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Anti-Abortion Groups Shrug Off Election Losses, Look to Courts, Statehouses for Path Forward



Rachana Pradhan
Wed, 22 Nov 2023 10:00:00 +0000

Anti-abortion groups are firing off a warning shot for 2024: We're not going anywhere.

Their leaders say they're undeterred by recent election setbacks and plan to plow ahead on what they've done for years, working through state legislatures, federal agencies, and federal courts to outlaw abortion. And at least one prominent anti-abortion group is calling on conservative states to make it harder for voters to enact ballot measures, a tactic Republican lawmakers attempted in Ohio before voters there enshrined the right to abortion in the state's constitution.

“For us, this is a civil rights battle. We have innocent human beings whose lives are being destroyed,” said Carol Tobias, president of the National Right to Committee, one of the country's largest anti-abortion groups. “And we're going to keep fighting because we think those are human beings who deserve protection.”


The movement is no stranger to the long , working over decades to get the Supreme Court to overturn , the landmark 1973 decision establishing a constitutional right to abortion that the high court nullified last year.

But Republican lawmakers and anti-abortion candidates have struggled to coalesce around a unified message ahead of the 2024 elections. In addition to the Ohio defeat, voters in Virginia on Nov. 7 effectively rejected Gov. Glenn Youngkin's proposal to ban abortion after 15 weeks by giving control of the state legislature to Democrats. Democrats are expected to keep capitalizing on anger over the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization.

In its aftermath, abortion rights supporters have successfully won campaigns in seven states. In Ohio, a state Donald Trump won by healthy margins in both 2016 and 2020, 57% of voters supported a constitutional amendment protecting abortion rights. Voters in 11 more states could see abortion-related initiatives on their ballots next year, including in Colorado, Missouri, Nebraska, and South Dakota.

The Ohio vote “makes clear it's essential that the critical work of the pro-life movement must carry on with renewed energy and enthusiasm,” Jim Daly, president of Focus on the , said in a statement following the Nov. 7 election results.


“The GOP already tried the ‘ostrich strategy' in 2022 of ignoring the issue and hoping it would go away. It didn't work,” Susan B. Anthony Pro-Life America said in a memo after the Ohio vote that urged the Republican Party to clarify its stance.

As abortion opponents push ahead, there is some disagreement over the best tactics, said Mary Ziegler, a professor at the of California-Davis and historian on the abortion debate in the U.S.

Some anti-abortion groups want to focus more on strategies that don't depend on voters, instead “going to the points of access you have, which are state legislatures and federal courts,” Ziegler said. Other insist they need to win over voters, either by doing a better job selling their positions or moderating what they'll accept, to secure lasting change.

“There's a sort of underlying, ‘How much do we care about voters?' divide,” she said.


So far, 14 states, mostly in the South and Midwest, have enacted near-total abortion bans, and an additional seven states have instituted bans between six and 18 weeks of gestation. Anti-abortion groups are also deploying strategies to limit — if not eliminate — access to prescription medicines used for most abortions in the U.S.

A threatening access to mifepristone, one of two pills for medication abortion, is making its way through the federal courts. And several anti-abortion groups are trying to revive enforcement of the Comstock Act, a 19th-century law that prohibits the mailing of “obscene” materials and information, as a way to ban the mailing of abortion pills nationwide.

The anti-abortion movement could “cancel out some of these victories at the polls that I don't think voters are aware of,” Ziegler said.

“This is a movement that formed not to win elections but to advance fetal rights,” she said.


Anti-abortion groups aren't unified in their messaging. SBA Pro-Life America, for example, is pushing Republican candidates to back a national 15-week abortion ban. Others say it is time to do away with that type of incremental strategy — according to the Centers for Disease Control and Prevention, 93% of abortions in 2020 occurred at 13 weeks or earlier.

“I would call it a capitulation,” Kristan Hawkins, president of for Life of America, said of a 15-week ban.

SFLA supports enacting federal legislation banning abortion at six weeks — a time before many women realize they're pregnant — or earlier. Hawkins said SFLA would keep “passing laws and then enforcing laws” to notch victories as anti-abortion groups  have for decades.

Groups are “engaged in a marathon, and not a sprint on this,” she said. “We have to keep marching forward and doing what we're doing best.”


Tobias, of the National Right to Life Committee, said its ongoing strategy will be lobbying state legislatures, and focusing more on when abortion should be allowed, such as in cases involving rape or incest, rather than just gestational limits. She said the organization is not calling on Congress to pass a national abortion ban because there aren't 60 votes in the Senate that would be needed to overcome a filibuster.

“We need to start talking about the reasons that women are getting abortions,” she said, “and then how we can help or impact those reasons or make sure that women realize that there is other support available.”

Tobias and others also threw cold water on pursuing abortion-related ballot measures of their own. “It's very clear ballot referendums are a ‘get-rich-quick scheme' for the consultant class,” Hawkins said.

If anything, abortion opponents want to make it more difficult for voters to enact such measures. In a Nov. 7 statement, Americans United for Life said states where abortion is heavily restricted and ballot measures are possible — including Florida, Mississippi, and Oklahoma — should move to require legislative referrals for all future amendments.


Abortion rights supporters say the next steps for their opponents aren't so simple. People are “never going to accept this idea of having fewer rights,” said Gabriel Mann, spokesperson for Ohioans United for Reproductive Rights, the ballot committee that spearheaded the state constitutional amendment campaign.

“They've had five decades since Roe to convince the American people that somehow everyone would be better off sacrificing their own reproductive rights,” Mann said. “They failed.”

By: Rachana Pradhan
Title: Anti-Abortion Groups Shrug Off Election Losses, Look to Courts, Statehouses for Path Forward
Sourced From: kffhealthnews.org/news/article/anti-abortion-election-losses-statehouses-courts/
Published Date: Wed, 22 Nov 2023 10:00:00 +0000

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Kaiser Health News

Bathroom Bills Are Back — Broader and Stricter — In Several States



Jazmin Orozco Rodriguez
Thu, 29 Feb 2024 10:00:00 +0000

Republican lawmakers in several states have resurrected and expanded the fight over whether transgender people may use bathrooms and other facilities that do not match their sex assigned at birth.

At least one bill goes so far as making it a crime for a transgender person to enter a facility that doesn't match the sex listed on their birth certificate.

The debate has been popping up in statehouses across the nation in recent months, predominantly in conservative, rural states, including at a hearing of the Arizona Senate's Health and Human Services Committee in February. Proponents of that state's SB 1628, which defines “male,” “female,” and other terms through rigid definitions of biological sex, argued that women's rights are at stake. Opponents disagreed and said the language would erase transgender people from state statute and legal protections.


The bill states that Arizona may “separate single-sex” environments for males and females, including within athletics, living facilities, locker rooms, bathrooms, domestic violence shelters, and sexual assault crisis centers, meaning that transgender women could be prohibited from entering such spaces meant for women. Researchers have found that transgender women experience assault at a rate nearly four times as high as cisgender women.

The latest round of proposals, like the one in Arizona, expand on an earlier spate of “bathroom bills,” which sought to restrict transgender people's access to public restrooms and locker rooms. In some instances, the proposed laws would extend far beyond access to facilities by excluding trans people from state anti-discrimination laws and dictating makeup of athletic teams. Legal experts say the new bills put states at risk of violating federal anti-discrimination laws, which could throw billions of dollars in federal into jeopardy for states and crisis centers that receive federal grants.

At least one state — Utah — removed lines that specifically mention shelters and similar facilities because of concerns about losing federal funding.

In addition to the bill passed in Utah, lawmakers introduced similar bills in Idaho, Georgia, Arizona, New Mexico, Iowa, and West Virginia. The measures mirror a model bill created by the Independent Women's Center, a conservative nonprofit that seeks to rewrite state laws to rely on sex assigned at birth. Versions of the policy were approved through legislation or executive orders last year in Kansas, Nebraska, Oklahoma, and Montana. A similar bill was also introduced in Congress last year by Sen. Cindy Hyde-Smith (R-Miss.) and Rep. Debbie Lesko (R-Ariz.)


Jennifer Braceras, vice president for legal affairs and founder of the Independent Women's Law Center, testified in support of the proposal in Arizona.

“Everyday Americans know that a woman is an adult human female,” Braceras said, referring to the definition in the bill that a female is “an individual who has, had, will have or would have, but for a developmental anomaly or , the reproductive system that at some point produces ova.”

She told state lawmakers that activists seek to convince judges and others that men who identify as women have an unfettered right to enter women's spaces and said the policy is a tool to restrict that access.

Braceras added that just because the model legislation does not include gender in its definitions, that doesn't prohibit state lawmakers from choosing to include it in their policies. Conservative proponents of the legislation emphasize the difference between sex and gender, saying the former is an immutable biological fact and the latter a set of cultural norms.


The narrow definition of sex and provisions that declare certain spaces be protected as “single-sex environments,” including domestic violence shelters and rape crisis centers in some states' versions of the policy, raise questions about compliance with federal laws that prohibit discrimination based on sex or gender.

Anya Marino, director of LGBTQI equality at the National Women's Law Center, said that if a court found these state statutes at odds with federal laws, the federal law that ensures protection on the basis of gender would supersede the state laws.

Beyond how the laws could be interpreted or implemented, Marino expressed concern about other consequences these debates can have, including violence against people who “fail to conform against an extremist idealistic view of how sexes should appear,” she said.

“It's part of a larger objective to control people through body policing to determine how they love and how they navigate their lives.”


Yet the legal ramifications are unclear.

In Montana, where one of these proposals became law after SB 458 was approved during last year's session, lawmakers weighed the risks of potentially violating federal law and losing billions in funding.

The state's legislative fiscal analysts determined that $7.5 in federal funds were on the line in the first year, depending on how state agencies implemented the law and whether those actions were deemed violations of anti-discrimination laws. The bill passed regardless and was signed by Republican Gov. Greg Gianforte.

A legal challenge of the statute is pending. Regardless, the Montana Department of Public Health and Human Services cited the law's passage as justification to revive a ban on transgender people changing the sex designation on their birth certificate. The ban was originally instituted in 2022 and struck down by a judge before the new law passed.


“DPHHS must follow the law, and our agency will consequently process requests to amend sex markers on birth certificates under our 2022 final rule,” department director Charlie Brereton said in a Feb. 20 statement announcing the change.

Lawmakers in Utah removed language specifically identifying domestic violence shelters and rape crisis centers as “sex-designated” spaces that could exclude transgender people after hearing concerns from local and state about losing federal funding. Though lawmakers removed mention of those specific venues from the bill, they kept provisions that prohibit transgender people from entering sex-designated restrooms, public showers, or locker rooms that don't correspond with their sex assigned at birth unless their birth certificate has been amended or they've undergone gender-affirming surgery accordingly. The bill was fast-tracked, approved, and signed by Republican Gov. Spencer Cox two weeks after the legislative session began.

More recently, West Virginia lawmakers removed language from HB 5243 that named domestic violence shelters and rape crisis centers as places where the state could distinguish between the sexes.

Republican Delegate Kathie Hess Crouse, sponsor of the bill, said the language was removed because it was unnecessary.


“By removing the specific examples, we're making it extremely clear that this list is not the full list of single-sex environments that West Virginia may have,” she said.

The West Virginia House approved the bill in February and it is pending approval from the Senate.

Asked about constituents who testified in opposition to the bill with concerns that it would negatively affect transgender people, Hess Crouse said they were misinformed. She asserted the bill doesn't create new rights or take any away.

“The bill is a definitional bill for our courts to have guidance when interpreting laws that already exist in West Virginia,” she said. “If anyone in the state is not happy with the laws we already have on the books, they can work with their legislator to bring a bill that changes the law.”


Hugo Polanco, a trial attorney for the Maricopa County public defender's office, testified in opposition to the bill in Arizona on behalf of the state's American Civil Liberties Union chapter.

“Let's be clear,” he said. “Trans rights are women's rights. Advances in trans rights tear down barriers based on gender stereotypes, creating the opportunity for each of us to determine our own life story.”

Alex del Rosario, a national organizer with the National Center for Transgender Equality, said this slate of bills harms transgender people by attempting to eliminate protections for them.

“Policing people's bodies while excluding transgender and intersex people from using the restroom does not protect anyone's privacy,” they said. “Extremist politicians have been taking advantage of the American public, projecting a false image of transgender people, especially transgender women, to stoke fear and distrust of a community that many people don't understand.”


By: Jazmin Orozco Rodriguez
Title: Bathroom Bills Are Back — Broader and Stricter — In Several States
Sourced From: kffhealthnews.org//article/state-bathroom-bills-sex-definitions-transgender-trans/
Published Date: Thu, 29 Feb 2024 10:00:00 +0000

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Kaiser Health News

Readers Call on Congress to Bolster Medicare and Fix Loopholes in Health Policy



Thu, 29 Feb 2024 10:00:00 +0000

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.

Occupational Therapists Change Lives. CMS Must Better Them.

Occupational therapists are critical in helping patients adjust to new circumstances, empowering them with the tools they need to overcome barriers and regain control over their lives. Whether you're transitioning from homelessness into a home (“In Los Angeles, Occupational Therapists Tapped to Help Homeless Stay Housed,” Jan. 24) or relearning how to do everyday tasks following a stroke, OTs are key to patients' care plan.


But the critical care provided by OTs is being threatened by another year of payment cuts imposed by Medicare, our nation's program for people age 65 and up. Many older patients treated by OTs access insurance coverage through Medicare, which typically reimburses providers at a lower rate than private insurers. And now, with payment cuts that went into effect on Jan. 1 — despite warnings and backlash from lawmakers, patients, and providers — OTs are struggling to deliver care with lower Medicare payment.

Investing in occupational therapy improves outcomes for patients, has the potential to reduce the burden on hospitals and other health care clinicians, and keeps individuals healthy and independent. Medicare's payment cuts only compromise the ability of providers to deliver comprehensive, compassionate care. Medicare must recognize the long-term patient benefits occupational therapy has to offer.

Luckily, Congress is considering a bill that would reverse these harmful payment cuts. The Preserving Seniors' Access to Physicians Act of 2023 (HR 6683), would reverse the cuts that went into effect on Jan. 1, alleviating financial stress for occupational therapists and preserving patient access. I strongly urge lawmakers to prioritize and protect occupational therapy services and immediately pass HR 6683 for America's Medicare patients.

— Doug Fosco, an occupational therapist practicing at Two Trees Physical Therapy in Ventura, California


An assistant professor at Ontario's Western University weighed in on X.

Great to see the role of #occupationaltherapy with persons who experience #homelessness profiled in @latimes. Thanks #deborahpitts for your work in LA with @USC and #skidrowhousingtrust . Check it out @CAOT_ACE @OSOTvoice ! @CAEHomelessness https://t.co/S5s9jhgoxI

— Carrie Anne Marshall, PhD (@cannemarshall) January 24, 2024

— Carrie Anne Marshall, Sydenham, Ontario

Congress Must Finish the Job on Site-Neutral Payments


There's an obvious solution to rein in government spending and patient out-of-pocket costs: Pay identical prices for identical care (“In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength,” Feb. 13).

As a community oncologist, it is clear to me how Medicare favors hospitals by paying more for services provided in hospital outpatient departments (HOPDs) than the same care delivered in community-based facilities. For example, last year, Medicare paid over 2.5 times as much in an HOPD as in a free-standing office for drug administration services. It's not just Medicare paying too much; patients also face higher out-of-pocket costs for care provided in HOPDs. If the Lower Costs, More Transparency Act is signed into law, cancer patients would immediately pay less for treatments like chemotherapy.

One unintended consequence of current payment disparities is consolidation. To leverage higher reimbursements, health scoop up independent practices — a growing problem that is particularly pronounced in oncology. From 2008 to 2020, 435 community cancer clinics closed, while 722 contracted with or were acquired by hospitals. This consolidation is reducing patient access, particularly in rural areas, where many independent clinics operate small satellite sites that tend to be the first to close when hospitals acquire a community-based practice.

It's time for Congress to finish the job through bills like the Lower Costs, More Transparency Act and the SITE Act, which would help level the playing field once and for all.


— Scott Rushing, Vancouver, Washington

The chief marketing officer of SKYGEN cut to the chase on X.

In the battle to control healthcare costs, hospitals are deploying their political power to protect their bottom lines. https://t.co/97r502KrpM

— Donald H. Polite (@DonaldPolite) February 15, 2024

— Donald H. Polite, Milwaukee


The ‘Gold Card' Shuffle

Prior authorization, by definition, creates delays in care and bureaucratic barriers for physicians — which is why it is so troubling that many insurers now require prior authorization for large categories of procedures with no evidence of overuse or inappropriate use. With health insurers increasingly implementing questionable prior authorization policies, state and federal lawmakers are racing to erect safeguards that ensure patients' access to timely care (“States Target Health Insurers' ‘Prior Authorization' Red Tape,” Feb. 12).

Much of the legislation to address this growing problem centers around the use of “Gold Cards” that exempt providers whose previous requests for prior authorization have been approved for a certain period. In general, these laws are important for patients who can't afford to wait for care — especially in the field of gastroenterology where severe abdominal pain or blood in the stool could indicate a serious like cancer.

However, some insurance companies are co-opting the “Gold Card” term to justify new prior authorization requirements instead of streamlining existing ones. Consider the case of UnitedHealthcare, which announced it would roll out a “Gold Card” prior authorization program this year for most colonoscopies and endoscopies. No other insurer has levied such a policy, nor does the research suggest there is an overutilization of these vital services. Despite nearly a year of good faith efforts to seek transparency and guidance from UHC, the company has failed to release any data or justification that these services are improperly utilized.


If anything, diagnostic and surveillance colonoscopies and endoscopies may be underutilized. New research from the American Cancer Society shows an alarming spike in the number of younger Americans being diagnosed with and dying from colorectal cancer. Since symptoms of colorectal cancer don't often appear until the disease is at a more advanced stage, early detection is key. Any disruption to surveillance colonoscopies (which follow removal of a precancerous polyp and are part of the screening continuum) caused by UHC's forthcoming prior authorization policy would be dangerous for the company's 27 million commercial beneficiaries.

The American Gastroenterological Association strongly urges UHC to rescind its “Gold Card” prior authorization policy. Policymakers must monitor how insurers are co-opting concepts meant to protect patients, in particular UHC's faux “Gold Card,” which threatens patient access to a procedure proven to save lives.

— Barbara Jung, president of the American Gastroenterological Association, Seattle

In an X post, a senior fellow at the Manhattan Institute pointed out the value in requiring prior authorization.


Case-by-case prior authorization is never fun, but surely preferable to most other methods of eliminating needless spending (ex post denials of reimbursement, higher cost-sharing, capped global budgets, etc…) https://t.co/nYijeiAUtP

— Chris Pope (@CPopeHC) February 12, 2024

— Chris Pope, a senior fellow at the Manhattan Institute, New York City

Hospice in Prison: A Transformative View

I was so impressed with Markian Hawryluk's exceptionally well-written article “Death and Redemption in an American Prison” (Feb. 21). I was privileged to serve as an inaugural member of the American Hospital Association's Circle of Life Award committee, from 1999 to 2004. The were established to recognize the most outstanding hospice and palliative care programs in the U.S. The very first year, we received an application from the country's largest maximum-security prison in Angola, Louisiana, the subject of Mr. Hawryluk's wonderful article. The prison was one of the five finalists chosen for a site visit in 2000. I volunteered to be on team to visit and evaluate the prison's hospice services.


Twenty-four years later, I still remember my conversation with one of the inmate volunteers who had just returned from bathing and feeding a dying prisoner. He told me the inmate said, “I love you.” Then the inmate volunteer stated, “I never heard those words before — not from my father, who I never met, nor from my mother.” In 2000, if one were sentenced to life at the Louisiana State Penitentiary, there was no chance for parole. When we met with the warden, he mentioned there was a waiting list of prisoners who wanted to be hospice volunteers.

Please convey my deep appreciation to Mr. Hawryluk for his outstanding article.

— Paul Hofmann, president of the Hofmann Healthcare Group, Moraga, California

A digital storyteller shared the article on X.


Your one, long read for – it's beautifully and thoughtfully written and reported”Sometimes when you're in a dark place, you find out who you really are and what you wish you could be,” Steven Garner said. “Even in darkness, I could be a light.”https://t.co/57asjh11ZV

— Ameera B. ا ميرة بت 🪬 (@meerabee) February 19, 2024

— Ameera Butt, Los Angeles

Feeling Insecure Because of Social Security Tactics

When will you continue your series on the overpayments to the Social Security Administration (“Overpayment Outrage”)? People are still suffering without benefits because the agency says people were overpaid and wants the money back. Why is nobody else asking more questions?


People in this country worked hard and paid taxes. And when it is time to retire, the Social Security Administration refuses to pay if, all of a sudden, it discovers you have been overpaid. They have told me I owe them $30,000 from over 20 years ago, and I do not know what they are talking about, but they want to take my retirement money until it's paid off. Or they want you to say it is OK to take a percentage out. Doing that would say you're guilty and you owe the money — to me, that's blackmail.

New immigrants get free phones, medical care, debit cards, food assistance, schooling … that comes to more than my little amount of retirement money. It seems the government can afford to take care of them, but not their own. Everyone who has had their Social Security taken away should be entitled to the free services they get, as we are in the same position — now we have nothing either.

— Thomas Troy, New York City

Lifelong Minnesotan and epidemiologist Eric Weinhandl chimed in on X.


Relatively severe incompetency. Social Security Chief Apologizes to Congress for Misleading Testimony on Overpaymentshttps://t.co/HYPcTU5tVW

— Eric Weinhandl (@eric_weinhandl) December 27, 2023

— Eric Weinhandl, Victoria, Minnesota

A Balanced View of the Law Curbing Surprise Bills

KFF Health News' Elisabeth Rosenthal has long advocated for quality, patient-centric medical care. However, her recent article, “The No Surprises Act Comes with Some Surprises” (Feb. 14), falls short in its analysis of surprise medical billing and the federal No Surprises Act (NSA). While she places blame on physicians, the reality is more complicated.


Patients with health insurance should not be burdened with paying more than their normal in-network cost-sharing amount for unexpected out-of-network care. This is not controversial. The legislative debate was never about whether to act on surprise billing, but rather how to act. While insurers favored policies that would allow them to calculate the payment rate medical providers receive, with the NSA, Congress instead chose an approach intended to protect sustainable payment rates that would preserve patients' access to care. The NSA removes patients from payment disputes between insurers and providers and is intended to encourage negotiations between insurers and providers, with an option for neutral arbitration.

Rosenthal's article implies a “greedy doctor” narrative, omitting discussion of insurers as contributing to the problems with the NSA's implementation. While the article notes that many requests for arbitration came from private equity-associated provider organizations, it neglected to note that a single insurance company (UnitedHealthcare) was involved in almost 40% of arbitration disputes. That is more than the rest of the top five insurance organizations combined. The article also quotes and references papers by Zack Cooper, whose undisclosed connections with UnitedHealthcare came to light through litigation. As reported, UnitedHealthcare not only provided data to Cooper, but helped frame the narrative of the work.

NSA rulemaking has financially incentivized insurers to leverage the NSA to unilaterally reduce existing contracted rates and push physicians out-of-network. As for the projected number of requests for arbitration in 2022 (which underestimated “providers' ire by an order of magnitude”), that projection ignored existing data. In just the first six months of 2021, Texas alone had more than twice as many arbitration submissions for its state law as the federal government projected for the nation for a full year. More importantly, the article ignores the issue of why doctors request arbitration. Since arbitration is - and “loser pays,” there is a strong disincentive to request it without a solid reason. In the second quarter of 2023, providers won nearly 80% of disputes, reflecting the fact that doctors are going to arbitration when insurers' actions are unreasonable.

Further, while it is true that before the NSA too many patients were receiving bills for unexpected out-of-network care, a report from the Department of Health and Human Services noted that out-of-network billing was actually declining prior to the NSA. Physician survey data suggests that post-NSA out-of-network care is now increasing due to some insurers' actions.


The bipartisan NSA is a balanced solution to a complicated problem. Difficulties with the law's implementation, including the volume of dispute submissions and backlog of cases, are due to unintended consequences from rulemaking. Addressing these challenges requires an honest conversation about their cause. Going forward, rulemaking is needed to promote fair network contracting, limit the need for arbitration, and, most importantly, protect patients' access to care.

— Rich Heller, a pediatric radiologist and the associate chief medical officer for health policy, Radiology Partners, Chicago

Anesthetist-emergency physician-family doctor David Moniz, in an X post, warned of the “unseen consequences” of the No Surprises Act.

Check out the surprising outcomes of the No Surprises Act, designed to protect patients from unexpected medical bills. While it's successfully shielded many patients, there are unseen consequences. Read the full article here: https://t.co/YFa0xweRe7#health, #healthpolicy, #he

— David Moniz (@DavidMoniz15) February 14, 2024


— David Moniz, Chilliwack, British Columbia

Title: Call on Congress to Bolster Medicare and Fix Loopholes in Health Policy
Sourced From: kffhealthnews.org/news/article/reader-response-congress-medicare-health-policy-loopholes-letters-to-editor/
Published Date: Thu, 29 Feb 2024 10:00:00 +0000

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Hacking at UnitedHealth Unit Cripples a Swath of the US Health System: What to Know



Darius Tahir
Thu, 29 Feb 2024 10:00:00 +0000

Early in the morning of Feb. 21, Change Healthcare, a company unknown to most Americans that plays a huge role in the U.S. system, issued a brief statement saying some of its applications were “currently unavailable.”

By the afternoon, the company described the situation as a “cyber security” problem.

Since then, it has rapidly blossomed into a crisis.


The company, recently purchased by insurance giant UnitedHealth Group, reportedly suffered a cyberattack. The impact is wide and expected to grow. Change Healthcare's business is maintaining 's pipelines — payments, requests for insurers to authorize care, and much more. Those pipes handle a big load: Change says on its website, “Our cloud-based network supports 14 billion clinical, financial, and operational transactions annually.”

Initial reports have focused on the impact on pharmacies, but techies say that's understating the issue. The American Hospital Association says many of its members aren't getting paid and that doctors can't check whether patients have coverage for care.

But even that's just a slice of the emergency: CommonWell, an institution that helps health providers share medical records, information critical to care, also relies on Change technology. The system contained records on 208 million individuals as of July 2023. Courtney Baker, CommonWell marketing , said the network “has been disabled out of an abundance of caution.”

“It's small ripple pools that will get bigger and bigger over time, if it doesn't get solved,” Saad Chaudhry, chief digital and information officer at Luminis Health, a hospital system in Maryland, told KFF Health .


Here's what to know about the hack:

Who Did It?

Media reports are fingering ALPHV, a notorious ransomware group also known as Blackcat, which has become the target of numerous enforcement agencies worldwide. While UnitedHealth Group has said it is a “suspected nation-state associated” attack, some outside analysts dispute the linkage. The gang has previously been blamed for hacking casino companies MGM and Caesars, among many other targets.

The Department of Justice alleged in December, before the Change hack, that the group's victims had already paid it hundreds of millions of dollars in ransoms.


Is This a New Problem?

Absolutely not. A study published in JAMA Health Forum in December 2022 found that the annual number of ransomware attacks against hospitals and other providers doubled from 2016 to 2021.

“It's more of the same, man,” said Aaron Miri, the chief digital and information officer at Baptist Health in Jacksonville, Florida.

Because the assaults disable the target's computer , providers have to shift to paper, slowing them down and making them vulnerable to missing information.


Further, a study published in May 2023 in JAMA Network Open examining the effects of an attack on a health system found that waiting times, median length of stay, and incidents of patients leaving against medical advice all increased — at neighboring emergency departments. The results, the authors wrote, mean cyberattacks “should be considered a regional disaster.”

Attacks have devastated rural hospitals, Miri said. And wherever health care providers are hit, patient safety issues follow.

What Does It Mean for Patients?

If You're Caught in a Cybersecurity Breach, Here Are Steps to Take:

– Monitor the notices and bills you receive from insurers and providers. Contact them immediately if anything seems suspicious.– If a medical provider requests your Social Security number on intake forms, leave the space blank, and politely push back if they insist.– If your health plan offers free credit or identity theft monitoring following a breach, take it.If you're concerned your data has been compromised: – Go to the Federal Trade Commission's identity theft site to file an identity theft report, if appropriate.– If someone used your name to get medical care, contact every provider who may have been involved and get copies of your medical records. Correct any errors.– Notify your health plan's fraud department and send a copy of the FTC identity theft report.– File free fraud alerts with the three major credit reporting agencies.Michelle Andrews


Year after year, more Americans' health data is breached. That exposes people to identity theft and medical error.

Care can also suffer. For example, a 2017 attack, dubbed “NotPetya,” forced a rural West Virginia hospital to reboot its operations and hit pharma company Merck so hard it wasn't able to fulfill production targets for an HPV vaccine.

Because of the Change Healthcare attack, some patients may be routed to new pharmacies less affected by billing problems. Patients' bills may also be delayed, industry executives said. At some point, many patients are likely to receive notices their data was breached. Depending on the exact data that has been pilfered, those patients may be at risk for identity theft, Chaudhry said. Companies often offer free credit monitoring services in those situations.

“Patients are dying because of this,” Miri said. Indeed, an October preprint from researchers at the of Minnesota found a nearly 21% increase in mortality for patients in a ransomware-stricken hospital.


How Did It Happen?

The Health Information Sharing and Analysis Center, an industry coordinating group that disseminates intel on attacks, has told its members that flaws in an application called ConnectWise ScreenConnect are to blame. Exact details couldn't be confirmed.

It's a tool tech support teams use to remotely troubleshoot computer problems, and the attack is “apparently fairly trivial to execute,” H-ISAC warned members. The group said it expects additional victims and advised its members to their technology. When the attack first hit, the AHA recommended its members disconnect from systems both at Change and its corporate parent, UnitedHealth's Optum unit. That would affect services ranging from claims approvals to reference tools.

Millions of Americans see physicians and other practitioners employed by UnitedHealth and are covered by the company's insurance plans.


UnitedHealth has said only Change's systems are affected and that it's safe for hospitals to use other digital services provided by UnitedHealth and Optum, which include claims filing and processing systems.

But not many chief information officers “are jumping to reconnect,” Chaudhry said. “It's an uneasy feeling.”

Miri says Baptist is using the conglomerate's technology and that he trusts UnitedHealth's word that it's safe.

Where's the Federal ?


Neither executive was sanguine about the future of cybersecurity in health care. “It's going to get worse,” Chaudhry said.

“It's a shame the feds aren't helping more,” Miri said. “You'd think if our nuclear infrastructure were under attack the feds would respond with more gusto.”

While the departments of Justice and State have targeted the ALPHV group, the government has stayed behind the scenes more in the aftermath of this attack. Chaudhry said the FBI and the Department of Health and Human Services have been attending calls organized by the AHA to brief members about the situation.

Miri said rural hospitals in particular could use more funding for security and that agencies like the Food and Drug Administration should have mandatory standards for cybersecurity.


There's some recognition among officials that improvements need to be made.

“This latest attack is just more evidence that the status quo isn't working and we have to take steps to shore up cybersecurity in the health industry,” said Sen. Mark Warner (D-Va.), the chair of the Senate Select Committee on Intelligence and a longtime advocate for stronger cybersecurity, in a statement to KFF Health News.

By: Darius Tahir
Title: Hacking at UnitedHealth Unit Cripples a Swath of the US Health System: What to Know
Sourced From: kffhealthnews.org/news/article/unitedhealth-change-healthcare-blackcat-hack-cybersecurity/
Published Date: Thu, 29 Feb 2024 10:00:00 +0000

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