. A six-month waiting period to re-enroll would help lower premiums by incentivizing people to remain enrolled.
  • Eliminating the “age bands” – that force insurers to overcharge younger enrollees. The young would pay less, enroll more, and therefore drive down premiums for everyone.

 

Conservatives would rather not put any more taxpayer funds into the healthcare system but a short-term funding package with these reforms could lead to long-term lower premiums.

Medicaid and The Killer Drugs

 

Medicaid causes many problems, not to mention it provides second-class healthcare. In recent posts I have pointed to the negative impact of Medicaid on state budgets and education (Medicaid – The State Killer) and its negative impact on the defense of our nation (Medicaid – The Defense Killer.) Today we’ll talk about how Medicaid is contributing to the epidemic of opioid abuse that is killing people.

President Trump declared recently the opioid epidemic is a national emergency. The proof of this is irrefutable. According to The Wall Street Journal, drugs now rank as the leading cause of death for Americans under age 50. Think about that. That’s higher than auto accidents, higher than cancer, higher than diabetes or heart disease. It’s even higher than urban violence that is booming in big cities like St. Louis, Chicago, Detroit, and Baltimore.

Opioid overdoses have quadrupled since 1999, and fatalities are soaring. The number of overdoses in Ohio alone this year is projected to exceed the nationwide count in 1990. In the mostly rural state of New Hampshire, opioid abuse was a major issue in the 2016 presidential campaign.

Most opioid abuse and overdoses begin with prescription painkillers that lead to addiction. Although the majority of people prescribed these drugs never become addicted, a significant minority get hooked and then turn to street drugs to feed their addiction. These street drugs are usually laced with fentanyl and heroin, far stronger opioids with lethal side effects.

How does Medicaid impact this picture?

A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Senator Ron Johnson has called attention to evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse.

According to a federal Health and Human Services (HHS) analysis requested by Senator Johnson, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states – those that increased eligibility to 138% from 100% of the federal poverty level (FPL), than in the 21 non-expansion states between 2013 and 2015.

It is especially alarming to note the marked disparities between neighboring states based on whether they opted into ObamaCare’s Medicaid expansion. Deaths increased twice as much in New Hampshire (108%) and Maryland (44%) – where Medicaid expanded – as in Maine (55%) and Virginia (22%). Drug fatalities skyrocketed by 41% in expansion Ohio while climbing only 3% in non-expansion Wisconsin.

Vast quantities of opioids can be obtained cheaply with Medicaid cards. A police detective in Wisconsin told Senator Johnson’s office that 240 oxycodone pills can be purchased with a Medicaid card for a $1 co-pay and resold for $4,000 on the street! A single Vicodin pill (hydrocodone) sells for as much as $50.

Senator Johnson says, “It appears that the program has created a perverse incentive for people to use opioids, sell them for large profits and stay hooked.” He is calling for the Inspector General of HHS to investigate Medicaid’s controls to prevent such abuses. Hopefully, President Trump’s emergency declaration will provide funding for expanded opioid treatment. But it is clear that reigning in the abuse of Medicaid is an important part of the solution.