#(and also to hold members of staff/departments accountable for failing to follow university policy when interacting with disabled students)

[feinstone]

Congratulations on graduating! That must be an amazing feeling.

thank youuuu <3

technically i won't be graduating until the end of the year because i finished past the cut off date for my uni's mid-year graduation ceremonies, but i'm happy to have finished regardless.

it's been a really difficult and long process, and i had to delay finishing my degree by 2 years due to a long string of Life Events (Not Fun) that got in the way of me completing the last 2 courses i had left in my degree as of mid-2022, so i'm glad i finally managed to get to the end of a semester without some random bullshit stopping me for the first time in several years lmao.

i dropped out of high school after i got sick, and i thought i was gonna have to drop out of uni too, despite all the work i've put in to pull my life together. it really means a lot to me that i managed to make it through to the end this time, even though it was tough to keep my head above water sometimes.

[gordonwilliamsweb]

OSHA Let Employers Decide Whether to Report Health Care Worker Deaths. Many Didn’t.

As Walter Veal cared for residents at the Ludeman Developmental Center in suburban Chicago, he saw the potential future of his grandson, who has autism.

This story also ran on The Guardian. It can be republished for free.

So he took it on himself not just to bathe and feed the residents, which was part of the job, but also to cut their hair, run to the store to buy their favorite body wash and barbecue for them on holidays.

“They were his second family,” said his wife, Carlene Veal.

Even after COVID-19 struck in mid-March and cases began spreading through the government-run facility, which serves nearly 350 adults with developmental disabilities, Walter was determined to go to work, Carlene said.

Staff members were struggling to acquire masks and other personal protective equipment at the time, many asking family members for donations and wearing rain ponchos sent by professional baseball teams.

All Walter had was a pair of gloves, Carlene said.

By mid-May, rumors of some sick residents and staffers had turned into 274 confirmed positive COVID tests, according to the Illinois Department of Human Services COVID tracking site. On May 16, Walter, 53, died of the virus. Three of his colleagues had already passed, according to interviews with Ludeman workers, the deceased employees’ families and union officials.

State and federal laws say facilities like Ludeman are required to alert Occupational Safety and Health Administration officials about work-related employee deaths within eight hours. But facility officials did not deem the first staff death on April 13 work-related, so they did not report it. They made the same decision about the second and third deaths. And Walter’s.

It’s a pattern that’s emerged across the nation, according to a KHN review of hundreds of worker deaths detailed by family members, colleagues and local, state and federal records.

Workplace safety regulators have taken a lenient stance toward employers during the pandemic, giving them broad discretion to decide internally whether to report worker deaths. As a result, scores of deaths were not reported to occupational safety officials from the earliest days of the pandemic through late October.

KHN examined more than 240 deaths of health care workers profiled for the Lost on the Frontline project and found that employers did not report more than one-third of them to a state or federal OSHA office, many based on internal decisions that the deaths were not work-related — conclusions that were not independently reviewed.

Work-safety advocates say OSHA investigations into staff deaths can help officials pinpoint problems before they endanger other employees as well as patients or residents. Yet, throughout the pandemic, health care staff deaths have steadily climbed. Thorough reviews could have also prompted the Department of Labor, which oversees OSHA, to urge the White House to address chronic protective gear shortages or sharpen guidance to help keep workers safe.

Since no public agency releases the names of health care workers who die of COVID-19, a team of reporters building the Lost on the Frontline database has scoured local news stories, GoFundMe campaigns, and obituary and social media sites to identify nearly 1,400 possible cases. More than 260 fatalities have been vetted with families, employers and public records.

For this investigation, journalists examined worker deaths at more than 100 health care facilities where OSHA records showed no fatality investigation was underway.

At Ludeman, the circumstances surrounding the April 13 worker death might have shed light on the hazards facing Veal. But no state work safety officials showed up to inspect — because the Department of Human Services, which operates Ludeman and employs the staff, said it did not report any of the four deaths there to Illinois OSHA.

The department said “it could not determine the employees contracted COVID-19 at the workplace” — despite its being the site of one of the largest U.S. outbreaks. Since Veal’s death in May, dozens more workers have tested positive for COVID-19, according to DHS’ COVID tracking site.

OSHA inspectors monitor local news media and sometimes will open investigations even without an employer’s fatality report. Through Nov. 5, federal OSHA offices issued 63 citations to facilities for failing to report a death. And when inspectors do show up, they often force improvements — requiring more protective equipment for workers and better training on how to use it, files reviewed by KHN show.

Still, many deaths receive little or no scrutiny from work-safety authorities. In California, public health officials have documented about 200 health care worker deaths. Yet the state’s OSHA office received only 75 fatality reports at health care facilities through Oct. 26, Cal/OSHA records show.

Nursing homes, which are under strict Medicare requirements, reported more than 1,000 staff deaths through mid-October, but only about 350 deaths of long-term care facility workers appear to have been reported to OSHA, agency records show.

Workers whose deaths went unreported include some who took painstaking precautions to avoid getting sick and passing the virus to family members: One California lab technician stayed in a hotel during the workweek. An Arizona nursing home worker wore a mask for family movie nights. A Nevada nurse told his brother he didn’t have adequate PPE. Nevada OSHA confirmed to KHN that his death was not reported to the agency and that officials would investigate.

KHN asked health care employers why they chose not to report fatalities. Some cited the lack of proof that a worker was exposed on-site, even in workplaces that reported a COVID outbreak. Others cited privacy concerns and gave no explanation. Still others ignored requests for comment or simply said they had followed government policies.

“It is so disrespectful of the agencies and the employers to shunt these cases aside and not do everything possible to investigate the exposures,” said Peg Seminario, a retired union health and safety director who co-authored a study on OSHA oversight with scholars from Harvard’s T.H. Chan School of Public Health.

A Department of Labor spokesperson said in a statement that an employer must report a fatality within eight hours of knowing the employee died and after determining the cause of death was a work-related case of COVID-19.

The department said employers also are bound to report a COVID death if it comes within 30 days of a workplace incident — meaning exposure to COVID-19.

Yet pinpointing exposure to an invisible virus can be difficult, with high rates of pre-symptomatic and asymptomatic transmission and spread of the virus just as prevalent inside a hospital COVID unit as out.

Those challenges, plus May guidance from OSHA, gave employers latitude to decide behind closed doors whether to report a case. So it’s no surprise that cases are going unreported, said Eric Frumin, who has testified to Congress on worker safety and is health and safety director for Change to Win, a partnership of seven unions.

“Why would an employer report unless they feel for some reason they’re socially responsible?” Frumin said. “Nobody’s holding them to account.”

Downside of Discretion

OSHA’s guidance to employers offered pointers on how to decide whether a COVID death is work-related. It would be if a cluster of infections arose at one site where employees work closely together “and there is no alternative explanation.” If a worker had close contact with someone outside of work infected with the virus, it might not have been work-related, the guidance says.

Ultimately, the memo says, if an employer can’t determine that a worker “more likely than not” got sick on the job, “the employer does not need to record that.”

In mid-March, the union that represented Paul Odighizuwa, a food service worker at Oregon Health & Science University, raised concerns with university management about the virus possibly spreading through the Food and Nutrition Services Department.

Workers there — those taking meal orders, preparing food, picking up trays for patient rooms and washing dishes — were unable to keep their distance from one another, said Michael Stewart, vice president of the American Federation of State, County and Municipal Employees Local 328, which represents about 7,000 workers at OHSU. Stewart said the union warned administrators they were endangering people’s lives.

Soon the virus tore through the department, Stewart said. At least 11 workers in food service got the virus, the union said. Odighizuwa, 61, a pillar of the local Nigerian community, died on May 12.

OHSU did not report the death to the state’s OSHA and defended the decision, saying it “was determined not to be work-related,” according to a statement from Tamara Hargens-Bradley, OHSU’s interim senior director of strategic communications.

She said the determination was made “[b]ased on the information gathered by OHSU’s Occupational Health team,” but she declined to provide details, citing privacy issues.

Stewart blasted OHSU’s response. When there’s an outbreak in a department, he said, it should be presumed that’s where a worker caught the virus.

“We have to do better going forward,” Stewart said. “We have to learn from this.” Without an investigation from an outside regulator like OSHA, he doubts that will happen.

Stacy Daugherty heard that Oasis Pavilion Nursing and Rehabilitation Center in Casa Grande, Arizona, was taking strict precautions as COVID-19 surged in the facility and in Pinal County, almost halfway between Phoenix and Tucson.

Her father, a certified nursing assistant there, was also extra cautious: He believed that if he got the virus, “he wouldn’t make it,” Daugherty said.

Mark Daugherty, a father of five, confided in his youngest son when he fell ill in May that he believed he contracted the coronavirus at work, his daughter said in a message to KHN.

Early in June, the facility filed its first public report on COVID cases to Medicare authorities: Twenty-three residents and eight staff members had fallen ill. It was one of the largest outbreaks in the state. (Medicare requires nursing homes to report staff deaths each week in a process unrelated to OSHA.)

By then, Daugherty, 60, was fighting for his life, his absence felt by the residents who enjoyed his banjo, accordion and piano performances. But the country’s occupational safety watchdog wasn’t called in to figure out whether Daugherty, who died June 19, was exposed to the virus at work. His employer did not report his death to OSHA.

“We don’t know where Mark might have contracted COVID 19 from, since the virus was widespread throughout the community at that time. Therefore there was no need to report to OSHA or any other regulatory agencies,” Oasis Pavilion’s administrator, Kenneth Opara, wrote in an email to KHN.

Since then, 15 additional staffers have tested positive and the facility suspects a dozen more have had the virus, according to Medicare records.

Gaps in the Law

If Oasis Pavilion needed another reason not to report Daugherty’s death, it might have had one. OSHA requires notice of a death only within 30 days of a work-related incident. Daugherty, like many others, clung to life for weeks before he died.

That is one loophole — among others — in work-safety laws that experts say could use a second look in the time of COVID-19.

In addition, federal OSHA rules don’t apply to about 8 million public employees. Only government workers in states with their own state OSHA agency are covered. In other words, in about half the country if a government employee dies on the job — such as a nurse at a public hospital in Florida, or a paramedic at a fire department in Texas — there’s no requirement to report it and no one to look into it.

So there was little chance anyone from OSHA would investigate the deaths of two health workers early this year at Central State Hospital in Georgia — a state-run psychiatric facility in a state without its own worker-safety agency.

On March 24, a manager at the facility had warned staff they “must not wear articles of clothing, including Personal Protective Equipment” that violate the dress code, according to an email KHN obtained through a public records request.

Three days later, what had started as a low-grade illness for Mark DeLong, a licensed practical nurse at the facility, got serious. His cough was so severe late on March 27 that he called 911 — and handed the phone to his wife, Jan, because he could barely speak, she said.

She went to visit him in the hospital the next day, fully expecting a pleasant visit with her karaoke partner. “By the time I got there it was too late,” she said. DeLong, 53 “had passed.”

She learned after his death that he’d had COVID-19.

Back at the hospital, workers had been frustrated with the early directive that employees should not wear their own PPE.

Bruce Davis had asked his supervisors if he could wear his own mask but was told no because it wasn’t part of the approved uniform, according to his wife, Gwendolyn Davis. “He told me ‘They don’t care,’” she said.

Two days after DeLong’s death, the directive was walked back and employees and contractors were informed they could “continue and are authorized to wear Personal Protective Gear,” according to a March 30 email from administrators. But Davis, a Pentecostal pastor and nursing assistant supervisor, was already sick. Davis worked at the hospital for 27 years and saw little distinction between the love he preached at the altar and his service to the patients he bathed, fed and cared for, his wife said.

Sick with the virus, Davis died April 11.

At the time, 24 of Central State’s staffers had tested positive, according to the Georgia Department of Behavioral Health and Developmental Disabilities, which runs the facility. To date, nearly 100 staffers and 33 patients at Central State have gotten the virus, according to figures from the state agency.

“I don’t think they knew what was going on either,” Jan DeLong said. “Somebody needs to check into it.”

In response to questions from KHN, a spokesperson for the department provided a prepared statement: “There was never a ban on commercially available personal protective equipment, even if the situation did not call for its use according to guidelines issued by the Centers for Disease Control and Prevention and the Georgia Department of Public Health at the time.”

KHN reviewed more than a dozen other health worker deaths at state or local government workplaces in states like Texas, Florida and Missouri that went unreported to OSHA for the same reason — the facilities were run by government agencies in a state without its own worker safety agency.

Inside Ludeman

In mid-March, staff members at the Ludeman Developmental Center were desperate for PPE. The facility was running low on everything from gloves and gowns to hand sanitizer, according to interviews with current and former workers, families of deceased workers, and union officials.

Due to a national shortage at the time, surgical masks went only to staffers working with known positive cases, said Anne Irving, regional director for AFSCME Council 31, the union that represents Ludeman employees.

Residents in the Village of Park Forest, Illinois, where the facility is located, tried to help by sewing masks or pivoting their businesses to produce face shields and hand sanitizer, said Mayor Jonathan Vanderbilt. But providing enough supplies for more than 900 Ludeman employees proved difficult.

Michelle Abernathy, 52, a newly appointed unit director, bought her own gloves at Costco. In late March, a resident on Abernathy’s unit showed symptoms, said Torrence Jones, her fiancé who also works at the facility. Then Abernathy developed a fever.

When she died on April 13 — the first known Ludeman staff member lost to the pandemic — the Illinois Department of Human Services, which runs Ludeman, made no report to safety regulators. After seeing media reports, Illinois OSHA sent the agency questions about Abernathy’s daily duties and working conditions. Based on DHS’ responses and subsequent phone calls, state OSHA officials determined Abernathy’s death was “not work-related.”

Barbara Abernathy, Michelle’s mom, doesn’t buy it. “Michelle was basically a hermit,” she said, going only from work to home. She couldn’t have gotten the virus anywhere else, she said. In response to OSHA’s inquiry for evidence that the exposure was not related to her workplace, her employer wrote “N/A,” according to documents reviewed by KHN.

Two weeks after Abernathy’s passing, two more employees died: Cephus Lee, 59, and Jose Veloz III, 52. Both worked in support services, boxing food and delivering it to the 40 buildings on campus. Their deaths were not reported to Illinois OSHA.

Veloz was meticulous at home, having groceries delivered and wiping down each item before bringing it inside, said his son, Joseph Ricketts.

But work was another story. Maintaining social distance in the food prep area was difficult, and there was little information on who had been infected or exposed to the virus, according to his son.

“No matter what my dad did, he was screwed,” Ricketts said. Adding, he thought Ludeman did not do what it should have done to protect his dad on the job.

A March 27 complaint to Illinois OSHA said it took a week for staff to be notified about multiple employees who tested positive, according to documents obtained by the Documenting COVID-19 project at the Brown Institute for Media Innovation and shared with KHN. An early April complaint was more frank: “Lives are endangered,” it said.

That’s how Rose Banks felt when managers insisted she go to work, even though she was sick and awaiting a test result, she said. Her husband, also a Ludeman employee, had already tested positive a week earlier.

Banks said she was angry about coming in sick, worried she might infect co-workers and residents. After spending a full day at the facility, she said, she came home to a phone call saying her test was positive. She’s currently on medical leave.

With some Ludeman staff assigned to different homes each shift, the virus quickly traveled across campus. By mid-May, 76 staff and 198 residents had tested positive, according to DHS’ COVID tracking site.

Carlene Veal said her husband, Walter, was tested at the facility in late April. But by the time he got the results weeks later, she said, he was already dying.

Carlene can still picture the last time she saw Walter, her high school sweetheart and a man she called her “superhero” for 35 years of marriage and raising four kids together. He was lying on a gurney in their driveway with an oxygen mask on his face, she said. He pulled the mask down to say “I love you” one last time before the ambulance pulled away.

The Illinois Department of Human Services said that, since the beginning of the pandemic, it has implemented many new protocols to mitigate the outbreak at Ludeman, working as quickly as possible based on what was known about the virus at the time. It has created an emergency staffing plan, identified negative-airflow spaces to isolate sick individuals and made “extensive efforts” to procure more PPE, and it is testing all staffers and residents regularly.

“We were deeply saddened to lose four colleagues who worked at Ludeman Developmental Center and succumbed to the virus,” the agency said in a statement. “We are committed to complying with and following all health and safety guidelines for COVID-19.”

The number of new cases at Ludeman has remained low for several months now, according to DHS’ COVID tracking site.

But that does little to console the families of those who have died.

When a Ludeman supervisor called Barbara Abernathy in June to express condolences and ask if there was anything they could do, Abernathy didn’t know how to respond.

“There was nothing they could do for me now,” she said. “They hadn’t done what they needed to do before.”

Shoshana Dubnow, Anna Sirianni, Melissa Bailey and Hannah Foote contributed to this report.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

OSHA Let Employers Decide Whether to Report Health Care Worker Deaths. Many Didn’t. published first on https://nootropicspowdersupplier.tumblr.com/

[stephenmccull]

OSHA Let Employers Decide Whether to Report Health Care Worker Deaths. Many Didn’t.

As Walter Veal cared for residents at the Ludeman Developmental Center in suburban Chicago, he saw the potential future of his grandson, who has autism.

This story also ran on The Guardian. It can be republished for free.

So he took it on himself not just to bathe and feed the residents, which was part of the job, but also to cut their hair, run to the store to buy their favorite body wash and barbecue for them on holidays.

“They were his second family,” said his wife, Carlene Veal.

Even after COVID-19 struck in mid-March and cases began spreading through the government-run facility, which serves nearly 350 adults with developmental disabilities, Walter was determined to go to work, Carlene said.

Staff members were struggling to acquire masks and other personal protective equipment at the time, many asking family members for donations and wearing rain ponchos sent by professional baseball teams.

All Walter had was a pair of gloves, Carlene said.

By mid-May, rumors of some sick residents and staffers had turned into 274 confirmed positive COVID tests, according to the Illinois Department of Human Services COVID tracking site. On May 16, Walter, 53, died of the virus. Three of his colleagues had already passed, according to interviews with Ludeman workers, the deceased employees’ families and union officials.

State and federal laws say facilities like Ludeman are required to alert Occupational Safety and Health Administration officials about work-related employee deaths within eight hours. But facility officials did not deem the first staff death on April 13 work-related, so they did not report it. They made the same decision about the second and third deaths. And Walter’s.

It’s a pattern that’s emerged across the nation, according to a KHN review of hundreds of worker deaths detailed by family members, colleagues and local, state and federal records.

Workplace safety regulators have taken a lenient stance toward employers during the pandemic, giving them broad discretion to decide internally whether to report worker deaths. As a result, scores of deaths were not reported to occupational safety officials from the earliest days of the pandemic through late October.

KHN examined more than 240 deaths of health care workers profiled for the Lost on the Frontline project and found that employers did not report more than one-third of them to a state or federal OSHA office, many based on internal decisions that the deaths were not work-related — conclusions that were not independently reviewed.

Work-safety advocates say OSHA investigations into staff deaths can help officials pinpoint problems before they endanger other employees as well as patients or residents. Yet, throughout the pandemic, health care staff deaths have steadily climbed. Thorough reviews could have also prompted the Department of Labor, which oversees OSHA, to urge the White House to address chronic protective gear shortages or sharpen guidance to help keep workers safe.

Since no public agency releases the names of health care workers who die of COVID-19, a team of reporters building the Lost on the Frontline database has scoured local news stories, GoFundMe campaigns, and obituary and social media sites to identify nearly 1,400 possible cases. More than 260 fatalities have been vetted with families, employers and public records.

For this investigation, journalists examined worker deaths at more than 100 health care facilities where OSHA records showed no fatality investigation was underway.

At Ludeman, the circumstances surrounding the April 13 worker death might have shed light on the hazards facing Veal. But no state work safety officials showed up to inspect — because the Department of Human Services, which operates Ludeman and employs the staff, said it did not report any of the four deaths there to Illinois OSHA.

The department said “it could not determine the employees contracted COVID-19 at the workplace” — despite its being the site of one of the largest U.S. outbreaks. Since Veal’s death in May, dozens more workers have tested positive for COVID-19, according to DHS’ COVID tracking site.

OSHA inspectors monitor local news media and sometimes will open investigations even without an employer’s fatality report. Through Nov. 5, federal OSHA offices issued 63 citations to facilities for failing to report a death. And when inspectors do show up, they often force improvements — requiring more protective equipment for workers and better training on how to use it, files reviewed by KHN show.

Still, many deaths receive little or no scrutiny from work-safety authorities. In California, public health officials have documented about 200 health care worker deaths. Yet the state’s OSHA office received only 75 fatality reports at health care facilities through Oct. 26, Cal/OSHA records show.

Nursing homes, which are under strict Medicare requirements, reported more than 1,000 staff deaths through mid-October, but only about 350 deaths of long-term care facility workers appear to have been reported to OSHA, agency records show.

Workers whose deaths went unreported include some who took painstaking precautions to avoid getting sick and passing the virus to family members: One California lab technician stayed in a hotel during the workweek. An Arizona nursing home worker wore a mask for family movie nights. A Nevada nurse told his brother he didn’t have adequate PPE. Nevada OSHA confirmed to KHN that his death was not reported to the agency and that officials would investigate.

KHN asked health care employers why they chose not to report fatalities. Some cited the lack of proof that a worker was exposed on-site, even in workplaces that reported a COVID outbreak. Others cited privacy concerns and gave no explanation. Still others ignored requests for comment or simply said they had followed government policies.

“It is so disrespectful of the agencies and the employers to shunt these cases aside and not do everything possible to investigate the exposures,” said Peg Seminario, a retired union health and safety director who co-authored a study on OSHA oversight with scholars from Harvard’s T.H. Chan School of Public Health.

A Department of Labor spokesperson said in a statement that an employer must report a fatality within eight hours of knowing the employee died and after determining the cause of death was a work-related case of COVID-19.

The department said employers also are bound to report a COVID death if it comes within 30 days of a workplace incident — meaning exposure to COVID-19.

Yet pinpointing exposure to an invisible virus can be difficult, with high rates of pre-symptomatic and asymptomatic transmission and spread of the virus just as prevalent inside a hospital COVID unit as out.

Those challenges, plus May guidance from OSHA, gave employers latitude to decide behind closed doors whether to report a case. So it’s no surprise that cases are going unreported, said Eric Frumin, who has testified to Congress on worker safety and is health and safety director for Change to Win, a partnership of seven unions.

“Why would an employer report unless they feel for some reason they’re socially responsible?” Frumin said. “Nobody’s holding them to account.”

Downside of Discretion

OSHA’s guidance to employers offered pointers on how to decide whether a COVID death is work-related. It would be if a cluster of infections arose at one site where employees work closely together “and there is no alternative explanation.” If a worker had close contact with someone outside of work infected with the virus, it might not have been work-related, the guidance says.

Ultimately, the memo says, if an employer can’t determine that a worker “more likely than not” got sick on the job, “the employer does not need to record that.”

In mid-March, the union that represented Paul Odighizuwa, a food service worker at Oregon Health & Science University, raised concerns with university management about the virus possibly spreading through the Food and Nutrition Services Department.

Workers there — those taking meal orders, preparing food, picking up trays for patient rooms and washing dishes — were unable to keep their distance from one another, said Michael Stewart, vice president of the American Federation of State, County and Municipal Employees Local 328, which represents about 7,000 workers at OHSU. Stewart said the union warned administrators they were endangering people’s lives.

Soon the virus tore through the department, Stewart said. At least 11 workers in food service got the virus, the union said. Odighizuwa, 61, a pillar of the local Nigerian community, died on May 12.

OHSU did not report the death to the state’s OSHA and defended the decision, saying it “was determined not to be work-related,” according to a statement from Tamara Hargens-Bradley, OHSU’s interim senior director of strategic communications.

She said the determination was made “[b]ased on the information gathered by OHSU’s Occupational Health team,” but she declined to provide details, citing privacy issues.

Stewart blasted OHSU’s response. When there’s an outbreak in a department, he said, it should be presumed that’s where a worker caught the virus.

“We have to do better going forward,” Stewart said. “We have to learn from this.” Without an investigation from an outside regulator like OSHA, he doubts that will happen.

Stacy Daugherty heard that Oasis Pavilion Nursing and Rehabilitation Center in Casa Grande, Arizona, was taking strict precautions as COVID-19 surged in the facility and in Pinal County, almost halfway between Phoenix and Tucson.

Her father, a certified nursing assistant there, was also extra cautious: He believed that if he got the virus, “he wouldn’t make it,” Daugherty said.

Mark Daugherty, a father of five, confided in his youngest son when he fell ill in May that he believed he contracted the coronavirus at work, his daughter said in a message to KHN.

Early in June, the facility filed its first public report on COVID cases to Medicare authorities: Twenty-three residents and eight staff members had fallen ill. It was one of the largest outbreaks in the state. (Medicare requires nursing homes to report staff deaths each week in a process unrelated to OSHA.)

By then, Daugherty, 60, was fighting for his life, his absence felt by the residents who enjoyed his banjo, accordion and piano performances. But the country’s occupational safety watchdog wasn’t called in to figure out whether Daugherty, who died June 19, was exposed to the virus at work. His employer did not report his death to OSHA.

“We don’t know where Mark might have contracted COVID 19 from, since the virus was widespread throughout the community at that time. Therefore there was no need to report to OSHA or any other regulatory agencies,” Oasis Pavilion’s administrator, Kenneth Opara, wrote in an email to KHN.

Since then, 15 additional staffers have tested positive and the facility suspects a dozen more have had the virus, according to Medicare records.

Gaps in the Law

If Oasis Pavilion needed another reason not to report Daugherty’s death, it might have had one. OSHA requires notice of a death only within 30 days of a work-related incident. Daugherty, like many others, clung to life for weeks before he died.

That is one loophole — among others — in work-safety laws that experts say could use a second look in the time of COVID-19.

In addition, federal OSHA rules don’t apply to about 8 million public employees. Only government workers in states with their own state OSHA agency are covered. In other words, in about half the country if a government employee dies on the job — such as a nurse at a public hospital in Florida, or a paramedic at a fire department in Texas — there’s no requirement to report it and no one to look into it.

So there was little chance anyone from OSHA would investigate the deaths of two health workers early this year at Central State Hospital in Georgia — a state-run psychiatric facility in a state without its own worker-safety agency.

On March 24, a manager at the facility had warned staff they “must not wear articles of clothing, including Personal Protective Equipment” that violate the dress code, according to an email KHN obtained through a public records request.

Three days later, what had started as a low-grade illness for Mark DeLong, a licensed practical nurse at the facility, got serious. His cough was so severe late on March 27 that he called 911 — and handed the phone to his wife, Jan, because he could barely speak, she said.

She went to visit him in the hospital the next day, fully expecting a pleasant visit with her karaoke partner. “By the time I got there it was too late,” she said. DeLong, 53 “had passed.”

She learned after his death that he’d had COVID-19.

Back at the hospital, workers had been frustrated with the early directive that employees should not wear their own PPE.

Bruce Davis had asked his supervisors if he could wear his own mask but was told no because it wasn’t part of the approved uniform, according to his wife, Gwendolyn Davis. “He told me ‘They don’t care,’” she said.

Two days after DeLong’s death, the directive was walked back and employees and contractors were informed they could “continue and are authorized to wear Personal Protective Gear,” according to a March 30 email from administrators. But Davis, a Pentecostal pastor and nursing assistant supervisor, was already sick. Davis worked at the hospital for 27 years and saw little distinction between the love he preached at the altar and his service to the patients he bathed, fed and cared for, his wife said.

Sick with the virus, Davis died April 11.

At the time, 24 of Central State’s staffers had tested positive, according to the Georgia Department of Behavioral Health and Developmental Disabilities, which runs the facility. To date, nearly 100 staffers and 33 patients at Central State have gotten the virus, according to figures from the state agency.

“I don’t think they knew what was going on either,” Jan DeLong said. “Somebody needs to check into it.”

In response to questions from KHN, a spokesperson for the department provided a prepared statement: “There was never a ban on commercially available personal protective equipment, even if the situation did not call for its use according to guidelines issued by the Centers for Disease Control and Prevention and the Georgia Department of Public Health at the time.”

KHN reviewed more than a dozen other health worker deaths at state or local government workplaces in states like Texas, Florida and Missouri that went unreported to OSHA for the same reason — the facilities were run by government agencies in a state without its own worker safety agency.

Inside Ludeman

In mid-March, staff members at the Ludeman Developmental Center were desperate for PPE. The facility was running low on everything from gloves and gowns to hand sanitizer, according to interviews with current and former workers, families of deceased workers, and union officials.

Due to a national shortage at the time, surgical masks went only to staffers working with known positive cases, said Anne Irving, regional director for AFSCME Council 31, the union that represents Ludeman employees.

Residents in the Village of Park Forest, Illinois, where the facility is located, tried to help by sewing masks or pivoting their businesses to produce face shields and hand sanitizer, said Mayor Jonathan Vanderbilt. But providing enough supplies for more than 900 Ludeman employees proved difficult.

Michelle Abernathy, 52, a newly appointed unit director, bought her own gloves at Costco. In late March, a resident on Abernathy’s unit showed symptoms, said Torrence Jones, her fiancé who also works at the facility. Then Abernathy developed a fever.

When she died on April 13 — the first known Ludeman staff member lost to the pandemic — the Illinois Department of Human Services, which runs Ludeman, made no report to safety regulators. After seeing media reports, Illinois OSHA sent the agency questions about Abernathy’s daily duties and working conditions. Based on DHS’ responses and subsequent phone calls, state OSHA officials determined Abernathy’s death was “not work-related.”

Barbara Abernathy, Michelle’s mom, doesn’t buy it. “Michelle was basically a hermit,” she said, going only from work to home. She couldn’t have gotten the virus anywhere else, she said. In response to OSHA’s inquiry for evidence that the exposure was not related to her workplace, her employer wrote “N/A,” according to documents reviewed by KHN.

Two weeks after Abernathy’s passing, two more employees died: Cephus Lee, 59, and Jose Veloz III, 52. Both worked in support services, boxing food and delivering it to the 40 buildings on campus. Their deaths were not reported to Illinois OSHA.

Veloz was meticulous at home, having groceries delivered and wiping down each item before bringing it inside, said his son, Joseph Ricketts.

But work was another story. Maintaining social distance in the food prep area was difficult, and there was little information on who had been infected or exposed to the virus, according to his son.

“No matter what my dad did, he was screwed,” Ricketts said. Adding, he thought Ludeman did not do what it should have done to protect his dad on the job.

A March 27 complaint to Illinois OSHA said it took a week for staff to be notified about multiple employees who tested positive, according to documents obtained by the Documenting COVID-19 project at the Brown Institute for Media Innovation and shared with KHN. An early April complaint was more frank: “Lives are endangered,” it said.

That’s how Rose Banks felt when managers insisted she go to work, even though she was sick and awaiting a test result, she said. Her husband, also a Ludeman employee, had already tested positive a week earlier.

Banks said she was angry about coming in sick, worried she might infect co-workers and residents. After spending a full day at the facility, she said, she came home to a phone call saying her test was positive. She’s currently on medical leave.

With some Ludeman staff assigned to different homes each shift, the virus quickly traveled across campus. By mid-May, 76 staff and 198 residents had tested positive, according to DHS’ COVID tracking site.

Carlene Veal said her husband, Walter, was tested at the facility in late April. But by the time he got the results weeks later, she said, he was already dying.

Carlene can still picture the last time she saw Walter, her high school sweetheart and a man she called her “superhero” for 35 years of marriage and raising four kids together. He was lying on a gurney in their driveway with an oxygen mask on his face, she said. He pulled the mask down to say “I love you” one last time before the ambulance pulled away.

The Illinois Department of Human Services said that, since the beginning of the pandemic, it has implemented many new protocols to mitigate the outbreak at Ludeman, working as quickly as possible based on what was known about the virus at the time. It has created an emergency staffing plan, identified negative-airflow spaces to isolate sick individuals and made “extensive efforts” to procure more PPE, and it is testing all staffers and residents regularly.

“We were deeply saddened to lose four colleagues who worked at Ludeman Developmental Center and succumbed to the virus,” the agency said in a statement. “We are committed to complying with and following all health and safety guidelines for COVID-19.”

The number of new cases at Ludeman has remained low for several months now, according to DHS’ COVID tracking site.

But that does little to console the families of those who have died.

When a Ludeman supervisor called Barbara Abernathy in June to express condolences and ask if there was anything they could do, Abernathy didn’t know how to respond.

“There was nothing they could do for me now,” she said. “They hadn’t done what they needed to do before.”

Shoshana Dubnow, Anna Sirianni, Melissa Bailey and Hannah Foote contributed to this report.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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[christineharrington1994]

louisiana department of insurance license search

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[thisdaynews]

BREAKING:IPPIS October deadline: No pay, no work, union tells FG

New Post has been published on https://thebiafrastar.com/breakingippis-october-deadline-no-pay-no-work-union-tells-fg/

BREAKING:IPPIS October deadline: No pay, no work, union tells FG

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The Academic Staff Union of Universities will on Monday (today) meet with the leadership of the National Assembly as part of its battle against the controversial Integrated Payroll and Personnel Information System.

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A source in the nation’s parliament confided in one of our correspondents that the meeting would be held behind closed doors today (Monday).

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 He said, “It has been confirmed that the ASUU leadership will meet the leadership of the National Assembly on Monday. The meeting will centre on the ongoing face-off between ASUU and the Federal Government over the IPPIS saga.”

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President Muhammadu Buhari, had during the 2020 budget presentation at the National Assembly on October 8, ordered that all public sector workers must register for the IPPIS to save cost and fight corruption by blocking leakages in the Federal Government’s salary payment structure.

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But ASUU had last week opposed the  President’s directive, saying the IPPIS negated the law on university autonomy.

The Accountant-General of the Federation, Alhaji Ahmed Idris, who faulted  ASUU, said the union’s position was an open endorsement of corruption.

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Also, the Minister of Finance, Budget and National Planning, Mrs Zainab Ahmed, had on Thursday said no government agency must resist the payment system.

The Special Adviser to the Senate President on Media and Publicity, Ola Awoniyi, on Sunday confirmed ASUU’s meeting with the National Assembly leadership.

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He said the meeting would hold at 11am in his principal’s conference room.

Awoniyi in a WhatsApp message to one of our correspondents, wrote, “The Academic Staff Union of Universities will meet His Excellency, the Senate President, on Monday at Meeting Room 301 by 11am.”

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When contacted, the ASUU National President, Prof. Biodun Ogunyemi, also confirmed the meeting, but declined to provide details of demands the union would table before the Senate President.

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“The most important thing is that we are meeting tomorrow (Monday). We want to discuss the Nigerian education generally. All issues (including the IPPIS) will be touched. I think that is enough,” the ASUU president noted.

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No pay, no work, union tells FG

But the South-West branch of the union on Sunday reiterated its opposition to the Federal Government’s move to enrol university lecturers in the IPPIS.

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The ASUU leaders from the South-West during a press conference held at the University of Ibadan, described the IPPIS as “a one-size-fits-all approach tainted with corrupt tendencies.”

The ASUU position was made known by the Coordinator of the South-West, Prof. Ade Adejumo, who led the Chairman of the University of Ibadan chapter, Prof Deji Omole, and its Investment Secretary, Prof. Ayo Akinwole, to address journalists at the ASUU Secretariat on the UI campus.

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Adejumo was asked what would be the reaction of the union to the Federal Government’s statement that anyone who failed  to register  for the  IPPIS by  October 31  would not be paid, he said, “ASUU’s  position has always remained no pay, no work.”

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Adejumo berated the Accountant-General of the Federation for alleging that ASUU was encouraging corruption by its opposition to  the IPPIS.

He said the IPPIS was rather capable of encouraging corruption, more so that its civil service nature negated the legal administration of universities.

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Adejumo said, “Sequel to this fact of the peculiar nature of universities from the civil service, Ministries, Departments and Agencies of government, government had agreed to the autonomy of public universities in Nigeria and had signed into law the Universities Miscellaneous Provisions (Amendment) Act in 2003.

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“The IPPIS clearly violates the law. The Universities Miscellaneous Provisions (Amendment) Act 2003, provides in Section 2AA unequivocally, as follows: ‘the power of the council shall be exercised, as in the laws and statutes of each university and to that extent, establishment circulars that are inconsistent with the laws and statutes of the university shall not apply to the universities.

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“Inter alia, the 1992 Act establishing, for example, the Federal Universities of Agriculture Section 8 (1 and 4) provides; ‘Subject to the provisions of this Act relating to the visitor, the council shall be the governing body of each university and shall be charged with the general control and superintendence of the policy, finance and property of the university. The council shall ensure that proper accounts of the university are kept and that the accounts of the university are audited annually by an independent firm of auditors approved by the council.’

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“Our union has no reason to believe that the President of the Federal Republic of Nigeria will flagrantly act against the law, which he vowed to uphold in his oath of office.”

While declaring that ASUU had aversion for corruption,  Adejumo asked the Office of the Accountant-General of the Federation to name Nigeria’s  corrupt public officials it recovered about N273bn from.

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“Who were the culprits that have been sanctioned for such infractions?” he asked.

On the retirement schedule of academics which is 70 years for professors, the union stated that the IPPIS only recognised 60 years of age.

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He stated, “The IPPIS is too rigid a platform that it discountenances the peculiarities of the university system in the sacred areas of replacement or recruitment of academics, mobility of academic staff for visiting, adjunct, part-time and sabbatical offers.

“Not only these, academics are chopped off the platform at the age of 60 thereby creating bottlenecks in the collection of salaries and emoluments because once the name of a worker is removed, such a victim will continue to frequent Abuja until it is rectified. The victim not only abandons his duty post, but faces the hazards on the Nigerian roads. The platform also does not capture the earned academic allowances and remunerations due to academics who retire before the age of 65.”

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Adejumo also berated the Federal Government for failing to implement the 2009 agreement, stressing that the government had not released its report on the presidential audit visitation panel to universities.

He said vice-chancellors had been turned to “errand boys” of some assistant directors who summoned them to Abuja at will through text messages.

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He said, “Our members are poised to pursue another patriotic struggle that will assert sanity in the university system and in the country at large. The tools of the struggle are now being primed and oiled, the union will have no blame when they begin to grind.”

IPPIS: Our fears – Gombe State varsity lecturers

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Also,  the Chairman of ASUU at the Gombe State University, Dr Oladimeji Lawal, in an interview with The PUNCH, said the IPPIS would duplicate the functions of universities’ governing councils.

He said the IPPIS model was developed in such a manner that anyone above 60 years of age would not receive salary.

He also said ASUU had a better alternative.

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Lawal stated, “So, if you are brought into this net, automatically if you are 61, 62 years, you will not get paid because the system was programmed not to recognise any worker who is more than 60 years.

“Universities around the globe are created as ivory towers. This explains the autonomous status of institutions; their freedom, ability to operate in a manner in which universities operate elsewhere. The power to recruit staff, pay as and when necessary, to expand without being subjected to bureaucratic control which is typical of the civil service. Government seems to approach universities as one of its departments and agencies. We have a better model than the IPPIS.”

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Lawal added that it was not true that the IPPIS would ensure accountability and transparency.

He wondered why federal and state governments had failed to constitute visitation panels in the  public institutions.

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He stated, “The fact that we say universities have autonomy does not mean that fraudulent activities can’t be prosecuted. In as much as the governing council has the right to supervise the running of these universities, the visitor has the authority from time to time to constitute a visitation panel, to overhaul whatever that must have happened in five years with a view to establishing whether things were rightly or wrongly done.”

UNILORIN VC knocks ASUU

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But the Vice-Chancellor of the University of Ilorin, Prof. Sulyman  Abdulkareem, knocked ASUU for rejecting the IPPIS.

The vice-chancellor,  during a press conference in the university, supported the Federal Government on the IPPIS.

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Abdulkareem said, “ASUU’s logic is not clear to me. I wonder why ASUU is taking a different position after attending a meeting with the representatives of all the five unions in the nation’s university system with the representatives of the Federal Government where they were adequately briefed on the new policy.

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“I want to appeal to members of ASUU not to delay the October salary of the staff of federal universities with their action because the new system will not change their salaries. It is only the nomenclature that is changing.”

He explained that with the IPPIS, the Federal Government would maintain the payment of its employees’ salaries without cheating them.

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The vice-chancellor stated,   “What probably is the fear of many of the academic members of staff  is that the system would expose them for not working for the money they earn in their primary place of engagement.”

We are in agreement with FG–OAU management

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Although the Vice-Chancellor, Obafemi Awolowo University, Ife, Osun State, Prof  Eyitope  Ogunbodede,  was not available for comment, the Public Relations Officer of the university, Mr Abiodun Olanrewaju, said from the available records, only ASUU among other unions in the university was opposed to the IPPIS.

Olanrewaju, who reacting on behalf of the authorities of the institution, said as far as the management was concerned, it was in agreement with the Federal Government on the issue.

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Olanrewaju said, “We have different unions on the university and the only union that the Federal Government says is not cooperating is ASUU.

“So, I would have expected  reactions from ASUU. It is purely a union matter and has nothing to do with the university. On the matter, we are in agreement with the Federal Government.”

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ASUU faction takes stand today

However, a breakaway faction of ASUU, the Congress of University Academics, will make its position on the IPPIS known on Monday (today).

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The National Legal Adviser of the union, Ayodeji Ige, in an interview with one of our correspondents on Sunday, said, “The decision will be taken tomorrow (today). A decision will be taken tomorrow and we will make it known to the media. The appropriate organs will address the press conference.”

[dinafbrownil]

Sickened By Billing Abuses, Readers And Tweeters Stand Up For Patients’ Rights

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Private Equity Predators?

First of all, let me thank you for writing about such an important issue (“Investors’ Deep-Pocket Push To Defend Surprise Medical Bills,” Sept. 11). I am going to tell you about my personal pain regarding surprising medical billing.

They can call themselves Doctor Patient Unity group or any other fancy name, but the reality is that they are all predators. I say this because I am the victim of these doctors groups. I work as a linguist with the U.S. Army and have top-secret clearance. I could lose my clearance if any of my bills go to a collections agency.

I had appendix surgery on Nov. 6, 2018, at the Davis Medical Center in Layton, Utah. The surgeon had told me that my surgery would take only 10 to 15 minutes. After two hours of surgery, I was released from the hospital and sent home. My insurer, CIGNA, paid all the Davis hospital bills and I paid my portion of the bills. Then in March 2019, I received two separate doctor’s bills totaling about $48,000. My insurance was not paying the doctor’s bills because they were out-of-network. The doctor’s office kept sending me letters to pay $48,000 from my pocket; if I did not pay, I was told, my bills would be sent to collections.

Finally, I received a letter from the collections agency saying that if I did not pay $26,770, it would send the information to the credit agencies. Can the Doctor Patient Unity group tell me what I should do? Should I lose my clearance and my job because I cannot afford to pay $26,770? Should I borrow money from the bank and then pay high interest to the bank for the rest of my life?

— Aziz Rehman, Kaysville, Utah

This is a very misleading article. Many independent physicians speaking out want IDR to solve the problem of outliers and take patients #OutOfTheMiddle. Insurance-backed lobbyists are using this issue as a #TrojanHorse to enrich corporate shareholders at expense of physicians.

— Amy Mecozzi Cho, MD MBA (@amychomd) September 12, 2019

On Twitter, Dr. Amy Mecozzi Cho of Minneapolis diagnosed holes in the article. For example, she told KHN, “the contracted rates for insurance are misleading since our bad debt for patients with high-deductible insurance is greater than 60% of their deductible, but insurance companies won’t bill them because they know this. And so our effective rates for commercial insurance are actually much lower than contracted. The medical loss ratio and the CBO estimates are not capturing these costs to patients and physicians.”

Religious Malpractice

My sister, a hospital chaplain (of Roman Catholic faith), informs me that it’s considered chaplain malpractice to try to force a patient to cope with suffering in the exact way others think they should (“Firing Doctor, Christian Hospital Sets Off National Challenge To Aid-In-Dying Laws,” Aug. 30). It would follow, then, that a hospital’s requiring staff to “help” patients “appreciate the Christian understanding of redemptive suffering” is a paternalistic dismissal of patient integrity and a form of malpractice. The medical relationship is between the patient and the doctor, not the patient and the Vatican.

— Gloria Kohut, Grand Rapids, Mich.

Many hospitals in India are controlled by religious organisations (Hindu, Jain, Christian, Muslim) Are they also as intolerant to differences in one's approach to what is ethical in medical practice as the Christian hospital in this case? https://t.co/Nzy6JN348B

— Amar Jesani (@amarjesani) September 8, 2019

— Amar Jesani, Mumbai, India

It’s unfathomable that students with disabilities can’t get the aid they need to attend college and live in the community! Bravo to this Stanford freshman for fighting for services. It’s past time for readily available help for students! #DisabilityRightshttps://t.co/EuVnUzEX8b

— Areva Martin, Esq. (@ArevaMartin) September 2, 2019

— Areva Martin, Los Angeles

Squeezing The Most Out Of Student Aid

I saw Jenny Gold’s excellent article in the Los Angeles Times about a disabled student’s need for assistance as she starts school at Stanford (“Spotlight: A Young Woman, A Wheelchair And The Fight To Take Her Place At Stanford,” Sept. 4). I wanted you to be aware that the Department of Rehabilitation in California pays for additional expenses for students to train them for future employment. This includes laptops, supplies, transportation expenses, necessary expenses. They might also pay for expenses for care above and beyond the approval of the state Department of Health Care Services.

All students face the issue of how to support themselves while in college. Stanford’s lovely gift of education for all who are accepted is often not used due to the high expenses of that area. Many students are unable to afford college, even with a full scholarship.

Those who have paid their way with student loans and are now employed in high service areas, such as medicine, psychiatry, social services and teaching, are strapped with lifetime payments. Our best and our brightest who serve our communities are in debt to the point where their income barely pays their lifetime of student loans. Sylvia Colt-Lacayo’s situation may have more expenses, but the debt of $2,000 a month is not unique for a full-time university student.

— Teresa L. Pardini, LMFT, Creativity in Counseling, Nipomo, Calif.

This young woman got 4.25 GPA & a full ride to Stanford despite never drinking ANYTHING at school so she wouldn't have to pee, bc that's what it takes for ♿ kids to excel in an abled world. That she still has to fight for care should infuriate you.https://t.co/B9vH1c1ATK

— Sonja Sharp (@sic_sonja) September 3, 2019

— Sonja Sharp, Los Angeles

A Heroine In The Opioid Fight

Please thank this wonderful, dedicated and tough woman (“Longtime Crusader Against OxyContin Begins To See The Fruits Of Her Struggle,” Sept. 17). That criminal company and every single member of the Sackler family had been well aware of the entire scam for decades, but they kept their mouths shut, turned their heads, denied everything and couldn’t care less since they were stuffing their individual pockets with hundreds of millions of dollars for each member of that large family. Every dollar should be clawed back from each family member. They’re laughing all the way to the Sackler Wing of 20-plus museums around this planet.

— David Padawer, Pittsburgh

As the father of a recovering opioid addict I see Barbara's efforts and passion for accountability is so heroic. The loss of her son is so terrible….

— Dave (@dwpena) September 17, 2019

— Dave Pena, Roseville, Calif.

Senior Hunger And Pangs Of Conscience

I’ve been a medic for over 20 years. I have patients that have to pick between eating or taking their medications. It’s disgraceful. We need to have articles like this written every day (“Starving Seniors: How America Fails To Feed Its Aging,” Sept. 3). Thank you.

— Eric Johnson, Marana, Ariz. 

Many hospital stays are for ppl w complications of starvation and malnutrition – confusion/delirium, dangerous electrolyte imbalances in salt, sugar, potassium

We need programs for starving People.

How America Fails To Feed Its Aging https://t.co/gv6Z8HnqZH @khnews

— Tina Chee, MD, MPA (@Tina_Chee_MD) September 3, 2019

— Dr. Tina Chee, New York City

I’m 68, a widower, disabled after two open-heart surgeries, with no family left. The last person to visit me at home was the yearly home health care nurse, back in February.

I am just like the people in your article: old, worn-out and forgotten. After a lifetime of work, I get by on a check that’s half of what a minimum-wage worker flipping burgers might make at $15 an hour. I can barely afford to eat the burgers now. No one, no insurance company, no politician is trying to help seniors out of poverty.

My biggest fear is dying and my little dogs being left alone for weeks or months to die before anyone finds me. Having moved to a rural area after my wife died, people don’t warm up fast to outsiders. It’s awful not to speak to anyone for years — yep, years — outside of cashiers. Just letting you know there are a lot of us out here.

— Rick Wrenn, Mount Carmel, Tenn.

What happens when the system designed to protect millions of seniors facing starvation is broken? The Older Americans Act is one critical piece holding many local Meals on Wheels programs together. We need you to ask… https://t.co/eicvq9gRln

— Chapa Arts & Photog. (@Berrysicles) September 12, 2019

— Maria De Jesus Chapa, Houston

Double Checking Fact-Check Facts

As the chairman of Physicians for Fair Coverage (PFC), I have joined doctors around the country in working to protect patients from surprise medical bills. I am writing now to set the record straight on the implications of various federal policies under debate in Congress. Not only did KHN’s recent article (“Doctors Argue Plans To Remedy Surprise Medical Bills Will ‘Shred’ The Safety Net,” Aug. 7) overlook research from the American Journal of Managed Care, the Centers for Disease Control and Prevention, and the Congressional Budget Office, it created a myopic interpretation of our argument in order to label it as “false,” which resulted in an inaccurate conclusion with respect to a complex issue that deserves a thorough, data-driven and factual examination.

According to the CBO, a benchmarking approach would cut payments to in-network physicians by as much as 20%. This translates into tens of billions of dollars shifted away from in-network physicians who are not sending surprise bills over the next decade. Emergency physicians treat all patients regardless of their insurance status. As a result, 70% of their patients are uninsured, seniors or poor families and children. Therefore, there is no practical difference between reducing commercial insurance payments and reducing Medicaid or Medicare rates. KHN’s own previous case study found that contributing factors to hospital closures include “high uninsured rates and a payer mix dominated by Medicare and Medicaid.” So, a benchmarking policy would create even larger disparities in quality and access to care over time for vulnerable populations.

Others agree that commercial payments play a critical role in supporting the care of America’s most vulnerable patients, including: American Academy of Orthopaedic Surgeons, American College of Emergency Physicians, American College of Radiology, America’s Essential Hospitals, American Hospital Association, American Medical Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association and Federation of American Hospitals.

Instead of speaking with health care experts to better understand how reimbursement dynamics and patient access are inextricably linked in today’s economy, this article relied exclusively on the opinions of two biased research fellows who advocate for the very policy that our ad opposes and whose statements are misleading at best. The assessment also disregards a quote from the California Medical Association describing a lack of available anesthesiologists under California’s benchmarking approach.

PFC’s mission is to protect patients from surprise medical bills. That is why, this year alone, we helped drive constructive compromises that produced new laws in Texas, Colorado, Nevada and Washington. Similarly, at the federal level, we support legislation that uses a proven independent dispute resolution model to protect patients without disrupting responsible, in-network practices. To further protect patients, it’s important that Congress does not create an even larger public health issue with respect to the safety net while fixing the real issue of surprise bills.

— Dr. Sherif Zaafran, Washington, D.C.

When I traveled around the state last fall, Kansans made it clear that Medicaid expansion is a high priority. I'm going to do everything in my power to ensure this will be the year we will finally expand Medicaid in Kansas. #RebuildingKansashttps://t.co/gg7BXeopMp

— Laura Kelly (@LauraKellyKS) September 6, 2019

— Gov. Laura Kelly, Topeka, Kan.

Infected With Advocacy

Your story about Medicaid expansion fails to attempt any serious description of the reasons for opposition to this expansion (“How Political Maneuvering Derailed A Red State’s Path To Medicaid Expansion,” Sept. 6). The reader is left with the clear impression that opponents are ill-informed, parsimonious, uncaring of others (especially the poor) or all of the above. There is no suggestion that such opposing might be in good faith. You really can do better than this. You insult the intelligence of your readers when you fail to deliver the whole story in a fair and evenhanded manner so they can decide for themselves. There is enough “us vs. them” in current media. Don’t drag it into health care. If you want to take positions on important health care issues, please create an editorial page; don’t infect your “news” with those positions. And no, I’m not a Republican. I’m an independent tired of constant advocacy in the media disguised as news. Thank you.

— Geoff Hargreaves-Heald, Lincoln, Mass.

Two (not shocking, maybe disappointing) takeaways: – Citizen intent matters little if a few state actors know how to work the system. – Nothing works better than high medical bills for getting middle class voters to empathize with Medicaid recipients.https://t.co/JxHaho26pU

— Juhyung Sun (@JuhyungSun) September 6, 2019

— Juhyung Sun, Tucson, Ariz.

Why Prescribed Weight Loss Is Ill-Advised

What the author of the article dismissing the opinion of the dietitian who claimed stigma and yo-yo dieting cause more harm than obesity itself failed to mention is that, for many people, how weight might contribute to the development of physical illnesses is immaterial (Obesity Stigma And Yo-Yo Dieting, Not BMI, Are Behind Chronic Health Conditions, Dietitian Claims, Sept. 17). The prescription to lose weight, in and of itself, is damaging. Most dieters regain 100% or more of weight lost within five years. Additionally, people who are told to lose weight and subsequently diet are at significantly increased risk for body dissatisfaction, bingeing, disordered eating and eating disorders.

Health is not just physical health. Descartes invented mind-body dualism in a thought experiment in the 1600s. It is an idea that permeates modern culture and medicine to this day. However, we are not separate from our minds. Our mental health is not separate from our “true” health.

Obesity may or may not cause illness. If the process of losing weight creates more illness in the form of shame and eating disorders as well as health care avoidance, then continuing to blindly recommend it is irresponsible. The recommendation to diet should be made with an informed consent process. “Being overweight may put you at risk of developing X, Y and Z. I am recommending caloric restriction to remedy that. Caloric restriction is known to be ineffective in the long term, and puts you at risk of developing an eating disorder or of weighing more than you do now. The alternative to caloric restriction is to thoughtfully examine obstacles to your access of whole, nutritious foods, whether they be financial, psychological or otherwise.

“Compassionately adopting a diet that over time puts more colors on your plate and replaces processed foods with whole foods may in itself lead both to weight loss and decreased risk of chronic medical conditions. Additionally, finding a way to increase your physical activity, such that the activity is associated with joy and self-care, will also be protective against chronic conditions and may contribute to weight loss. However, if at any point weight loss becomes the goal rather than the logical outcome of sustainable changes, then we are back at the dieting step, with all its consequent risks.”

It doesn’t matter whether obesity causes illness. Deliberately losing weight is an ineffective approach to addressing what may or may not be a problem, and additionally causes harm. Let us guide patients toward what they have control over: food choices and increased activity, and let go of the number, not because it doesn’t influence health, but because focusing on it is ineffective and counterproductive.

If a formerly obese person is now skinny but miserable, hungry, obsessive, depressed and food-preoccupied because that’s what we evolved to do in the context of weight loss, why is that better? Any solution has to respect mental and physical health outcomes, or it is not truly a health-based recommendation.

— Dr. Sarah O’Neil, Boston

This article ignores the massive growing body of evidence around #weightstigma, argues against just two pieces @chr1styharrison put forward, then just uses quotes from experts to rebuff this claim and not evidence and the use of an odd metaphor about carrots.

— Kerry (she/her) (@HAEScoach) September 18, 2019

— Kerry Beake, Mandurah, Australia

Summer Camp Rehab — Or Torture?

The article “At This Summer Camp, Struggling With A Disability Is The Point” (Aug. 13) portrays what you describe as “necessary” but what many of us adults with disabilities remember as rehab torture — traumatic memories of painful so-called therapy with questionable or no demonstrable results. Even if the program had results, many of us would have chosen not to experience the pain. It’s old-style rehab of pretending it isn’t torturous and “we know what’s best for you.” This sort of rehab was vehemently rejected by disability activists years ago. It’s too bad adults who experienced this kind of therapy weren’t consulted. I believe few of them would describe this in positive terms. It’s not a new concept: If you work hard, with pain, you can become independent! So if you can manage to dress yourself in four hours and get ready for bed in three hours, you’re independent and met the goals set for you, even though you’re so tired you can’t enjoy the remaining few hours of your day. Most adults with disabilities would set a goal of having a quality of life over being independent. This was a very biased story and should have been more balanced from very different perspectives, especially from those with disabilities.

— RoAnne Chaney, executive director of the Michigan Disability Rights Coalition, East Lansing, Mich.

SUMMER CAMP FOR KIDS WITH DISABILITIES! There should be more camps just like this one! This Nashville camp was started for kids who have disabilities that require physical therapy, and the camp counselors turn the exercises into games! https://t.co/F2uMFpSSLs

— D'Amore Injury Law (@DAmoreInjuryLaw) July 31, 2019

— Tom von Alten, Boise, Idaho

Prescribing A ‘Deep-Dive’ Into Hospital Excesses

I think KHN Editor-in-Chief Elisabeth Rosenthal’s piece on hospital excesses is right on the mark (“Analysis: How Your Beloved Hospital Helps To Drive Up Health Care Costs,” Sept. 5). I was affiliated with a New York City hospital as a voluntary internist and retired four years ago. I wonder if it would be possible to do a “deep dive” analysis of a representative hospital’s charges and expenditures (several New York hospitals come to mind as candidates) by an investigative reporting group. I suspect there is a lot of money being spent that does not enhance patient quality of care (i.e., excessive numbers of administrators getting egregious salaries). I think you’ve discussed the salient reasons these contributing cost factors have not been widely discussed or debated ― but they must be.

I remember a news story about a patient who bought his artificial hip implant in the U.S. wholesale and, to save money, took it with him to Belgium to have it inserted. The hospital looked like a factory, and he was reluctant to go in — but he did, and as it turned out everything went well and he saved a lot of money!

― Dr. Lawson Moyer, New York City

from Updates By Dina https://khn.org/news/september-letters-readers-and-tweeters-patient-rights/

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[oselatra]

First, get a job

On June 1, with the blessing of the Trump administration, Arkansas became the first state in the 50-year history of the Medicaid program to impose a work requirement on certain beneficiaries.

On June 1, with the blessing of the Trump administration, Arkansas became the first state in the 50-year history of the Medicaid program to impose a work requirement on certain beneficiaries.

Medicaid provides publicly funded health insurance to almost 1 million Arkansans — including the disabled, the elderly and children on ARKids — but the new work requirement will apply only to nondisabled, working-age, low-income adults. Around 280,000 such beneficiaries are covered by Arkansas Works, the state's name for Medicaid expansion under the Affordable Care Act. (Somewhat confusingly, the program has been called "Arkansas Works" since 2015, though the work requirement itself is a new feature.)

At first glance, the requirement is both limited in application and modest in scope. Even among Arkansas Works beneficiaries, about 75 percent will be exempt. For the approximately 69,000 recipients to whom the requirement may apply, the state Department of Human Services will mandate 80 hours of approved "work activities" each month, which can include school, job searches and volunteering along with punching the clock. Governor Hutchinson, who championed the policy, has cited Arkansas's 3.8 percent unemployment rate as evidence it's reasonable to ask able-bodied adults to find a job.

"This is not about punishing anyone," Hutchinson said March 6, when the federal Centers for Medicare and Medicaid Services (CMS) approved Arkansas's waiver implementing the requirement. "It's to help them to move out of poverty and up the economic ladder." Asked how many people were likely to lose coverage, Hutchinson said he expected noncompliance to be "minimal."

Yet health care advocates warn that Arkansas's experiment could nonetheless lead to thousands losing insurance, including many who are now working.

One reason is that documenting the work activities of some 69,000 people each month will entail a dense new web of red tape. It's not enough to simply have a job; beneficiaries must report their work habits monthly through an online portal set up by DHS. Reporting by mail or phone will not be allowed — though the website may be unavailable up to 10 hours every day.

Any change of job that involves a change of income must be reported to DHS. Cash income, whether earned through mowing lawns or waiting tables, must be rigorously documented and reported. Though some exemptions are automatic, others must be reported regularly. And, if a beneficiary fails to report his or her information for three nonconsecutive months out of the calendar year, that person will not only be removed from the Medicaid rolls, but also be locked out of the program until the following January — regardless of whether he or she qualifies for an exemption later in the year.

Joan Alker, the executive director of Georgetown University's Center for Children and Families, has been closely tracking the progress of work requirements in Arkansas and elsewhere. "I think the lessons of history are very clear," she said. "When you have more red tape and paperwork, people lose coverage. When you have more uninsured parents, you're probably going to see more uninsured children as well."

"We're extremely concerned about significant losses of coverage as a result of these new requirements being rolled out in a very rushed manner," she said.

Hospitals are also concerned. Coverage losses would lead to more uninsured people using emergency rooms for care, driving up costs and threatening small hospitals' survival.

"If someone who is eligible for the program loses their eligibility ... their care through the hospital now goes to uncompensated care," Arkansas Hospital Association President and CEO Bo Ryall said. (The AHA is a donor to the Arkansas Nonprofit News Network, sponsor of this article.)

Our House, a shelter for the working homeless in Little Rock, is one of dozens of employment and training (E&T) sites statewide that assist beneficiaries on the food stamp program, or SNAP. Lyndsey Czapansky, who runs the E&T program at Our House's career center, said staff are actively training to help clients navigate the system. Still, she's concerned about the possibility of clients losing coverage because of how it could affect their ability to find and keep employment.

"You need to be in good health to keep a steady job," Czapansky said. "When my clients come in, the first thing that we do is enroll them in Medicaid. If they're locked out, I don't know what we'll do, especially if they need mental health care or intensive dental work or diabetes treatment."

Marquita Little, the health policy director for Arkansas Advocates for Children and Families, said most beneficiaries probably are unaware of their new obligations. "Even the people who know about [the work requirement] don't know that they have to take action or what they need to do," Little said. "There are going to be a lot of opportunities for people to fall through the cracks."

***

Medicaid expansion has transformed health coverage in Arkansas since it was first authorized by the state in 2013. U.S. Census Bureau data shows Arkansas's overall uninsured rate fell from 16 percent in 2013 to 8 percent in 2016. Only Kentucky, a similarly poor state that also expanded Medicaid, saw a greater decline in its rate of uninsured adults over that period.

In 2015, when Hutchinson inherited Medicaid expansion from his Democratic predecessor, Mike Beebe, he chose to embrace the program. That angered some conservatives in the state legislature who have attempted each year to block the Arkansas Works budget in defiance of the governor. The reauthorization fight has replayed every year at the Capitol, pitting Republican against Republican.

But work requirements tend to unite the party. Days after Hutchinson announced the Trump administration had approved Arkansas's waiver, the GOP-dominated legislature passed the Arkansas Works budget with little fuss. Polls show work requirements are also broadly popular among the public: In a poll released last June by the Kaiser Family Foundation, a health advocacy group, about 70 percent of respondents said states should be allowed to implement such policies.

The majority of people on Arkansas Works likely already have jobs. A national Kaiser Family Foundation analysis released in December found that 42 percent of non-elderly Medicaid adults worked full-time and another 18 percent worked part-time, based on Bureau of Labor Statistics data. Among the 40 percent without a job at the time of the survey, about one-third said they weren't working because they were taking care of a family member and another third said they were ill or disabled. Most of the remainder said they were retired or attending school.

However, employment often comes in fits and starts for the working poor. A study published in May by the Urban Institute, a Washington, D.C., think tank, found that among those Arkansas Works beneficiaries who today hold a job, almost one-third may fail to meet the state's new requirements year-round. Of those low-income, employed beneficiaries who likely do not qualify for an exemption, 32 percent wouldn't meet the 80-hour threshold for at least one month out of the year.

Anuj Gangopadhyaya, the lead author of the Urban Institute study, explained that beneficiaries who "work in high turnover occupations or jobs with high seasonality could have their coverage jeopardized."

Census Bureau data indicates that when such individuals are working, they work far more than 80 hours per month, Gangopadhyaya added. "We found they're averaging about 35 hours per week, so it's not that they're opting to not work. ... It's more a matter of whether they have consistent work or not." DHS has said it won't allow beneficiaries to apply "surplus" hours accrued one month to later months that same year.

To supporters of the work requirements, such details are outweighed by a need to create accountability for Arkansas Works beneficiaries.

"I think that there are people who need some sort of encouragement to get job training or to accept the job," state Sen. Jim Hendren (R-Gravette), the GOP majority leader and a nephew of the governor, said in a recent interview. "I am a believer that deadlines work. ... I'm hopeful that by setting expectations, people who are getting some benefits of insurance by others paying for it realize that it's fair and reasonable that they should pursue and obtain work, so that they can contribute to the next person."

Beneficiaries subject to the requirement will be referred to the Department of Workforce Services, which is tasked with connecting those individuals to job training and wraparound services. However, the state has budgeted no new money for an influx of clients at its workforce centers. Hendren said he didn't think that would be a problem.

"If we get to the point where people are sincerely trying to get job training and the programs are not available, we either need to do a better job of making those programs available or we need to give them some relief on taking away their health insurance," he said. "I don't want to penalize people because we're asking them to do something impossible — but I don't believe right now that's the case."

***

Hendren also pointed out the exemptions are generously drawn. "I think there was a very fair and reasonable effort to make this apply to a population that really should be seeking employment and accepting it if it's offered to them," he said.

"Arkansas actually has quite broad exemption criteria compared to other states trying to implement work requirements," Gangopadhyaya acknowledged. Kentucky, Indiana and New Hampshire have also received approval from the Trump administration to impose work requirements, though Arkansas will be the first to get its system off the ground. (Based on estimates from Kentucky, about 40 percent of the 480,000 adults in that state who rely on Medicaid expansion are expected to be subject to the requirement, as opposed to about 25 percent of Arkansas Works beneficiaries.)

But a close examination of DHS' documentation reveals several surprising details about how the policy will actually operate. Contrary to what the governor has said, DHS will not require beneficiaries to work 80 hours per month. Instead, it will require they earn a certain level of income: $680 per month, which is the equivalent of working 80 hours at $8.50 per hour, Arkansas's minimum wage. Each month, Medicaid recipients will enter their earned income into the online portal, rather than the number of hours they have worked.

By using income as a proxy measurement for labor hours, DHS appears to assume all Arkansas Works beneficiaries are making minimum wage. Someone who makes twice that rate, or $17 per hour, would only have to work 40 hours each month to meet the $680 monthly threshold. A beneficiary fortunate enough to earn $34 per hour would meet the requirement by working just 20 hours each month, or five hours per week. In an email, DHS spokeswoman Amy Webb confirmed this accurately described its system for measuring work hours.

Arkansas Works covers low-income adults ages 19-64, but the requirement will apply only to those from ages 19-49. (It's being rolled out in phases: Those in the 30-49 age range must begin reporting in 2018 and those in the 19-29 range will begin in the first half of 2019.) People ages 50-64 are automatically and permanently exempt, meaning they will not have to report any information to DHS.

Perhaps more surprisingly, DHS will also automatically exempt anyone above a certain income level. DHS assumes beneficiaries who make more than $680 per month at the time they apply for health coverage are working enough hours to meet the requirement. That means the compliance burden of reporting work activities will only apply to people making below $680 per month, or about 67 percent of the federal poverty level. (To be eligible for Arkansas Works, a person must make less than 138 percent of the poverty level, or about $1,396 per month for an individual. Therefore, beneficiaries earning between 67 and 138 percent of the poverty line won't be subject to the requirement.)

Some exemption categories will require beneficiaries to report regularly to DHS: full-time student status, enrollment in a drug or alcohol treatment program, caring for an incapacitated person, "short-term incapacitation" resulting from a medical emergency, and a catchall "good cause" exemption that DHS staff must evaluate on a case-by-case basis. Webb said DHS workers will handle "good cause" exemption requests by phone or email.

Asked how much agency staff time would be required to assist beneficiaries and process exemption requests, Webb said the agency did not have an estimate.

Other exemptions will be automatically granted based on the beneficiary's initial application or other state data. Along with the age and income limits, these categories include workers receiving unemployment benefits, people designated "medically frail" due to certain diagnosed health issues, people already subject to a SNAP work exemption and women who were pregnant at the time of application.

Most importantly, an automatic exemption will also apply to anyone living in a household with a dependent child under age 18, whether or not the beneficiary actually cares for that child. That means a 25-year-old living with his parents would be automatically exempt from the work requirement if he has a minor sibling who lives at home. Marci Manley, a DHS spokeswoman, confirmed in an email that "any adult living in the home with a child under the age of 18 will have an exemption, they need not be a guardian or parent."

Little, the Arkansas Advocates policy director, said she was taken aback to learn the dependent child exemption was so broad. "I suppose as an advocate I should be saying 'Oh, that's great,' ... but the leakier it is, the more concerning it is that we are even rolling out this requirement," Little said. "If you have leaks on this end of it, you're going to have a lot of leaks in other places."

The exemptions are drawn so broadly that many likely won't be touched by the work requirement, Little acknowledged. "People that fall into their automated categories are probably going to be OK," she said. But workers on the margins of the economy who don't qualify automatically for an exemption may be in danger of losing coverage.

"I'm most worried about that group," Little said. "They're the people we see eligible for a couple months and then ineligible. They're the seasonal workers. They're people who inconsistently work because they can't get reliable permanent full-time employment. ... That's also where you're more likely to see people with mental illnesses or physical conditions where they're healthy one day and they're not the next."

***

The Center for Budget and Policy Priorities, a liberal-leaning D.C.-based think tank, warned the convoluted exemption categories would inevitably confuse beneficiaries. "These policies are so inherently complex that even if they try to put in exemptions and exceptions, they're still hard to implement and hard for people to take advantage of," Jennifer Wagner, a senior policy analyst with the CBPP, said in a recent conference call.

The confusion may be exacerbated by the fact that DHS, in an effort to minimize expenses, intends to administer the requirement without hiring any new employees.

"Arkansas has tried to do it in a way that hasn't increased staffing costs," Wagner said. In pursuit of a fully automated system, DHS expects all beneficiaries to report through the web portal, an unusual policy feature that required approval from federal CMS.

DHS Director Cindy Gillespie has said the online-only reporting requirement is an effort to save money. "If you implement it in the old-fashioned way of 'Come into our county office,' we would have to hire so many people," she said in March, soon after the waiver was approved.

Gillespie said the agency's long-term goal was to make all of its communications electronic. She also framed the portal as a means of pushing younger beneficiaries to gain computer literacy skills. "We need to help them get an email [address] and learn how to deal in that world, or they will never be successful," Gillespie said.

But the Urban Institute analysis of 2016 Census Bureau data found that among the 69,000 beneficiaries likely to be subject to the requirement, over a quarter had no internet service at home or regular cell phone service. Over half lacked broadband access. An online-only requirement, Gangopadhyaya said, is "a curious thing to do in Arkansas, which has the second-lowest internet access [rate] in the entire nation."

Little noted that DHS hasn't built a dedicated system to handle the complex new requirements. "It's the same Access Arkansas page that people have always used," she said. "We've kind of piecemealed the IT part of this. ... I think it would have cost more to build a system that was more user-friendly."

Alker, the Georgetown professor, pointed out DHS has had serious IT problems in the past. "Arkansas does not have a great history in terms of its eligibility and enrollment systems working well to begin with," she said. In 2015, tens of thousands of beneficiaries were kicked off of Medicaid due to changes in the state's income verification process — a mess that took months of work to resolve.

In a monitoring plan DHS submitted to federal CMS in May, the agency noted another detail: "The portal will be available daily between 7 a.m. and 9 p.m. except for times when it is necessary to take the portal offline for system upgrades." That suggests the system could be unavailable for up to 10 hours out of every day. Asked why the portal would be offline so often, Webb said by email that "this is the time when the system does updates, maintenance, and handles batch processing, etc."

Sen. Hendren admitted this part of the rollout could be rocky. "There's no question there may be some problems we'll have to solve in regards to people with limited internet access or those IT problems at DHS," he said. "But that does not mean you just do nothing and abandon the effort to continue to help people find employment and job training."

Computer systems may also help explain why Arkansas has kept its implementation costs much lower than that of Kentucky, which intends to begin implementing its work requirement in July. DHS says it has spent about $7.6 million on the work requirements this fiscal year. The figure includes $6.8 million spent on the IT system changes, 90 percent of which were paid by federal funds.

In contrast, the Louisville Courier-Journal reported in February that Kentucky increased its administrative budget for Medicaid by about $187 million for the fiscal year. Dustin Pugel, a policy analyst with the Kentucky Center for Economic Policy, a think tank in Berea, said most of that amount is expected to go toward IT contracts and workforce services administration.

"We already had an online application system and we just expanded that functionality to accommodate the reporting of activities," Webb wrote in an email when asked about the discrepancy in costs between the two states.

Like Arkansas, Kentucky is trying to avoid bringing on new staff to administer the requirement. "[Kentucky Gov.Matt Bevin] has said more than once they don't plan on hiring a single person to help administer this waiver," Pugel said. (Kentucky's work requirement is being challenged in federal court by a group of beneficiaries who say the Trump administration overstepped its legal authority when it approved the state's waiver, a case that could have ramifications for Arkansas.)

In Arkansas, the other $800,000 spent by DHS paid for a contract with the Arkansas Foundation for Medical Care to place phone calls to beneficiaries. DHS has also sent letters to enrollees and made a series of informational web videos. But informing 69,000 people of a complex new requirement will take a massive outreach effort, and DHS is expecting much of that task to fall to other outside parties: commercial insurance carriers.

In Arkansas, most Medicaid expansion beneficiaries are covered by private plans sold by insurers on the state's health insurance marketplace, rather than regular fee-for-service Medicaid. That unusual approach to expansion — dubbed "the private option" — means carriers have a financial stake in preventing the work requirement from eroding coverage gains.

Max Greenwood, a spokeswoman for Arkansas Blue Cross and Blue Shield, the largest carrier in the state, said the company is already contacting Arkansas Works members subject to the requirement. DHS will send each carrier a weekly list of their members who are exempt and those in danger of losing coverage.

"We've also reached out to all our agents, our brokers, our customer service teams, our provider partners and our retail stores to help provide additional support and direct member engagement," Greenwood said.

However, many beneficiaries rarely communicate with their insurance carrier. Providers such as hospitals typically won't be able to see when a patient is in danger of losing coverage.

"Hospitals will be helpful, and most hospitals do have Wi-Fi access or the ability to find someone a computer terminal," the AHA's Ryall said. "But, we don't have the in-depth information to identify someone who comes into the hospital and says, 'You need to enter this information.' Our people will certainly be asking those questions, but it will be up to the patient to let us know if they need assistance."

The requirement will indeed create much work — for beneficiaries logging their hours, for DHS staff vetting paperwork, and for insurers, providers and advocates helping thousands of enrollees navigate a new layer of bureaucracy. It is less clear whether the policy will lead to either significant gains in employment or reductions in coverage. But in the view of Hendren and other Republicans, the work requirement is a vital part of keeping Arkansas Works manageable.

"I want you to understand, the purpose is not to take away health insurance for people. The purpose is to make the program sustainable," Hendren said.

"We know we're always going to have people who get into a bind, and we certainly know that it helps to provide health care to folks in those situations," he added. "But we also know that there's no free lunch and money doesn't grow on trees, and we have to do our best to manage the program so that it doesn't become unsustainable and we have to make dramatic cuts."

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. It is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.

First, get a job

[thisdaynews]

‘Height of irony’: Pompeo’s subpoena pushback rankles diplomats

New Post has been published on https://thebiafrastar.com/height-of-irony-pompeos-subpoena-pushback-rankles-diplomats/

‘Height of irony’: Pompeo’s subpoena pushback rankles diplomats

“What the administration appears to want are political operatives who are loyal not to the United States but to the president in furthering his personal, political and financial goals,” said Philip Gordon, a former senior official in the Obama administration who co-authored a recent op-ed defending Yovanovitch. “That’s where it’s demoralizing for the career diplomats.”

A current State Department staffer, speaking on condition of anonymity to protect his job, described the Pompeo letter as “the height of irony.”

Pompeo’s rebuff of Hill Democrats follows a report that his department has ramped up a probe into emails of former Secretary of State Hillary Clinton, Trump’s 2016 White House rival, in ways that are ensnaring some career diplomats. In addition,State’s inspector general is due to soon release a major report into alleged political retaliation against career staffers under Pompeo’s predecessor, Rex Tillerson.

The inspector general recently released a separate report that found an assistant secretary of state, Kevin Moley, acted abusively toward career staff. Pompeo, however, has not fired Moley.

Separately, but still alarming to career employees, are Trump’s attacks on the unnamed whistleblower whose complaint helped prompt the impeachment inquiry. The president has cast the whistleblower’s sources as “spies” engaged in “treason” and implied that they should be executed. He’s also sought to unmask the whistleblower, saying in a series of tweets Tuesday: “Why aren’t we entitled to interview & learn everything about the Whistleblower, and also the person who gave all of the false information to him.”

Yovanovitch is one of several State Department employees House investigators hope to interview as they dig into the impeachment inquiry. She originally was supposed to be deposed Wednesday, before being rescheduled to Oct. 11. The impeachment inquiry was launched after revelations that Trump asked Ukraine’s president to investigate one of his 2020 political rivals, former Vice President Joe Biden.

A congressional aide confirmed Tuesday evening that the State Department inspector general has made an “urgent request” to brief Hill staffers on Ukraine-related issues Wednesday.

Yovanovitch, a decorated diplomat with more than 30 years in the U.S. Foreign Service, came under fire earlier this year by Trump’s personal attorney, Rudy Giuliani, as well as Donald Trump Jr., and elements in the conservative media. They claimed that she had an anti-Trump bias, and there were indirect allegations that she’d tried to block Ukrainian investigations into Biden and his son, Hunter.

Yovanovitch was known for pressing Ukraine’s government to fight corruption, a position long held by the U.S. government, which has been sending military aid to Ukraine in its battle against Russia. But the conservative attacks nonetheless appeared to undermine her. Pompeo pulled Yovanovitch out of Kyiv in May, some two months before she was due to leave the post.

The maelstrom of attacks on Yovanovitch seemed to reach all the way to the Oval Office. In a July 25 phone call with Ukraine’s new president, Volodymyr Zelensky, Trump trashed the ambassador and even appeared to make a veiled threat against her.

“The former ambassador from the United States, the woman, was bad news,” Trump said, adding later, “She’s going to go through some things.”

The president’s comments, revealed in a detailed call memo released by the White House, spurred outrage among the thousands of Civil and Foreign Service officers who work at State or have done so in the past. Organizations such as the American Academy of Diplomacy and the American Foreign Service Association put out statements in her support.

“Whatever views the administration has of Ambassador Yovanovitch’s performance, we call on the administration to make clear that retaliation for political reasons will not be tolerated,” wrote the academy, a nonpartisan group of former U.S. diplomats.

The State Department did not respond to a request for comment for this story.

Members of the Foreign and Civil Service make up the backbone of the U.S. government, and they are sworn to serve in a non-partisan fashion. That means they implement U.S. policy regardless of which party or which president is in power. They provide expertise and institutional memory that is supposed to aid an administration’s political appointees.

But from the beginning, Trump’s political appointees viewed the career staffers with suspicion, suggesting that they comprised a “deep state” determined to derail the Republican president’s agenda. Conservative media outlets fueled such claims. Some printed lists of career staffers dubbed “Obama holdovers,” even though many had joined government long before Barack Obama was president.

At the same time, State Department employees angered Trump political appointees early on when around 1,000 signed on to a “ dissent memo” expressing their unhappiness with Trump’s executive order banning the citizens of several Muslim-majority countries from entering the United States.

Sean Spicer, the White House press secretary at the time, said if the “career bureaucrats” had a problem with the order, “they should either get with the program or they can go.”

Pompeo’s role in the drama is mixed. When he first joined the Trump administration, he led the CIA, and he spoke highly of the men and women who worked for him. He took over as the chief U.S. diplomat from Tillerson, whose support for steep budget cuts, obsession with reorganizing the State Department, and failure to turn to its experts alienated many career diplomats.

Pompeo promised to bring “swagger” back to the State Department, and he named a number of career diplomats to top posts. At the same time, he has been exceptionally careful not to show any differences between himself and Trump, so he’s often not publicly defended his department.

For instance, he’s said virtually nothing in public to criticize Trump’s repeated efforts to dramatically cut the State Department’s budget. He’s insisted that he won’t tolerate political retaliation against career staffers, but he’s failed to take steps that many staffers feel is necessary to hold people accountable.

In some cases, it’s not clear what Pompeo can do. He has not fired Moley, for example, but, according to his aides, that’s because Moley holds a Senate-confirmed role and Pompeo legally can’t oust him. Department leaders have counseled Moley about his actions and say they are implementing a “corrective action plan” for his bureau. They won’t say, however, if Pompeo has ever asked Trump to use his authority to fire Moley.

A former State Department official told POLITICO that Pompeo tried to protect Yovanovitch behind the scenes, and that his decision to pull her out of Kyiv early may have helped her. She wasn’t fired by Trump; instead, she’s still on the U.S. payroll and spending time at Georgetown University. Yovanovitch could not be reached for comment.

Pompeo listened in on the July 25 call between Trump and Zelensky, according to a Wall Street Journal account that the State Department is not disputing. But he’s ignored or deflected questions about the call and his decision to withdraw the ambassador.

The secretary’s letter Tuesday offered some of his most effusive praise of his employees. “I will use all means at my disposal to prevent and expose any attempts to intimidate the dedicated professionals whom I am proud to lead and serve alongside at the Department of State,” he wrote.

But given the context, lawmakers and many in the career ranks didn’t buy his concern as sincere. Three Democratic House committee chairmen — Eliot Engel of New York, Adam Schiff of California, and Elijah Cummings of Maryland — accused Pompeo of trying to bully people from appearing on the Hill.

Pompeo “should immediately cease intimidating Department witnesses in order to protect himself and the President,” the lawmakers wrote. “Any effort to intimidate witnesses or prevent them from talking with Congress—including State Department employees—is illegal and will constitute evidence of obstruction of the impeachment inquiry.”

Pompeo’s letter also drew derisive comments from people who remember his time as a congressman, when he loudly pressured the Clinton-led State Department to release information about the 2012 attack that killed four Americans, including an ambassador, in Benghazi, Libya.

“It is a bit rich,” said Gordon, who reported to Clinton during her time in Foggy Bottom.

Some veteran government employees fear the revelations from the impeachment inquiry will further demoralize the Foreign Service and others who work for the State Department.

One sign of that? Since the memo detailing Trump’s call with his Ukrainian counterpart was released, dozens of Foreign Service officers have joined a private Facebook group for those considering quitting their jobs, a member of the group told POLITICO.

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