Predatory Healthcare

Predatory Healthcare Pricing

“Because I Can”

Remember Martin Shkreli? He is the New York vulture capitalist who bought the drug company that makes EpiPens, inexpensive devices that can save your life if you get stung by a bee and go into anaphylactic shock. That would have been acceptable, except that Shkreli then jacked up the unit price five hundred plus percent, putting Epi-Pens out of reach of many who need them. His justification essentially was “I did it because I can.” He instantly became the poster child for all that is wrong with American healthcare.

If you think predatory healthcare pricing is limited to big cities in the East, let me introduce you to Ascension Senior Living, a Catholic healthcare system that provides long term care to the elderly, especially those with debilitating diseases like Dementia, Alzheimer’s, Huntington’s and other independence robbing cognitive maladies.

Those who have lost the freedom to come and go to the fog of brain disease or injury are often placed in long term care facilities called “assisted living” or “memory care” units when they can no longer safely be cared for in the community. Those confined to these facilities who have no money or limited incomes can receive government assistance, usually funded by Medicaid, to pay the cost of their care.

If your grandmother was able to amass some retirement savings before becoming afflicted with memory loss or the ability to make rational decisions and has to be placed in “assisted living,” there is no government assistance until her savings are depleted, so she pays the full cost of her care until her money is gone.

Most “assisted living” facilities accept both Medicaid funded and private pay residents. Both are supposed to receive the level of care appropriate to their individual needs without respect to who pays the bills. The rates charged to Medicaid funded residents are regulated by state and federal rules. The rates charged to those who pay their own way are not.

In my retirement, I work part-time providing guardianship services by court appointment for those suffering from diseases that impair their ability to make decisions on their own and need someone to make fundamental decisions to make sure they receive adequate care and treatment. Guardians can also be appointed to manage the financial assets for those in their charge. Guardians must follow an objective standard with respect to decisions made for their wards, both personal and financial, that requires them all to be made with the ward’s “best interest” as the foremost consideration.

In these dual roles as a guardian, I am responsible for an 80 plus year old person with dementia who has been placed at Alexian Village, an “assisted living” facility in Northern Milwaukee County, for several years. My ward’s condition is stable and no one anticipates that the level of care provided by Alexian Village staff will increase substantially in the near future. The level of care and the quality of life provided has been excellent. Because my ward has money saved, the rate charged by the facility for services provided was about $5,400 per month, which is average for similar facilities in the area.

Ascension Senior Living recently purchased Alexian Village. The new owners decided that they needed a greater profit margin from Alexian. In order to justify rate increases, they came up with an 11 page assessment questionnaire that purports to measure how much staff time a resident will need to receive the care they need. After “assessing” my ward, without my knowledge or consent, the new managers decided that my ward was on “Level Two” and would be required to pay an additional $1,200 per month.

The problem with this 20+% bump, $14,000 more per year, is that Alexian Village is not going to provide any additional services or staff time to my ward for these additional payments. After I complained about the arbitrary and unconscionable increase, the regional vice-president asked for a meeting where they announced they had recalculated the assessment and figured out my ward was really at “Level One,” lowering the additional payment for the same level of service to a mere $800 more per month or $9,600 more per year. The justification offered amounted to little more than a Shkreliesque, “Because we can.”

Ascension management knows they have a captive and vulnerable population. They know it would be terribly disruptive and damaging for those in their care to be uprooted from all they currently know and moved to a more reasonably priced facility. Ascension raised the unregulated rates for those who can pay just to turn a larger profit.

If you need to start looking for “assisted living” for an elderly parent or grandparent, consider anyplace else other than Alexian Village or any other facility connected to Ascension Senior Living. Their pricing philosophy is anything but Christian and they do not seem to care. Shkreli would be proud, but probably say they did not raise the rates enough.

Waring R. Fincke is a retired attorney and serves as a guardian for the elderly and disabled.

Just Saying No Isn't Governing

Just Saying “No” Is Not Governing

Compromise Works

Republican legislators, state and federal, are slowly learning that actual governing requires more than just saying “no” to new taxes, kowtowing to wealthy donors and sticking to talking points crafted by those whose agenda is to advance their own personal agendas and dismantle the government.

On the federal level, even with control of both houses of congress, allies in the Oval Office and a majority on the Supreme Court, the GOP cannot pass its signature piece of legislation repealing and replacing the dreaded Obamacare.

The House of Representatives’ version pushed and praised by Speaker Paul Ryan was homage to his mentor and philosophical guru, Ayn Rand. Their vision of healthcare insurance coverage is to take it away from over 22 million Americans, dismantle and underfund what might be left of Medicaid, and provide enormous tax breaks to the wealthy and health insurance companies already reaping substantial profits on the misery of the ill. Their mantra appears to be, “I’ve got mine. If you cannot afford it, you cannot have it and clearly do not deserve to have it.”

The initial version from the U. S. Senate was not much better. 22 million would still lose coverage and Medicaid remained on the chopping block. Senate Majority Leader Mitch McConnell could not corral 51 votes from his fellow republicans for his bill, even after arm-twisting from the White House and closed door deals with hold out senators.

The next version was released on Thursday with small tweaks to try to win over skeptics in the GOP ranks. There were some improvements, but the basic flaws remain. Here are the low points.

Medicaid payments would be fixed per-person amounts to the states that are guaranteed not to keep up with rising healthcare costs. These cuts will hurt the young and elderly disproportionally, especially when joined with the rollback of Medicaid expansions.

Insurance plans would no longer have to meet minimum coverage benefit standards. Sicker people would be forced into higher benefit plans, driving up the costs which would lead to higher premiums, co-pays and deductibles. This will drive up premiums. The fund created to help high premium costs is wholly insufficient.

Tax credits and health savings accounts for catastrophic health insurance plans are useless to low-income folks who lack disposable income to utilize them.

Also still gone will be the requirement for all to carry health insurance. With the young and healthy out of the pool, premiums for the remaining older and sicker will skyrocket.

McConnell’s move to keep the Obamacare taxes on the wealthy is a sly move to win senate votes, but is merely sleight of hand to cover a later, larger tax cut for the rich under the budget reconciliation rule that will only require 51 votes to pass.

Public pushback from all sectors has been substantial and will continue making it hard for some GOP senators and representatives to support the Senate bill in its current form. Without a large measure of compromise to win over enough Democratic votes, Obamacare will remain the law of the land until driven to ruin by GOP sabotage.

In Wisconsin, we are not much better off. Even with control of both houses of the legislature, the governor’s office and the Supreme Court, we cannot pass a state budget for the next two years. The state’s budget was supposed to be passed by July 1^st. We did not run out of money or close up shop like some other states without passed budgets, but we remain stalled nonetheless.

A majority of us want to put money back into public education that previous budgets stripped away. We also want decent highways and roads upon which to travel. Because our legislators are still stuck on “no new taxes,” we do not know how much state aid will flow to our public schools leaving local budgets in limbo. Similarly, we have highway construction projects around the state in limbo and no idea what may be available to fix local roads in our cities and towns. School funding appears to be contingent upon road funding.

Many conservatives no longer buy into increased borrowing to fund road construction and repair. They recognize the need for increased revenue to fix the problem.

One solution, a non-starter for the leadership, would be to increase the gas tax by five cents a gallon. The gas tax used to be indexed to inflation, but that died under GOP control so we are stuck with a 2006 tax level. Cars and truck are more fuel efficient, so we buy less gas. Gas tax revenues are down as a result.

Not finding a solution to road funding jeopardizes education funding and local budgeting. A three-month budget delay will keep the DOT from proceeding with some planned projects. A four-month delay will impact local road budgeting and a delay until August could mean loss of federal highway funds.

Maybe it is time to sit down with Democrats and find solutions that will command the votes to govern, as our government requires.

Waring Fincke is a retired attorney and serves as a guardian for the elderly and disabled.