Ohio Benefits Group

A number of hospitals and health systems are reducing their workforces or jobs due to financial and operational challenges. 
Below are workforce reduction efforts or job eliminations announced this year. 
Editor's Note: This webpage was created Jan. 19 and updated Nov. 22.
November
Valhalla, N.Y.-based Westchester Medical Center Health Network is eliminating two regional CEO roles amid an operating model change. The restructuring also includes the recent lay off of about 130 employees, primarily in corporate and administrative roles.
Chapel Hill, N.C.-based UNC Health laid off about 40 leadership-level employees, or fewer than 2% of its leaders. The layoffs did not include C-suite roles and were mostly at the vice president level.
Pontiac (Mich.) General Hospital notified the state of plans to lay off 248 employees after learning that Medicare will halt payments for inpatient hospital services. The layoffs are set to occur in two phases.
Indianapolis-based Indiana University Health is eliminating some leadership roles as it implements a new operating model, consolidating from six regions to four. The move primarily affects nonclinical leadership roles.
Alta Vista Regional Hospital in Las Vegas, N.M., eliminated three positions — two full-time and one part-time — as it works to align its workforce with operational needs. Ashoke "Bappa" Mukherji, CEO of Java Medical Group, which manages the hospital for its owner, Nashville, Tenn.-based Dava Health, confirmed to Becker's that the reductions affected nightshift ER registration clerks.
The University of Vermont Health Network, based in Burlington, announced plans to implement significant reductions in clinical services and administrative functions, which are expected to affect up to 200 jobs. These measures are a response to budget cuts mandated by the Green Mountain Care Board.

Springfield, Mass.-based Baystate Health cut 134 leadership positions systemwide, affecting less than 1% of its workforce. Some affected positions are vacant and will remain unfilled while others are held by leaders who will leave the health system.
Westchester Medical Center Health Network is laying off workers. The nine-hospital system, based in Valhalla, N.Y., said the layoffs affect about 130 people primarily in corporate and administrative roles.
Providence Swedish in the South Puget Sound region of Washington state will close a majority of its outpatient physical, occupational, and speech therapy programs. The move, effective Jan. 17, will result in 55 layoffs, The Olympian reported.
Pittsburgh-based UPMC is laying off about 100 employees, or 0.1% of its workforce. A UPMC spokesperson confirmed the layoffs but declined to answer additional questions about the types of positions affected and the timeline.
October
Flint, Mich.-based Insight Health System plans to lay off an unspecified number of employees at Trumbull Regional Medical Center and Hillside Rehabilitation Hospital, both in Warren, Ohio. Dallas-based Steward Health Care, which filed for bankruptcy in May, initially shared plans to close the two hospitals in late August prior to Insight taking over. Insight received bankruptcy court approval to purchase the two facilities from Steward on Oct. 16.
Bassett Healthcare Network in Cooperstown, N.Y., eliminated 100 administrative jobs. The positions were all occupied, and affected individuals were welcomed to apply for other jobs within the network, according to hospital officials. 
Coniva, Calif.-based Emanate Health will lay off 107 employees. Sixty-three of the layoffs will draw from per diem, part-time and full-time positions across the organization, according to an Oct. 15 statement shared with Becker's. The remaining layoffs will come from the permanent closure of Emanate Health Home Care and Emanate Health Imaging, effective Dec. 9. 
Oakland, Calif.-based Kaiser Permanente filed plans with the state to lay off 20 employees across multiple California locations, effective Dec. 6. The layoffs largely affect information technology and business function positions.
Dallas-based Steward Health Care filed a WARN notice for 255 employees at its Phoenix-based St. Luke's Behavioral Health Center. The notice, obtained by Becker's, indicates that most affected employees will be laid off on Oct. 1. However, the notice states that a small number of employees will remain on staff to ensure the facility's security and to perform essential administrative tasks.
September
Cambridge, Mass.-based Beth Israel Lahey Health is laying off workers as it navigates rising costs, a spokesperson confirmed to Becker's Sept. 28. The health system, which operates 14 hospitals, did not say how many or which positions would be affected. 
Glendale-based University of Southern California Verdugo Hills Hospital will close its labor and delivery services, along with its neonatal intensive care unit, on Nov. 20. As a result, it will lay off 65 employees, according to a Sept. 20 WARN notice obtained by Becker's. The layoffs affect multiple specialty registered nurses, technicians, lactation consultants and nursing managers.
Oakland, Calif.-based Kaiser Permanente will lay off 43 employees across several California locations, according to multiple WARN notices obtained by Becker's. The layoffs, expected to take effect in late November, will primarily affect information technology and finance positions.
Schenectady, N.Y.-based Ellis Medicine laid off 33 employees after closing its nursing home and rehabilitation center, according to a WARN notice filed Sept. 23 with the state. A system spokesperson told Becker's affected employees were offered positions elsewhere within the organization, and most accepted. 
Signature Psychiatric Hospital will close its two locations in Kansas City, Mo., and Liberty, Mo., resulting in 154 layoffs. The layoffs affect 124 full-time and 30 part-time employees, according to regulatory documents published Sept. 13.
Corvallis, Ore.-based Samaritan Health Services laid off about 80 employees, around 1% of its workforce, and implemented temporary pay cuts for senior leaders for the remainder of the year. The layoffs primarily affect those in non-patient-facing roles, according to the health system. Some other employees saw their hours reduced or voluntarily separated from the health system. 
Southwestern Health Resources, a 31-hospital joint venture based in Farmers Branch, Texas, laid off 129 employees. The layoffs occurred on Sept. 10 and affected some managerial and director positions.  
Modesto, Calif.-based Stanislaus Surgical Hospital will suspend operations indefinitely and lay off all 160 employees. The layoffs, anticipated before Sept. 15, will affect various positions, including registered nurses, nursing assistants, supervisors, physical therapy assistants, midlevel providers, imaging technicians and admissions and office staff, according to The Modesto Bee.
Oakland, Calif.-based Kaiser Permanente will close its last skilled nursing facility in the U.S., the Kaiser Permanente Post Acute Care Center in San Leandro, Calif. The closure, which began in June, will affect 249 jobs.
August
Dallas-based Steward Health Care will lay off 944 employees in Ohio due to hospital closures. The layoffs will affect workers at Trumbull Regional Medical Center and Hillside Rehabilitation Hospital, both in Warren, Ohio, which are expected to close on or around Sept. 20. Employees at Steward's Northside Regional Medical Center, a breast health center affiliated with Trumbull, will also be affected.
Presque Isle, Maine-based Northern Light AR Gould Hospital, part of Brewer, Maine-based Northern Light Health, is laying off an undisclosed number of layoffs. Management positions are affected, but inpatient nursing positions are not, according to an Aug. 15 statement shared with Becker's.
Houston-based Texas Children's Hospital is laying off 5% of its workforce, or roughly 1,000 employees. The layoffs include front-line healthcare workers and those in leadership positions, The Houston Chronicle reported Aug. 6. 
Dallas-based Steward Health Care plans to lay off 1,243 employees due to the closure of two of its hospitals: Dorchester, Mass.-based Carney Hospital and Ayer, Mass.-based Nashoba Valley Medical Center. Steward will lay off 753 employees at Carney Hospital and 490 employees at Nashoba Valley Medical Center, effective Aug. 31, according to WARN notices filed by the system.
Beaver, Pa.-based Heritage Valley Health System laid off several workers and is closing multiple facilities. The workforce and service cuts were made for financial reasons as the system continues to evaluate a potential partner, president and CEO Norman Mitry said in a July 31 letter to employees, according to Beaver County Radio.
July
Ann & Robert H. Lurie Children's Hospital in Chicago laid off a "very small" number of employees following a comprehensive budget review, the hospital confirmed in a July 27 statement shared with Becker's. The hospital declined to confirm the number of affected positions.
Chicago-based CommonSpirit plans to lay off employees at hospitals in Oregon and Tennessee. CHI Mercy Health-Mercy Medical Center and Centennial Medical Group in Roseburg, Ore., is eliminating 18 jobs, mostly in leadership support, according to local news outlet KLCC. Additionally, Chattanooga, Tenn.-based CHI Memorial Hospital is laying off workers and reassigning others to address financial challenges, according to the Times Free Press. 
Howard Brown Health, a federally qualified health center that serves the LGBTQ+ community in the Chicago area, is laying off 43 employees, or 7% of its workforce. The layoffs include management, administrative and other staff positions, according to a July 1 Howard Brown news release. They are effective Aug. 30.
Oakland, Calif.-based Kaiser Permanente laid off 51 IT workers in Pleasanton, Calif. Affected positions do not provide direct patient medical care, according to the health system.
June
Winston-Salem, N.C.-based Novant Health is laying off 81 IT workers as it transitions additional digital products and services to Deloitte Digital. The layoffs are slated to take effect Aug. 25, according to a notice filed with the state.
Middletown, N.Y.-based Garnet Health laid off 26 employees, or about 1% of its workforce. The layoffs amount to about $4.6 million in salaries and benefits costs and affect staff in management, union and non-union positions.
West Monroe, La.-based Glenwood Regional Medical Center, part of Dallas-based Steward Health Care, laid off 23 employees. Affected roles included leadership, a spokesperson for the hospital said in a statement shared with Becker's. 
Cleveland-based University Hospitals is reducing its leadership structure by more than 10% as part of more than 300 layoffs. COO Paul Hinchey, MD, told Becker's C-suite level leaders and vice presidents were included in the cuts. 
Portland-based Oregon Health & Science University told staff June 6 that it plans to lay off at least 500 employees, citing financial issues. The news follows the institution and Portland-based Legacy Health signing a binding, definitive agreement to come together as one health system under OHSU Health. 
May
The All of Us Research Program, a collaboration of the University of Arizona in Tucson and Phoenix-based Banner Health, plans to lay off 45 workers due to reduced federal research funding, according to an Arizona WARN notice filed May 28. The program, launched in 2018, is part of HHS' National Institutes of Health.
Burlington, Mass.-based Tufts Medicine will lay off 174 employees due to industry challenges, the health system confirmed in a May 21 statement shared with Becker's. The layoffs, which have varying effective dates, will primarily affect administrative and non-direct patient care roles. Some leadership roles were affected, a spokesperson told Becker's. 

Doral, Fla.-based Sanitas Medical Center laid off 56 employees between May 17 and May 20. Some of the affected roles included nine care coordinators, one care educator, and two case managers, according to a May 20 WARN notice accessed by Becker's.
Select Specialty Hospital in Longview, Texas, will close on or about June 30, affecting 94 employees, Becker's has confirmed. The hospital, operated by Mechanicsburg, Pa.-based Select Medical, is a 32-bed, critical illness recovery facility.
White Rock Medical Center in Dallas laid off nearly 35% of its staff. The hospital temporarily stopped taking patients transported by emergency medical services due to the layoffs, The Dallas Morning News reported. It has since resumed accepting those patients.

Oakland-based Kaiser Foundation Hospitals is laying off 76 workers in California. The layoffs primarily affect employees in IT and marketing, according to regulatory documents filed with the state May 1.
April
Pittsburgh-based UPMC will lay off approximately 1,000 employees. The layoffs, which represent more than 1% of the health system's 100,000 workforce will primarily affect nonclinical, administrative and non-member-facing employees. 
Union Springs, Ala.-based Bullock County Hospital laid off 95 employees beginning April 9, according to regulatory documents filed with the state. The layoffs occurred as Bullock seeks to become a rural emergency hospital and is ending psychiatric services as part of the shift, AL.com reported April 25.
Jackson Health System reduced compensation programs for senior leaders; laid off fewer than 25 people, including one hospital CEO; and froze many vacant positions, especially in support and nonclinical areas, a spokesperson for the Miami-based organization confirmed to Becker's. President and CEO Carlos Migoya shared these efforts in a message to staff, citing financial challenges.
Coos Bay, Ore.-based Bay Area Hospital plans to conduct layoffs as it outsources its revenue cycle management operations, a spokesperson for the hospital confirmed to Becker's. The transition will affect 27 positions.
Manchester, N.H.-based Catholic Medical Center plans to cut 142 positions, including 54 layoffs. An April 18 letter to employees from CMC president and CEO Alex Walker, obtained by Becker's, said cuts would occur through the 54 staff eliminations, open position cuts, reduced hours, planned departures, and resource redeployment in satellite locations for CMC.
Marshfield (Wis.) Clinic Health System will lay off furloughed staff, effective in early May. The health system furloughed about 3% of its workforce in January, affecting positions mostly in non-patient-seeing departments, including leadership roles. 

Norwalk, Ohio-based Fisher-Titus Medical Center laid off some workers in nonclinical roles and reduced hours for others. Seven employees, about 0.5% of the health system's workforce, were laid off  April 1. Work hours were reduced for another 10 positions, a hospital spokesperson told Becker's.
March
Robbinsdale, Minn.-based North Memorial Health is laying off 103 employees in clinical and nonclinical roles, citing financial challenges. The layoffs affect several services across the two-hospital system. 
AHMC's San Gabriel (Calif.) Valley Medical Center is laying off 62 workers, according to regulatory documents filed with the state March 13. The layoffs take effect May 13.
Miami-based North Shore Medical Center, part of Steward Health Care, started conducting layoffs as part of cuts to some of its programs amid the Dallas-based health system's continued financial struggles. Around 152 workers represented by 1199SEIU were laid off, a union spokesperson confirmed. However that number could be higher as their members do not represent every employee at NSMC, the spokesperson said.
Oakland, Calif.-based Kaiser Foundation Hospitals is laying off more than 70 employees. The layoffs primarily affect those in IT roles.
February
Lion Star, the group that operates Nacogdoches (Texas) Memorial Hospital, is closing four of its clinics on March 22, which will result in fewer than 50 layoffs, a Lion Star spokesperson confirmed to Becker's. No additional layoffs are planned.
Little Rock-based Arkansas Heart Hospital has laid off fewer than 50 employees since the beginning of 2024, citing low reimbursement rates. The layoffs affected lower-paying positions, Bruce Murphy, MD, CEO of the hospital, said, according to Arkansas Business.
Cincinnati-based Mercy Health will lay off some call center positions. The system attributed the move to its partnership with a third party to operate its enterprise contact center for primary care scheduling.
Ridgecrest (Calif.) Regional Hospital announced more layoffs to avoid closure. It is laying off 31 more employees, including seven licensed vocational nurses and four registered nurses, two months after it announced plans to lay off nearly 30 others and suspend its labor and delivery unit, Bakersfield.com reported Feb. 15.
Medford, Ore.-based Asante health system laid off about 3% of its workforce. The layoffs primarily affected administrative and support roles and were necessary to offset "financial headwinds" over the past several years, according to a report from NBC affiliate KOBI-TV, which is based on an internal memo sent to staff Feb. 9. 
Oakdale, Calif.-based Oak Valley Hospital District is scaling back services and laying off workers to improve its finances. The hospital said in a Feb. 2 statement shared with Becker's that it will close its five-bed intensive care unit, discontinue its family support network department and lay off 28 employees, including those in senior management and supervisor positions. 
Chicago-based Rush University System for Health laid off an undisclosed number of workers in administrative and leadership positions, citing "financial headwinds affecting healthcare providers nationwide." No additional information was provided about the layoffs, including the number of affected employees.
University of Chicago Medical Center laid off about 180 employees, or less than 2% of its roughly 13,000-person workforce. The majority of affected positions are not direct patient facing, the organization said in a statement shared with Becker's.
Fountain Valley, Calif.-based MemorialCare laid off 72 workers due to restructuring efforts at its Long Beach (Calif.) Medical Center and Long Beach, Calif.-based Miller Children's and Women's Hospital. The layoffs include 13 positions at Long Beach Medical Center's outpatient retail pharmacy, which is closing Feb. 2, a spokesperson for MemorialCare said in a statement shared with Becker's.
January
George Washington University Hospital in Washington, D.C., part of King of Prussia, Pa.-based Universal Health Services, is laying off "less than 3%" of its employees. The move is attributed to restructuring efforts.
Amarillo-based Northwest Texas Healthcare System, also part of Universal Health Services, announced plans to lay off a "limited number of positions." The move is attributed to restructuring efforts. 
Lehigh Valley Health Network is cutting its chiropractic services and laying off 10 chiropractors. The layoffs are effective April 12 and due to restructuring. The Allentown, Pa.-based health system has 10 chiropractic locations, according to its website. 
Central Maine Healthcare is laying off 45 employees as part of management reorganization. The Lewiston-based system, which also ended urgent care services at its Maine Urgent Care on Sabattus Street in Lewiston on Jan. 12, has 3,100 employees total.
University of Vermont Health Network, based in Burlington, is cutting 130 open positions. The move is part of the health system's efforts to reduce expenses by $20 million.
Med-Trans, a medical transport provider based in Lewisville, Texas, closed its UF Health ShandsCair base serving Gainesville, Fla.-based UF Health Shands Hospital on Jan. 10 due to decreased transportation demands. The move also resulted in layoffs, a spokesperson for UF Health, the hospital's parent company, told Becker's in a statement. 
RWJBarnabas Health, based in West Orange, N.J., is laying off 79 employees, according to documents filed with the state on Jan. 8. The layoffs are effective March 31 and April 5. A spokesperson for the health system told Becker's that 74 of the positions were "time-limited information technology training job functions." The other layoffs were due to closure of an urgent care center.

​https://www.beckershospitalreview.com/finance/4-hospitals-health-systems-cutting-jobsjan19.html?origin=BHRSUN&oly_enc_id=6443H4794601F1A

Medicare Advantage aka Part C.  Changes are coming soon.

10 key questions facing Medicare Advantage

1. How long will hospitals put up with denied payments?
2. What other options do hospitals have? 
3. What is the future of prior authorization? 
4. How will the two-midnight rule shake up hospitals' relationship with MA?
5. Has MA lost its luster for insurers? 
6. Will MA benefits be cut back? 
7. Are supplemental benefits working? 
8. Can CMS curb overpayments? 
9. Does MA deliver better outcomes? 
10. What's the future of traditional Medicare?

​Click here to read the full Story

​https://www.beckerspayer.com/payer/10-key-questions-facing-medicare-advantage.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6443H4794601F1A

In 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered
under Part D, Medicare’s outpatient drug benefit. The cap on copays and coinsurance for prescription drugs is
another critical cost-saving measure resulting from the Biden Administration’s Inflation Reduction Act and
comes on top of the elimination of 5% coinsurance in the catastrophic coverage phase of the Part D benefit, in
effect for 2024.

“There is already a $3,200 out-of-pocket cap in place under Part D this year,” said Joseph Peters, Jr.,
Secretary-Treasurer of the Alliance. “The $2,000 cap in 2025 will bring seniors and their families even more
relief.”
An analysis from KFF Health News found that, from 2012-2021, an estimated 5 million Part D beneficiaries
faced out-of-pocket drug costs that exceeded $2,000. KFF now predicts that 1.5 million Medicare beneficiaries
could save money in any single year thanks to the cap.
Importantly, those with especially serious conditions like cancer and rheumatoid arthritis, who are the most
likely to spend thousands upon thousands on out-of-pocket costs, will benefit the most from the cap.



The Ohio ARA Educational Fund is responsible for the content of this newsletter. Contact Norm Wernet, President by mail to 500 S Front St, Suite 1100, Columbus,
Ohio 43215 or by phone at 614.224.8271 x1004 or email [email protected] . More information is available at the ARA website:
www.retiredamericans.org. The Ohio ARAEF gives permission to reproduce the material of this newsletter with attribution.

​By 
Dena Bunis,
Published August 10, 2023
 
List prices of the 25 brand-name prescription drugs that Medicare Part D spends the most on have, on average, more than tripled since these medications came on the market, a new AARP Public Policy Institute report has found.
In 2021, Medicare spent nearly $81 billion on these 25 brand-name medications that were taken by more than 10 million Americans enrolled in a Part D prescription drug plan, including those who had drug coverage through a Medicare Advantage plan. In all, Medicare covered 3,500 prescription drugs in 2021 for a total cost of $216 billion, according to data from KFF, formerly the Kaiser Family Foundation. That means these 25 medications alone accounted for over 37 percent of Medicare's prescription drug spending that year.
 
The AARP report also found that the lifetime price increases for all but one of the top 25 drugs greatly exceeded the annual rate of inflation. 
“This report really solidifies the impact of drug companies’ relentless price increases year after year,” says Leigh Purvis, author of the report and AARP’s prescription drug policy principal. 
How rising drug prices hurt Medicare beneficiariesPurvis said these price increases have a direct impact on many Medicare beneficiaries whose out-of-pocket prescription drug costs are often calculated as a percentage of the price. “Every time you see a percentage price increase, that increase will affect the coinsurance that they pay,” Purvis says.
These price hikes, Purvis added, can be particularly challenging for Medicare beneficiaries who typically take four or five prescription drugs every month. A recent study in the Journal of the American Medical Association found that 1 in 5 older adults have tried to mitigate the high cost of prescription drugs, often by skipping doses prescribed by their health care providers.
“It’s a shame anyone today must face the decision of whether to fill their prescription or put food on the table,” says Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer. “Rest assured that AARP will keep fighting for additional measures to lower prescription drug prices so Americans are no longer charged the highest prices in the world for the medications they need.”
AARP conducted this study just as the Centers for Medicare & Medicaid Services is preparing to release the names of the first 10 prescription medications whose prices will be subject to negotiation as part of the Inflation Reduction Act of 2022. CMS will choose the top 10 drugs based on total Medicare spending and other factors, such as whether these drugs have a generic alternative and how long they’ve been on the market.
The new law also now requires drugmakers to pay a rebate to Medicare if their prices increase faster than the rate of general inflation, a provision that is designed to discourage manufacturers from continuing the outsize price increases highlighted in the AARP report.
AARP’s analysis found that over the course of the lifetime of these drugs, their price increases ranged from 20 percent to 739 percent. Not surprisingly, the longer a brand-name drug has been on the market the larger its lifetime price increase, the AARP report found.
The largest lifetime percentage increase among these drugs was for Lantus, an insulin product used to treat diabetes that was introduced in 2000. Its price has increased by 739 percent since then. The second highest increase was for Enbrel, which was introduced in 1998. The list price for this rheumatoid arthritis drug increased by 701 percent. Of the 25 drugs listed, eight are used to treat diabetes and five are cancer medications.
Top 25 Medicare DrugsHere are the prescription medications that Medicare spends the most on, the year each drug came to market, and how much the list prices have increased over their lifetimes.

 

Drug name
Entered market
Price hike over lifetime
1. Eliquis
2012
124 percent

2. Revlimid
2005
270 percent

3. Xarelto
2011
168 percent

4. Humira
2002
562 percent

5. Trulicity
2014
91 percent

6. Januvia
2006
275 percent

7. Lantus
2000
739 percent

8. Jardiance
2014
97 percent

9. Imbruvica
2013
108 percent

10. Ozempic
2017
38 percent

11. Novolog
2000
628 percent

12. Xtandi
2012
83 percent

13. Trelegy Ellipta
2017
20 percent

14. Enbrel
1998
701 percent

15. Biktarvy
2018
29 percent

16. Symbicort
2006
158 percent

17. Myrbetriq
2012
114 percent

18. Invega
2009
126 percent

19. Ibrance
2015
53 percent

20. Levemir
2005
360 percent

21. Victoza
2010
209 percent

22. Entresto
2015
78 percent

23. Restasis
2002
330 percent

24. Pomalyst
2013
102 percent

25. Stelara
2009
184 percent

 
 
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for The Orange County Register and as a health policy and workplace writer for Newsday.
 
https://www.aarp.org/politics-society/advocacy/info-2023/medicare-drug-prices-triple.html

“How do I prove that I’m a Veteran?” It’s a question often asked by those who once served in the military. Many businesses offer discounts to Veterans for restaurants, hotels, stores, recreational activities and even home improvement, among other perks. Former service members will want to take advantage of those opportunities.
First, you’ll want to apply for VA’s Veteran ID Card (VIC), which is a digital photo ID you can use to get those discounts. Since September 2022, all new Veteran ID cards have been digital. A Veteran with a physical ID card can continue using it to get discounts. The VIC is separate from the VA health care ID, which a Veteran receives when enrolling in VA health care.
If you have any questions or need help, email VA’s VIC program at [email protected].
Click here to apply online and login using your existing Login.gov, ID.me, DS Logon or MyHealtheVet account. A Veteran without any of these accounts can create a free Login.gov or ID.me account. If you are unable to submit your VIC application through VA.gov, please use Access VA. 
When applying, make sure to have your social security number; a digital copy of your DD214, DD256, DD257 or NGB22 that you can upload; and a copy of a current and valid government-issued ID, such as a driver’s license, passport or state-issued identification card.
You’ll also need a digital color photo of yourself from the shoulders up. The photo should follow all of these standards:

• Show a full, front view of your face and neck with no hat, head covering or headphones covering or casting shadows on your hairline or face.
• Be cropped from your shoulders up much like a passport photo.
• Show you with your eyes open and in a neutral expression.
• Be taken in clothing you’d wear for a driver’s license photo.
• Be a square size and have a white or plain-color background with no scenery or other people in the photo.
• Show what you look like now, meaning a photo that is no older than 10 years old; it should be uploaded as a .jpeg, .png, .bmp or .tiff file.

A Veteran must meet certain criteria to be eligible for a VIC, including both of these requirements:

• Service on active duty, in the Reserve or in the National Guard, including the Coast Guard.
• Receipt of an honorable or general discharge under honorable conditions.

If the Veteran received an other-than honorable, bad conduct or dishonorable character of discharge, that person is not eligible for a Veteran ID card. If a Veteran has an uncharacterized or unknown discharge status, VA must verify that person’s eligibility before approving an application. The Veteran must provide a copy of his/her discharge papers when applying for a VIC to prove their character of discharge.
After a Veteran applies for a VIC, VA will check that person’s eligibility and verify that the character of discharge meets eligibility requirements, the ID submitted is valid and the image chosen to appear on the card meets photo requirements.
VA will then send an email letting the Veteran know the status of the application. If the Veteran has an unknown or uncharacterized discharge status, the application will take more time to process. VA may need to request your records from the National Personnel Records Center, part of the National Archives and Records Administration.
If a Veteran receives an email from VA asking for additional information or evidence to process the application, that person must sign in to AccessVA and update the application.
VA will send an email with the digital card attached if a Veteran is eligible for a Veteran ID Card.
For more information, email VA at [email protected]. You can also click here.

​https://news.va.gov/117828/va-id-card-proof-discounts/?utm_id=19APR2023

Patients are getting blindsided by ‘facility fees,’ and states are taking actionAbout half of all patients are getting hit with facility fees, which are billed for doctor visits at hospital-owned clinics, as three in four physicians are now employed by hospitals, health systems or other corporate entities.By Markian Hawryluk | April 07, 2023


When Brittany Tesso’s then-3-year-old son, Roman, needed an evaluation for speech therapy in 2021, his pediatrician referred him to Children’s Hospital Colorado in Aurora. With in-person visits on hold due to the COVID-19 pandemic, the Tessos met with a panel of specialists via video chat.
The specialists, some of whom appeared to be calling from their homes, observed Roman speaking, playing with toys, and eating chicken nuggets. They asked about his diet.
Tesso thought the $676.86 bill she received for the one-hour session was pretty steep. When she got a second bill for $847.35, she assumed it was a mistake. Then she learned the second bill was for the costs of being seen in a hospital — the equipment, the medical records, and the support staff.
“I didn’t come to your facility,” she argued when disputing the charges with a hospital billing representative. “They didn’t use any equipment.”
This is the facility fee, the hospital employee told her, and every patient gets charged this.
“Even for a telehealth consultation?” Tesso laughed in disbelief, which soon turned into anger.
Millions of Americans are similarly blindsided by hospital bills for doctor appointments that didn’t require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses, particularly when hospitals don’t employ their own physicians. But consumer advocates say there’s no reason hospitals should charge more than independent clinics for the same services.

“If there is no change in patient care, then the fees seem artificial at best,” said Aditi Sen, a Johns Hopkins University health economist.
At least eight states agree such charges are questionable. They have implemented limits on facility fees or are moving to clamp down on the charges. Among them are Connecticut, which already limits facility fees, and Colorado, where lawmakers are considering a similar measure. Together, the initiatives could signal a wave of restrictions similar to the movement that led to a federal law to ban surprise bills, which took effect last year.
“Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients,” said Rep. Emily Sirota, the Denver Democrat who sponsored the Colorado bill.
Generally, patients at independent physician clinics receive a single bill that covers the physician’s fee as well as overhead costs. But when the clinic is owned by a hospital, the patient generally receives separate bills for the physician’s fee and the facility fee. In some cases, the hospital sends a single bill covering both fees. Medicare reduces the physician’s payment when a facility fee is charged. But private health plans and hospitals don’t disclose how physician and facility fees are set.
Children’s Hospital Colorado officials declined to comment on the specifics of Tesso’s experience but said that facility fees cover other costs of running the hospital.
“Those payments for outpatient care are how we pay our nurses, our child life specialists, or social workers,” Zach Zaslow, senior director of government affairs for Children’s Hospital said in a February call with reporters. “It’s how we buy and maintain our imaging equipment, our labs, our diagnostic tests, really all of the care that you expect when you come to a hospital for kids.”
Research suggests that when hospitals acquire physician practices and hire those doctors, the physicians’ professional fees go up and, with the addition of facility fees, the total cost of care to the patient increases, as well. Other factors are in play, too. For instance, health plans pay the rates negotiated with the hospital, and hospitals have more market power than independent clinics to demand higher rates.

Those economic forces have driven consolidation, as hospital systems gobble up physician clinics. According to the Physicians Advocacy Institute, 3 in 4 physicians are now employed by hospitals, health systems, or other corporate entities. And less competition usually leads to higher prices.
One study found that prices for the services provided by physicians increase by an average of 14% after a hospital acquisition. Another found that billing for laboratory tests and imaging, such as MRIs or CT scans, rise sharply after a practice is acquired.
Patients who get their labs drawn in a hospital outpatient department are charged up to three times what they would pay in an office, Sen said. “It’s very hard to argue that the hospital outpatient department is doing that differently with better outcomes,” she said.
Hospital officials say they acquire physician practices to maintain care options for patients. “Many of those physician practices are not viable and they were having trouble making ends meet, which is why they wanted to be bought,” said Julie Lonborg, a senior vice president for the Colorado Hospital Association.
States are considering limits on facility feesAlong with Colorado and Connecticut, other states that have implemented or are considering limits on facility fees are Indiana, Minnesota, New Hampshire, Ohio, Texas, and Washington. Those measures include collecting data on what facility fees hospitals charge, prohibiting add-on fees for telehealth, and requiring site-neutral payments for certain Medicaid services. A federal bill introduced in 2022 would require off-campus hospital outpatient departments to bill as physician providers, eliminating the possibility of charging facility fees.
Connecticut has gone the furthest, banning facility fees for basic doctor visits off-campus, and for telehealth appointments through June 2024. But the law’s application still has limitations, and with rising health care costs, the amount of facility fees in Connecticut continues to increase.
“It hasn’t changed much, partly because there’s so much money involved,” said Ted Doolittle, who heads the state’s Office of the Healthcare Advocate. “They can’t just painlessly take that needle out of their arm. They’re addicted to it.”
Bill would prohibit fees for primary careThe Colorado bill would prohibit facility fees for primary care visits, preventive care services that are exempted from cost sharing, and telehealth appointments. Hospitals would also be required to notify patients if a facility fee would apply. The ban would not apply to rural hospitals. The bill was scaled back from a much broader proposal after criticism from hospitals about its potential consequences.
Rural hospital executives, like Kevin Stansbury, CEO of Lincoln Health, a small community hospital in the eastern Colorado town of Hugo, had been particularly worried about the impact of a fee ban. The state hospital association estimated his hospital would lose as much as $13 million a year if facility fees were banned. The 37-bed hospital’s netted $22 million in patient revenue last year, resulting in a loss. It stays open only through local taxes, Stansbury said.
“This will still harm access to care — and especially essential primary and preventive care that is helping Coloradans stay healthier and out of the hospital,” Lonborg said of the revised approach. “It will also have a detrimental impact on access to specialty care through telehealth, which many Coloradans, especially in rural parts of the state, have come to depend on.”
The Colorado bill presents particular challenges for health systems such as UC Health and Children’s Hospital, which rely on the University of Colorado School of Medicine for staffing. For outpatient appointments, the medical school bills for the doctor’s fee, while the hospital bills a facility fee.
“The professional fee goes solely to the provider, and, very frequently, they’re not employed by us,” said Dan Weaver, vice president of communications for UC Health. “None of that supports the clinic or the staff members.”
Without a facility fee, the hospital would not receive any payment for outpatient services covered by the ban. Weaver said the combination of the clinicians’ and facility fees is often higher than fees charged in independent clinics because hospitals provide extra services that independent physician clinics cannot afford.
“Prohibiting facility fees for primary care services and for telehealth would still cause significant problems for patients throughout our state, forcing some clinics to close, and causing patients to lose access to the care they need,” he said.
Backers of the Colorado bill disagree.
“The data on their costs and their revenue paints a little different picture of their financial health,” said Isabel Cruz, policy manager for the Colorado Consumer Health Initiative, which backs the bill.
From 2019 through 2022, UC Health had a net income of $2.8 billion, including investment gains and losses.
The Colorado market is dominated by large health systems that can dictate higher rates to health plans. Plans pass on those costs through higher premiums or out-of-pocket costs.
“Unless the employers and patients that are incurring the prices are raising the alarm, there really isn’t a strong incentive for health plans to push against this,” said Christopher Whaley, a health care economist with the nonprofit think tank Rand Corp.
Consumer complaints helped pave the way for the federal No Surprises Act, which protects against unanticipated out-of-network bills. But far more people get hit with facility fees — about half of patients compared with 1 in 4 hospital patients who receive surprise bills, Whaley said.
Dr. Mark Fendrick, a University of Michigan health policy professor, said facility fees are also generally surprises but don’t fall under the definition of the No Surprises Act. And with the rise of high-deductible plans, patients are more likely to have to pay those fees out-of-pocket.
“It falls on the patient,” Fendrick said. “It’s a tax on the sick.”
Tesso held off paying the facility fee for her son’s visit as long as possible. And when her pediatrician again referred them to Children’s Hospital, she called to inquire what the facility fee would be. The hospital quoted a price of $994, on top of the doctor’s fee. She took her son to an independent doctor instead and paid a $50 copay.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

https://www.benefitspro.com/2023/04/07/patients-are-getting-blindsided-by-facility-fees-and-states-are-taking-action/?kw=Patients%20are%20getting%20blindsided%20by%20%27facility%20fees%2C%27%20and%20states%20are%20taking%20action&utm_source=email&utm_medium=enl&utm_campaign=bprodailynews&utm_content=20230410&utm_term=bpro&oly_enc_id=8686I4299356B7C

Texas judge strikes down ACA’s free preventive care requirementThe ruling, which applies nationwide and takes effect immediately, mandates that insurers and employers are not required to cover certain free preventive screenings for cancer, heart disease and other diseases under Obamacare.By Lynn Cavanaugh | March 30, 2023

The Earle Cabell Federal Bldg. houses the U.S. District Court for the Northern District of Texas.

Today, a federal judge in Texas struck down a key provision of the Affordable Care Act requirement that insurers and employers cover free preventive screenings for cancer, heart disease, HIV and other diseases. The decision, which applies nationwide and takes effect immediately, threatens access to over 100 million Americans who use these services, which include mammograms and STD testing.
Judge Reed C. O’Connor of the U.S. District Court for the Northern District of Texas –who previously struck down the entire ACA law before it was upheld by the Supreme Court – granted Braidwood Management Inc.’s request to block an ACA requirement for cost-sharing coverage of preventive services.
The ruling invalidates nationwide zero cost-sharing coverage requirements of preventive services recommended by the U.S. Preventive Services under the Affordable Care Act and finds that required coverage of PrEP for HIV violates the Religious Freedom Restoration Act. Cost sharing will likely deter patients from scheduling those procedures. The ruling won’t impact every preventive screening, as some recommendations predate the ACA, which was signed into law in 2010. More than 2,000 legal challenges have been filed in state and federal courts contesting parts for all of the Affordable Care Act (ACA) since it became law. Today’s case, Braidwood Management v. Becerra, involved the ACA’s requirement that most private insurance plans cover specific preventive care items and services — such as contraceptive care and supplies, as well as cancer screenings. The case could have long-term implications for millions of people who are covered by private insurance, according to Kaiser Family Foundation.
In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs also challenged the requirement to cover medication to prevent HIV, based on religious grounds.
In September 2022, Judge O’Connor ruled partly in favor of the plaintiffs and partly in favor of the Department of Health and Human Services (which defended the ACA).
While not surprised by Judge O’Connor’s decision, “It is imperative that these critical preventive services must continue for the health of our nation,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We expect that the U.S. government will quickly act to stay this decision so that preventive services can continue nationwide, and appeal it. Preventive services are all critical and well-established medical services … While the appeals process moves forward, we call on health insurers to act on their own and continue to cover these preventive services without cost-sharing for the benefit of their enrollees.”
Related:  Texas court decision could change preventative medical services costsAs a result of the ruling, “the government may no longer be able to require insurance plans to cover certain preventive services and items at no cost to patients. Insurers and employers would once again have discretion over whether to cover preventive services, resulting in lower premiums in some cases but also a patchwork of coverage,” according to KFF. “Any rollback of the government’s ability to enforce these requirements could impact the millions of people covered by private insurance. The outcome of this case could also have broader ramifications for the authority of federal agencies to address a wide range of issues through regulation.”
It is likely that the Biden administration will appeal the ruling. KFF officials maintain that Braidwood Management v. Becerra has the potential to reach the U.S. Supreme Court.

https://www.benefitspro.com/2023/03/30/texas-judge-strikes-down-acas-free-preventive-care-requirement/

​As pharmacy benefit managers face scrutiny on Capitol Hill, a new Ohio lawsuit alleges Express Scripts and Prime Therapeutics used a Switzerland-based company to illegally drive up drug prices.By Alan Goforth | March 29, 2023

Public officials continue to turn up the heat on pharmacy benefit managers. Less than a week after a U.S. Senate committee approved PBM reform legislation, the Ohio Attorney General has sued Express Scripts and Prime Therapeutics, alleging that the companies conspired to illegally increase drug prices.
“PBMs are modern gangsters,” Attorney General David Yost said. “They were designed to protect and negotiate on behalf of employers and consumers after big pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market.”
The lawsuit alleges that Express Scripts, one of the country’s three largest PBMs, responded to criticism of its model by forming the group purchasing organization Ascent Health Services in 2019. It then granted Prime Therapeutics ownership in Ascent before moving its operations to Switzerland, which allowed it to further obfuscate its pricing models. The lawsuit also names Cigna Group, parent company of Express Scripts; Evernorth Health, another subsidiary of Cigna; Humana Pharmacy Solutions; Humana, parent company of Humana Pharmacy Solutions; and Ascent.
Express Scripts and Prime Therapeutics then used their shared stake in Ascent to share pricing, discount and rebate information with one another as well as with Humana Pharmacy Solutions, an Ascent customer, which drove up prices further, according to the lawsuit.
“Both drug buyers and sellers have little choice but to play the game by the PBMs’ rules, allowing PBMs to extract both monopoly profits from individuals and monopsony (a market situation where there is only one buyer) profits from the market,” Yost said.
Related: PBMs face scrutiny as House committee opens investigationThe suit alleges multiple violations of the Valentine Act, Ohio’s antitrust law, which prohibits price fixing, controlled sales and other agreements that restrain trade and hurt competition. The act is broader than its federal counterpart, the Sherman Act, in that the Ohio law prohibits market harms in addition to consumer harms. The lawsuit seeks seeks statutory fines and restitution of any illegals profits.
Yost has been a vocal critic of PBMs and the models they deploy to manage drug spending, particularly rebates and spread pricing. He has filed multiple lawsuits against different PBMs, making this week’s filing just the latest salvo in a lengthy war.
PBMs have been intensely scrutinized in the debate over who is at fault for rising drug costs, and pharmaceutical manufacturers typically blame PBMs for driving up expenses. In addition to congressional action, the Federal Trade Commission subpoenaed six of the largest PBMs – CVS Caremark; Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems – last year.
https://www.benefitspro.com/2023/03/29/pbms-are-gangsters-ohio-ag-alleges-in-lawsuit-against-express-scripts-6-others/?printer-friendly

Releasing ownership data on Medicare-certified hospitals will boost healthcare transparency and promote competition, HHS says. By Jacqueline LaPointe
December 21, 2022 - HHS is releasing ownership data on all Medicare-certified hospitals in a bid to promote competition in a highly consolidated industry.
“At President Biden’s direction, this Administration puts consumers first – and we believe consumers deserve transparency,” HHS Secretary Xavier Becerra said in a recent announcement. “At HHS, we continue taking unprecedented action to deliver on President Biden’s vision. We are pulling back the curtain and letting the sunshine in on hospital and nursing home ownership because it is what the public deserves.”
“As we work to expand access to high-quality, affordable [healthcare], we will make sure there is transparency to ensure that facilities are held accountable and people can make the best-informed decisions on their care.”
Dig Deeper

• Experts Predict Strong Merger and Acquisition Activity for 2023
• Biden’s EO on US Competition Will Impact Hospital Mergers
• Increase in Cross-Market Hospital Systems May Hurt Market Competition

Detailed information on the ownership of more than 7,000 hospitals will be available for the public to view on CMS’ website. The information includes enrollment information, such as organization name, type, practice location addresses (e.g., off campus), National Provider Identifier (NPI), CMS Certification Number (CCN); detailed information about each owner, such as whether it is an organization or an individual and whether it is a direct owner or indirect owner (that is, there is at least one subsidiary between it and the provider); and a numerical associate ID for each owner to enable linkage to the enrollment file.
Making hospital ownership data publicly available will benefit researchers, enforcement agencies, and patients, according to HHS.
Researchers and other agencies will be able to use the data to identify common owners that have had histories of poor performance, for example. The federal department also said the information could be used to analyze data and trends on how market consolidation impacts consumers with increased costs, without necessarily improving quality of care, and to evaluate the relationships between ownership and changes in healthcare costs and outcomes.
HHS also plans to analyze the data to inform policy approaches that promote competition in healthcare.
Healthcare is a heavily consolidated industry as more organizations combine to achieve economies of scale and tap into greater innovation. However, industry stakeholders have criticized healthcare consolidation, saying it leads to less competition and higher prices for consumers. Patients may also face fewer options for healthcare services in concentrated markets, thereby limiting access to affordable care for consumers.
The American Hospital Association (AHA), however, has stood its ground in asserting that mergers and acquisitions help reduce hospital costs.
In 2021, AHA updated its analysis of hospital transactions and found that mergers and acquisitions were associated with a 3.3 percent reduction in operating expenses between 2009 and 2019. Based on this figure, acquired hospitals could save $9.5 million each year.
Although, research has shown that these deals do not improve quality and may even make it worse in some communities.
HHS has committed to increasing transparency in healthcare in an effort to promote competition. With greater competition, the federal department hopes to reduce healthcare costs for consumers without impacting the quality of care they receive.
HHS also said releasing hospital ownership data will allow patients to make more informed choices when it comes to selecting a healthcare provider.
CMS is expected to update the data on a monthly basis and provide it in a searchable format on data.cms.gov. Hospital ownership data will also be available in a flat Excel file.

​https://revcycleintelligence.com/news/hhs-releases-ownership-data-on-all-medicare-certified-hospitals

• September 27, 2022
• By InvestmentNews

Medicare beneficiaries will pay slightly lower Part B premiums and income-related surcharges next year as the Centers for Medicare & Medicaid Services partly reverses the sizable increases it put in place for 2022 in an effort to build reserves for expenses related to a new Alzheimer’s drug.
Individuals enrolled in Medicare Part B, which covers doctor visits and other outpatient services, will pay a monthly premium of $164.90 in 2023, which is down $5.20 from $170.10 in 2022.
In 2022, the Medicare Part B premium jumped $21.60, a 15% increase that was one of the largest in Medicare’s history, in part because CMS was required to accumulate reserves against the cost of the newly approved Alzheimer’s drug, Aduhelm.
While Aduhelm had been approved by the Food and Drug Administration, the approval was controversial, as was the drug’s initial price tag, at $56,000 per year. But last December, Aduhelm’s manufacturer, Biogen, said it would cut the drug’s cost by half, to $28,000 a year, as of Jan. 1.
In the wake of the price cut, CMS reassessed the 2022 Part B premium increase. It decided not to alter the 2022 premium in mid-year but said the lower price tag on Aduhelm was likely to mean a lower Medicare Part B premium for 2023.
Higher-income Medicare beneficiaries will also pay a little less next year. In 2023, individuals with modified adjusted gross income of $97,000 or more and married couples with MAGIs of $194,000 or more will pay additional surcharges ranging from an extra $65.90 per month to an extra $395.60 per month on top of the standard Part B premium. In 2023, those IRMAA surcharges ranged from $68.00 to $408.20 per month.
Married couples where both spouses are enrolled in Medicare pay twice as much.
Medicare Part B premiums and IRMAA surcharges are usually deducted directly from monthly Social Security benefits, although people who aren’t yet claiming Social Security are billed directly by Medicare. The cuts in the Part B premium and IRMAA surcharges come as the spike in U.S. inflation is expected to result in a large cost-of-living adjustment to Social Security benefits in 2023.
Earlier this month, Mary Johnson, Social Security analyst for the Senior Citizens League, projected Social Security benefits could increase by 8.7% next year, based on the August consumer price index.
The Social Security Administration is expected to announce the official cost-of-living adjustment for 2023 on Oct. 13, after the government releases September CPI. The COLA is based on the increase in the average CPI for the third quarter — July, August and September — over the previous year’s third quarter.

https://www.investmentnews.com/medicare-part-b-premium-irmaa-surcharges-to-decline-in-2023-227074www.investmentnews.com/medicare-part-b-premium-irmaa-surcharges-to-decline-in-2023-227074

17 May 2022
Military.com | By Patricia KimeAfter nearly 30 years of trying to prove a theory -- that an environmental toxin was responsible for sickening roughly 250,000 U.S. troops who served in the 1990-91 Persian Gulf War -- Dr. Robert Haley says new research confirms that sarin nerve gas caused Gulf War Illness.
Following the Gulf War, nearly one-third of all who deployed reported unexplained chronic symptoms such as rashes, fatigue, gastrointestinal and digestive issues, brain "fog," neuropathy, and muscle and joint pain. Federal agencies spent years broadly dismissing the idea that troops may have been suffering from exposure to chemical agents, with many veterans experiencing symptoms sent to mental health providers.
But a study published last week in the journal Environmental Health Perspectives used genetic research and survey data to determine that U.S. service members exposed to sarin were more likely to develop Gulf War Illness, and those who were exposed and had a weaker variant of a gene that helps digest pesticides were nine times more likely to have symptoms.
Read Next: Congress' First Military UFO Hearing in 50 Years Deflates Speculation on Alien Spacecraft
"Quite simply, our findings prove that Gulf War illness was caused by sarin, which was released when we bombed Iraqi chemical weapons storage and production facilities," said Haley, director of the Division of Epidemiology in the Internal Medicine Department at University of Texas Southwestern Medical Center.
"There are still more than 100,000 Gulf War veterans who are not getting help for this illness and our hope is that these findings will accelerate the search for better treatment," Haley said.
Originally developed as a pesticide, the chemical weapon sarin was known to have been stockpiled by Iraqi President Saddam Hussein prior to and after the 1990-91 Persian Gulf War. The synthetic nerve agent attacks the central nervous system and brain, killing victims by triggering an overreaction of neurotransmitters that causes convulsions and asphyxiation.
Thousands of coalition troops likely were exposed to sarin and cyclosarin, an organic phosphate also used as a chemical weapon, when the U.S. destroyed a bunker housing chemical weapons at the Khamisiyah Ammunition Storage Depot in southern Iraq, sending a plume of contaminants that spread across a 25-mile radius. Others may have been subjected to low levels of contaminants, as troops frequently reported that chemical weapons alarms went off in the absence of any apparent attack.
In the years following the war, veterans who sought medical help at the Department of Veterans Affairs were greeted with skepticism and sent to psychiatrists for mental health treatment. Health surveys conducted by the VA in the early 2010s of Gulf War veterans focused mainly on questions about psychological and psychiatric symptoms.
And in 2013, veterans' suspicions of the lack of concern at the VA were confirmed when VA whistleblower and epidemiologist Steven Coughlin came forward to say that the department buried or obscured research findings that would link physical ailments to military service -- a concerted effort to deny veterans health care and benefits.
Coughlin's charges were later confirmed by an email sent to staff from former Undersecretary for Benefits Allison Hickey expressing concern that changing what the VA still calls "chronic multisymptom illness" to "Gulf War illness" might "imply a causal link between service in the Gulf and poor health which could necessitate legislation for disability compensation for veterans who served in the Gulf."
Research Confirms Earlier, Smaller StudiesFor the new study into sarin, Haley and colleagues randomly selected 1,116 veterans who completed a U.S. Military Health Survey, including 508 who deployed and developed Gulf War Illness and 508 veterans who went but never developed symptoms. They collected blood and DNA samples from each participant and asked the veterans whether they heard nerve gas alarms during their deployment, and if so, how often.
The researchers also tested for variants of a gene that helps the body metabolize pesticides, called PON1. Some people have variants of this gene that are more effective in breaking down sarin while others have a variant that helps process chemicals like pesticides but is less efficient against sarin.
The study found that those who reported hearing nerve agent alarms and who also had the least robust form of the gene had a nine-fold chance of having Gulf War Illness. Those with a genotype that is a mix of the two variants had more than four times the chance of having Gulf War Illness, while those who just heard nerve agent alarms, which the researchers used as a proxy for exposure, raised the chance of developing the condition by nearly four times, although to a lesser degree of those who have a mix of genes.
According to the researchers, the data "leads to a high degree of confidence that sarin is a causative agent for Gulf War Illness."
"Our hypothesis was, if you have the strong form of the gene, then when you're exposed to low-level sarin, that gene makes a strong isoenzyme that destroys sarin in your blood. If you have the weak form of the gene, the enzyme that it makes is not very strong, so it goes through your blood into your brain and you get sick," Haley said in an interview with Military.com. "You've heard the expression 'correlation does not equal causation,' right? That's true, unless you are dealing with a gene-environment interaction."
A Mysterious MaladyThe mysterious symptoms experienced by thousands of service members, which came to be known as Gulf War Syndrome and, later, Gulf War Illness, generated hypotheses of the possible cause, including an additive in anthrax vaccines, preventive medicines given to troops such as the anti-nerve agent pyridostigmine bromide, ciprofloxacin, depleted uranium, and exposure to nerve gas, pesticides or smoke from oil well fires.
A congressional investigation in 1997 concluded that the Departments of Defense and Veterans Affairs had very little interest in finding a cause and blamed the symptoms as related to stress or other mental health disorders.
In its report, the Committee on Government Reform and Oversight found that the DoD and VA were "plagued by arrogant incuriosity and a pervasive myopia that sees a lack of evidence as proof" that the illness didn't exist.
"Sadly, when it comes to diagnosis, treatment and research for Gulf War veterans, we find the Federal Government too often has a tin ear, a cold heart and a closed mind," the report noted.
As Congress investigated the issue, Haley was studying possible causes, funded by Ross Perot, the Texas billionaire and Navy veteran known for donating to veterans' charities and resources, including efforts to help U.S. prisoners of war in Vietnam.
Haley's early work pointed to sarin as a possible cause, but other scientists, including the medical body of the National Academies of Sciences, Engineering and Medicine, found his studies to be insufficient in size and suffering from selection or "recall bias," meaning that vets may or may not remember whether they heard nerve gas alarms and how often.
Haley said the new research links veterans with Gulf War Illness with their genotype and "cannot be explained away by errors in recalling the environmental exposure or other biases in the data."
Others now concur. In an editorial accompanying the study, Marc Weisskopf, a professor of environmental epidemiology and psychology at the Harvard T.H. Chan School of Public Health, and Kimberly Sullivan, a research associate professor with Boston University School of Public Health, said the study makes a strong case for a causal link and explains, to some extent, why some troops got sick and some did not.
"The authors' exploration of a gene-environment interaction between presumed nerve agent exposure and the PON1 gene offers some strong arguments that there is a true causal effect at work," they wrote in their opinion piece.
The VA has established service connection for Gulf War veterans with certain chronic, unexplained symptoms, which the department calls "chronic multisymptom illness" or "undiagnosed illness."
Those who have certain symptoms, such as chronic fatigue syndrome, fibromyalgia and some gastrointestinal disorders, and served in the 1990-1991 conflict do not have to prove service connection and are eligible for benefits including a health exam, health care and disability compensation.
Historically, however, the VA has been strict in determining service connection. A 2017 Government Accountability Office report found the VA denied 83% of 102,000 claims filed for Gulf War Illness between 1994 and 2015.
New HopeHaley said the research could pave the way for more veterans to access health care and benefits and open up research into possible treatments. He said that the symptoms are caused by brain inflammation, which may be treatable once scientists figure out exactly how sarin works.
"Once we know, we could come up with treatments to reverse it," Haley said. "I really believe this is optimistic and that it means this is not brain damage. This is not loss of neurons and like a stroke or something that you're never going to recover from."
Among the veterans excited about the new study is Paul Sullivan, a Persian Gulf War veteran who works as director of veteran outreach at the law firm Bergmann & Moore and deployed to Iraq as an Army cavalry scout with the 1st Armored Division in 1991.
He said the results provide evidence that affected veterans need to access care from the VA.
"This landmark study provides a clear path for VA to presume sarin exposure for all 1991 Gulf War veterans," Sullivan said Thursday. "The study provides a compelling missing scientific link for treatment research for my fellow Gulf War Veterans disabled since our exposures during Desert Storm."
Haley said he has received letters from veterans asking if they could get tested for the different types of the PON1 gene and whether it would be helpful. Routine genetic testing does not include PON1, but further research may lead to a diagnostic test that would provide peace of mind to veterans, he said.
The research was conducted in collaboration with a survey research team from North Carolina-based RTI International and funded by the DoD and VA, both of which have funded thousands of studies on Gulf War Illness despite long-standing skepticism.
"This is the scientific process. Nobody's bad. Nobody's good. People have their theories. Skepticism is the name of the game. That is what makes it fun," Haley said.

​https://www.military.com/daily-news/2022/05/17/researchers-think-theyve-found-cause-of-gulf-war-illness.html?ESRC=mr_220523.nl

:Nevada dentist David White has seen diseased and rotted teeth in the mouths of patients who routinely put off checkups and avoided minor procedures such as fillings. While dental phobia is a factor, White said, the overriding reason people avoid treatment is cost.
To help patients lacking dental insurance, White in 2019 started offering a membership plan that looks much like an insurance policy — except it’s good only at his offices in Reno and Elko. Adults pay $29 a month — or $348 a year — and receive two free exams, two cleanings, X-rays and an emergency exam, services valued at $492. They also get a 20% discount on office procedures such as fillings and extractions.
About 250 of White’s patients have signed up, and it’s led many to visit more frequently for routine exams and get necessary treatment, he said. “It’s pushing patients toward better oral health,” White said.
He’s among a quarter of dentists nationwide offering memberships, according to a 2021 survey of 70,000 dentists by the American Dental Association.
These in-office plans are largely targeted to the 65 million Americans who lack dental insurance and have to pay out-of-pocket for all their care. Dentists also like the plans better than handling insurance plans because they don’t have to deal with insurers’ heavily discounted reimbursement rates, waits to get preapprovals to provide services and delays in getting their claims paid.


Lack of dental coverage contributes to the delaying or forgoing of dental care by 1 in 4 adults, according to a KFF analysis of a 2019 national survey.
Kleer, a Wayne, Pennsylvania, company started in 2018, has helped more than 5,000 dentists set up the offerings. “Patients on membership plans act like insured patients and come in as much as insured patients, but they pay less for coverage while dentists get paid more,” said CEO Dave Monahan. “All we are doing is cutting out the middleman,” he said.
Monahan said business has soared during the covid-19 pandemic as more dentists, confronted with higher costs for personal protective equipment and more patients without job-based coverage, saw the need for such plans.
Anthony Wright, executive director of consumer health advocacy group Access California, said he’s skeptical about the value of individual dental insurance but said patients also should be cautious about a dental membership plan because they are generally not overseen by states. “People should be aware that this is a generally unregulated field, so it’s buyer beware,” he said.
Before joining a membership plan, consumers should ask what the dentist charges for procedures so they know not just the discount but their actual out-of-pocket cost. In some cases, the membership plans are a viable option.
“If you are going to an established practice and if the costs are reasonable and within your budget, it may make some sense” to enroll, he said.
Vanessa Bernal, office manager at Winter Garden Smiles in central Florida, said many patients who are self-employed or work for small businesses have joined the practice’s membership plan.
“They don’t have employer coverage, and if they went to buy it on their own they would face a waiting period, whereas our discounts start immediately,” she said.
Winter Garden Smiles has enrolled more than 370 patients in its plan, which costs $245 a year for children and $285 for adults. The office has dropped out of three small insurance networks since starting its own plan.
Many of the plans being offered around the country look much like dental insurance. Patients pay the dental office typically $300 to $400 a year. In return, they receive certain preventive services at no charge and other procedures at a discount.
But the membership plans don’t have the annual deductibles or waiting periods that can make individually purchased dental insurance unattractive. Another deterrent to traditional insurance plans is their maximum benefit limits, usually $1,200 to $1,500 a year. In comparison, patients with memberships can use the discounts for unlimited treatment.
About half of Americans get dental coverage through their workplace. Those policies are generally the best buy for those with the benefit. But Medicare doesn’t offer dental coverage, and most state Medicaid programs don’t cover dental treatment for adults.
But for patients without a job-based plan, purchasing an independent dental policy is expensive and, unlike buying health insurance, it’s unclear whether the benefit outweighs the costs. That’s because dental costs are not as financially catastrophic as hospital bills, which can run into tens of thousands of dollars.
Annual dental insurance premiums typically range from $400 to $700. Most plans cover all the cost of preventive services, like cleanings. For minor procedures, like fillings, the plans generally pay 70% to 80%. For major procedures, such as crowns, the plans often pay about 50% of the cost, which is still more than what the membership plans cover. The insurance plans, however, often have negotiated prices with dentists, so plan members’ responsibility is reduced by that also.
Melissa Burroughs, who leads an oral-health-for-all campaign for the advocacy group Families USA, said the dental membership plans may help some people, but they don’t solve the problems of high dental costs and insurers treating coverage for teeth differently than for the rest of the body. “I don’t think these plans are the answer, and they definitely don’t meet the standard to make care truly affordable for many people,” she said.
Megan Lohman, CEO of Plan Forward, an Indianapolis company that helps set up membership plans, said many insurers haven’t raised reimbursement rates in years, encouraging dentists to offer their own plans. “We do not see dental insurance going away, but patients and dentists just needed an alternative,” she said.
Patients say they appreciate that services under the memberships are less expensive than when paying strictly out-of-pocket, and prepaying for services motivates them to seek preventive services.
“The membership plan keeps me on track, as it’s almost like I have a down payment on my care,” said Christina Campbell, 29, of Hamden, Connecticut. She had dental coverage under her mother’s policy until she was 26 and then started shopping for her own coverage.
When her dentist, Kevin D’Andrea, mentioned his plan, she decided it looked too good to pass up. With the membership, she said, she is back to getting twice-annual checkups and cleanings, and she no longer hesitates when it’s time for X-rays. Campbell, who manages a winery, pays $38 a month.
Holly Wyss, 59, of Greenwood, Indiana, found dental insurance too expensive, so she joined a $300-a-year membership plan through her dentist, David Wolf. The discounts saved her several hundred dollars on two crowns, she said. “For me, it’s a no-brainer,” said Wyss, a nurse practitioner. “It’s been a godsend to me, since everything I pay is out-of-pocket.”
Among the groups lacking dental insurance that have recently attracted attention are people covered by traditional Medicare. Many private Medicare Advantage plans, however, offer some dental benefits. These plans provide coverage only at certain dental offices, have a premium and often cover just a small portion of patients’ costs. The average limit on coverage is $1,300, and more than half of enrollees are in plans with a $1,000 cap on benefits, according to a report from KFF.
President Joe Biden and congressional Democrats have proposed adding a dental benefit to Medicare, along with other health care initiatives, as part of a $3.5 trillion human infrastructure plan those lawmakers are seeking to push through this fall. The bill released by the House Ways and Means Committee this month would still leave beneficiaries paying 20% of costs for preventive services such as checkups and between 50% to 90% of costs for certain procedures. And the law, if passed, could take five years or more to implement.
The need among older Americans is great.
Nearly half of Medicare beneficiaries, or 24 million people, had no dental coverage in 2019, according to KFF. In 2018, almost half of all Medicare beneficiaries had not visited a dentist within the past year (47%), with higher rates among African Americans (68%) and Hispanics (61%).
D’Andrea, the Hamden, Connecticut, dentist, said the membership plan he started in 2020 builds patient loyalty. “Patients know upfront what their out-of-pocket expenses are, and they don’t have to wait and see what their insurance will cover,” he said. “It’s like a game the insurers play, keeping us on hold for an hour to get preapprovals. We pull enough teeth in the office, and it’s the same getting information out of them.”

Auhors Link Click Here: khn.org/news/article/dentists-chip-away-at-uninsured-problem-by-offering-patients-membership-plans/view/republish/

TIAA-CREF Individual & Institutional Services LLC, a subsidiary of Teachers Insurance and Annuity Association of America (TIAA), agreed Tuesday to pay the Securities and Exchange Commission $97 million in restitution to settle charges of inaccurate and misleading statements related to rollovers.
TIAA was also charged with a failure to adequately disclose conflicts of interest to thousands of participants in TIAA record-kept employer-sponsored retirement plans (ESPs).
The $97 million includes a $9 million SEC civil penalty, plus reimbursement of a portion of the affected clients’ Portfolio Advisor account fees and interest on those fees. The payment settles both the SEC’s case and a parallel action announced the same day by the Office of the New York Attorney General.
According to the SEC’s order, from Jan. 1, 2013, through March 30, 2018, TC Services and its Wealth Management Advisers failed to “adequately disclose the full nature and extent of their conflicts of interest in recommending to clients that they roll over their retirement assets” into a managed account program called Portfolio Advisor.
The order finds that TC Services failed to adequately disclose compensation practices that incentivized the firm and its WMAs to recommend Portfolio Advisor for reasons other than a client’s particular investment needs.
“Over the course of six years, tens of thousands of customers were pressured by TIAA advisors to move their investments from low-cost, employer-sponsored retirement plans to higher-cost, individually-managed accounts,” the New York attorney general’s office said, adding that the Portfolio Advisor program “was significantly more expensive for clients and generated hundreds of millions of dollars in fees for TIAA.”
TIAA also agreed to undertake significant internal reforms, including:

• Subjecting all rollover recommendations to a strict fiduciary standard;
• Eliminating differential compensation for sales of managed accounts;
• Eliminating or fully disclosing other advisor conflicts of interests related to recommending managed accounts;
• Using plain language to disclose when advisors are not acting as fiduciaries; and
• Training advisors to offer a fair comparison between managed accounts and employer-sponsored plans.

According to the SEC’s order, “TC Services trained its WMAs to make, and its WMAs made, representations that they offered ‘objective’ and ‘non-commissioned’ advice, ‘put the client first,’ and acted in the client’s best interest while holding themselves out as fiduciaries. This was misleading because TC Services’ financial incentives for WMAs rendered their advice non-objective and TC Services did not ensure that WMA’s recommendations were, in fact, in the best interest of its clients.”
TC Services “simultaneously applied continual pressure to compel WMAs to prioritize the rollover of ESP assets into Portfolio Advisor over lower cost alternatives,” the SEC states.
The ‘hat switch’During the relevant period, “TIAA Services’ compliance training materials instructed advisors that they wore two hats: at times they were a fiduciary (when they acted as an investment adviser representative), and at other times they were not (when they acted as a registered broker-dealer representative,” according to the attorney general’s office.
“In practice, this distinction was counterintuitive and inherently misleading. TIAA Services applied an investment adviser fiduciary standard to all the preliminary stages of the Sales Process right up to but not including the moment when an Advisor provided an actionable investment recommendation,” the NY case states. “Many Advisors were themselves confused about their dual roles and did not fully understand when TIAA Services expected them to act as fiduciaries and when TIAA Services treated them only as broker-dealer registered representatives.”
At times, the case continues, “TIAA Services’ compliance training materials were in direct conflict with the firm’s Sales Process training materials.”
TC Services also failed to adopt and implement written policies and procedures reasonably designed to prevent violations of the Investment Advisers Act in connection with rollover recommendations, the SEC said.
Melissa Hodgman, acting director of the SEC Enforcement Division, added in a statement that “rollovers of ESPs are of paramount importance to investors seeking financial security in retirement, and advisers acting in a fiduciary capacity need to provide their clients with complete and accurate disclosure so that they may make fully informed investment decisions.”
Investment advisors “must clearly and accurately disclose their conflicts of interest. Here, TC Services’ disclosures and misleading statements downplayed and obscured financial incentives that created conflicts between it and its WMAs on one hand and its clients on the other,” added Adam Aderton, co-chief of the SEC Enforcement Division’s Asset Management Unit.
A TIAA spokesperson said Tuesday in a statement shared with BenefitsPRO’s sister site ThinkAdvisor that TIAA “cooperated with regulators, and we’re pleased to settle this matter that covers a time period that ended more than three years ago. We regret the times that we did not live up to our clients’ expectations of us.”
TIAA, the spokesperson added, has “learned some valuable lessons and have applied those lessons to enhancing our training, supervisory controls and disclosures.”

https://www.benefitspro.com/2021/07/14/tiaa-to-pay-97m-for-pressuring-investors-into-rollovers-412-118617/?kw=TIAA%20to%20pay%20%2497M%20for%20pressuring%20investors%20into%20rollovers&utm_source=email&utm_medium=enl&utm_campaign=retirementadvisorpro&utm_content=20210715&utm_term=bpro

Aluminum Is Intricately Associated with the Neuropathology of Familial Alzheimer’s Disease
​APRIL 9, 2021
Keele, UK – A new study published in the Journal of Alzheimer’s Disease Reports continues to support a growing body of evidence that aluminum contributes to the pathogenesis of Alzheimer’s disease (AD). Researchers found aluminum co-located with phosphorylated tau protein, which is an early initiator of AD. This study builds upon two earlier published studies (including Mold et al., 2020, Journal of Alzheimer’s Disease) from the same group. The new data demonstrate that aluminum is co-located with phosphorylated tau protein, present as tangles within neurons in the brains of early-onset or familial Alzheimer’s disease. “The presence of these tangles is associated with neuronal cell death, and observations of aluminum in these tangles may highlight a role for aluminum in their formation,” explained lead investigator Matthew John Mold, PhD, Birchall Centre, Lennard-Jones Laboratories, Keele University, Staffordshire, UK.


The earlier research highlighted widespread co-localization of aluminum and amyloid-β in brain tissue in familial AD. The researchers used a highly-selective method of immunolabelling in the current study, combined with aluminum-specific fluorescence microscopy. Phosphorylated tau in tangles co-located with aluminum in the brain tissue of the same cohort of Colombian donors with familial AD were identified. “It is of interest and perhaps significance with respect to aluminum’s role in AD that its unequivocal association with tau is not as easily recognizable as with amyloid-β. There are many more aggregates of aluminum with amyloid-β than with tau in these tissues and the latter are predominantly intracellular,” remarked co-author, Professor Christopher Exley.



George Perry, PhD, Editor-in-Chief of the Journal of Alzheimer’s Disease, comments: “Aluminum accumulation has been associated with Alzheimer’s disease for nearly half a century, but it is the meticulously specific studies of Drs. Mold and Exley that are defining the exact molecular interaction of aluminum and other multivalent metals that may be critical to formation of the pathology of Alzheimer’s disease.”
“The new data may suggest that the association of aluminum with extracellular senile plaques precedes that with intracellular aggregates of tau. These relationships with both amyloid-β and tau may account for the high levels of aluminum observed in the brain tissue of donors with familial AD versus those without a diagnosis of neurodegenerative disease,” said Dr. Mold. “Tau and amyloid-beta are known to act in synergy to produce neurotoxicity in AD and our data provide new evidence for a role of aluminum in this process.”
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​https://www.iospress.nl/ios_news/aluminum-is-intricately-associated-with-the-neuropathology-of-familial-alzheimers-disease/?utm_source=join1440&utm_medium=email

1 Apr 2021
The Penny Hoarder | By Robin HartillIf you receive VA disability pay, Social Security or SSI and you haven't received your third stimulus check, your wait is almost over. The IRS just announced that payments to those receiving VA disability could be made in mid-April, while most payments for people who receive other federal benefits and aren't required to file a tax return will be made Wednesday, April 7.
The April 7 payment date applies to those who get benefits from Social Security retirement and disability, Supplemental Security Income and the Railroad Retirement System. A payment date for those who get VA benefits hasn't yet been announced.
Why Are VA Disability and Social Security Recipients Still Waiting?
If you file a tax return and receive benefits, chances are good that you're among the 127 million Americans who have already gotten their $1,400 stimulus checks. But about 30 million recipients of Social Security and other benefits are still waiting on stimulus money.
That's because the IRS is processing stimulus payments using 2019 and 2020 tax returns. But just as with the first two rounds of payments, the IRS didn't require recipients of Social Security and other benefits to file a tax return if they weren't otherwise required to. Instead, the IRS got the information it needed from the appropriate agency.
This time around, the IRS was waiting on Social Security and other agencies to provide updated direct deposit information and addresses for recipients. On March 25, after the House Ways and Means Committee issued a 24-hour ultimatum, the Social Security Administration provided the updated information. The VA and Railroad Retirement System provided the information earlier last week.
For recipients of VA benefits, the IRS news release announcing payment dates says: "The IRS continues to review data received for Veterans Affairs (VA) benefit recipients and expects to determine a payment date and provide more details soon. Currently, the IRS estimates that Economic Impact Payments for VA beneficiaries who do not regularly file tax returns could be disbursed by mid-April."
Do I Have to Do Anything to Get My Check?
Probably not. If you received the first two checks, you're probably in line to get this one, too. The only thing you can do right now is wait.
One exception: If you have dependents, you may need to file a tax return, because the IRS may not get dependent information directly from Social Security or another agency. This time around, you'll get $1,400 for each dependent, regardless of their age. If you have dependent children, submitting a return could also help you get a child tax credit of $3,600 for children younger than 6 or $3,000 for children 17 and younger.
You may not receive money on behalf of your dependent with your check. If you don't get it with your check, the IRS will send you the extra money once it processes your return.
You can expect to receive your third stimulus check however you get your federal benefits, either through direct deposit or a Direct Express Debit Mastercard. If you've closed the bank account the IRS has on file, your bank will reject the deposit and you'll get your payment in the mail.
Can I Track My Stimulus Check Yet?
If you receive federal benefits and don't file a tax return, not yet. The IRS Get My Payment tool will be updated the weekend of April 3-4 for benefit recipients who are getting paid on April 7.
The information is updated once a day. Avoid multiple log-ins, as you may get locked out for 24 hours.
This article was originally published by The Penny Hoarder.

https://www.military.com/daily-news/2021/04/01/heres-when-va-disability-social-security-ssi-recipients-will-get-their-1400-stimulus-checks.html?ESRC=army_210406nl