AFFORDABLE CARE ACT WAS WRITTEN IN A WAY THAT KILLED ACCESS FOR ANY HEALTH CARE THAT IS NOT PREVENTATIVE ONLY ESPECIALLY FOR THOSE HAVING PRE-EXISTING CONDITIONS.
Republicans are simply telling it like far-right wing global Wall Street players they and Clinton neo-liberals are.
Below we see an article written in 2014 saying just that and the exclusionary tactics for pre-existing across the nation soared during Obama---remember, far-right wing global Wall street Clinton neo-liberals do not enforce Federal laws so Obama's Health and Human Services never enforced pre-existing condition coverage it simply allowed for the exclusion.
Here in Baltimore we have been hearing patients not able to access simple ASTHMA and DIABETES treatments and these vectors of course are major health issues.
IF AN ORGANIZATION OR MEDIA OUTLET KEEPS PRETENDING CLINTON/OBAMA POLICIES ARE HELPING WE THE PEOPLE INSTEAD OF KILLING THE 99% PLEASE STOP TYING TO THOSE OUTLETS. WE NEED REAL LEFT SOCIAL PROGRESSIVE HEALTH CARE ACTIVISM FOR REVERSING AFFORDABLE CARE ACT AND REBUILDING EXPANDED AND IMPROVED MEDICARE FOR ALL.
'If you have this condition, go elsewhere. And that's just the type of discrimination the Affordable Care Act was supposed to end'.
Insurance Plans May Have a Loophole for Pre-existing Conditions
Plans on the health insurance marketplace may be selecting patients by what drugs they cover.
By Lindsey Cook, Data Editor | Sept. 22, 2014, at 4:06 p.m.
Insurance Plans May Have a Loophole for Pre-existing Conditions
For those with pre-existing conditions, health insurance still isn't created equal. (iStockPhoto)
The Affordable Care Act changed the rules on how health insurance plans dealt with pre-existing conditions, outlawing the practice of turning away patients with expensive conditions or charging them a drastically higher cost for coverage. But an editorial alleges some health insurance companies operating on the new marketplaces created by Obamacare may have found a loophole that allows them to discourage sick patients from enrolling in a specific plan.
The change has to do with how drugs are categorized in health systems. From the editorial published online at the American Journal of Managed Care:
"For many years, most insurers had formularies that consisted of only three tiers: Tier 1 was for generic drugs (lowest copay), Tier 2 was for branded drugs that were designated “preferred” (higher co- pay), and Tier 3 was for “nonpreferred” branded drugs (highest copay). Generic drugs were automatically placed in Tier 1, thereby ensuring that patients had access to medically appropriate therapies at the lowest possible cost. In these three-tier plans, all generic drugs were de facto “preferred.” Now, however, a number of insurers have split their all-generics tier into a bottom tier consisting of “preferred” generics, and a second tier consisting of “non-preferred” generics, paralleling the similar split that one typically finds with branded products. Copays for generic drugs in the “non-preferred” tier are characteristically much higher than those for drugs in the first tier."
As Mother Jones highlighted, while motivating people to choose cheaper drugs that have been shown to work just as well as the expensive ones is certainly fair, for some illness, there is no drug in the bottom tier. Instead of motivating patients to choose a different drug, the message plans are sending is: If you have this condition, go elsewhere. And that's just the type of discrimination the Affordable Care Act was supposed to end.
Charles Ornstein of ProPublica reported two advocacy groups have filed a complaint that some plans in the marketplace discriminate against patients with HIV in this exact manner:
"Specifically, the complaint contended that the plans placed all of their HIV medications, including generics, in their highest of five cost tiers, meaning that patients had to pay 40 percent of the cost after paying a deductible. The complaint is pending.
Rising Cost Of Generic Drugs
'It seems that the plans are trying to find this wiggle room to design their benefits to prevent people who have high health needs from enrolling,' said Wayne Turner, a staff lawyer at the National Health Law Program, which filed the complaint alongside the AIDS Institute of Tampa, Florida."
In another article published today in the Journal of Managed Care and Specialty Pharmacy, researchers found plans only cover certain drugs used to treat rare diseases 65 percent of the time. The group looked at 11 drugs used to treat diseases that included Huntington disease and sickle cell anemia. Bronze plans were less likely than silver plans to cover the drugs. The drugs were often placed in the highest of the four tiers.
Across the 11 medications, all are most likely to either be placed on the highest tiers of four-tier formularies or not covered altogether. The high tier placement is reflected in Grouping I and II with the exception of Soliris. Zavesca was not covered by nearly half of plans. Due to their formulation, Soliris, Ceredase, Cerezyme, Elelyso and Vpriv are most commonly not covered under the pharmacy benefit and may be covered under the medical benefit instead, which is consistent with the findings.
For the 6 drugs that are expected to be covered under the pharmacy benefit, coinsurance and co-payment rates under silver plans ranged widely. Coinsurance across all 6 drugs ranged from 10 percent to 50 percent, while average coinsurance rates ranged from 27 percent (Droxia) to 38 percent (Zavesca). Co-payment rates across the products ranged from as low as $20 to as high as $250. Average co-payments fell within the range of $61 (Albenza) to $144 (Xenazine).
The results showed significant state-by-state differences in which medications were covered and how they were covered.
The clause in Affordable Care Act tied to keeping RE-ADMISSIONS down actually paying health systems to keep patients from repeated interactions with those systems lead to an obvious outcome..........health systems designed structures that would not allow patients to re-admit and here is one avenue along with self-administered care-----telehealth. This is to where many of those chronic and pre-existing illness patients went and know what? This isolation and inability to re-enter hospitals as needed harmed millions of US citizens. It has become----WHAT WE DON'T KNOW AS HEALTH INSTITUTIONS IS BETTER as patients outsourced to after-care for-profits et al seeing lower and lower quality of care creating data as if all steps are covered while patient health is often DETERIORATING.
MAKE NO MISTAKE---THIS KEEPING RE-ADMISSIONS DOWN POLICY WAS NOT ABOUT GOOD HEALTH CARE IT WAS ONLY ABOUT LOWERING ACCEPTABLE STANDARDS.
'Remote patient monitoring (RPM)—such as telehealth and tele monitoring—can help improve patients’ experience of care, reduce hospitalization and the costs associated with them, according to a study from the Commonwealth Fund'.
The Affordable Care Act simply removed most patients from having the security of centralized hospital care and on-site after-care clinics to the same deregulated system of networks from home care nursing to finding a family member willing to be paid to home care all of which is now filled with often unqualified care structures as families already stressed financially are forced to find the cheapest avenue to meet these NO-READMITTENCE/NO EXTENDED HOSPITAL STAY policies. What ACA creates is that CORE of hospital as for-profit assembly line medical provider ----able to charge higher and higher rates per procedure getting patients out the door and into a myriad of after-care structures. Since there is no profit from these after-care structures there is no oversight and accountability and the family not being health professionals are now expected to navigate this very, very, very bad system of after-care.
This was the Affordable Care Act ending DO NO HARM medicine to maximize hospital profits while pushing citizens into the position of seeing loved ones left untreated/mistreated. This is indeed the same structure built overseas in Foreign Economic Zones in developing nations.
Shortage of caregivers hits home as families scramble to find help
For one mother, a hospital bed was the only choice.
By Chris Serres Star Tribune
February 27, 2016 — 10:03pm
Jim Gehrz – Star Tribune
Gallery: Pictures are hung on a wall in the living room of Heather Sawyer's Belle Plaine home.
An acute and worsening shortage of home care workers across much of Minnesota has reached a crisis point, threatening patient safety and forcing families into desperate measures to care for their loved ones.
As hiring accelerates in a tightening job market, thousands of openings for $10-an-hour caregiving jobs are going unfilled. The vacancy rate for personal care aides in rural Minnesota recently hit 14 percent — highest in at least 15 years, according to state workforce data.
Unable to find and retain caregivers, many Minnesotans are turning to an informal network of friends and relatives to help care for aging or disabled family members. Some are quitting their jobs and even cashing out their retirement accounts to provide essential care, while home care agencies find themselves relying on less-experienced caregivers with little or no training, agency executives said.
“These are desperate times,” said Karen Holt, social worker at New Directions Inc., a home care agency in White Bear Lake. “Sometimes, you end up reusing the same staff over and over, and people are getting burned out. … It’s putting people’s lives in jeopardy.”
And the need is growing. The Minnesota Department of Human Services, which regulates home care, estimates that Minnesota will need to fill almost 60,000 direct-care and support positions by 2020, particularly as the state shifts funding toward care in the community rather than in nursing facilities. “The seriousness of our health-care workforce shortage is an issue I have heard again and again … and is one we all have to face together,” said Human Services Commissioner Emily Johnson Piper.
Registered nurse Patty Tice moved 10-year-old Morgan Sawyer from bed as she helped Morgan’s mother, Heather, at right.
For Heather Sawyer of Belle Plaine, the shortage hit home last fall, when her home care agency calmly informed her one afternoon that it no longer had enough nurses to provide care for her daughter Morgan, 10, who requires round-the-clock assistance for a range of conditions, including cerebral palsy and epilepsy.
Suddenly, Sawyer was scrambling to fill two 12-hour nursing shifts a day, seven days a week.
A single mother, Sawyer called nearly two dozen agencies but was unable to fill the empty shifts before her daughter’s care was officially terminated. So, in late October, she wheeled Morgan into the acute care unit of Children’s Hospital in Minneapolis, even though she was not sick. The girl would spend the next 21 days confined to a hospital bed, largely separated from her family, while her mother searched for caregivers.
The official reason for Morgan’s hospital stay, listed in her discharge papers: “Home Care Failure.”
“It broke my heart placing [Morgan] in a hospital when she wasn’t even sick,” Sawyer, 34, said as she bathed her daughter. “But I had no other choice. My daughter’s safety comes first.”
For some families, recruiting and retaining caregivers has become such a hassle that they provide the care themselves. Katie Paulson of Hanover said she has taken a temporary leave of absence from her $90,000-a-year sales job because she can’t find a regular nurse for her 3-year-old son, Von, who has a life-threatening adrenal disease and heart condition that require constant monitoring. Von’s last nurse quit just before Christmas for a better-paying job at a hospital, Paulson said.
To make ends meet while she’s at home, Paulson is considering whether to borrow money from her family or cash out her 401(k) retirement account. “The system is failing us,” she said. “You almost feel like you have no choice but to have people in your house that you don’t even like because there’s such a severe shortage.”
Labor-market analysts blame the shortage on the tight job market and historically low wages in the home care sector. Minnesota’s unemployment rate of 3.5 percent is at its lowest level since 2001, with many hospitals and nursing homes raising wages to fill vacant positions. The gap in pay between home and hospital-based care has widened considerably; registered nurses now make three times more per hour than home care aides, according to state workforce data.
Government programs are partly to blame. Home care agencies that participate in the state-funded personal care assistance program are reimbursed $17.01 for every hour of care, which reflects a 5 percent increase from 2014 but which still places a low ceiling on the wage agencies can pay their workers.
Posting fliers at the U
To compete, home care agencies from Faribault to Duluth are dangling special incentives such as $1,200 retention bonuses and free meals and transportation. Yet the new perks have not been enough to outweigh the hardships of a profession that can impose grueling demands, from suctioning tracheostomies and dressing wounds to lifting heavy patients.
“Employers are having a very hard time selling these positions,” said Oriane Casale, a state labor market analyst. “The working conditions can be very poor and the pay is low.”
Bearing the greatest brunt of the shortage are people with disabilities like Linda Wolford, 53, of Roseville. Despite having a spinal muscular condition that severely limits her mobility, Wolford still must carve out several hours a week to train and recruit the caregivers who now rotate through her home. “It’s like running a business,” said Wolford, a manager in the University of Minnesota’s disability resources center.
A few years ago, when the postrecession job market was still weak, Wolford received a dozen or more responses for every posting on sites like Care.com. Now, Wolford said she’s lucky to get a single response from a posting. Many who do call lose interest once they discover that the job requires heavy lifting, she said.
Lately Wolford has begun pinning fluorescent-pink “PCA wanted” fliers near elevators and student areas around the U.
“I’ve had caregivers since I was 18 years old, and it’s never been this hard to recruit help,” Wolford said one day last week as she sped through an underground campus tunnel with a pile of fliers. “People are cherry picking. You tell them about your needs and they say, ‘I don’t think I can do that.’ ”
Morgan Sawyer, 10, needs constant care for cerebral palsy and other conditions. Without a nurse at home, her mother was forced to hospitalize her for 21 days last fall.
But with no signs of the shortage abating, home care agencies can afford to be selective. Andrea Bejarano-Robinson, 35, who has mild cerebral palsy, said an agency recently turned her away because she lives in a suburb, New Hope, and her house is not close enough to a bus stop.
“What exactly do they want me to do?” she asked. “I can’t pick up my house and move it to a different street.”
On a recent morning, Sawyer gently wiped a moist washcloth over the outstretched arms and legs of her daughter as a nurse adjusted the oxygen level on her ventilator. It would take two hours to wash, feed and clothe Morgan before a visit from a speech therapist. As the elaborate choreography unfolded, Morgan smiled and stretched out her arms in appreciation.
“People have told me, ‘Why don’t you just put your daughter in a group home,’ ” Sawyer said. “My response is, ‘No, I am never going to do that!’ There isn’t a home in the world that can give her the love that she gets right here.”
This was the Affordable Care Act ending DO NO HARM medicine to maximize hospital profits while pushing citizens into the position of seeing loved ones left untreated/mistreated. This is indeed the same structure built overseas in Foreign Economic Zones in developing nations.
These after-care policies especially for our chronically ill---those with pre-existing conditions is hard for an middle-upper middle class family to meet----our lower income families are doing without or getting anyone to sit with patients.
'The report states that seven out of 10 patients who required hospital care or out-of-hours treatment did not have a follow-up appointment'.
Below we see an article from UK as their national health program is dismantled and privatized as well having the same failures in access in major disease vectors this one is asthma. We have that same problem in Baltimore and across the US. These failures to try in many chronic illnesses do not lead to immediate death but shorten patients' lives-----some failures are leading to deaths in the short term.
ALL THIS HAS HAPPENED THESE SEVERAL YEARS OF AFFORDABLE CARE ACT AS PRE-EXISTING CONDITIONS HAVE BEEN IGNORED.
Trump and Congress today are simply stopping all that left social progressive posing and stating FORGET ABOUT IT ----to all major disease vectors whose treatments kill profitability for these global health systems.
Two Thirds Of Asthma Patients Not Getting Basic Care, Charity Warns
By Ella Pickover, Press Association Health Correspondent PA for HuffPost UK
Millions of asthma patients are not receiving basic levels of care to keep their condition in check, a charity has warned.
Two thirds of sufferers are not being given fundamental care that is needed to manage their condition, Asthma UK said.
This is around 3.6 million people across the UK.
Full provision of this care would “reduce the impact of asthma, reduce hospital admissions and improve the lives of hundreds of thousands of people”, according to a new report by the charity.
Basic care includes having an appropriate asthma review at least once a year, or more for severe cases and children, being on the right medication and knowing how to use it and having a written asthma action plan.
The Annual Asthma Survey, based on responses from 4,650 patients from around the UK, found that there is variation in the proportion of people receiving basic care across the country - with some areas “lagging behind others”.
Patients in Northern Ireland appeared to get the best basic care, where 47.6% patients received all elements of recommended care.
The lowest proportion was in London, where just 27.5% patients received this care.
But the authors cautioned that it is not just this basic care that is “failing people with asthma”.
The report states that seven out of 10 patients who required hospital care or out-of-hours treatment did not have a follow-up appointment.
The authors said: “Correct discharge arrangements after a hospital stay for asthma saves lives, and this is a particularly worrying finding.”
There are around 5.4 million people with asthma in the UK.
In 2015, 1,468 people died from the condition - the highest number for more than a decade.
The charity said that two thirds of asthma deaths are preventable with the right basic care.
“It is worrying that basic care is not being delivered on a consistent basis, because every person with asthma should be receiving this care,” said the charity’s clinical lead Dr Andy Whittamore.
Kay Boycott, chief executive of Asthma UK, said: “With the 2014 National Review of Asthma Deaths reporting two out of three asthma deaths are preventable with good basic care, it is hugely disappointing that the latest Asthma UK care survey shows little has changed since that damning report.
“It is clear that expecting old ways to tackle long-standing problems won’t work.
“We must take a bold, new approach and take advantage of new asthma digital health solutions to transform the way asthma care is delivered and support self-management.
“Digital asthma action plans, smart inhalers and automated GP alerts are just some of the ways asthma care could be brought up to date and help reduce the risk of potentially fatal asthma attacks.”
Here is a list of the proportion of patients in each region who received all elements of basic asthma care, according to Asthma UK.
:: East Midlands: 33.5%
:: East of England: 30.4%
:: London: 27.5%
:: North East: 38.5%
:: North West: 34.5%
:: Northern Ireland: 47.6%
:: Scotland: 41.1%
:: South East: 33.2%
:: South West: 34.2%
:: Wales: 32.2%
:: West Midlands: 32.2%
:: Yorkshire and the Humber: 28.1%
An NHS England spokeswoman said: “Whilst we recognise the important issues in this annual survey, we also expect patients to take shared responsibility for managing aspects of this long-term condition.
“It is important that patients consult with their GP where necessary and know how to use their medication properly.
“In future, digital solutions may improve dialogue with health professionals and ensure the widespread development of personal asthma action plans to help avoid unnecessary and costly hospital visits for treatment.”
And here is why our asthma patients are finding it harder and harder to get treatment for what was an ordinary disease vector-----Affordable Care Act and Trans Pacific Trade Pact places emphasis on BRAND NAME MEDICINE-----new patents from those pesky BIOTECHS attached to our global IVY LEAGUE universities.
As this article states----they are always COSTLY----and much of the policies created in ACA are designed to end payment for old treatments while denying access to these more costly treatments----this is probably true in UK as well.
THIS IS PREDATORY, PROFIT-DRIVEN health care where DO NO HARM is eliminated while promoting the most costly new innovative treatment takes priority and only a small percentage of US citizens can afford these new treatments. That percentage will disappear as global health tourism markets to only the global 1% and their 2%.
This is happening across all chronic/pre-existing disease vectors
New Asthma Treatment Successful but Costly
- By Lara Salahi
For Jenny McLeland, 33, of St. Louis, severe asthma restricted not only her breathing but her daily life.
McLeland, who has had asthma since birth, tried everything her doctors recommended to relieve her asthma, from playing sports to taking the highest dosage of asthma medication.
"It felt like someone's strangling you," said McLeland. "It's scary when you have nowhere else to go and what you're on is the best you're going to get."
In 2007, McLeland enrolled in a clinical trial for an invasive procedure called bronchial thermoplasty. Since then, she hasn't experienced a single asthma attack.
For hundreds of severe asthmatics who have undergone bronchial thermoplasty – the first nondrug treatment for asthma approved by the U.S. Food and Drug Administration in 2010 – the results have been life-changing.
"When you've lived with it for so long, you learn to adapt to it, but it's been amazing realizing after the thermoplasty how much I was limited," she said.
However, the dramatic improvement comes with a hefty price tag.
Bronchial thermoplasty is expensive, costing anywhere from $15,000 to $20,000 depending on the procedure, and most insurance companies won't pay for it.
The treatment is reserved only for patients for whom medication hasn't worked. Although five-year follow-up studies have found the procedure to be safe and effective, most insurance companies still consider the procedure experimental.
McLeland is one of many who have bypassed the cost of the treatment by enrolling in a clinical trial. Her husband was also successfully treated through the same trial. This treatment is not something she could afford if it wasn't for a clinical trial, she said.
But not all patients who qualify for the procedure necessarily qualify for a study. Nearly 25 million Americans have asthma. As much as 10 percent of people with asthma have what is considered the most severe form and make up the majority of the health care costs of the disease.
Americans spend nearly $18 billion on asthma, the majority of which is spent on treating the illness through emergency hospital visits and multiple medications, according to the Asthma and Allergy Foundation.
"Knowing that we have another way to attack asthma and have another tool in our toolbox is extremely exciting," said Dr. Sumita Khatri, co-director of the Asthma Center for the Cleveland Clinic.
Bronchial thermoplasty works by delivering thermal energy to the airway wall through a catheter to burn away smooth muscle that is inflamed in asthma patients.
The procedure, completed in three sessions, widens the airways enough to decrease the ability of the airways to constrict in response to a trigger and reduce the frequency of asthma attacks.
The procedure is currently available in more than 150 medical centers in 40 states. Studies suggest that the average patient who undergoes bronchial thermoplasty is likely to experience a 30 percent reduction in asthma symptoms and an 82 percent reduction in asthma-related visits to the emergency room.
"This is a one-time treatment and it's very effective and safe," said Dr. Lisa Kopas, a pulmonologist at St. Luke's Episcopal Hospital in Houston.
But the procedure isn't expected to rid patients of medications completely.
While bronchial thermoplasty is FDA-approved to reduce asthma symptoms, it has not been shown to improve lung function or reduce over-response in the airways that triggers the need for rescue medications.
"Your asthma will not be cured," said Khatri, who said that research is still under way regarding the procedure. "All of these [procedures] are nice and good, and hopefully we'll find more benefits in the longer term, but you'll still need to be on your asthma medications."
Dr. Michael Simoff, director of bronchoscopy and interventional pulmonology at Henry Ford Hospital in Michigan, has had 30 to 40 patients referred to him over the past six months for the procedure. He's had to turn many patients away because insurance will not pay for the treatment and the patients can't afford it.
"It puts us in a difficult situation," said Simoff. "My hands are tied, because we see people, we evaluate them and see that they're good candidates, but they don't fill the criteria to be in a study."
Simoff has petitioned many insurance companies in Michigan to review their policy, but it's been slow-going, he said.
In January 2012, the Centers for Medicare and Medicaid Services agreed to pay for the disposable catheters used during bronchial thermoplasty. The procedure requires three bronchoscopies using three catheters that cost around $1,000 to $2,500 each.
"I do think it will become a mainstream procedure in the long run," said Simoff. "I really believe that when we move forward, the patients will need less medication." Many who believe in bronchial thermoplasty, including Simoff, said insurance coverage would not only benefit the patient but would save insurance companies money in long run.
"I'm saving so much money not having to pay for monthly medications that were mostly covered by health insurance," said McLeland. "The overall cost coverage for insurance companies of that and the emergency room visits makes it beneficial."
"Asthma care is one of the most common and costly chronic conditions for insurers," said Mike Tringale, vice president of external affairs at the Asthma and Allergy Foundation of America. "This new procedure for severe asthma is an important breakthrough for patients, especially for a disease like asthma, where there has not been much change in the therapy options for a decade.
Even with the current out of pocket costs, many patients find the relief from their asthma worth it.
"Day to day life is affected when you can't breathe well," said Khatri. "Whenever a patient is able to afford it, if they believe in it strongly enough, they're willing to pay."
I wanted to share this one more time because this is PUBLIC HEALTH------most of American citizens' disease vectors stem from corporate environmental devastation.......and these few decades of CLINTON/BUSH/OBAMA have allowed complete disregard to environmental pollution to our air, water, soil. US cities deemed Foreign Economic Zone MOVING FORWARD has a goal of bringing global corporate campuses and global factories as well as stripping US of natural resources anyway they can so environmental illnesses WILL SOAR and global Wall STreet pols KNOW THIS.
Here we have the destruction of nuclear warheads under OBAMA'S START TREATY----we were sold the idea this was a dismantling of nuclear stock when it was simply a restructuring to NEW NUCLEAR TECHNOLOGY so they are destroying these arsenals while building just as many new nukes.
CONDITIONS FOR PUBLIC HEALTH WILL DECREASE DRAMATICALLY AS ACCESS TO HEALTH CARE DISAPPEARS. THESE GOALS ARE DELIBERATE---WILLFUL-----DONE WITH MALICE AND OUR HEALTH SYSTEM EXECUTIVES KNOW THIS.
It is because environmental disease vectors are going to soar that far-right wing global Wall Street CLINTON/BUSH/OBAMA are in such a hurry to end our developed nation quality of public health care for all.
Of course global GREEN CORPORATION has patented lots of INCINERATORS to sell to global corporate campuses telling us this will protect WE THE PEOPLE-----just as CLEAN COAL AND CLEAN NATURAL GAS-
'He said he can barely believe the Army allows this environmental hazard to continue. “What,” he asked, “does this say about how caring they are about the people around these sites, including their own employees?”
Open Burning at U.S. Military Sites Inflames Activists in Nearby Towns
By Dan Ross on May 4, 2017
372 3 397
Soon after Erin Card moved to within two miles of the Radford Army Ammunition Plant in Virginia two years ago, she began to notice threads of smoke that occasionally rose above the heavily wooded site. She started asking about the source, and eventually was stunned by what she learned: Toxic explosives were being burned in the open air.
“It just seems crazy to me,” said Card, 36, who lives with her husband and their three young boys.
The open burning and open detonation of hazardous waste explosives is banned in many countries, including Canada, Germany and the Netherlands. Likewise, in this country, private industry long ago was forced to abandon the primitive disposal practice.
But the U.S. military and Department of Energy have been allowed to continue the open burning and detonation of explosives and, in a few cases, even radioactive wastes under a 1980 exemption from the Environmental Protection Agency. The EPA exemption was granted to provide time to develop better disposal techniques. Yet today, the U.S. allows open burning and detonation in at least 39 locations, according to federal data obtained by FairWarning. In the continental U.S., that includes 31 military sites, at least five Department of Energy operations and one private business that handles wastes for the Department of Defense.
The government also continues the practice in Guam and the Puerto Rican island of Vieques, where open detonation, practice bombing and weapons development have fueled controversy for more than 6o years.
“It’s crazy that in the 21st century, they’re still allowed to do it,” said Marylia Kelley, executive director of Tri-Valley CAREs, an environmental watchdog group monitoring the cleanup of an open burn site at the Lawrence Livermore National Laboratory in Northern California. Plans call for the construction of thousands of homes within a mile of the open burn site at Lawrence Livermore – which, Kelley argues, will expose residents to a range of toxic emissions. “It’s an extremely crude technology,” she said.
Up in Flames
Decades after open burning of hazardous waste was all but eliminated in favor of more environmentally sound disposal methods, the U.S. military continues to use open burning and open detonation to destroy munitions at dozens of sites across the country and in U.S. territories. Several Department of Energy sites involved in nuclear weapons production also use open burning (Click on flame icons to identify the sites.).
Sources: U.S. Department of Defense and the Department of Energy’s National Nuclear Security Administration
The EPA allows the open burning of waste explosives if it won’t bring “unsafe releases” into the surrounding environment. But burning and detonating explosives in the open appear to do just that. Ken Shuster, a veteran EPA expert in hazardous waste disposal, described the “tremendous amount” of air, soil and groundwater contamination caused by open burning in a presentation he gave last October to fellow agency employees.
According to Brian Salvatore, a Louisiana State University expert in toxic emissions, the open burning of explosives routinely releases some of the most potent known toxins, including cadmium, dioxins and furans. “There’s a whole assortment of them, and it’s really awful,” he said.
What’s more, alternative disposal methods long have existed, and the Defense Department has been urged to use them for decades. As far back as 1991, the EPA told the Pentagon that “safe alternatives” to open burning and detonation “can and should be developed.” In 1997, Congress told the Defense Department to come up with environmentally clean disposal methods for munitions, rockets and explosives within five years, but little progress was made.
Even the argument that Pentagon officials often raise about open burning being cheaper than the alternatives is far from certain. The EPA’s Shuster said it is a “myth” when you factor in the environmental cleanup costs—sometimes hundreds of millions of dollars—at open burn sites. “We’re finding that’s it not so cheap if you include the total costs,” he told his colleagues.
Erin Card, holding her 2-year-old son, Evan, says she sometimes feels “sick to my stomach with worry” about emissions from the nearby Radford Army Ammunition Plant in Virginia.In an email to FairWarning, Army spokesman Wayne V. Hall said the Defense Department has reduced its use of open burning and open detonation and is evaluating new technologies to enable it to cut back further. Hall said open detonation is used in emergencies, when munitions are determined to be unsafe for storage or transport and when no other option exists because of the munitions’ “size and explosive content.”
The Defense Department, he added, “must continually balance our commitment to being good stewards of the environment with our commitment to accomplishing missions vital to national security.”
The EPA failed to respond to repeated requests for comment for this story.
The latest defense spending bill included an amendment requiring the National Academy of Sciences to study alternatives to open burning. U.S. Sen. Tammy Baldwin, a Democrat who helped push through the amendment, has long championed the cleanup in her home state of Wisconsin at the Badger Army Ammunition Plant, which used to conduct open burning. “This will ensure that other sites are not contaminated the way that the Badger site was,” Baldwin wrote in an email.
But some believe the National Academy’s study—to be completed by June 2018 — is no more than foot-dragging. Open burning of explosives has persisted despite years of evaluation of alternatives and even though some of those methods already are being used to destroy some of the nation’s stockpile of chemical weapons, which are generally considered more difficult to break down.
Ted Prociv, former deputy assistant to the Secretary of Defense for chemical and biological matters, characterized the new congressionally approved study as an academic exercise. He said the military should instead conduct practical tests using alternative disposal systems already available and then decide on whether to ban open burning and detonation. Prociv is currently a project coordinator for one such system, the Davinch detonation chamber, which he said was used to dispose of chemical weapons in Japan as far back as 1992. A ban, Prociv said, is “the only thing that’s going to get these guys to do anything.”
“Monstrous” legislative quagmire
The munitions stockpile needing to be destroyed is staggering. According to a recent Government Accountability Office report, the total as of February 2015 was 529,373 tons. The Pentagon estimates that from fiscal year 2016 to fiscal year 2020, another 582,789 tons will be added.
Part of that stockpile sits at the Blue Grass Army Depot in Kentucky. The base alerts the surrounding residents before any open burning or detonation, whose blasts can be heard six miles away at the office of Craig Williams, program director of the Kentucky Environmental Foundation. “When you start hearing things blowing up, theoretically you’re supposed to be prepared,” he said.
Brian Salvatore, a Louisiana State University expert in toxic emissions, says the open burning of explosives routinely releases some of the most potent known toxins.Williams, a foe of open burning who previously campaigned for the Defense Department to dispose of chemical weapons safely, says a “monstrous” legislative quagmire awaits anyone challenging such a widely used military practice as open burning.
Experts, though, warn of the potential consequences of inaction. The EPA’s Shuster, in his recent presentation, described “unbelievable” high levels of toxic groundwater contamination from the open burning of explosives, involving chemicals such as RDX, TNT and perchlorate. He said the contaminants, all linked to human health problems, in some cases have penetrated drinking water systems.
As for the toxic air emissions, LSU’s Salvatore said they sometimes aren’t properly monitored. He said that’s partly because the most sophisticated technologies to detect fine particulates are rarely used, and also because the emissions are dispersed. “You have no stack or chimney to concentrate the focus of the emissions. They just go willy-nilly everywhere,” he said.
Inadequate air and groundwater monitoring can extend beyond the perimeter of bases as well, sometimes making it difficult to verify the source of toxic contamination in surrounding areas. Perchlorate, for example, is a contaminant released through open burning at the Radford Army Ammunition Plant in southwest Virginia. Though plant officials maintain that it’s unlikely perchlorate contamination of nearby drinking water supplies comes from open burning, they said it hasn’t been “determined definitively.”
The iffy assessments are little comfort for Erin Card, the mother who can see the smoke from open burning at Radford. Her husband has suffered from cancer, though he’s now in remission. The eldest of their young boys, Rex, now 5 years old, had a cyst by his thyroid removed. Although the family moved to within close range of the base only around a year and one-half ago, they have lived in the general area, within five miles of the plant, for more than 12 years. “Sometimes, I feel sick to my stomach with worry,” Card said.
A dearth of data makes it hard to prove the links that critics suspect exist between open burning and chronic health problems among nearby residents. A 1991 Boston University study found that residents near a former open burn site in Massachusetts had higher than expected rates of lung cancer and that a causal link to open burning was possible.
Craig Williams, program director of the Kentucky Environmental Foundation, previously campaigned for the Defense Department to dispose of chemical weapons safely and now he is opposing open burning.Some experts suspect that chronic health problems suffered among soldiers who worked at burn pits in Afghanistan and Iraq is related to their exposure to toxic substances. But conventional explosives being burned in the U.S. are merely one type of the hazardous materials — including gasoline, pesticides, medical wastes, animal and human carcasses and possibly chemical weapons—that were burned in those war zones. The Department of Veterans Affairs is still studying the long-term health effects from exposure to these sites.
Decades of monitoring
The lasting environmental impact from some open burning, however, is difficult to dispute. At Wisconsin’s Badger Army Ammunitions Plant, which stopped open burning in 1996, hundreds of monitoring wells track miles of groundwater pollution. Large groundwater plumes contaminated with chemicals such as DNT and chlorinated solvents from two former burn sites there still flow into the Wisconsin River, according to the Army’s monitoring well data. “The Army said that they’re going to be out here for decades monitoring the groundwater,” said Laura Olah, executive director of Citizens for Safe Water Around Badger.
(A spokesman for Badger, Mike Sitton, confirmed that the groundwater monitoring will continue for decades because the Army is using a passive process known as monitored natural attenuation, or MNA, to break down the contaminants naturally. He said the monitoring ensures that there will be little risk to public health.)
Occasionally, open burning and detonation has proven controversial enough to prompt shutdowns. That was the case at the Sierra Army Depot in Northern California, where blasts were so powerful, they rattled windows of nearby homes. In 1999, the depot was the second-worst source of toxic chemicals in all of California, according to EPA data. A lawsuit filed by local residents and environmentalists was settled with the Army agreeing in 2001 to open burn or detonate munitions only in an emergency.
Public pushback also shut down open burning at the former Louisiana Army Ammunitions Plant, now known as Camp Minden. Plans to open burn some 15 million pounds of M-6 propellant provoked uproar, forcing the plant two years ago to instead install a contained burn system to incinerate the stockpile. (Now that the incineration of the waste explosives is nearly complete, the contained burn system also is due to be shut down and removed, following a campaign by local activists to prevent Camp Minden from becoming a long-term disposal site.)
According to Ralph Hayes, founder of El Dorado Engineering, which designed and built the incinerator at Camp Minden, the air emissions from the contained burn unit were cleaner than the ambient air. But incinerators won’t singlehandedly solve the problem of open burning, say experts.
Mark Toohey, a juvenile court judge, was horrified to learn that toxic explosives were being burned in the open air at the Holston Army Ammunitions Plant in Tennessee.“The disadvantages of incinerators are many,” said John Follin, the founder of General Atomics, a San Diego-based military contractor. The company builds what are known as Super Critical Water Oxidation systems that dispose of wastes by cooking them in water in a pressurized chamber. He says the process leaves behind water and occasional salts and metallic oxide particles. In contrast, Follin says, some incinerated explosives still emit dangerous chemicals while they are being destroyed, such as dioxins, furans, and nitrogen oxides. He added that they can leave behind toxic residents or, as he put it, “a hell of an ash problem.”
Incinerators are one of the options being reviewed at the Holston Army Ammunitions Plant in Tennesee, where smoke from open burning has clouded the skies since the 1940s. A 2012 Army Corps of Engineers report identified two alternative disposal methods that can be used to destroy “all present and future wastes” at Holston, but the Army still is “pursuing alternative technologies,” said Justine Barati, a spokeswoman for the Defense Department’s Joint Munitions Command.
Barati, in an email, said the plant operates in “strict compliance” with its permit conditions. But it appears that hasn’t always been the case. In 2015, the Tennessee Division of Solid Waste Management found that Holst0n had illegally burned, among other things, materials contaminated by toxic compounds called PCBs, or polychlorinated biphenyls.
For Mark Toohey, a 61-year-old juvenile court judge whose hometown is nearby Kingsport, Tenn., the smoke seemed like no more than a minor nuisance for decades. In fact, he didn’t even know whether it was coming from Holston or from one of the region’s heavy-polluting plants. But five years ago, when the plumes started getting thicker and darker, Toohey was horrified when he finally learned that the source was toxic explosives being burned in the open air at the military site.
Toohey, who lives a mile and one-half from Holston, blames the smoke for triggering the chronic asthma and severe sinusitis that his wife, Connie, suffers. Their daughter, Jenna, who lives close by, is also troubled by severe sinusitis. The health threat created by the burning is “morally indefensible,” Toohey said.
Now, when the fires burn on base, the Tooheys shut themselves inside and close all of the doors and windows. One time, when the smoke was especially debilitating, the Tooheys packed their bags and left town. He said he can barely believe the Army allows this environmental hazard to continue. “What,” he asked, “does this say about how caring they are about the people around these sites, including their own employees?”
Literally trillions of dollars were looted in health industry frauds against our Medicare and Medicaid Trusts----against SS Disability enough to grow national health institutions broadly inside US and overseas. The health systems overseas in Foreign Economic Zone developing nations were built by these global health systems LIKE JOHNS HOPKINS. When CLINTON/BUSH/OBAMA global Wall Street pols and players tell WE THE PEOPLE to go overseas to get that health care REQUIRED TO ALL CITIZENS PAYING PAYROLL TAXES FOR DECADES-----those overseas facilities paying staff enslaving wages if any-----that model coming to our US cities deemed Foreign Economic Zone health systems being built in BALTIMORE DOWNTOWN right now----same developing nation wages---same third world quality of care----tell those global Wall Street pols and players this:
EVIDENCE-BASED HEALTH RESEARCH HAS FOUND IT IS MORE EFFECTIVE AND EFFICIENT TO SEND ALL 5% AND THEIR 1% TO OVERSEAS HEALTH FACILITIES TO PRACTICE THEIR GLOBAL HEALTH TOURISM WHILE WE THE PEOPLE TAKE EXISTING HEALTH FACILITIES BUILT WITH MASSIVE FRAUDS AGAINST OUR PRE-PAID HEALTH TRUSTS.
We have all we need to rebuild our strong, developed nation quality of care for ALL----we simply need to GET RID OF GLOBAL WALL STREET POLS AND PLAYERS.
This was written Clinton era 1990s----during Bush and Obama these health industry frauds SOARED----we had MEDICARE AND MEDICAID Trusts funded through 21 century for all the health care WE THE PEOPLE need! Those overseas health facilities in Thailand, China, Ecuador, Peru were all built by global Wall Street with our own PRE-PAID HEALTH CARE SAVINGS for goodness sake!
Health care fraud cases on the rise $1 trillion industry is a lucrative target, especially locallyU.S. attorney taking aimMost cases initiated by whistle-blowers alleging faulty bills
August 19, 1996|By John Rivera | John Rivera,SUN STAFFThe U.S. health care system has grown into a trillion-dollar-a-year behemoth, making it a fat target for unscrupulous entrepreneurs who are stealing billions of dollars.
Next to violent crime, fighting health care fraud has become the priority for Baltimore's U.S. attorney and the FBI -- as it has for Attorney General Janet Reno -- and they are using a Civil War-era statute to do it: the federal False Claims Act.
Adopted in 1863 when profiteers were gouging the Union army by such acts as selling gunpowder kegs filled with sawdust, the law encourages whistle-blowers to come forward. It allows an employee who has evidence that a company is defrauding the government to file a lawsuit and receive part of any settlement.
Commonly called "qui tams," a Latin abbreviation for "he who brings an action for the king as well as himself," the suits provide investigators with inside information in a very complex field.
Health care fraud "is easy to do, and there are a million different ways to do it," said Special Agent Kevin L. Perkins, who leads a 10-agent white-collar crime squad in Baltimore that is focusing many of its resources on health care fraud.
"It's nice to have an insider," he said. "It's so much more efficient."
Baltimore -- with its teaching hospitals and medical research facilities and the headquarters of the Health Care Financing Administration, which oversees Medicare -- is emerging as a leader in qui tam litigation.
According to Justice Department statistics, 19 qui tam cases were filed in Baltimore in recent years, most of them related to health care fraud. And in the past two weeks, four new qui tam cases were filed in U.S. District Court in Baltimore, three of them related to health care fraud.
"We're known for being very aggressive on qui tam litigation," said Assistant U.S. Attorney Kathleen McDermott, who prosecutes health care cases in Baltimore. And to encourage more whistle-blowers to come forward, the FBI has established a hot line to report health care fraud, (800) 581-4114.
Last year, three major recoveries of federal funds were made in U.S. District Court in Baltimore.
In April 1995, U.S. HomeCare, which handled billing for several subcontractors serving Medicare patients, agreed to pay the federal government $650,000, without admitting guilt, to settle allegations it submitted false claims. Tina Schenherr, who was fired after making allegations, got $123,000.
In May, Dickeyville resident Terry Fletcher received $1.3 million for bringing her qui tam suit against MetPath Inc. Fletcher alleged that MetPath, one of the nation's largest independent clinical laboratories, billed the Medicare and Medicaid programs for millions of dollars in tests that never were performed. The Teterboro, N.J.-based company agreed to pay $8.6 million to settle the claims.
In October, National Medical Systems agreed to pay a $1.5 million settlement for billing the government for 200 top-of-the-line lymphedema pumps when it provided much cheaper equipment. Public Integrity Inc., a watchdog group for the medical-equipment industry, received $225,000 for bringing the suit.
Because of the vast number of transactions, the risk of a health care fraud being caught is not particularly high, say federal law enforcement officials. So much of the claims processing, which is where much of the fraud occurs, is done electronically by third parties. Transactions are completed "in a nanosecond," with no paper trail.
"Much of it is undetectable without a whistle-blower coming forward," McDermott said.
The False Claims Act was rarely used in recent decades until it was amended in 1986 during the Reagan-era military buildup. As when it first was employed, its target was unscrupulous military contractors, like the ones who were charging the government for goods such as the legendary $500 toilet seat.
In the past decade, the government has recovered more than $1 billion through cases filed under the False Claims Act, according to the Justice Department.
To begin a false claims action, the employee files a complaint with the facts of the alleged fraud. The suit is sealed for at least 60 days to allow authorities to investigate, and cases with merit usually are sealed longer.
The U.S. attorney looks at the qui tam lawsuit and decides whether to join the action. If the government intervenes, the whistle-blower can receive 15 percent to 25 percent of the
A whistle-blower can pursue the case alone. The chances for success are far less, but the payoff is bigger, 25 percent to 30 percent.
In the largest case, Douglas D. Keeth's qui tam suit against United Technologies Corp. in Hartford, Conn., where he was an executive vice president, was settled in 1994 for $150 million. Keeth's 15 percent share was $22.5 million.
The American people often do not understand how health care was paid historically. FDR NEW DEAL created a FEDERAL FUND TO REIMBURSE LOCAL HOSPITALS for health care given to people unable to pay. This fund is what allowed any person needing emergency care or treatment for serious disease vectors to get that care. So, a MEDSTAR or JOHNS HOPKINS treats that uninsured citizen and if no payment was made these hospitals simply filed a payment claim to this FEDERAL HEALTH FUND. This has been done through modern history and it is separate from our MEDICARE AND MEDICAID TRUSTS.
OUR POOR CITIZENS HAVE ALWAYS HAD THIS FEDERAL FUND PAYING FOR WHAT WAS ACCESS TO MOST HOSPITAL AND EMERGENCY ROOM CARE---THIS PAID FOR OUR IMMIGRANT HEALTH ACCESS AS WELL.
When Obama and Clinton neo-liberals installed Affordable Care Act they ENDED THIS VITAL FEDERAL HEALTH FUND because they do not want any PUBLIC SUBSIDY of health care. These global Wall Street Clinton neo-liberals used the excuse ---
WELL, ALL CITIZENS WILL HAVE HEALTH INSURANCE SO WE DON'T NEED THIS FUND.
At the same time each state had its complement of this Federal fund and they are now getting rid of it. This is what will have 99% of WE THE PEOPLE not able to even access ordinary hospital care. THIS WAS DONE BY OBAMA AND CLINTON NEO-LIBERALS AS PART OF AFFORDABLE CARE ACT.
Simply because a Republican state did not expand Medicaid is not the point----ENDING THIS VITAL FDR NEW DEAL FEDERAL HEALTH CARE ACCESS PROGRAM WAS A CRIME.
'Federal health officials have given Florida's low income pool more than $1 billion a year since 2005, but are likely stopping the funds this summer because the Affordable Care Act assumed that states would expand Medicaid and that hospitals wouldn't need those funds because more patients would have insurance'.
This is why hospitals have these several years been allowed to refuse injured citizens-----they know there is no Federal reimbursement fund.
Lost Federal Money Quandary for Hospitals
By Associated Press • Jan 20, 2015
Florida health officials and lawmakers are facing a quandary over how to replace the likely annual loss of $1.3 billion in federal funds which compensate hospitals and providers that care for large numbers of uninsured and Medicaid patients.
UF Shands Hospital, Gainesville
Credit Wikimedia Commons
The state has known for some time that the so-called low-income pool funding will likely end in June. It's still unclear what the bottom line impact will be on the state budget, but the seemingly inevitable loss in hospital funding could be just the ammunition that Medicaid expansion proponents have been looking for.
The federal government asked Florida to study alternate ways to help hospitals pay for treating uninsured and Medicaid patients. A report released late Thursday offers three possibilities, including expanding Medicaid to roughly 1 million more low-income Floridians, which Republican lawmakers have vehemently opposed. But they may warm to the idea when faced with the possibility of having to dip into general revenue funds. The Legislature, which convenes in March, would have to approve any expansion.
Federal health officials have given Florida's low income pool more than $1 billion a year since 2005, but are likely stopping the funds this summer because the Affordable Care Act assumed that states would expand Medicaid and that hospitals wouldn't need those funds because more patients would have insurance. But when Florida lawmakers rejected Medicaid expansion in 2013, hospitals have lobbied aggressively about the negative impacts of losing those critical funds.
The report laid out two other possible ways to replace the federal funds, including switching to a broad-based funding source, which could include a health care related tax and an increase in how much patients and insurance companies pay for services. Another possibility is to create an incentive program that pays hospitals for quality health outcomes such as low infection and re-admission rates. But hospitals generally do not like that approach because they aren't guaranteed payments as they are now and would only get the funds if they meet certain objectives.
The report warns "no single option or combination thereof is void of drawbacks."
The reports points out that Medicaid expansion would significantly reduce the amount of uninsured, but warns the state might not want to pick up the tab. The federal government has agreed to pay 100 percent of the bill for the first three years and 90 percent after that. But one of the main reasons state Republicans rejected expansion in 2013 is because they worried the feds won't make good on their 90 percent commitment, leaving Florida on the hook for billions of dollars.
Florida hospital groups are pushing for Medicaid expansion and a replacement funding source, saying both are essential.
"Florida has over 3 million people without health care coverage. Most work in low wage jobs that do not offer health benefits. They often lack access to primary care and wait until serious illness arises before seeking treatment. The uncompensated care that results is something Florida's businesses and patients have come to understand through higher health insurance premiums and out-of-pocket costs," Florida Hospital Association President Bruce Rueben said, noting the challenges in the current Medicaid program highlighted in the report.
The state transitioned its Medicaid program to a managed care model last year, paying private insurance companies a set amount of money to care for patients. The loss of federal hospital dollars could also impact those insurers. That's because some hospitals like Miami's Jackson Health System are able to get local government funding to offset their costs for caring for so many uninsured patients. When the federal hospital funding dipped during the recession, some hospitals gave their local funds to the state so the state could draw more federal dollars and essentially buy back their rate cuts.
"If insurance companies have to increase how much they pay hospitals to make up for this loss, then it could impact the state budget because the state might have to pay insurers more money to manage Medicaid populations," Florida's Medicaid director Justin Senior told a Senate committee last week.
When asked how much it could impact the state budget, Senior said it's difficult to predict.
"There are $800 million in local tax dollars that go to support hospital rates," and he said it's possible that all, none or some of it would have to come from state's general revenue.