Surprise Medical Billing Drives Up Health Care Spending by $40 Billion a Year

The Fiscal Times – Health Care

Surprise Medical Billing Drives Up Spending by $40 Billion a Year: Report

By Michael Rainey       December 17, 2019

Getty Images/Joe Raedle

It looks like Congress won’t be doing anything about surprise medical bills this year, but a new study in Health Affairs shows why the issue will likely remain font and center next year.

Analyzing reams of insurance data, researchers found that many out-of-network bills come from a small percentage of medical specialists who typically work in emergency rooms at for-profit hospitals and who therefore cannot be avoided by patients. While out-of-network charges are produced by only a small percentage of hospitals and practitioners, the bills that do emerge are sometimes much higher than average and push up spending by private insurers by billions of dollars – costs that are eventually reflected in everyone’s premiums.

“When physicians whom patients cannot avoid can work out of network from in-network hospitals, it exposes patients to significant financial risk and raises physicians’ in-network payments,” the study says. “Anesthesiologists, pathologists, radiologists, and assistant surgeons are out of network in approximately 10 percent of cases [in the study]. We estimated that these specialists’ ability to bill out of network raises total health care spending for people with employer-sponsored insurance by approximately 3.4 percent ($40 billion).”

Dan O’Neill, a health policy fellow at the Robert Wood Johnson Foundation, did some quick back-of-the-envelope math to calculate the average cost for policyholders, based on the study in Health Affairs: “To boil this down to a headline: The business practice of surprise billing costs a typical American family on a private health plan about $1,000 per year (+/-).”

Trump’s proposed Social Security disability cuts could end benefits for thousands.

USA Today – Politics

Trump’s proposed Social Security disability cuts could end benefits for thousands. What to know

This is why Social Security is running out of money


NASHVILLE, Tenn. – The Trump Administration is proposing new rules for the nation’s safety net program for people with disabilities that could end benefits for tens of thousands of people.

The rules would require more frequent paperwork checks of people getting Social Security disability payments in a process known as a “continuing disability review.”

The proposed new rules have alarmed some advocates for people with disabilities, who call it a “backdoor way” to cut people from a program already under scrutiny for taking years to review disability claims and wrongly denying benefits.

Social Security Administration officials say the plan would “enhance program integrity and ensure that only those who continue to qualify for benefits will receive them.”

Whose Social Security disability benefits would be impacted?

More than 16 million adults and children currently receive disability benefits, but the Social Security Administration isn’t saying how many people the new rules would affect.

The agency has said it expects to conduct 4.4 million more continuing disability reviews over ten years if the rules take effect. The reviews would add $1.6 billion in administrative costs, but save $2.8 billion in benefits when people are cut from the program.

Using those figures, national advocates for people with disabilities estimate tens of thousands of people stand to lose disability benefits each year.

Alan Chrisman holds medical bills and records near the McDonald's where he worked at as a maintenance employee before being diagnosed with stage 4 colorectal cancer. This photo has been altered to blur the address on the envelope.

What is Social Security disability?

The Social Security Administration is best known for retirement benefits, but it also oversees two programs for people living with disabilities:

Supplemental Security Income, or SSI, is for low-income individuals without a work history. The maximum payment for an individual is $783 a month beginning in January.

Social Security Disability Insurance is for workers who become disabled. Payment amounts depend on past earning. In 2019, the average payment was $1,234 per month.

To qualify for either, individuals must show they have a long-term medical, psychological or intellectual impairment that prevent them for working.

Children who are blind or have severe functional limitations expected to last at least a year or result in death also qualify.

Tennesseean investigation: How some Tennessee doctors earn big money denying disability claims

The fine print on disability reviews

Once on disability, adults and children are subject to “continuing disability reviews” by Social Security staff.

The reviews require recipients to submit medical, income and asset records as well as documentation of living arrangements. Social Security staff then decide whether someone still qualifies for benefits.

How frequently anyone is required to go through a review depends on which of three categories Social Security has placed them in. Individuals whose conditions are expected to improve — babies born prematurely, for example — are in a category called “medical improvement expected” and reviewed every six to 18 months.

Victory for disability advocates: Supreme Court won’t hear Domino’s Pizza accessibility case

People with debilitating or terminal conditions are in a “medical improvement not expected” category, reviewed every five to seven years.

Those in the “medical improvement possible” category are reviewed every three years.

Social Security officials are proposing a fourth category, “medical improvement likely,” to be reviewed every two years.

Children would also be automatically reassessed at age 6 and 12. The Social Security Administration would also change some of the criteria for deciding in which category to place individuals.

You can read the rules here.

How applying for disabilities works in Tennessee
How applying for disabilities works in Tennessee

Disability docs: Doctors speed through disability claims, make millions: 6 takeaways from our investigation

Why the Social Security plan is controversial

The reviews require recipients to submit large volumes of paperwork, a complicated and burdensome process for people living with a disability.

People go through a similar process when they first apply, which can take two or more years to complete.

Advocates are concerned people would lose benefits because they are unable to navigate the process, even though they did not experience any medical improvement.

A Tennessean investigation earlier this year found that some doctors hired to review disability claims raced through the paperwork at an implausible pace while billing six figures annually.  Experts say it’s impossible to review disability claims so quickly without wrongfully rejecting claims. The report prompted an investigation by the Government Accountability Office, which is ongoing.

Advocates have also questioned the Social Security Administration’s projected savings.

The new reviews will save about $1.50 for every dollar spent, according to agency estimates.

Those projected savings, however, are significantly lower than what the Social Security Administration says it saves on current disability reviews: about $19 for every dollar spent.

What happens next?

A public comment period is open until Jan. 31 before the rules can be approved.

Congressional Democrats, in a letter to the Social Security Administration on Dec. 19, requested the comment period be extended to March 16.

Comments may be submitted online here or mailed to the Office of Regulations and Reports Clearance, Social Security Administration, 3100 West High Rise Building, 6401 Security Blvd., Baltimore, Maryland 21235-6401.

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This article originally appeared on Nashville Tennessean: Social Security disability benefits program may change: Things to know

Trump rails against windmills: ‘I never understood wind’

The Hill

Trump rails against windmills: ‘I never understood wind’

By John Bowden       December 22, 2019

Trump rails against windmills: 'I never understood wind'
© Getty Images


President Trump  lashed out again at wind farms on Saturday, claiming that the production of wind turbines causes a large carbon footprint.

During a speech to the conservative student group Turning Point USA, Trump told attendees that he “never understood” the allure of wind power plants, according to a report from Mediaite.

“I never understood wind,” Trump said, according to Mediaite. “I know windmills very much, I have studied it better than anybody. I know it is very expensive. They are made in China and Germany mostly, very few made here, almost none, but they are manufactured, tremendous — if you are into this — tremendous fumes and gases are spewing into the atmosphere. You know we have a world, right?”

“So the world is tiny compared to the universe. So tremendous, tremendous amount of fumes and everything. You talk about the carbon footprint, fumes are spewing into the air, right spewing, whether it is China or Germany, is going into the air,” the president added.

Critics of wind power plants frequently point to the carbon emissions from concrete and other manufacturers involved in the production of wind power farms as a reason against further construction of wind farms. However, the American Wind Energy Association (AWEA) found that wind farms around the world generated enough energy to avoid 200 million tons of carbon pollution from burning fossil fuels last year, and estimates that most wind power plants repay their own carbon footprints within six months of operation.

Trump also claimed during his speech that wind power plants are responsible for killing birds, including bald eagles.

“A windmill will kill many bald eagles,” he said, according to Mediate. “After a certain number, they make you turn the windmill off, that is true. By the way, they make you turn it off. And yet, if you killed one, they put you in jail. That is OK. But why is it OK for windmills to destroy the bird population?”

study earlier this year found that about 150,000 birds are affected by wind turbines in some way every year in the U.S., a number that remains far lower than the number killed by domestic animals each year.

John Roberts’s Surprisingly Straightforward Task Ahead

Chief Justice John Roberts

Now that President Donald Trump has been impeached, the nation’s attention will soon turn to Chief Justice John Roberts, who is constitutionally obliged to preside over the forthcoming Senate trial. This may seem like an impossibly difficult task: How will he respond to potential Republican efforts to truncate the proceedings with a premature vote? And more challenging still, at a time when the Supreme Court stands accused of politicization and ideological polarization, how will he resolve contentious disputes without putting his own neutrality, and that of the judiciary, in question?

For answers, the country doesn’t have to look further than the hands-off approach perfected by Roberts’s predecessor, Chief Justice William Rehnquist, who rightly recognized that the Senate—not the chief justice—commands the proceedings. The senators themselves will determine just how hard or easy Roberts’s job will be, but as Rehnquist demonstrated, the Senate’s rules and historically heavy reliance on its own past practices prevent it from forcing a skillful presider into an uncomfortable corner.

To be sure, Rehnquist was uniquely suited to preside over President Bill Clinton’s impeachment trial. The respect he commanded from the Senate flowed in part from the fact that he happened to be an impeachment expert: Years before Clinton’s impeachment trial, Rehnquist, an amateur historian, published a well-received book detailing the impeachments and acquittals of Supreme Court Justice Samuel Chase and President Andrew Johnson. The Senate was aware of Rehnquist’s authority on the process—its solemn objectives and potential pitfalls—as well as his views on the importance of those acquittals. In Rehnquist’s assessment, the conviction of Chase or Johnson would have upset the checks and balances established by the Constitution, undermining judicial review (in the case of Chase) and executive authority (in the case of Johnson) and moving the nation closer to a regime of congressional supremacy.

Roberts does not have similarly articulated views on the subject. But the suggestion that he will do anything to inject himself into the political fray or serve as the ultimate decider on key issues not clearly addressed by the Senate rules or precedents requires ignoring his well-established commitment to judicial nonpartisanship and sensitivity to respecting the powers and competencies of the various branches. The suggestion also reflects, at best, confusion over his duties as the official presider.

One popular analogy for understanding the Senate phase of the proceedings is a standard civil or criminal trial, in which the chief justice plays the role of judge while the senators act as the jury. It’s an appealing analogy, but also a very bad one. Judges decide law, and juries assess facts. In an impeachment trial, by contrast, the senators will make virtually all the important legal determinations as well as the factual ones. The Senate’s function in deciding the legal issues is no small point, given that facts have not been the primary point of disagreement in any past presidential impeachments. The disagreements have been largely over the legal significance of those facts.

Roberts, should he follow Rehnquist’s lead, will serve not as the judge but as the presiding officer. There is a script for that. He will read the senators’ written questions. He will recognize speakers. He will call the Senate to order; he will call recesses; he will adjourn. Like Rehnquist, he may occasionally get up to stretch his back, but probably only after politely advising the chamber that this is not intended to disrupt the proceedings. On issues minor and major, he will rely heavily on the Senate parliamentarian, Elizabeth MacDonough (the first woman ever in the role), who will serve as a living encyclopedia of Senate rules and conventions—in other words, supply in real time the information required to facilitate recognition of and deference to Senate precedents, and in this way establish some neutral baselines. In a 1978 interview, Floyd Riddick, who served as Senate parliamentarian during preparations for the planned impeachment of President Richard Nixon, explained the point simply: “Generally speaking, I think [the chief justice] would find, just like the senators find, that it’s better to follow the practices and precedents of the Senate which are told [to] him by a nonpolitical person, rather than to go out on a limb on his own … and get overruled by the Senate.”

That’s not to say Roberts will make no important decisions, or that in these complex, highly formalistic proceedings, there won’t be material points of procedure that invite scrutiny from lawmakers and the nation. But his role will be limited by constitutional design. Under Article I, Section 2, the Senate has “the sole Power to try all Impeachments,” and the Senate impeachment rules reflect this mandate. Those rules are subject to revision by a Senate majority, but in the century and a half since the very first presidential impeachment, that of President Johnson, they have undergone only minor updates and will likely prove sticky. The same rule that allows the chief justice to rule on evidence and objections also says that he can refer these matters for determination by the Senate. Rehnquist made referrals, and when he decided to rule, it was with the common sense and savvy that came of understanding he could be instantly overruled by a simple majority vote. (The majority’s ability to overturn the presiding officer is not unique to the impeachment process, but an ordinary point of procedure incorporated from the Senate’s standing rules.)

The country should be less concerned about anything the chief justice is likely to do and more concerned about how fairly his decisions will be portrayed by commentators eager to wring political significance from his every word and action. This is a point worth considering because historically, this commentary has ventured into the absurd. For instance, the Trump supporter and radio personality John Cardillo has made waves for arguing that Chief Justice Roberts should recuse himself from presiding over a Trump impeachment trial. Why? Because in 2018 Roberts asserted the independence of the judiciary after Trump publicly criticized “an Obama judge” who issued an order preventing the administration’s asylum policy from going into immediate effect. In response, Roberts issued a rare statement: “We do not have Obama judges or Trump judges, Bush judges or Clinton judges. What we have is an extraordinary group of dedicated judges doing their level best to do equal right to those appearing before them.”

The idea that Roberts compromised his judicial neutrality by asserting judicial neutrality is not a serious proposition to anyone familiar with 28 U.S.C § 455 or the code of conduct for United States judges (which does not bind Supreme Court Justices, but which they all consult for guidance. That the recusal proposal has received any airtime at all is itself an outgrowth of the political gloss that was applied to Roberts’s statement back when he made it. At the time, observers insisted, some gleefully and some disapprovingly, that the statement was a “rebuke” of Trump. This characterization says a great deal about the country’s growing cultural tendency to breathlessly examine the federal judiciary through the prism of personal entanglement, rather than constitutional obligations and institutional competencies. The proposition that there was anything improper about the chief justice’s affirmation of the federal judiciary’s independence ignored the fact that he is the face of a professional workforce and co-equal branch of government whose legitimacy turns on principles of impartiality that were challenged by the president of the United States.

America has few precedents for presidential impeachment, and none for presidential conviction and removal. The public rightly finds the idea of politicians charging and trying anyone profoundly weird and disconcerting, and to make sense of how this is supposed to work, to understand the saga that is about to unfold, people will naturally grasp for metaphors and models. They want a framework to consult as they read the news and watch the televised proceedings. They want a factual basis for discerning when their representatives are conducting themselves thoughtfully and in adherence to their oath of office, or throwing down like prizefighters in a hopeless partisan melee.

As the country searches for something solid and dispassionate in the midst of political spectacle, it will benefit, on balance, from seeing the chief justice presiding. Not because he will serve as a judge, but because he won’t. Not because he will force any major rulings, or save the Senate from itself, but because he can’t. The question of removal lies in the hands of 100 people constitutionally assigned to answer it. It’s out of Roberts’s hands.

This story is part of the project “The Battle for the Constitution,” in partnership with the National Constitution Center.

Jane Chong is the former deputy managing editor of Lawfare and served as a law clerk on the U.S. Court of Appeals for the Third Circuit.

Trump Has Now Shifted $1.7 Million From Campaign Donors To His Private Business


Trump Has Now Shifted $1.7 Million From Campaign Donors To His Private Business

The Trump campaign is spending big money at the president’s properties, according to a review of Federal Election Commission data. Yet the records show that Donald Trump still has not donated any of his own funds to the campaign. That means America’s billionaire-in-chief has shifted $1.7 million from campaign donors into his private business.

Forbes first reported on this arrangement one year ago, when documents showed that Trump’s companies had taken in $1.1 million of campaign-donor money. By the end of 2018, that figure had climbed to $1.3 million. Subsequent disclosures show that more than $450,000 flowed into the Trump empire from January to September of this year.

The biggest beneficiary has been Trump Tower Commercial LLC, which controls the president’s famous Manhattan skyscraper. Trump still owns the entity, which has accepted $1.2 million in rent from the reelection effort and another $225,000 from the Republican National Committee. Since Trump became president, an estimated 1.6% of the tower’s revenue has come from either the RNC or the reelection campaign. The majority of Trump Tower’s income comes from Gucci, which leases 49,000 square feet of prime retail space on Fifth Avenue for roughly $21 million a year.

In the basement of Trump Tower, a much smaller space now serves as an official campaign store, selling hats, T-shirts, signs and other memorabilia. The rent payments for that space could be flowing through an entity called Trump Restaurants LLC, which has taken in $87,000 of rent since Trump became president. On a price-per-square-foot basis, the campaign may be paying more for that basement space than Gucci is paying for its street-level location upstairs. Smaller spaces tend to command higher rates, but the payments have nonetheless raised eyebrows.

The disclosures reveal one payment to Tag Air Inc., an entity set up to lease the president’s personal Boeing 757. It was the first time since Trump took office—and therefore gained access to Air Force One—that the campaign paid the president’s private aviation company. The amount was small, just $2,700, and the exact rationale remains unclear.

A spokesperson for the Trump Organization ignored specific questions about the expenditures, instead issuing a general statement asserting that the transactions are legal. “The campaign pays fair market value under negotiated rental agreements and other service agreements in compliance with the law,” the spokesperson said in a statement. “The campaign works closely with campaign counsel to ensure strict compliance in this regard.”

The Trump Corporation, another one of the president’s companies, collected $65,000 from the Trump campaign in the first nine months of 2019, more than it did during all of 2018. Campaign filings list those expenses as “legal and IT consulting.” It is not clear why the Trump Organization is charging the campaign for such things or why the expenses increased since 2018.

There are additional questions about money flowing into Trump Plaza LLC, which collects roughly $3,850 in monthly rent, according to the filings. Trump Plaza LLC controls a property on Third Avenue in New York City, which includes 128 parking spaces, seven storefronts and eight residential units. It’s a mystery what the campaign is renting there, although a former member of Trump’s 2016 team previously told Forbes that staffers sometimes crashed at an apartment on the premises.

One high-profile property that did not take in much money during the first nine months of 2019? The Trump International Hotel in Washington, D.C. Forbes found just $761 of expenditures there from January through September 2019. Over the same period in 2018, the Trump campaign doled out more than $30,000 at the hotel. Not that the business is going without customers. The Republican National Committee, for example, spent more than $35,000 there from January to September.

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Dan Alexander: I write about Donald Trump, the people around him, and how they affect business. Before he won the presidency, I covered billionaires, industrial America and sports. My …

The Lincoln Project: Conservative critics launch PAC to take down Trump.

By Abbey Marshall              December 17, 2019
A group of conservative critics of President Donald Trump — including lawyer George Conway, husband of White House aide Kellyanne Conway — is launching a super PAC that will spend the next year actively working against Trump’s reelection and Trump loyalism within the GOP.a man wearing a suit and tie: George Conway.© Chip Somodevilla/Getty Images George Conway.

“Patriotism and the survival of our nation in the face of the crimes, corruption and corrosive nature of Donald Trump are a higher calling than mere politics,” the founders of Lincoln Project wrote in a New York Times opinion piece published Tuesday. “As Americans, we must stem the damage he and his followers are doing to the rule of law, the Constitution and the American character.”

The group also pledged to transcend partisanship to preserve Constitutional principles. “(Trump) has neither the moral compass nor the temperament to serve,” the opinion piece continues.

George Conway, a conservative lawyer who has frequently offered scathing criticism of Trump, has created political headaches for Kellyanne Conway, one of Trump’s most loyal advisers. George Conway and Trump have exchanged pointed barbs, with Conway calling for the president’s impeachment for allegedly corrupt behavior, and Trump coining Conway the “husband from hell.”

George Conway: I’m ‘horrified’ and ‘appalled’ that the GOP has come to this

Now, as George Conway is actively campaigning against his wife’s boss, questions are sure to continue about the opposing political stances.

Other principals in the group include Steve Schmidt, a former adviser to John McCain; John Weaver, the chief strategist for John Kasich’s presidential campaign in 2016; and Republican political strategist Rick Wilson.

The group is aiming to raise and spend millions of dollars on advertising to dissuade Republican voters from backing Trump’s reelection bid.

“Those wounds can be bound up only once the threat has been defeated,” the Lincoln Project founders wrote. “So, too, will our country have to knit itself back together after the scourge of Trumpism has been overcome.”