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Feinwachs To Offer Convention Keynote
David Feinwachs
Attorney David Feinwachs will offer the keynote address at the 2012 Convention to be held in Braham on Thursday, April 19th.
Feinwachs has been a champion of healthcare transparency and accountability since his forced departure from the Minnesota Hospital Association (MHA) in late 2010. David was the general counsel for the MHA for nearly 30 years. A revealing video produced by Feinwachs helped illustrate the lack of transparency in healthcare plans funded by the state and administered by private insurance companies.
At issue in the video is the double-standard and lack of accountability that is now the rule for the non-profit HMOs in Minnesota (by law, all Minnesota HMOs are required to be organized as non-profit entities). Feinwachs describes the accountability problem as a “black box.” State “tax dollars go into the black box” of HMO accounting in the form of $3.8 billion dollars in tax money every biennium, and they are “never accounted for” in any meaningful way, according to Feinwachs.
The actions taken by Feinwachs created a flurry of legislative activity by members of both parties. Their efforts were an attempt to address the ongoing lack of oversight for tax dollars spent blindly on healthcare by private insurance companies. To date, the only apparent change has been an Executive Order from Gov. Dayton to require some enhanced reporting of expenditures by the HMOs. No meaningful legislation on transparency was produced in 2011. Legislation for 2012 remains up in the air as politics begins to trump policy. ~
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Accountability Bill now "Toothless?"
March 30, 2012
It appears that the "teeth" have been taken out of proposed pieces of HMO Accountability legislation. Amendments newly added to a once-strong bill now restore ambiguity and murkiness to a bill originally designed to give clarity about how $3.8 billion healthcare tax dollars are spent by Minnesota's HMOs. Cut and paste this link for more... http://bit.ly/H8Eld8
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HMO Accountability Now in Back Seat
March 26, 2012
A piece of strong, bipartisan Minnesota *legislation, designed to increase the HMO’s transparency and accountability for state health programs, has been temporarily sidelined.
Questions were raised last session over the $3.8 billion per biennium handed over to the non-profit insurance companies that run the state’s healthcare programs. As a result of the discussions both bodies of the Minnesota legislature crafted legislation which aimed to remedy that situation. Lack of HMO accountability seemed to be a high priority issue in 2012 as the Health and Human Services committees in the House and Senate held hearings on various bills.
A hearing held on February 14th in the House was the centerpiece of the early discussions.
Presenters at that meeting included Human Services Commissioner Lucinda Jesson and Deputy Commissioner Scott Leitz. The hearing also featured a presentation by former MN Hospital Association general counsel David Feinwachs, which helped shed light on the current system. It prompted tough questioning from the Human Services Committee members during the 3 1/2 hour hearing.
Representatives from the MN Council on Health Plans, who represent the HMOs, also were on hand. They were grilled about issues relating to the transparency, or lack thereof, in the state tax-funded and HMO administered health services in Minnesota. The Health Plan’s speakers argued, not very successfully, that their auditing and accounting procedures were “very thorough” and needed no added scrutiny. Despite the Health Plan’s reps assurances that transparency was at a high level, the committee members expressed serious doubts.
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At the speaker’s table left to right were: Medica’s Geoff Bartsch, David Feinwachs (former general counsel to the MN Hospital Association), DHS Commissioner Lucinda Jesson and DHS Deputy Commissioner Scott Leitz. They all fielded some probing questions during a joint Health & Human Services Committee meeting convened February 14th by Reps. Jim Abeler (Anoka) and Steve Gottwalt (St. Cloud), chairs of the Reform and Finance, committees of the MN House, in that order.
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Adding fuel to the questioning and discussion was the revelation earlier in the day that the Federal Government had launched an investigation of the Minnesota Medicaid program. Medicaid has oversight provided by the MN Department of Human Services, and is run by the state’s non-profit HMOs.
The ranking member of the U.S. Senate Judiciary Committee sent a letter to Gov. Mark Dayton asking why UCare, a Minnesota health plan company, repaid $30 million in Medicaid funds to the state as a "gift," rather than as a refund or reimbursement.
In the letter, Sen. Chuck Grassley (IA), said he's “...concerned that the way the funds were returned was meant to avoid reimbursing money to the federal government.”
Grassley’s reference was to e-mails sent by Minnesota Department of Human Services Commissioner Lucinda Jesson in March 2011, in which she described how UCare should draft its press release about returning the Medicaid funds to the state.
"In order to have a good chance of keeping all of this money, it must be characterized as a donation. If a refund, feds clearly get half," Jesson wrote in an e-mail.
The contents of that e-mail exchange prompted some extended questioning of DHS Commissioner Jesson and her Deputy, Scott Leitz. They stated that the dollars returned to the state from UCare ($30 million) was always termed as a donation, not as a refund.
A more in-depth question then arose about the nature of the relationship between DHS and the HMOs who receive $3.8 billion plus in state tax dollars per biennium to run healthcare programs.
According to David Feinwachs examination and interpretations, the unlimited reserves that HMOs accumulate in state tax dollars should be closely scrutinized. These reserves are created to fend off their “risk” of large claims. “The HMOs are never at risk…” Feinwachs stated when referring to massive reserves held by the HMOs. He explained that the way the system is set up now, if an HMO running one of the state health programs experiences a shortfall one year, the rates are adjusted by DHS the next year to make up for the HMOs previous year’s “loss.”
Sen. Grassley also sent letters to all of the Minnesota’s non-profit HMOs in charge of the state healthcare programs and recipients of state tax dollars. In these letters he focuses on a number of key points, including some designed to examine potential “overpayments” received by the HMOs from Minnesota’s DHS.
Sen. Grassley’s letters and questions get at the heart of the accountability matter and, for those of you who are concerned taxpayers, they can be found at:
http://scr.bi/H0iQKH
*(HF 2412 and SF 1824)
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HMO Accountability Now A Priority in Minnesota
February 28, 2012
A tireless effort by members of Greater Minnesota Health Care Coalition (GMHCC) is finally starting to yield a return in terms of legislative action.
Since early 2007, the GMHCC members have trumpeted the lack of legislative oversight for billions of tax dollars spent on healthcare in Minnesota. Those funds have been earmarked for the various state-funded programs like General Assistance Medical Care (GAMC), MnCare and Medical Assistance (MA).
Tax dollars assigned for those programs flow through to a number of HMOs who are designated as program administrators in almost all cases. The price tag is nearly $4 billion dollars per biennium.
A quick history shows that this system of flowing tax dollars through HMOs to do “managed care” of people enrolled in the aforementioned programs began in the early to mid 80’s in Minnesota.
Originally created as a “pilot project” to measure whether HMOs could deliver some healthcare services more cost effectively, it subsequently turned into a “permanent” program.
Numerous efforts by advocates and members of the MN Legislature to measure the HMO’s administrative effectiveness have been thwarted over the years.
Most recently, a push that was spearheaded by GMHCC in 2007 resulted in an OLA (Office of Legislative Auditor) report in 2008. The OLA report gave a partial glimpse into the lack of transparency and accountability in the program’s administration by the HMOs.
The issue of accountability was front and center as the subject of a joint Health & Human Services hearing, which combined both the Reform and Finance committees in a joint informational session.
Rep. Jim Abeler and Rep. Steve Gottwalt chairs of the HHS Reform and Finance committees respectively, recently convened a joint informational hearing. The impetus for the hearing was the information about the lack of HMO accountability brought forth by David Feinwachs. Feinwachs was general counsel to the MN Hospital Association for over 30 years. He was terminated for promoting information showing the lack of accountability by HMOs.
Legislation to help address the issue of HMO accountability has been offered up by Rep. Carolyn Laine and Rep. Steve Gottwalt in the MN House. The House bill is a companion to a similar measure authored by Senator Sean Nienow of Cambridge. At the heart of both bills is a call for independent and comprehensive audits of the HMOs accounting records for the state-funded healthcare programs.
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Occupy Movement Comes To Minnesota
The number of protests now known as the “Occupy” movement grows a little more each day around the country and, at last count, listed over 100 sites nationwide.
In Minnesota the OccupyMN protest has developed in downtown Minneapolis near the Hennepin County Government Center.
A variety of interests/concerns are represented at the site including spots for campaign finance reform, environmental protection, bank regulation and oversight, and, of course, healthcare reform.
100+ people were on hand (in the rain) for an October 25th Healthcare Reform Rally at Occupy MN.A healthcare reform rally was called for the evening of October 25th at the plaza and representatives from at least a half dozen groups turned out to take part in the action. Physicians for a National Health Plan (PNHP-MN), MN Universal Health Care Coalition (MUHCC), Greater Minnesota Health Care Coalition (GMHCC), Universal Health Care Action Network (UHCAN-MN), Minnesota Nurses Association (MNA), Service Employees International Union (SEIU), and the Minnesota Green Party made up the bulk of the rally contingent.
After a 20-25 minute gathering rally the group took to the street and marched three blocks away to the front of the U.S. Court of Appeals plaza (also known as Bankruptcy Court). The gathering spot was chosen because of the preponderance of bank foreclosures attributable every year to overwhelming personal medical expenses.
According to PNHP-MN spokesperson Dr. Elizabeth Frost, over 60% of all bankruptcies filed in the United States are medical expense related and, of those, almost 70% had health insurance. “This is obscene (foreclosures due to medical costs) and it’s wrong…” Frost said, “we really need to change our broken system to something that works for everyone, not just the very wealthy.”
Cravaack Attempts To Answer Medicare Questions
Congressman Chip Cravaack (CD8) has convened a handful of town hall forums in the district recently to give people the opportunity to hear from their elected representative.
His most recent forum was in downtown Mora at Freddie’s Restaurant on South Highway 65. A packed room greeted the Congressman as he spent the better part of an hour giving updates on a couple of topics, with heavy emphasis on the “overwhelming debt load” that the United States faces.
Cravaack’s presentation of charts and graphic illustrations lasted almost 40 minutes. He then opened the floor up to questions from a very polite and unusually supportive audience. The questions were mostly covered by the substance of his video presentation but he politely referred back to his charts or graphs for additional support.
One of the last questions had to do with Medicare and the proposed revamping of the entire structure. The questioner (from Seven County) asked why the proposed changes leaned heavily towards Medicare privatization through the use of a “voucher system.” To support the validity of the question an illustration was given by the questioner of the “disaster that was Part D.” He cited the small number of people that received substantial-to-moderate help and the disproportionate cost of the Medicare Part D Drug program, relative to that assistance.
Representative Cravaack stated that the Medicare changes that are being proposed under the Rep. Paul Ryan Budget plan will actually save Medicare almost “38% in overall costs.” He went on to say that the changes were “originally proposed during the Clinton administration by Alice Rivlin.” Cravaack went on to correct the terminology being used to describe the Medicare revamping, preferring to call the changes “premium support/subsidies” and not “vouchers.”
According to reports and an interview in the Washington Post* earlier this year, the referenced Alice Rivlin Medicare proposals (1993) were substantially different than the Ryan Medicare proposals (2011).
The biggest difference had to do with adjusting the amount of the support/voucher annually to the cost of inflation. If the cost of healthcare went up substantially, as has been the case for the past decade, the value of the support/voucher would drop dramatically. That shortfall would mean that the Medicare recipients would then be liable for more and more out-of-pocket expense.
At earlier town halls in Mountain Iron and at the Duluth Airport a number of questions regarding the reported savings of Medicare Part D went unanswered. Cravaack’s aides promised to “do research and get back” to the questioners shortly. As of November 14th there has been no follow-up from Rep. Cravaack's office for answers/responses to those requests.
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HMO's Reporting Requirements Under Scrutiny -
Will They Change?
A group of healthcare reform advocates, accompanied by some current legislators, received confirmation that Minnesota’s privately run system is lacking normal oversight and likely is wasting significant amounts of tax dollars.
A representative from a national accounting firm that specializes in the auditing of Managed Care Organizations (MCO) was asked to examine the practices used in monitoring the state-funded and privately administered healthcare programs in Minnesota. In his words, he was “shocked” by what he found. He called the lack of accountability “simply amazing” and indicated that the fact that this has been allowed to go on for so long “even more amazing.”
The visit and the subsequent look at the state’s healthcare practices were prompted in large part by the efforts of David Feinwachs. A video (created by Feinwachs) which pointed out the secretive nature of tax dollars handled by HMOs and insurance companies created quite a stir in the Minnesota legislature this past session. For his efforts Feinwachs was “released” from his duties as MHA (MN Hospital Association) General Counsel.
The attention to Feinwachs’ video and his accompanying report brought bipartisan support from the legislature. Republican Senator Sean Nienow (Cambridge) authored a number of bills aimed at improving transparency and increasing accountability. Likewise, Democratic Senator John Marty (Roseville) put forth similar bills with the same intent.
With the state facing a $5 billion budget shortfall, sharp scrutiny of the HMOs, which receive $3 billion bi-annually to provide health care for more than 500,000 individuals – looked inevitable early in the session. Reports that the HMOs’ financial reserves have ballooned to $2.5 billion only increased the calls for reform.
For some reason, none of the proposed bills for accountability ever got a hearing. “Bipartisan interest and no hearings – when’s the last time you saw that?” asked Feinwachs, a persistent critic of the state’s nonprofit health plans before, during and after his 30 year tenure as MHA General Counsel.
It is difficult to determine exactly why the impetus for overhauling the state’s rules for regulating HMOs, principally Blue Cross & Blue Shield, HealthPartners, Medica and UCare, dissipated and then disappeared. Capitol observers believe that a full-court press lobbying effort by the health plans effectively sidelined the issue. Together those four health plans have 27 registered lobbyists on the books.
An Executive Order issued by Gov. Mark Dayton in March may have had something to do with stalling the accountability efforts. One of the items in Dayton’s order was to cap HMO profits at 1%.
Under the directive, excess revenue would be returned to the state’s general fund. Critics of HMO accountability were unimpressed by the 1 percent cap on profits. That’s because there are no limits or definitions of what health plans can charge off as administrative overhead; the arrangement provides for no independent, outside audits of their books; and the cap is only in place for one year.
Nienow argued that the health plans can simply finesse their books to shield any profits. “The 1 percent cap is absolutely meaningless…” he said, “on paper it looks good… it’s something that makes everybody feel good, but doesn’t really do anything.”
Vermont Edges Closer to Single-Payer
Vermont has moved ahead of Minnesota and become the first state to lay the groundwork for single-payer health care when its governor signed an ambitious bill aimed at establishing universal insurance coverage for all residents.
"This law recognizes an economic and fiscal imperative," Vermont Governor Peter Shumlin said as he signed the bill into law. “We must control the growth in health care costs that are putting families at economic risk and making it harder for small employers to do business."
Legislators say the plan, approved by the Democratic controlled House and Senate this spring, aims to extend coverage to all 620,000 residents while containing soaring health care costs.
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The chief architect of the Vermont bill is Dr. William Hsiao, Harvard Professor of Economics and healthcare expert. Dr. Hsiao leads a new program in health systems studies at Harvard University. He received his Ph.D. in Economics from Harvard and is also a fully qualified actuary with extensive experience in private and social insurance. His work was the foundation for the successful single-payer healthcare system operating in Taiwan since 1995.
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In Vermont a key component of that legislation establishes a state health benefits exchange, as mandated by the new federal health care law. That exchange will then offer coverage from private insurers, state-sponsored and multi-state plans. It also will include tax credits to make premiums affordable for uninsured Vermonters.
Green Mountain Care (name given to the program in Vermont) will be managed by a five-member board; will set reimbursement rates for health care providers and streamline administration into a single, unified system.
Residents and small employers will be able to compare rates from the various plans and enroll for coverage of their choosing.
As designed, the goal is an eventual state-funded and operated single-payer system.
But its sponsors say that outcome is far from certain. The plan will be phased in over several years, with an evolving financial structure that mandates a number of conditions.
Among criteria are adoption of a financing plan by 2014; ensuring the new system costs less than the current fee-for-service one; and obtaining federal permission via a waiver to allow Vermont to proceed with the single-payer option, in around 2017.
Advocates of change say the current fee-for-service care in Vermont has a financial incentive to deliver more care, such as tests, with little attention to quality or better outcomes.
Vermont’s health care spending runs about $5 billion annually, with costs rising between 6.5 percent and 8.5 percent in recent years.
Some experts say a revised system would save an estimated $580 million annually and $1.9 billion by 2019, while creating several thousand jobs.
Reports:
Reuters and Burlington Free Press
Healthcare Education Session with Dr. William Hsiao
Seven County and GMHCC were well represented for a presentation by Dr. William Hsiao, well known healthcare expert and Professor of Economics at Harvard University. He spoke to a crowd of about 175 people on Sunday September 25th in St. Paul. Shown above are (l to r): Char Fisher (Central Senior Federation), Dr. William Hsiao, Tim Burkhardt (Executive Director 7 County, GMHCC Co-coordinator), Lila Skramstad (President – GMHCC), Mary Mayer (Treasurer - GMHCC, Central Senior Federation), and Jerry Challman (Vice President—GMHCC, N.E. Citizens Federation).
T.R. Reid ~ MUHCC Fundraiser
T.R. Reid
Seven County Attends Healthcare Fundraiser
Renowned Journalist and author T.R. Reid was the featured guest speaker at the Annual Summer Fundraiser sponsored by the Minnesota Universal Health Care Coalition (MUHCC) and the Physicians for a National Health Program (PNHP MN) Minnesota chapter. Seven County and its GMHCC partners are working closely with these groups, and more, to promote meaningful healthcare change.
Hundreds of people gathered at Macalester College in St. Paul in June to help support the cause of advancing the Minnesota Health Plan closer to passage into law in this state. Seven County had the privilege of attending this outstanding event and were represented by staff members Tim Burkhardt (Executive Director), Lisa Krahn (Outreach Coordinator), and Shannon Jackson (Communications Coordinator).
Reid spoke about the need to realistically assess reforms that have been proposed in order to find a ‘uniquely Minnesotan’ healthcare solution and he spoke glowingly about the concerted efforts underway in Minnesota to improve the delivery of healthcare for all citizens.
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Shown above: Lisa Krahn (7 County), T.R. Reid and Shannon Jackson (7 County).
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