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The Abstract
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> By Stephanie DiCapua Getman, Arnold Ventures
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Editor's note: The Abstract will take next week off and return April 7.
This week, AV Vice President of Health Care Erica Socker writes about Medicare Advantage:
Anyone who lives in Washington, D.C. right now is probably caught in the middle of an advertising war over Medicare — and the outcome will determine whether the critical public insurance program takes steps to improve its integrity and sustainability for generations to come.
The Biden administration is proposing changes to Medicare Advantage plan payments from the federal government. Medicare Advantage plans are private insurance companies that contract with the federal government to provide Medicare coverage. The country’s largest health payer, Medicare covers 1 in 5 Americans, including older Americans and people with disabilities. Medicare Advantage plans enroll nearly half of this population — more than 30 million people.
Medicare Advantage plans have a well-documented history of abusive and fraudulent billing practices that cost taxpayers and seniors billions each year — just what the Biden administration proposal seeks to address. In response to the administration’s proposal, the insurance industry has mounted an opposition campaign involving “buckets of money,” Mark E. Miller, the executive vice president of health care at Arnold Ventures, told The New York Times this week. The multimillion dollar campaign has included a Super Bowl LVII spot and at least $10 million in TV ads.
Fraud and abuse in Medicare Advantage cost us all. A practice among Medicare Advantage plans called upcoding — the aggressive and discretionary coding of diagnoses — leads to higher bills for the federal government and will cost taxpayers $23 billion this year alone. And beneficiaries in traditional Medicare shoulder some of the burden of waste and abuse by paying nearly $2 billion a year more in premiums.
The Biden administration’s proposed changes are a reasonable step and a check to waste, abuse, and fraud in the program. They will result in a 1% payment increase from the federal government to the plans — a more than $4 billion increase — though less than the 8.5% increase plans received last year.
At the prospect of a more than $4 billion increase in payments from the federal government to Medicare Advantage plans, the insurance industry has launched ads that paint the proposed changes as a cut that will hurt Medicare beneficiaries.
The evidence says otherwise.
Evidence strongly suggests changes are unlikely to impact enrollees’ benefits. Insurers have considerable headroom to reduce their profits and lower their costs without cutting back benefits and raising premiums for those with Medicare coverage. A cut to benefits is an insurance company choice that places the bottom line ahead of the needs of seniors.
In fact, just this month an independent Medicare commission created by Congress said that “a major overhaul of MA policies is urgently needed.” They also advised that “payments to plans could be reduced without substantial cuts to extra benefits that are highly valued by beneficiaries.”
Meanwhile, polls show the American people are eager to cut this waste, fraud, and abuse in Medicare Advantage. A new survey, supported by Arnold Ventures, found that nearly 9 out of 10 voters from across the political spectrum favor reforms to Medicare Advantage payments to prevent overbilling by insurance companies and reduce overpayments for coverage. And 7 in 10 voters think the government should do more to prevent fraudulent billing practices by health insurance companies in Medicare Advantage.
That’s exactly what the proposed changes aim to do. And while even more needs to be done, they are a commonsense first step.
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What Voters Think About
Sky-High Health Care Prices
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By Evan Mintz, director of communications
As health care becomes increasingly unaffordable for everyday Americans, a new survey finds that 9 in 10 voters from across the political spectrum think it is very important for Congress to work on lowering hospital prices — the primary driver of rising health care costs for consumers, employers, and taxpayers.
What's Happening: A new survey supported by Arnold Ventures found broad bipartisan support for a range of policies to help lower sky-high hospital prices for the privately insured, including stronger antitrust oversight, site-neutral payments for hospital outpatient departments, and direct limits on the prices hospitals can charge.
This survey was conducted by a bipartisan polling team — Guy Molyneux and Geoff Garin from Hart Research Associates and Bob Ward from Fabrizio Ward — and builds on a similar survey from 2021.
Why it Matters: The prices that hospitals charge the privately insured far exceed the prices that Medicare pays, with some hospitals charging three to five times Medicare rates. No wonder that about 40% of Americans say they have delayed or gone without medical care due to cost, and more than 100 million Americans have medical debt.
What's Next: Fortunately, state policymakers from across the political spectrum are pursuing policies to lower prices and improve affordability, such as directly limiting prices, banning facility fees, and addressing anticompetitive contracting practices and growing hospital monopolies.
At the federal level, the House Ways and Means Committee and Energy and Commerce Committee are holding hearings on health care affordability and transparency and competition, respectively. Legislation to strengthen price transparency was introduced recently; in the previous Congress, legislation to expand site-neutral payments and take on anticompetitive contracting practices was also introduced.
Read the story > |
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Breaking Up the National
Organ Monopoly
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By Sam Mar, executive vice president of communications and external affairs
This week, the Biden administration announced plans to break up the monopoly contract to manage the U.S. organ donation system.
What’s Happening: Last August, the Senate Finance Committee issued a damning report: “From the top down, the U.S. transplant network is not working, putting Americans’ lives at risk.” On March 22, the Department of Health and Human Services (HHS) answered calls from Congress and patient advocates to fix the system by breaking up the national organ transplant monopoly, the United Network for Organ Sharing (UNOS). UNOS has held the national contract for almost 40 years — since the inception of the National Organ Transplant Act (NOTA) in 1984 — and its failures have led to thousands of unnecessary patient deaths and billions in wasted taxpayer dollars.
Why it Matters: As The New York Times editorial board wrote, “an astounding lack of accountability and oversight in the nation’s creaking, monopolistic organ transplant system is allowing hundreds of thousands of potential organ donations to fall through the cracks.” The result of UNOS’ failures is that 33 Americans die every day waiting for an organ transplant — disproportionately people of color. While 95% of Americans support organ donation, a federally-funded study showed that only as few as 1 in 5 potential organ donors are recovered.
The national contract held by UNOS expires this year, and HHS has pledged that in breaking up the constituent pieces, the process would be competitive for the first time. This creates an opportunity for innovators from across the country in fields from policy to technology to logistics to rebuild the nation’s broken organ donation system in patients’ interests. For any potentially interested organizations, AV previously funded a roadmap to orient new entrants.
Bottom Line: Monopolies breed complacency and underperformance. The federally-funded organ monopoly is a case in point. HHS is taking the right steps by injecting much-needed competition and accountability into a system that consistently fails both patients and taxpayers. AV has been working for today’s result for eight years, with grantee Organize, bipartisan political leaders, and patient advocates from across the country.
Read the story in the Washington Post > (free link)
Watch the story on NBC Nightly News >
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Working Across the Aisle
on Criminal Justice Reform
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By Thomas Hanna, communications manager
In states and localities across the country, conservative organizations and policymakers continue to play a leading role in furthering criminal justice reforms. “What’s encouraging now is that many conservative leaders are leaning into the power of collaboration, recognizing that if we work together, we can pass and implement solutions that account for the breadth of stakeholder needs,” says Destiny Carter, AV’s advocacy manager of criminal justice.
What's Happening: At the federal level, several policing reform bills passed the House of Representatives in September 2022. They include the bipartisan Invest to Protect Act, which was co-sponsored by Republicans including U.S. Sens. Chuck Grassley and Ted Cruz. In Oklahoma, Republican Gov. Kevin Stitt, above, has become a national leader in red state criminal justice reform. And clean-slate policies are gaining traction, with The Nolan Center for Justice, established by the American Conservative Union Foundation, becoming a prominent voice in the movement.
“The tough on crime, ‘lock them up, throw away the key’ mindsets of the 1980s and ‘90s are a thing of the past,” says Kaitlin Owens, Nolan’s deputy director of advocacy. “In the last 10 years, I think we’ve seen a shift in what is ‘Republican,’ what is ‘conservative,’ and what can we do together to bridge that gap with Democrats.”
Why it Matters: Criminal justice reform is often portrayed as an issue that divides progressives and conservatives, Democrats and Republicans, blue states and red states. However, beneath the headlines are numerous examples of bipartisan coalitions effecting meaningful reforms centered on justice, equity, and community safety — often with conservatives playing a leadership role. As an organization that centers bipartisanship and evidence-informed policymaking, AV is encouraged so many conservative groups and individuals remain committed to working with their progressive counterparts to advance criminal justice reform, even amid the spike in crime the country experienced during the Covid-19 pandemic.
Read the story >
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How — and Why — to Reduce Long Prison Sentences
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By Thomas Hanna, communications manager
The Council on Criminal Justice’s (CCJ) Task Force on Long Sentences has released its final report, which includes 14 policy and legal recommendations to reduce long sentences in order to enhance public safety, reduce the prison population, decrease racial disparities, and improve services — particularly the treatment of mental health conditions and trauma — for both survivors of crime and people serving long sentences.
What's Happening: The report is the culmination of a year looking at the use and effects of long prison sentences in the United States (defined as 10 years or longer). The AV-supported task force, chaired by former U.S. Attorney General Sally Yates and former U.S. Rep. Trey Gowdy, a Republican, is made up of a diverse group of stakeholders — including former prosecutors and defense attorneys as well as serious crime survivors and formerly incarcerated individuals who served long sentences. The recommendations are informed by the most current research and their varied backgrounds.
Why it Matters: Long prison sentences are a feature of the U.S. criminal justice system and have played a significant role in the rise of mass incarceration over the past several decades. However, they raise numerous legal, moral, and social questions. As the report suggests, “these are not abstract questions. They ask how the criminal justice system should respond to the most painful and devastating experiences that people, families, and communities endure.”
What's Next: The task force believes that its recommendations can provide a vision and approach to long sentences that is both just and achievable. Furthermore, the task force hopes that the spirit of collaboration, problem solving, and consensus exhibited throughout its work can be inspiring to other policymakers and system actors grappling with complex topics.
Read the report >
Related: The final report from the AV-supported Council on Criminal Justice’s (CCJ) Task Force on Long Sentences was covered in USA Today and Time.
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AV Hires Jennifer Doleac
to Lead Criminal Justice Work
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By Evan Mintz, director of communications
 Arnold Ventures has
announced the hiring of Jennifer Doleac, a nationally renowned economist and leading figure in the field of evidence-based criminal justice policy,
as the philanthropy's next executive vice president of criminal justice.
What's Happening: Last year, Jeremy Travis announced he would be stepping down as executive vice president of criminal justice after joining Arnold Ventures in 2017 and overseeing significant growth in the criminal justice portfolio, adding new initiatives in policing, reintegration, corrections, prosecution, public defense, and fines and fees. Doleac will build on that legacy and lead AV's mission of translating research and data into policy with a goal of promoting community safety and improving the fairness and effectiveness of the criminal justice system.
Why it Matters: The national bipartisan movement for criminal justice reform is built on a foundation of effective, evidence-based policies that change the criminal justice system to improve people’s lives. Doleac has built her career on using rigorous research to pursue equity and fairness in the criminal justice system.
“With the heft of Arnold Ventures and its unparalleled team of experts, I’m confident that we can build on its achievements and catalyze even more meaningful and impactful change,” Doleac said.
What's Next: Doleac will assume the role of executive vice president of criminal justice on July 10, 2023.
Read the story >
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The ArnoldVentures.org homepage got a facelift this week. Why a redesign? We wanted to better tell the Arnold Ventures story — who we are and what we stand for — as well as make it easier to find fast facts about the philanthropy and navigate to different parts of the website.
Our reimagined homepage also more clearly presents the issue areas we work in — and why. Scroll down, and you'll still find plenty of news and policy updates.
Feel free to reach out to communications@arnoldventures.org to tell us what you think and what improvements you'd like to see next.
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Criminal Justice
- In The Nation, Equal Justice USA’s Executive Director Jamila Hodge points to Newark as a successful model of using an "ecosystem of funded programs" to reduce community violence.
- The Albuquerque Journal reports on how Gov. Michelle Lujan Grisham has signed legislation abolishing life sentences without parole for juveniles.
- The Los Angeles Times reports on California Gov. Gavin Newsom's plan to turn the infamous San Quentin prison into a rehabilitation, education, and training center based on the "Scandinavian Model" of incarceration. Related to the announcement, the Guardian interviews two people — Thanh Tran and James King — who were formerly incarcerated at San Quentin for their perspective.
Related: Watch this video about bringing Scandinavian practices to U.S. prisons.
- A recent Bureau of Labor Statistics report reveals that in 2021, the rate of U.S. adults under community supervision — probation or parole — fell to 1 in 69, the lowest levels since 1987. Read the full report here.
- In the Kansas City Star, Marc Levin, chief policy council of the Council on Criminal Justice, an AV grantee, explains why enacting clean slate policies would benefit the people of Missouri.
- On the 60th anniversary of the Supreme Court's Gideon decision, the National Conference of State Legislatures, an AV grantee, has published a new issue brief that looks at the right to counsel beyond felonies.
- The Los Angeles Times editorial board is using the Gideon anniversary to call on California to meet its public defense obligations, citing research from the 6th Amendment Center (6AC), an AV grantee, among others. NPR also ran a story on the Gideon anniversary that cites 6AC.
- In USA Today, the leaders of AV partners National Association of Criminal Defense Lawyers, National Legal Aid and Defender Association, and National Association for Public Defense highlight the critical role public defenders play and call for recommitment to, and investment in, public defense.
- Texas Monthly reports on proposed state legislation to change how bail works in cases involving certain non-capital offenses. The article cites AV’s newly announced executive vice president of criminal Justice, Jennifer Doleac, on the goal of reducing, not increasing, pretrial detention.
- New Jersey Spotlight News covers this week’s AV-supported bail reform event at the Christie Institute for Public Policy, which featured former Gov. Chris Christie.
Health Care
- California announced that it is partnering with Civica Rx — a nonprofit generic drug company supported by Arnold Ventures — as its manufacturing partner to produce low-cost insulin.
- Proposed payment changes from the Biden administration are a step forward but more must be done to stop insurance company waste and fraud, Mark E. Miller, executive vice president of health care for Arnold Ventures, tells Politico.
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The Kaiser Family Foundation published a report estimating the value of nonprofit hospitals’ tax exemptions in 2020 – nearly $28 billion. Over half of US hospitals are nonprofits and therefore subject to a series of “community benefit” requirements, including limitations on aggressive billing practices in exchange for these lucrative tax exemptions.
Related: Nonprofit hospitals are increasingly facing scrutiny from federal and state policymakers in light of reports documenting certain nonprofit hospitals’ predatory debt collection tactics.
Higher Education
- Sens. Bill Cassidy, John Cornyn, and Joni Ernst introduced a Congressional Review Act (CRA) resolution to overturn President Biden’s student loan cancelation. It is unlikely the resolution will get enough support in the Democratic-led Senate, and the president would certainly veto it if it did.
- In Politico, Michael Stratford reports that the Congressional Budget Office's estimate for Biden's new income-driven repayment plan is $230 billion over 11 fiscal years, more than than Education Department's estimate ($138 billion) and less than Penn Wharton’s ($333-$361 billion). CBO’s estimate assumes that more borrowers would choose Biden’s new student loan repayment plan because it is more generous than existing options.
- In an effort to hold higher education institutions accountable and protect students, the Department of Education will employ "secret shoppers" to monitor schools' compliance with the laws and regulations governing their participation in federal student aid, Inside Higher Ed reports.
- Student Defense releases two briefs in response to the Education Department's request for comments on online program manager (OPM) regulation and oversight. One finds that the "bundled services" loophole is illegal under the Higher Education Act; the other demonstrates how the bundled services loophole harms students by incentivizing predatory student recruitment practices.
Public Finance
- Brett Theodos, Brady Meixell, and Sophie McManus discuss what we do and don’t know about the Opportunity Zones program for the Urban Institute.
Contraceptive Choice and Access
- U.S. News reports on a recent study by George Washington University that people on Medicaid had greatly reduced access to long-acting birth control methods. In the study of physicians who treat Medicaid patients, only 10% offered methods like IUDs and implants.
- The Nevada Current reports on the hearing of Senate Bill 280, which would require hospitals to stock intrauterine devices (IUDs), a long-acting form of contraception, so that women giving birth could request them during their hospital stay. The bill would also require Medicaid and other insurers to cover the device and its insertion.
Climate and Clean Energy
- Rich Powell, CEO of AV grantee ClearPath, writes in RealClear Energy that the backlog of carbon capture permits threatens U.S. progress and leadership in clean energy deployment.
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Aiden Decker is an 18-year-old survivor who was abandoned, abused, and incarcerated. He is now preparing to build a family, rebuild his life, and repair the relationship with his father. The only thing holding him back is the juvenile justice system, which has laden him and his father with thousands of dollars of debt. Watch his story from AV grantee Debt Free Justice.
Also: U.S. Attorney General Merrick Garland spoke at the National Legal Aid & Defender Association's commemoration, supported by AV, of the 60th anniversary of Gideon Supreme Court decision. Watch his remarks here.
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- Bakari Sellers, author and former South Carolina representative, stops by "The Karen Hunter Show" on Sirius XM to talk about his family's experience with organ donation, how improving the system can save Black lives, and the need for more donors. Sellers' daughter, at 4 months old, received an urgent, lifesaving liver transplant. He talks deeply about the process as well as the failures of our country's organ donation system, the need for competition and oversight of the system, and bipartisan efforts at reform.
Related: Read Sellers' opinion piece in The Grio about inequities in the organ transplant system.
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- Radiated tortoise Mr. Pickles, the oldest animal at the Houston Zoo at 90, just became a father for the first time.
- "She sees farming as a way to heal generational wounds in the African-American community." A young Black farmer catalyzes community engagement in New Orleans' Lower Ninth Ward.
- Check out these astonishing images of the sun, as well as a solar tornado that is 14 Earths tall.
- When she's done with the scalpel, pediatric surgeon Felicity Fishman picks up her art supplies to leave her little patients with works of wonder.
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Have an evidence-based week,
– Stephanie
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Stephanie DiCapua Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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