Hospitals Shirking on Financial Assistance

view-overall-inpatient-billKiln, Mississippi    When the doctors’ union, the American Medical Association Journal of Ethics rings the bell on the horrid practices of hospitals, you know we have a tiger by the tail – and we’re in danger of continuing to be hurt badly!

The Journal looked at 140 hospitals to see how they were preparing for the mandatory rule taking full effect this January under the Affordable Care Act of providing financial assistance to lower income families. What they saw wasn’t pretty, although we could have told them that from our close inspection of many hospital IRS 990 forms in Texas, Louisiana, Arkansas, and other states.

First the Journal confirmed the fact that finding the information, even for them, and certainly this has been the case for us, was like finding a needle in a haystack. They looked at a random sample of 140 hospitals across fourteen states. In their survey, they found that half of the institutions did not say on their websites whether they were public, private, or nonprofit. Needless to say, their reporter was web savvy which also wouldn’t be true of many families desperate to find if the hospital offered any help. So, transparency, not! Also, not surprisingly, they found that for-profit hospitals generally had not voluntarily created financial assistance policies in line with what nonprofit, tax exempt hospitals are now required to do.

But here comes the real rub in what the Journal found and it goes to the heart of the vagueness of the IRS requirements for financial assistance in this new rule:

…hospital financial assistance policies vary significantly in terms of generosity and terms. Among the sample of financial assistance policies from 140 hospitals, eligibility cutoffs for financial assistance ranged from an income of 100 percent of the federal poverty level (FPL) to 600 percent of the FPL. Many hospitals with financial assistance policies offered free care to those with incomes up to 100-200 percent of the FPL and sliding scale discounts above that threshold. However, some hospitals did not offer any free care and only offered moderate discounts even to the poorest patients. Of the hospitals in the sample that provided eligibility information based on insurance status, a quarter excluded those with insurance from their financial assistance policies altogether.

Bottom line, if your wallet is a bit light, you better start doing some research so that when you get sick you can find that 600% hospital or you are up a creek with no paddle. And, for those hospitals that exclude any lower income family from financial assistance if they have any insurance at all regardless of the deductible, we, and all those like us, need to start figuring out a way to challenge their tax exempt so-called charitable status.

The Journal was also clear about the hospital rip that starts with the “rack” rates for cares or charge master rates.

Hospitals routinely charge uninsured patients undiscounted “chargemaster” prices, the “rack rates” or list prices of the health care industry, while government and commercial payers receive substantial discounts of 50 percent or more of the chargemaster prices for their members

Yes, you are hearing this right. If you are covered with insurance, your bill is discounted. If you are uninsured and out of luck, your bill is essentially doubled!

The Journal argues that California provided a model that would have been immeasurably better and that has worked well for hospitals and patients in that state.

California’s Hospital Fair Pricing Act… limits how much California hospitals may charge uninsured patients who earn less than 350 percent of the FPL or insured patients whose medical bills exceed 10 percent of household income

Unless a miracle happens in the next several months, like the old song, we’re all going to wish we were living in California. When the doctors of all people in the AMA start calling out hospitals as bloodsuckers, you know we’re in a fight for our lives.

***

Please enjoy the Wallflowers’ Back to California

Creepy but Reassuring to Read Hillary Emails

Screen Shot 2015-09-01 at 9.56.45 AMKiln, Mississippi    Let us be clear and make no bones about it, it was a huge misjudgment for Hillary Clinton to use a private email address and server while Secretary of State. No organization in their right mind would ever have allowed it, and it establishes an unfamiliarity with working for others, as opposed to yourself, which is worrisome at a very fundamental level in my view. There’s the whole transparency thing, which worries me less. She’s got folks gunning for her figuratively and literally, so it is not unreasonable to be cautious about information. The accountability issue is more my concern and the ability to subsume self-interest to collective enterprise.

Saying that she stubbed her toe does not equal believing she should take a fall. And, reading the actual reports of her emails is reassuring in some ways because there seems little smoke or fire. Long emails from your daughter giving you a heads’ up that essentially Haiti is going to hell in a hand-basket and it could end up on Mom and Dad’s shoes is good advice and what every parent should hope to hear from their children. Hearing from Chelsea that the State Department website is archaic and sucks, especially when Hillary as Secretary of State in all likelihood never did more than cast a passing glance at it every blue moon is also a tip from a young one bringing Mom back to modernity that would be invaluable I would think. Who knows what this really says about Hillary, since there were no reports of her action upon getting the down-low from her daughter, but definitely Chelsea’s stock went up in my book.

As did Hillary’s in a weird way. I like the fact that she might be perversely flattered that a robber used a Hillary mask in a heist, even if her tongue was in her check. Be honest with me, that’s hilarious, and the spot on response from the Clinton family lawyer, David Kendall, profiled recently as a courtroom killer of rare powers, assuring her that though robbers have used Nixon masks repeatedly and Reagan masks as well, she might be the first Democrat so honored, is also just plain a hoot. Even the reports of her wondering about the real skinny on White House gossip or whatnot is a fair play. She was riding for the brand, so she should care what was happening at the ranch house. This kind of stuff in my view makes her look human, and Hillary desperately needs to be seen more often as human, rather than a 21st century calculating machine.

Then there’s the tempest in the teapot aspect to all of this that leaves you feeling like you are peeping at someone’s personal emails over their shoulders. The skinny on that according to The New York Times on these emails that were…

4,368 documents totaling 7,121 pages, posted online …by the State Department as part of a monthly disclosure ordered by a court after the revelation that Hillary Rodham Clinton had used a private email server while she was secretary of state. The department initially said it had redacted information from roughly 150 emails because they contained sensitive information, then reduced that estimate to 125. The information was deleted because “confidential” materials — the lowest classification of government intelligence — had been discovered in the correspondence. None of the documents were marked classified at the time they were sent, said Mark Toner, a spokesman for the State Department.

Best join me in laughing about bank robbers in Hillary masks, because up close this little dust-up is starting to seem little more than boring no matter how bad it looks from a distance.

hillary_robber

UC’s, AC’s, and ULP Procedures Available to Expand NLRB Joint Employer Ruling

Screen Shot 2015-08-31 at 9.12.31 AMKiln, Mississippi    The decision in Browning-Ferris by the National Labor Relations Board clearly means a lot to subcontracted workers as we have discussed and their ability to bring the real power of the company, not their contractor to the bargaining table. The key in organizing new workers will be a deep understanding of the work situation of the potential bargaining unit sufficient to file initially for representation from joint employers, not just the outfit whose name is printed on the workers’ pay stubs.

It is well known that organizing the unorganized is hard and exacting labor already, now bringing in the joint employer will also be easier said, than done. Since the burden is on the union to establish the status, almost invariably without initial access to the contract between the subcontractor and the main company, much of the argument will have to be made based on a detailed understanding of the workplace and its rules. The contract establishing company prerogatives, either exercised or inherent, would not emerge without a subpoena, if there were a hearing, or board demand after the union’s filing of the petition. Under the new rules most of the hearing issues, if there are any as determined by the Regional Director, are after the election, so this will mean a quicker election but sealed ballots, as was the case with Browning-Ferris and the Teamsters, if a hearing is scheduled. This will be interesting.

We know from the decision that the Board has already ruled that any cases pending where petitioners had argued there was a joint employer status would find relief now. But what about subcontracted workers already under contract by unions? What relief do they get from the joint employer decision? Is there even a way to use the ruling to expand the unit already under contract given this new NLRB decision?

The simplest way to go would be to file an Amended Certification of AC petition with the board it would seem to me. According the NLRB’s Rules and Regulations:

The Employer or Union can file an AC Petition (1) to resolve an ambiguity in the description of a certified unit, (ii) to reflect a change in the duties of certain Employees in the unit, or (iii) to reflect a change in the identity of the bargaining agent.

The Browning Ferris decision was silent on existing units, so we are speculating obviously, but, hey, you make your case and take your chances. If it doesn’t work there is always the unfair labor practice route.

Conferring with Doug Young, our excellent Austin-based attorney, it also seemed to us like a unit clarification procedure might work in a situation where the union was seeking to add workers to the bargaining unit and trigger the joint employer status at the same time. A UC-petition, as it is known under the National Labor Relations Act, allows either a company or a union or in some cases both to petition the Board to determine issues like the placement of workers not initially part of the representation certification or decision and direction of election if circumstances changed in the workplace. Importantly, a unit clarification also allows for accretion or adding workers to the bargaining unit if an expansion of job titles or diverse workers had enlarged the unit. A finding that there is a “community of interest” with the existing bargaining unit, would either lead to an automatic accretion if the number of the additional workers is relatively small, often through voluntary compliance or recognition by the employer, or a new election among the added workers or the entire bargaining unit depending on the circumstances. If there is a UC-hearing, then it works just like an RC-hearing if there had been one on the initial filing. The new rules on elections give the Regional Director discretion on whether or not to allow a brief to be submitted by the attorney for the union or the company. That being the case, this process might not be seamless, but it will be quicker than in the past. I bet in the Browning Ferris case that the Teamsters already represented BFI workers and were organizing a new unit of the subcontracted recycling employees. In this situation the union would be going the other way and trying to accrete the primary company employees, especially if a small number like the BFI situation. Maybe a stretch, but still might be good exercise.

The other way to go, and perhaps the surest route, I would think would be simply to make a demand in bargaining that the big boss come to the table to bargain on the issues where they call the shots, and then to file an unfair labor practice 8a5 charge if they refuse to comply. The downside to my knowledge is that nothing has really sped up the ULP procedures. Evidence would be submitted by the union and reviewed by the Region and then “agenda-ed,” as they call it, to determine whether or not the Region will issue a ULP charge against the company, and then barring a company’s voluntary compliance, which I would rarely expect, it would be set for a hearing some, and more likely many, months away before a NLRB Administrative Law Judge, then a decision, then possible appeals, court challenges, etc, etc, etc. I’m not saying that would take forever, but it would absolutely take months, maybe years, so I’m not sure it’s the quickest route, even if it is the most accessible.

On the bottom line we won’t know until unions start jumping in the water and trying to swim.

***

Please enjoy A Fragile Tomorrow’s One Way Ticket (Featuring Joan Baez and the Indigo Girls)

Demand Withdrawing Arrest Warrants to Stop Debtors’ Prison

s27272609New Orleans   It seems almost incredible to say that anything good could come from a spokesperson from Ferguson, Missouri or for that matter the State of Missouri when it comes to criminal justice issues, but this may be proof that in fact the sun does shine on old dogs every once in a while.

But, yes, Ferguson, the St. Louis suburb now infamous for the police killing of Michael Brown last year and helping trigger the movement, Black Lives Matter, has announced that it is withdrawing thousands of arrest warrants for municipal violations. Furthermore they are also claiming to enact protocols that would prevent the incarceration of people who cannot pay fines and fees. Ferguson acted in advance of measures being taken by the State of Missouri and passed by its legislature to curtail and cap the cash that municipalities can keep from minor traffic beefs. Missouri is also moving to put an expiration date on practices of the modern criminal injustice system that have created debtors’ prisons of our jails and many of our communities by putting caps on the amount of time people can be locked up for failing to pay fines and fees. What can I say, other than, right on!

Well, plenty, starting with “it’s about time!” Not just for Ferguson, but everywhere. How much more evidence do we need that we have criminalized the poor with their own poverty and that the vicious cycle of pyramiding fines and fees that act as a huge bungee cord pulling people back into the system for every petty beef and larding on the costs until they’re back in jail? The Justice Department investigations have found this not just in Ferguson and other St. Louis suburbs, several of them vacuuming up more money in this way than Ferguson, but in communities around the country. We’ve cited excellent books including Michelle Anderson’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness early and prescient warnings in this area and Alice Goffman’s more recent unmasking of Philadelphia’s system in On the Run: Fugitive Life in an American City. How much more evidence do we need that this system is broken? How many more up-close-and-personal stories of this boomeranging of young men – and women – back to jail from selective policing in lower income, minority communities for minuscule beefs with escalating financial penalties?

Enough is enough.

In every community, we need to demand that lessons be learned from Ferguson, limits placed on penalties, and petty arrest warrants withdraw. There’s no way to repaint this problem or clean it up. We need a criminal injustice system makeover, a gut rehab down to the studs with an amnesty program vacating all of this garbage on minor, trivial matters, to realign our communities and our criminal justice and policing systems.

If Ferguson can do it, so can everyone else. It’s worth making the demands and engaging in the fight.

***

The Woodbox Gang’s Born With A Tail

Charter School Takeover Success Myth Shattered

charter-schoolNew Orleans    Call it what you may, charterization, privatization, or whatever the opposition of business and other elites to the public education system in the United States has gotten the kind of superficial analysis normally reserved for fashion trends and fall season television shows. The basic analysis is contentious and conducted at the high decibels of yelling voices arguing either that public schools suck, teachers are worthless and greedy, unions are obstacles, or on the other side that schools are suffering from inadequate funding, poor physical plants, and systemic racism that is abandoning many urban districts.

All of which made it a relief to finally see a sober, factual analysis of the largest charter school system experiment in the country that New Orleans has been subjected to in the wake of the post-Katrina takeover of the schools by Andrea Gabor, a professor at Baruch College of the City University of New York published in the New York Times.

Looking at the Recovery School District, as the charter takeover schools were called, Gabor finds that this so-called experiment has meant that the “reforms have come at the expense of the city’s most disadvantaged children, who often disappear from school entirely and, thus, are no longer included in the data.” Plain English: the charters only look good because they have been allowed to “cook the books.” Gabor quotes one of the few black charter-school leaders in the city saying, “There were pretty nefarious things done in the pursuit of academic gain” including “suspensions, pushouts, skimming, counseling out, and not handling special needs kids well.” This is the inevitable result of a system designed to teach to the test to survive. If you aren’t willing or able to educate the children, then get rid of them so that they don’t count against you in the scoring.

What’s going on? Gabor documents the following:

· After schools are taken over by charters, less than a third of the students in the previous school are enrolling.
· “In the decentralized charter system, no agency is responsible for keeping track of all kids,” meaning dropout rates are unreliable. An outside agency using Census Data from 2013, “found that over 26000 people in the metropolitan area between the ages of 16 and 24 are counted as ‘disconnected,’ because neither working or in school.”
· Takeover schools that were rated “F” as falling once charterized become “T” for turnaround, and thus are not counted as “failing,” “nor would 16 “D” schools. In fact “40 percent of RSD schools were graded ‘D,’ ‘T’ or ‘F’” in 2013-14.
· Most of charter performance have been “doled out selectively, mostly to pro-charter researchers, and much of the research has been flawed.” She cites a humiliating incident last year when the Cowen Institute had to retract a study claiming that “most New Orleans charters were posting higher-than-expected graduation rates and test scores.” Cowen had been the former head of Tulane University and unabashedly a charter cheerleader, including putting a million of Tulane’s money in a post-Katrina charter that would give preference to the children of professors and employees.
· A Stanford University center claimed progress with a flawed methodology that compared charter school performance to a supposed “twin,” even though there are no non-charter schools in New Orleans now.
· African-American educators argue that “the charter movement won’t have ‘any type of long-term sustainability’ without meaningful participation from the black community,” which in New Orleans is 60% of the city.

It goes on and on, but Gabor’s bottom line is worth remembering:

“For outsiders, the biggest lesson in New Orleans is this: It is wiser to invest in improving existing education systems than to start from scratch. Privatization may improve outcomes for most students, but it has hurt the most disadvantaged pupils”

In a city like New Orleans and many other urban districts throughout the country, the public school system is populated with “disadvantaged pupils” and minorities. Time to stop proselytizing and start educating.

Banksy’s Dismaland

Announcing: ACORN are an official part of Banskys Dismaland! And you can too - we need your help! Visit http://www.acorncommunities.org.uk/disma_volunteer to get involved!

Announcing: ACORN are an official part of Banskys Dismaland! And you can too – we need your help! Visit http://www.acorncommunities.org.uk/disma_volunteer to get involved!

New Orleans      At the end of a long catch-up Skype call with Stuart Melvin, ACORN United Kingdom’s national organizer, he mentioned he and some of the members were going to be spending some time at an odd street festival of sorts not far from our folks in Bristol, England along the coast in a town called Weston-super-Mare. Stu kinda laughed about it, said he couldn’t really describe it, but I should just Google the name of the town, and I’d get a sense of it. I meant to do so of course, but I didn’t, you know how these things go, there’s only so much time in the day.

A couple of mornings later I scan a piece in the New York Times about the latest mashup from world famous street and graffiti artist, and Bristol-native, the ever elusive, Banksy. The art community had been wondering what he had been up to during an unusually quiet stretch and suddenly, and in his typical way, secretly it seemed, he had opened a massive thing he called Dismaland on the English seaside. Interesting, I thought and kept on pushing.

Later at work an email from Stu says this bizarre experience went well. Ah, that’s right the gang was going to the shore, I’d almost forgotten. Finally, the pieces came together when I saw a Facebook picture of our crack ACORN Bristol organizer, Nick Ballard, waving an ACORN flag standing next to one of our volunteers, and in the background was, yes, you guessed it, Dismaland! Damned if Banksy and his people, whoever they might be, hadn’t invited ACORN to be one of the street attractions for this 5-week extravaganza that observers believe might attract as many as 400,000 people. No wonder Stu was excited that in his first afternoon out there in a couple of hours we had enrolled 50 provisional ACORN members, all of whom wanted ACORN in their towns!

The Guardian refers to Dismaland as a mixture of anarchism and amusement park. I’m Ok with that. Just days before the Bristol ACORN crew had posted pictures of a typical summer day and it was basically a shot of dark, cold, and rain. Now reading the descriptions of Dismaland and looking at some of the pictures, what can I say, I wish I were there!

For the art lovers, Banksy is displaying 58 artists’ work, and says these are pieces from the best contemporary artists in the world, “apart from the two that turned him down.” He has 10 new pieces on display including a thing on Cinderella where her carriage has crashed killing her and her horses. You buy your 3 pound ticket online except that the huge demand has crashed the dismaland.org.uk website of course when I first visited, and then you have to endure a cardboard security station with guards in pink hi-viz vests who tell you that you cannot bring squid into the park. There is a warning that no officials or lawyers from Disneyland are allowed entry of course.

There are the normal amusement park features with a twist. The isn’t an ATM but there is a “loan shop” for children that satirically jabs at 5000% interest rates and payday lending. There’s a portrait artist, but you can only get a portrait of the back of your head, which the promo says “is surprisingly revealing.” In a takeoff of the longstanding English institution, the Citizens Advice Bureau, the Comrade’s Advice Bureau teaches all interested in how they can unlock the bus display advertising posters and sells a special 5 pound tool to do the job. When asked whether this was legal, the Dismaland guide told The Guardian, “it is not illegal.”

How great is this? ACORN is honored and excited to be a part of this whole affair. But, hey, Banksy, what does it take for us to put this show on the road, so we can all go, have some laughs, be part of the fun, and shove our funny bones into the fat guts of the powers that be here and elsewhere around the world?

***

These pictures credited to The Guardian. . .

banksey2 banksey5 banksey1 banksey8 banksey4 banksey7 banksey9 banksey3 banksey6 banksey11 banksey10