Group backing private Medicare is funded by insurance giants

Group backing private Medicare is funded by insurance giants

https://apnews.com/8f6960ea00424a868fa3ef2dfcee7a92

WASHINGTON (AP) — A group gaining influence in Washington as a champion for Medicare beneficiaries is bankrolled by major health insurance companies that are trying to cash in on private coverage offered through the federal health insurance program.

The Better Medicare Alliance claims a far-flung network of seniors, with a Facebook community of more than 380,000 and 110,000 signed up to receive email alerts. Its website displays profiles of “BMA Seniors” who describe private Medicare plans in glowing terms. The Associated Press found that one of the featured seniors, David Kievit, died in March at age 91.

The multimillion-dollar budget for the alliance isn’t supplied by seniors, but by UnitedHealthcare, Aetna and Humana, according to the group’s president and its federal tax returns. There are many prestigious law firms with lawyers helping clients with ERISA claims which would be able to help them to start a new life peacefully in their desired location inside the country. The three insurance giants together account for close to 50 percent of all enrollees in private “Medicare Advantage” plans and stand to benefit as that part of Medicare keeps growing.

The organization’s website and Facebook page don’t say where its money comes from, making it easy to miss the industry tie.

Since its establishment in December 2014, the alliance has built its profile. It lobbies Congress and the administration and sponsors research. It has reported spending $370,000 so far this year on lobbying Congress primarily, according to disclosure records. Among other issues, the alliance is seeking the repeal of a tax on health insurers imposed by the Obama-era health care law.

President and CEO Allyson Schwartz enjoys credibility among Democrats, having helped pass the Affordable Care Act as a Democratic congresswoman from Pennsylvania. And Republicans have long been fans of private Medicare plans, giving the alliance a foothold in both political parties.

David Lipschutz, a senior policy attorney for the Center for Medicare Advocacy, a nonprofit legal organization that represents Medicare beneficiaries, called the Better Medicare Alliance an “Astroturf group.” The term refers to an organization that casts itself as a grassroots movement to mask their corporate interests.

“They represent themselves as representing Medicare beneficiaries, but they really represent the interests of the insurance industry,” Lipschutz said.

Schwartz rejects any suggestion that the organization is a front for the insurance industry. She said during an interview with the AP that the alliance’s funding sources “are well known,” even though the names and addresses of donors were blacked out of copies of the alliance’s tax returns that it provided to AP.

Federal rules permit nonprofits like the Better Medicare Alliance to shield the identities of donors. Critics say that’s problematic because the public has no way of knowing whether the anonymous donors have a specific interest in a matter before the administration, Congress or the courts.

“I don’t know that this entity is representative of the people who receive this type of insurance, or is it representing the interests of the businesses that offer this type of insurance,” said Daniel Borochoff, the president of CharityWatch, a national watchdog group. He reviewed alliance tax documents for AP and said it appears to be “akin to a trade organization.”

The alliance has received $19.9 million in donations over the last three years, accounting for 99.9 percent of its total revenue during that period, according to the organization’s tax returns for 2015 through 2017. Schwartz said when asked that the money came from UnitedHealthcare, Aetna and Humana.

“You can ask any nonprofit organization about their funders and say, ‘Do they tell you what to do? Does that dictate what you do?’” Schwartz said. “You pay attention to your funders, but you ought to be making your own decisions. We do.”

She said BMA has 125 “allies” that include the insurance companies, local agencies that serve seniors, patient advocacy groups, and nurse and doctor associations that all back Medicare Advantage. They include the American Medical Group Association and Meals on Wheels America.

“Our job is to find the common ground,” Schwartz said.

Medicare Advantage is a growing business for insurers. About 22 million Medicare beneficiaries, or close to 2 in 5, are expected to be covered by a Medicare Advantage plan next year. The private plans promise coordinated care and generally offer lower out-of-pocket costs. They limit choice of doctors and hospitals and employ other restrictions such as prior authorization for services.

UnitedHealthcare has 25 percent of the Medicare Advantage enrollees, Humana has 17 percent and Aetna has 8 percent, according to an analysis of government data by the nonpartisan Kaiser Family Foundation.

Schwartz earned just over $600,000 last year in base salary, bonus pay and other compensation, an increase of $52,000 from 2016. The alliance’s board of directors determined her salary following a compensation survey of comparable nonprofits, according to the tax returns, but she makes more than the top executives who run other Medicare-related organizations.

Max Richtman, president of the National Committee to Preserve Social Security and Medicare, earned $391,185 in 2017, according to the organization’s latest tax return. The group advocates against cuts to retirement security programs.

James Firman, president of the National Council on the Aging, was paid $343,558, according to the organization’s tax return that covers the year between July 1, 2016 and June 30, 2017, the latest available. The council is a decades-old advocacy group.

Among the senior profiles on the Better Medicare Alliance’s website is one of Kievet, a World War II veteran who died in March. There’s a photo of him wearing his veteran’s cap, along with a brief first-person article.

His family was startled to see his photo there, said his son, John Kievit, who lives near Houston.

“I’d like to see the article updated, at least,” he said.

Here is a recent post concerning Medicare Advantage insurance is really only good IF YOU ARE NOT SICK 

Medicare Advantage :you get what you pay for – OR – end up paying for what you get ?

All Medicare Part D, Medicare Advantage and Medicaid HMO programs are PRIVATE INSURANCE and what the Democratic candidates are describing is MEDICAID FOR ALL because they are claiming that no one will have any premiums, deductibles, co-pays.

Congress will go down this path for two reasons:

1. The feds will get to pay a FIXED monthly premium for each person

2. The insurance industry has one of the best funded “pot of money” to fund lobbyists.

It is claimed that lobbyists spend 9+ million/day to get Congress to pass bills in a certain way.  They claim that you can’t buy a member of Congress, but many seem to be on very Long TERM LEASES.

We NEED everyone in New York to contact the Governor’s office TODAY, December 23rd, and request that he sign S6531

We NEED everyone in New York to contact the Governor’s office TODAY, December 23rd, and request that he sign S6531.

It is CRITICAL that you emphasize the importance of the provisions of the bill that 1) license and regulate PBMs, 2) prevent PBMs from imposing onerous accreditation requirements above and beyond those of the state board of pharmacy, 3) provide all New Yorkers the same protections as patients in the Medicaid program by banning harmful spread pricing practices in commercial insurance plans, and 4) prohibit PBMs from substituting patients prescriptions without authorization from their prescribers.

Everyone reading this should make sure that their colleagues, patients, and other contacts are also contacting the Governor TODAY.

Even if you have already done so, please call the Governor again! And if you are on Twitter, please tweet at the Governor as well.

Governor Cuomo Contact:
Phone – 1-518-474-8390
Twitter – @NYGovCuomo

 

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Optum RX, CVS Caremark, and Express Scripts are PBMs. Learn more about how their practices are harming patients and taxpayers by watching this video: https://vimeo.com/319979701

Falsely accused of shoplifting, Tracy couple sues CVS after ordeal sends woman to ER

Falsely accused of shoplifting, Tracy couple sues CVS after ordeal sends woman to ER

https://www.recordnet.com/news/20191222/falsely-accused-of-shoplifting-tracy-couple-sues-cvs-after-ordeal-sends-woman-to-er

STOCKTON — A Tracy couple has filed suit against a national pharmacy chain, claiming employees at one of its stores in Tracy falsely accused the husband of shoplifting, then refused to fill the wife’s prescriptions for pneumonia and asthma medications. Later that same day, the wife — unable to breathe — was rushed to a hospital emergency room.

Lorina Fermaint, 34, a nurse raising four children with husband Vincent Mares, went to her doctor the morning of June 10 after suffering from a high fever for several days. Upon reviewing her X-rays, Fermaint’s doctor told her she had pneumonia. Combined with her asthma, she was having serious trouble breathing.

The doctor gave her prescriptions for medicines to treat both the pneumonia and the asthma, so Fermaint, being driven by her husband, went to the CVS pharmacy on West 11th Street in Tracy where she has been filling prescriptions since she was 15 years old.

She dropped off the prescriptions at the pharmacy counter and was told it would be about a 45-minute wait. Too weak to wait inside the store, she told her husband: “I don’t have the energy, so let’s just go wait in the car. As soon as we got into the car, I got a phone call from CVS. They told me the man I was with stole something from the store and they would not fill my prescriptions.”

Unsure what to do next, Fermaint surprised Mares by asking him if he had taken anything from the store. Perplexed by the question, Mares — who works as a plumber — said “of course not.”

So the couple went back into the CVS where they were met by a cashier who called two managers to the front of the store.

At that time, the managers explained that loss prevention staff had reviewed surveillance tapes and identified Mares as having taken merchandise from the store, Fermaint said.

Furthermore, the managers told Fermaint they wouldn’t release anything to her — not her medications even though she was plainly suffering, and not the prescriptions the doctor had written.

“They didn’t call the cops on us, which is really bizarre, especially if they have camera footage of it,” Fermaint said.

So Fermaint and Mares drove straight to the Tracy Police Department themselves. Fermaint said the officer they spoke with was confused by the pharmacy’s actions and said they can’t withhold medication.

The officer called the store, spoke to another manager who told him that Mares did not steal anything, but they now couldn’t release Fermaint’s medications until the next day because she had been “red tagged.”

That night at home without her medications, Fermaint suffered a severe asthma attack.

“It literally feels like you’re drowning and you can’t breathe at all,” she recalled. She spent hours in the hospital emergency room where she received stronger medications before being discharged with more prescriptions to fill at the same CVS pharmacy.

When she went in the next day, she said, “The lady behind the counter apologized to me. The managers told me about the red flag on my account, and another manager apologized saying (Mares) just fit the description of someone who shoplifted at another store. They tried to offer a $20 gift card to Target.”

The personal injury lawsuit, filed as in category of the statute of limitation accidents last Monday in San Joaquin County Superior Court by Tracy attorney Richard Hyppa on behalf of the couple against Rhode Island-based CVS Pharmacy Inc., seeks unspecified damages for personal injury and breach of duty and good faith.

“It’s a pretty unusual set of circumstances. These people did nothing wrong, yet the CVS employees took it upon themselves to determine that he had been shoplifting,” Hyppa said.

“It’s the kind of thing that shouldn’t happen to anybody,” he said.

A spokesman for CVS was not able to immediately address the situation or the lawsuit.

“We haven’t been served with this suit. Looks like it was just filed (last Monday). We will investigate the allegations therein,” Mike DeAngelis, senior director of corporate communications for CVS, responded by email to a request for comment.

Fermaint said she and her husband pursued a lawsuit for a variety of reasons. She described Mares as “a very hard worker and a family man who is of Latino descent and has tattoos on his body. To flat out lie about him really made me question their motives and what was behind that. Was he profiled?”

She expressed concern for others who might have experienced similar treatment. “If they can do this to me, they can do it to anybody. I know my rights and I know what they were doing is illegal and I wasn’t just going to let it go. They never apologized, they never said what they did was wrong. They just continued to justify their actions.”

“It humiliated us, in front of the store, in front of customers and other employees, and caused me to have severe anxiety and asthma because they refused to give me all of my breathing medications,” Fermaint said.

The first scheduled court hearing has been set for a case management conference at 8:30 a.m. June 18 before Judge Michael Mulvihill in Department 10C.

Contact reporter Joe Goldeen at (209) 546-8278 or jgoldeen@recordnet.com. Follow him on Twitter @JoeGoldeen.

Thomas Kline, MD: MYTH 7 You are a drug seeker, it’s in your head. Nope. It is SYSTEMIC INFLAMMATORY DISEASE!

Jul 9, 2015: Welcome to our COLD HEARTED .. FOR PROFIT … NO PRIVACY… Healthcare system

https://www.youtube.com/channel/UCl0gxZtNAGDoqlLHiLPzPCA

https://www.cchfreedom.org/

Is this like mafia/gangsters shaking down local retail businesses for pay offs ?

folks who do not understand the industry. I know when I submit a bid to a PBM there is not an exorbitant profit built into the equation…in fact, after all of the rebates and discounts, the profit margin is unbelievably slim. I also hear how the gov. Does not negotiate prices, well here is what I do know, when I submit anything to the government I have to use a formula to get a GNUP and use that number. It is far from retail. Most of the drugs that are at issue are specialty drugs and can be more of a supply and demand play. I have actually had to accept a 64% rebate demand from a PBM, not to mention administration fees of 4.5% and an early pay discount of 2%. There was another fee as well ~3%.

For those keeping score at home, that is 73.5% off of AWP (average wholesale price)

I had always heard that the PBM’s demanded rebates/kickbacks/discounts from the pharmas of up to 50% to have one of their drugs on the PBM’s formulary and being approved without going thru a PA.

Now it is more apparent was to why insulin is now several hundred dollars for a 10 ml vial.

With a vial of insulin costing $50 a few years ago .. it is easy to see why it could now be $200 because of demands of the PBM’s to PAD THEIR POCKETS.

For every $1 that a pharma wants to raise their price to cover increased business expenses… they would have to raise the price $4 to cover the kickback money to the PBM’s.

This also explains why Canada and other countries with national health insurance… there is no for profit insurance and PBM middlemen… and thus their retail price could be 75% less expensive.

It has been stated that the Insurance/PBM industries have one of the largest pots of money to funding lobbying, so.. it is unlikely that Congress will pass any such price controls… with 435 members of the House and 33-34 members of Senate up for reelection is 10 months..

 

If you think that ACLU is fighting discrimination against large parts of our population – read this

If you think that ACLU is fighting discrimination against large parts of our population – read this

https://www.aclu.org/news/civil-liberties/four-lawyers-four-projects-one-non-stop-year/

This email highlights the FOUR MAJOR CASES of the ACLU in 2019

boils down to transgender, LGBT, HIV rights, reproduction rights,  voting rights for illegal immigrants , other illegal immigration rights.

and of course, in this emailing they are ASKING FOR DONATIONS/MONEY and here is interesting asterisk …

Donations to the ACLU are not tax-deductible. 

another FOR PROFIT corporation ?

Take a guess where the discrimination of chronic pain pts is on the ACLU’s pecking order ?

Forced cold turkey withdrawal – caused a stroke that caused so much damage

It is with a heavy and broken heart that I must share the news that we are just learning of a #SuicideDue2Pain. She lives here in Oklahoma near me and was very active in many groups as well as planning to join us in advocacy events next year.

She was able to find a doctor to treat her pain a few months ago, but for some reason that Doctor left practice soon after she found her. This caused withdrawals again. During that time, she had a stroke that caused so much damage. She was discharged from the hospital after her stroke but apparently without good plans in place for care. We are still gathering exact details, so this is all the information we have at the moment and even this is still being confirmed. I will share more as I can, specifically her name & picture as soon as the family gives us permission.

On Nov 10th Michelle C. decided she couldn’t take the pain any more. We have & are reaching out to her state Senator and Representative as well as local media. We hope to make something positive of this, as that is something her and I spoke of at length –

she just wants her death to count and create change!

 

Pain Warriors documentary about Chronic Pain and medical establishment, short teaser

Pain Warriors documentary about Chronic Pain and medical establishment, short teaser

No Help, no medication. I want out. I’m not strong enough

No Help, no medication. I want out. I’m not strong enough

this is what I tried to do to myself tonight but I couldn’t cut deep enough I didn’t have a sharp enough blade. I am completely out of medication and no doctor will take me. I was again taken to Scripps ER. They wanted to hold me overnight, but I refused since all they would give me was gabapentin for nerve pain and stingily 2 mg of oxycodone. The nurse told me flippantly you fell asleep right after I gave it to you. I barked back That’s because I took a bunch of pills before being brought here by my mom. That’s the truth. I was talking to an old friend in Maryland and he excepted Christ on the phone with me. I took all the bottles I had = ketamine probably about six hundred milligrams, plus oxycodone 60 mg, +4 mg of Xanax. Unfortunately, my mom rushed me to Encinitas ER. Now I have no medication and I want out. I can’t handle it. The pain is way too severe. No doctor will give me what my body requires to stop hurting, and ER is just as strict because of the CDC and the DEA. They don’t care. I hope to be gone very soon. I can’t take anymore. Much love to both of you for trying so hard to help me. When I listen to that last interview from the Senators office, my hopes really dropped. He stated this is more of a federal issue, as much as we feel for this individual, meaning me, this is a much bigger problem which is going to take some time. I don’t have any more time. My body can’t take another day of this torture and neither could any other human being. Good luck on your crusade. Again use every bit of arsenal I have sent you. I know I email blessed you a lot last night = the sound of pain, some of my writings, some of my experiences, even picture of the hospital board with my name on it from last night. Today The straw broke the camels back. I could no longer do this, especially with no medication whatsoever. My doctor prescribed me a very small amount and said have a happy Christmas I’ll be back after the holidays I could only prescribe you a small amount but I hope it gets you through. It didn’t it’s already gone and not because I’m a drug attic, but my pain requires more medication then a doctor is allowed to prescribe. I love you both. Thank you for fighting so hard for me. I hope you can make a difference for somebody else.