Democrats press UnitedHealth Group over nursing home policies
In a letter to UHG CEO Stephen J. Hemsley, Wyden and Warren cited reporting from outlets including The Guardian that said his company was paying nursing homes to reduce hospital transfers of sick patients.
The senators wrote that UHG representatives told them bonus programs for nursing homes are offered to encourage 'adherence to certain quality measures.'
One of these programs allows for nursing homes to receive bonuses if they reach certain levels of influenza and pneumococcal vaccination rates and cholesterol medication adherence rates, while also maintaining a hospital admission per thousand rate below a certain threshold.
They also pointed to UHG institutional special needs plans, provided through its subsidiary Optum, which reportedly disincentivize 'medically-necessary hospitalizations and emergency room visits.' These plans also reportedly pressure nursing home residents to sign 'do not resuscitate' (DNR) and 'do not intubate' (DNI) orders.
At the time of The Guardian's reporting in May, UHG denied it was preventing hospital transfers or pushing patients to sign DNRs and DNIs.
'Put simply, these allegations suggest that UHG appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in UHG I-SNPs. Nursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical,' the lawmakers wrote.
Though they expressed their support for evidence-based models that reduce 'unnecessary hospitalizations of nursing home residents,' Wyden and Warren noted a briefing with UHG representatives did not resolve their concerns surrounding these reports.
The lawmakers requested information on UHG's I-SNP model, Optum's policies on transferring residents on I-SNP to the hospital as well as information on its bonus programs.
'Any attempt to take advantage of vulnerable nursing home residents is unacceptable, especially to pad a for-profit insurance company's revenues. It is vital that UHG respond to these alarming reports and provide prompt, detailed responses to our questions,' wrote Wyden and Warren.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Hill
a day ago
- The Hill
Abortion shield laws face mounting pressure
Republicans are waging a multipronged campaign against abortion shield laws in blue states, hoping to force the federal government to ultimately intervene. Legal experts say the effort will be difficult — as some states have already learned. State abortion shield laws are meant to protect providers and patients from civil and criminal actions. Eighteen states plus the District of Columbia have an abortion shield law, according to Rachel Rebouché dean of Temple University Beasley School of Law. Shield laws in eight of those states protect abortion providers regardless of patient location, which has helped cover health care providers who send abortion medication to telehealth patients living in states where the procedure is restricted. Republicans are fighting the laws in court, while also pushing for a federal law that supersedes the protection. More than a dozen GOP attorneys general recently urged congressional leadership in a letter to preempt the state laws by passing legislation that bans shield laws. Signees include Texas Attorney General Ken Paxton (R) and Louisiana Attorney General Liz Murrill (R), both of whom have taken legal action against a New York doctor for allegedly prescribing and mailing abortion pills to women in their respective states. Some legal experts don't think congressional leadership will introduce legislation to preempt state abortion shield laws because it would struggle to pass. 'It's just not realistic,' said James Bopp Jr., general counsel for the National Right to Life Committee, adding that there is not a single anti-abortion Democratic senator and at most two anti-abortion Democrats in the House. 'There is absolutely zero prospect of it passing the Senate, and it makes no sense to waste your time on things that are completely hopeless and pointless.' Bopp said he believes that the state lawsuits challenging abortion shield laws have an objective legal merit, arguing that since each state is sovereign, no other state can regulate conduct within them. He argues that in attempting to do this, abortion shield laws deny 'full faith and credit' to the state laws where these abortions occur. Paxton has led the charge in combating these laws in court, most notably with his lawsuit against New York physician Margaret Carpenter. His office sued Carpenter in December, accusing her of sending abortion pills to a Texas woman last year. Soon after, a Texas judge ordered Carpenter to pay more than $100,000 in penalties, but she did not respond to the lawsuit nor appear for the subsequent court hearing. Paxton has tried twice to force a New York county clerk to file the ruling against Carpenter, but the clerk has refused, citing the state's abortion shield laws. He is now seeking a writ of mandamus to compel the clerk, Taylor Bruck, to enforce the summary judgment and court summons. In January, a grand jury in Louisiana indicted Carpenter for also allegedly prescribing abortion medication to a woman in the state, resulting in state authorities requesting she be extradited. Paxton and Murrill have said that they will continue to try and press charges against Carpenter. 'That case is far from over, and we are continuing to evaluate our options to ensure that Dr. Carpenter faces justice in Louisiana,' Murrill said in a statement to The Hill. But New York leadership does seem likely to recognize Texas or Louisiana's judgments anytime soon. New York Gov. Kathy Hochul (D) has vowed to protect Carpenter. This puts Texas and New York at loggerheads, legal experts said, which could lead to a lengthy back and forth of appeals and clashing state court rulings that could lead to nowhere or eventually force a federal court to get involved. Legal experts told The Hill that Paxton's actions regarding the case against Carpenter suggest he is trying to get an abortion shield law case to be seen before the Supreme Court. 'This is the road toward getting courts to weigh in on whether or not shield laws, in doing what they do, will be upheld by the Supreme Court under various challenges,' said Rebouché. A spokesperson for Paxton did not respond to multiple requests for comment from The Hill. States filing lawsuits that challenge shield laws are going to face obstacles, and cases will be difficult to win, legal experts said. This is because a lot of the arguments that a state like Texas would make to suggest that an abortion shield law should be struck down by a federal court are untested in this context, according to Rebouché. Once at the Supreme Court, Texas would likely argue that New York's shield law is violating the Constitution's full faith and credit clause, which mandates that all states must respect the judicial proceedings of another state, she said. And winning a legal case arguing that an abortion shield law violates the full faith and credit clause could be difficult, since a state like New York could argue that the clause is not absolute, Rebouché said. There is a long-held exception to the clause that states are not required to enforce a penal law from another state. Mary Ziegler, a professor of law at the University of California, Davis, said the letter to congressional leadership could mean that anti-abortion lawmakers might not be confident they wouldwin a case at any federal level. 'It's not much of a vote of confidence in terms of how they think they're going to, you know, do in federal court when these clashes arrive there,' she said. While state courts battle, a Texas civil lawsuit could end up being how an abortion shield law case appears before the Supreme Court. A Texas man is suing a California doctor for allegedly providing his girlfriend with abortion medication. Unlike the other state challenges, the wrongful death suit was filed in federal court. It could potentially lead to the downfall of shield laws faster than any action taken by an attorney general.
Axios
2 days ago
- Axios
Obamacare sticker shock could jolt Republicans
Pressure on Congress to renew Affordable Care Act subsidies is likely to ramp up this fall as notices of 2026 premium increases go out and consumers get their first warnings that huge rate hikes could be coming. Why it matters: Backers of renewing the enhanced tax credits, which expire at the end of this year, hope the sticker shock could motivate Republicans to get behind a short-term reauthorization to avoid an uproar over premium increases in an election year. What they're saying:"This is going to rain starting in October; people are going to start getting these notices," said Leslie Dach, chair of the Democratic-aligned group Protect Our Care. "And it comes right to your doorstep, right to your mailbox." Republicans in Congress, he said, are not "going to do anything until they see the light of their constituents' eyes here … so the most important thing is to be sure people know what's going on." The big picture: Out-of-pocket premium costs for over 20 million enrollees in the ACA marketplaces will increase by an average of 75% if the enhanced subsidies expire at the end of this year, according to KFF. Congressional scorekeepers also project 4.2 million more people would become uninsured over a decade. That puts Republicans in a bind heading into the midterm elections: stuck between resisting an expansion of the ACA and the fear of steep health cost increases for their constituents. Although some GOP lawmakers are open to a deal on an extension, there's substantial concern over the projected $335 billion cost over 10 years — and the often-expressed sentiment that the subsidies are a handout to insurance companies. Between the lines: When exactly people will get notices about premium increases for next year depends in part on whether they are in one of the 20 states that run their own ACA marketplaces, where notices typically go out earlier. Insurers at a minimum must send notices before Nov. 1, when sign-ups for next year begin. Those notices tend not to have completely up-to-date individualized information, so many people likely will not see exactly how much more they will pay. But this year insurers are in discussions about how best to make clear that the enhanced subsidies are expiring. They're likely to include language informing people and telling them to check the portal for the exact premium increase. "I think that this could turn into quite a political issue for an important voting bloc, and frankly, a constituency that the data suggests swung more heavily toward Republicans in the last elections," said Ceci Connolly, CEO of the Alliance of Community Health Plans. "This will hit pocketbooks directly." The other side: Brian Blase, president of Paragon Health Institute and a health official in the first Trump administration, said that when the enhanced subsidies were originally passed in 2021 they were meant as a "temporary COVID measure," and that it was Democrats who set them to expire.
New York Post
2 days ago
- New York Post
Nancy Pelosi says sex changes for trans kids is something she's working for ‘at the national level'
Former House Speaker Nancy Pelosi said Thursday that sex changes for transgender children is something she's working for 'at the national level.' Earlier in the day, Pelosi toured the San Francisco VA Medical Center to review health-system upgrades, research initiatives and—according to a press release from her staff—the threat that House Republicans might slash core veterans' services. While speaking with reporters, she was asked how her office was responding to pauses to 'gender-affirming care' in California. 'That is something I'm working for at the national level, and we are hoping we can have gender-affirming care for our trans kids,' Pelosi said. 'It's a sad thing for us… I don't know what effect we can have nationally with what we have going on in the White House and in Congress.' She called the situation 'really sad, adding that a transgender-pride flag—five horizontal stripes of light blue, pink and white—hangs outside her office. Pelosi also said several colleagues display the same flag. She acknowledged that many Republicans on Capitol Hill oppose medical transition for transgender youth. 5 Nancy Pelosi toured the San Francisco VA Medical Center to review health-system upgrades on Thursday. AP 5 Pelosi was asked about 'gender-affirming care' while speaking with reporters during her visit to the San Francisco VA Medical Center. AP Still, she is not alone in her stance on sex changes for kids. Earlier this month, over a dozen officials from Democratic-led states filed a lawsuit to stop the Trump administration from blocking access to sex change procedures and treatments for people under the age of 19. The complaint, which was filed in the US District Court for the District of Massachusetts, argues that the Trump administration wants to impose a nationwide ban on sex change procedures by threatening providers with 'baseless criminal charges' and investigations. 5 Democrats are trying to stop the Trump administration from blocking sex change procedures people under the age of 19. AP The lawsuit names President Donald Trump, Attorney General Pam Bondi and the Justice Department as defendants. It challenges Trump's Jan. 28 executive order barring government support for sex change operations and treatments and two memos by Bondi and Assistant Attorney General Brett Shumate. Pelosi's office told Fox News Digital the Democrat was referring to this lawsuit when she spoke about supporting sex changes for children. 5 Attorney General Pam Bondi wants to investigate and prosecute those who offer sex-change treatments to minors. AP Bondi's memo directs the Department of Justice (DOJ) to investigate and prosecute those who offer sex-change treatments to minors. Shumate's memo directs prosecutors to prioritize investigations against doctors, hospitals and pharmaceutical companies that perform such procedures. In July, Kaiser Permanente announced that it would pause sex change surgeries for patients under 19 beginning Aug. 29 in response to the Trump administration's efforts on the matter. The same month, Children's Hospital Los Angeles shuttered its Center for Trans Youth Health and Development, one of the nation's largest clinics for transgender young people. 5 A person waved a trans pride flag at the WorldPride Parade in Washington, DC. Jen Golbeck/SOPA Images/Shutterstock The Children's National Hospital in Washington, DC, also announced that it will no longer provide gender transition-related medical interventions. Many states have laws restricting or banning sex change surgeries for children. The states named in the lawsuit – California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Washington DC, and Wisconsin. – allow such procedures.
