(MSCC) Sharon Jasprizza, Posted March 30, 2022

SUMMARY

Direct contracting entities: Handing Medicare over to Wall Street, Adaptive Reuse: Hotels to Housing initiatives

POLICY MEETING UPDATES

The prior 8:30 Homeless and Housing Policy meeting wrap-up as presented by attending members (see Addendum Addendum A for full recap

John Mudd spoke about Jim Johnson, consultant, who is helping to build MSCC’s foundation to improve management and effectiveness. The committees can be built for specific goals to move our overall mission with people and other nonprofits. The Columbia Healthcare Report’s mandates which we need to continue to drive. Our health committee’s purpose “Medicare v Managed care” can be easily merged with some of those mandates listed in the Columbia healthcare Report—the enrollment of people into the proper health care system in particular; especially those living on the streets

SPECIAL INTRODUCTION(S) AND OR UPDATES: 

• Daniel Pichinson, Ryan Chelsea Clinton—COVID numbers are declining, mask where appropriate, encourage others to vaccinate
• Chelsea Pickett, Housing Works: Piloting a Street Outreach Project to support people who are homeless and unstably housed, Young gay men of color, and drug users, youth, members of the LGQBT community needing support. Looking at where these demographics congregate and what would be the most helpful zones to start the project. Help is needed for the best place to begin and the opportunity for a health van. Contact Chelsea Pickett, c.pickett@housingworks.org with ideas
• Jordan Feiner, JFener@council.nyc.gov, from Council Member District 3, Erik Bottcher’s office, asked Chelsea to be in contact with him
• David Ukre, d.shoen_ukre@housingworks.org, Housing Works Outreach coordinator is developing events to engage with community members either monthly or weekly to provide support needs. Gift bags for clients will be provided at these events. Please inform David of specific locations to clean up sharps (discarded needles)
• Jordan Feiner is working with Ryan Health for mask giveaway at Penn South on noon on Friday
• Rue Parkin, HelpNYC, rue@helpnyc.co, starting HelpNYC conversations on the new Twitter spaces this Friday, follow HelpNYC on twitter. If your group or organization would like to be featured on the helpNYC Conversations on Twitter Spaces please email Rue at rue@helpNYC.co. Slots are available in March, April, and May of 2022. Follow Twitter at @helpNYC (https://twitter.com/helpNYC). helpNYC is looking to do outreach and tabling this summer at any events of festivals.  Contact outreach@helpNYC.co 1. If you are interested in having helpNYC table at your event 2. if you want your organizations listed on HelpNYC site, 3. If you have input or need the street sheets HelpNYC is working on to build out into communities. HelpNYC has recently launched the Landlord and Realtors initiative to survey people who provide housing and experience with vouchers in order to help people with vouchers. This involves collecting information from landlords, property managers, realtors, and others who have experience placing people who have publicly funded vouchers in housing. This information will possibly lead to a Landlord and Realtor Listings section on the helpNYC.info Resource Navigator website for New Yorkers to use when seeking housing with a voucher.  Landlords, property managers, realtors, and others who have experience working with people who are seeking housing with a voucher should complete the survey at https://www.helpnyc.info/survey/landlords-realtors-initiative
• Robert Seebeck, CB5 Information gathering and updates to come in April’s meeting
• Betty Kolod, physicianadvocacynyc, bettykolod@gmail.com, Three actions: 
  • NY Doctors Coalition is collaborating with health groups to create a response to subway safety plan, as criminalizing someone who is unhoused is not making anyone safer. She’s asks for comments and sponsors to a letter https://docs.google.com/document/d/1ysFIWj74xJOzspXtNfWAhvKT0STehL703e-gWZqGN5o/edit?usp=sharing
  • Housing Justice for All is planning a press conference outside of Montefiore
  • In person day in Albany on 3/9 is focusing on vouchers and housing justice’ Connect with Betty and NY Doctors Coalition for collaboration. Betty also noted in the chat she is on the board of Physicians for a National Health Program-NY Metro chapter and to email Betty to join the health professionals lobby day for the New York Health Act on May 3 and/or for an upcoming storytelling for advocacy training

• Lili Lopez Outreach Specialist NY Connects, 646-457-5364, llopez@cidny.org NY Connects, connects people with any Disability, any age to services, resources, or it can be based on people’s needs.  Contact us at 844-862-7930
• Winston Tokuhisa: a Member Leader with Neighbors Together and V.O.C.A.L. NY and a member of the Client Advisory Group for the Coalition for the Homeless

ACTIONS

• Contact Chelsea Picket, c.pickett@housingworks.org with idea and help to locate the best place to begin the outreach and the opportunity for a health van
• Jordan Feiner, JFener@council.nyc.gov, from Council Member, Erik Bottcher, is to connect with Chelsea Picket
• Please inform David Ukre, d.shoen_ukre@housingworks.org of specific locations to clean up sharps (needles)
• Contact rue@helpnyc.co for the following: 1. for HelpNYC to do outreach at your event; 2. if you want your organizations listed on HelpNYC site; 3. if you have input or need the street sheets HelpNYC is working on to build out into communities; 4. to be featured on the helpNYC Conversations on Twitter Spaces; 5. Landlords, property managers, realtors, and others who have experience working with people who are seeking housing with a voucher should complete the survey at https://www.helpnyc.info/survey/landlords-realtors-initiative
• Contact bettykolod@gmail.com: to sign onto letter regarding response to subway safety plan, and for information about the Housing Justice press conference and the In-person day in Albany, and to join the health professionals lobby day for the New York Health Act on May 3 and/or for an upcoming storytelling for advocacy training

HEALTHCARE: MEDICARE VS MANAGECARE

Claire Cohen, M.D., Physicians for a Nation Health Program,  cmcmd80@gmail.com PNHP.org/stopDCEs . The slide presentation link:https://docs.google.com/presentation/d/1BRqewrxCkJCwZKg6NVncMhJkFtnypcJUR2Fz-PPrB-c/edit#slide=id.p 

• Claire Cohen is a Child and Adolescent Psychiatrist practicing in Western Pennsylvania for over 40 years, working in school-based hospitals, community centers. Claire notes that there is a shortage of child psychiatrists and it is keeping her busy
• She’s active in communities such PNHP and Western PA System for single payer health care, to push health care as a human right and a public good

Medicare Contracting Program

• Dr. Claire Cohen is Involved with many coalitions to stop “the quietly done and under the radar†privatizing of Medicare
• Medicare Direct Contracting program started in 2019 under the Trump administration to change the way that Medicare pays for seniors’ care
• Rather than paying doctors and hospitals directly, Medicare gives third party middlemen called Direct Contracting Entities (DCEs) a monthly payment to “manage†the healthcare of seniors, and whatever they do not spend they keep as their profit
• Traditional Medicare is funded by taxes Americans pay. The funds go into Medicare Trust Fund which the doctor bills the service provided.  Over the last couple of decades this program has become known as Medicare Advantage, a soft third-party program where the third person keeps 15% of cost
• Direct Contracting was developed by the Center for Medicare & Medicaid Innovation (CMMI), an obscure agency within Health and Human Services that has the power to implement pilot programs and then scale them up WITHOUT Congressional approval
• President Biden appointed Health Secretary Zavier Becerra as Health Secretary. Sitting under Becerra is the ACA, and under the ACA is the Center for Medicare and Medicaid Innovation. Its mission is to “foster healthcare transformation by finding new ways to pay for and deliver care that can lower costs and improve costsâ€
• Adam Boehler, a CEO of a Private Equity Firm and former roommate of President Trump’s son in law, Jarred Kushner, was appointed by Donald Trump to lead the Centers for Medicare and Medicaid Innovation. Prior to the appointment, Adam Boehler ran a start-up called Landmark Health. It was Adam who came up with the idea of Direct Contracting
• The program started in April 2021 under Biden a who did snd is moving forward: there are 53 DCE’s (mostly private equity firms) operating in 38 states, including DC, Puerto Rico
• Virtually any type of company – regardless of healthcare experience – can apply to be a DCE, including commercial insurers and venture capital investors. Applicants are approved without input from Congress
• Program syphons money to private equity by maximizing revenues from the Medicare Trust Fund; minimizing revenue spent on patient care
• These two processes are done by “Upcoding†
• Upcoding makes seniors look sicker than they are. DCEs can get higher monthly payments if a person is sicker, from Medicare, regardless of how much care patients actually receive 
• Medicare allocated funding every year is called capitations
• The amount allocated for every senior is different every year; the sickest receives the most
• Claire referred to a coding table in her presentation to illustrate distribution strategies: the table shows typical coding where a senior is allocated $9,000 (2018 figures) for the year, based on the codes referred to in the first column of the table. If a person is totally healthy and there are no codes the senior allocation is $4.000 per year. The second column refers to the upcoding and the codes for people who are sicker. These “more sicker†codes allow Medicare to give a higher capitation and will allocate up to $32,000 per year per senior
• DCEs are allowed to keep 40% from the Medicare annual payments allocated to seniors. This is how the DECs make their profit
• The Inspector General Office shows Medicare Advantage, which has also done upcoding, has defrauded the Medicare Trust Fund of $109 billion for over the last 8 to 9 years by upcoding
• DCEs are allowed to keep as profit and overheads what they don’t spend on medical service. NOTE: This is a dangerous incentive to ration and restrict seniors’ care
• These financial incentives do not exist in Traditional Medicare
• Besides these last two dot points the following is affected: Medicare solvency is threatened because of the fraudulent upcoding exhausting the fund, and Seniors’ health and health care choices are threatened
• Summary: Direct Contracting threatens Medicare’s solvency, While Traditional Medicare spends 98% of its budget on patient care (2% overhead). Direct Contracting Entities may spend up to estimated 60% of what Medicare pays DCEs on patient care, keeping 40% as overhead and profit. Noted as above Medicare Advantage keeps up to 15% as overhead and profit
• How does this upscaling undermine Seniors’ choice? Up to 30 million seniors who actively choose Traditional Medicare may be automatically aligned with a DCE without their full knowledge or consent. A patient’s doctor may not understand this practice of aligning patients and the effects on a patient’s care. Seniors do not choose to join these DCEs
  • DCES entice Doctors to join eg Clover Health, Village MD. Once a doctor joins a DCE, CMS will automatically align all the doctor’s patients with the connected DCE
  • The senior receives a form letter from the DEC, which looks like something you would trash because of its general nature and a note about the seniors’ “Medicare benefits not changing.†The form letter also notes there is no need action, and states your doctor is concerned about your care. The letter does not make it clear to the senior what is really going on. The DCE letter gives the impression to seniors that their doctor is doing something to make the seniors medical care better 
• The only way to opt out of being auto-aligned to their doctor’s DCE, the senior needs to change primary care physicians – which is especially difficult for seniors in rural or other underserved areas
• Asking seniors to change primary care physicians undermines Traditional Medicare’s promise of free choice of provider
• The radical transformation of Medicare is seen in the following: The Center for Medicare Innovation plans to expand Direct Contracting to all Traditional Medicare within the decade. The measure the Center for Medical Innovation uses for its success is to have all Medicare FFS beneficiaries in a care relationship with “accountability for quality and total cost of care by 2030â€
• There was a change of name recently from DCE to the REACH Model. The differences between REACH are DCE are shown in table: https://innovation.cms.gov/media/document/gpdc-aco-reach-comparison
• Why hasn’t Congress stopped Medicare Direct Contracting? 
• Until recently, most members of Congress had never heard of Direct Contracting. Remember earlier in this recap, it is noted that there was no need for DCEs to go through Congress
• Katie Porter (D-CA-45) and Mark Pocan (D-W-02) found out about this fraudulent practice in the summer of 2021 and sent letters to groups including Claire’s PNHP to let them know what was happening. PNHP took the ball and ran with it. On November 30, 2021 Claire and team met with a variety of Congress members, including Pramila Jayapal, D-W-115-117) who then wrote a letter in December, which 54 members of Congress signing, and sending to HHS to demand an end to the program. 
  • See ADDENDUM B for news item and text of letter sent to Congress, https://pascrell.house.gov/news/documentsingle.aspx?DocumentID=4760
  • See ADDENDUM C for Jayapal’s and Dr Susan Rogers’ (President of Physicians for National Health Program, PNHP) op-ed in the Hill calling it the “biggest threat to Medicare you’ve never heard of†and “Wall Street investors are already tripping over themselves to get into the DC program†https://www.commondreams.org/news/2021/12/10/jayapal-biden-stop-trump-era-medicare-privatization-scheme-while-we-have-chance
• DCE, owners and investors are fighting back to protect their profits
• Claire has recordings of many congressional hearings on this health issues: one where Senator Elizabeth Warren (D-Ma-113th-117^th) came on board for the fight
• Resulting from the negative attention, the fight the Innovation Center and Industry rebranded the name to the “REACH Model†
• There is no real difference with the same problems and fraudulent abuse of Medicare and seniors

DISCUSSION

• Maribel Ruiz, MSCC Health Care Committee, raised the ANTHEM case currently being heard by Geoffrey S. Berman in the Southern District of New York.  ANTHEM has allegedly falsely certified the accuracy of the diagnosis data it submitted to Center for Medicare and Medicaid Services (CMS). Maribel asks Claire if there are any allies to work with to strengthen cases like this. The ANTHEM case is found at https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-files-civil-fraud-suit-against-anthem-inc-falsely-certifying
• Claire Cohen will bring this back to fighting group. Claire is looking for ways to support these lawsuits
• Claire Cohen and network contacted Elizabeth Fowler. Deputy Administrator and Director of Center for Medicare and Medicaid Innovation (CMMI) at https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-files-civil-fraud-suit-against-anthem-inc-falsely-certifying. Elizabeth Fowler claims they cannot stop direct contract because CMMI would be sued by the private equity firms
• David Ward, Trinity Church Wall Street, referred to the Supreme Court case that could limit the EPA’s power to fight climate change. David asks if this limitation of power would help to limit other federal powers 
• Claire Cohen does not know much about this case but says it may help our cause. Claire noted that many agencies have been doing ‘under the table deals’ for many years. Claire notes that if we need to make Congress aware of these issues so it can help us fight these “underhanded dealsâ€
• From our research since this meeting please note the EPA case may also “hobble the ability of federal agencies to regulate air pollution — and potentially, much more. But the major questions doctrine is not the only new twist that some of the court’s conservatives have advocated. Another is something called the non-delegation doctrine. As some conservatives see things, Congress is quite limited in how much regulatory power it can give to agencies.†https://www.npr.org/2022/02/28/1082934438/supreme-court-to-hear-a-case-that-could-limit-the-epas-power-to-fight-climate-ch
• Allen Oster, MSCC, spoke about the case before Judge Llyle Frank regarding a retirees’ group not represented by the Unions any more. The Judge has administered charges. The program has been reconfigured as a result. The interesting thing is that retirees who wanted to opt out have to pay a fee to the new Medicare Advantage program. Allen will contact Claire Cohen about the case.
• Coding Figures: Claire responds that when CCMI worked out the original capitation, it did not give the equity firms much profit, so they came up with a system whereby different codes give greater capitation amounts
• Documentation of the top 20 Medicare Advantage companies have been fraudulently upcoding to make more money. Venture capitalist and private equity were attracted to this system of making money and convinced the Trump administration to increase the profit margins from 15 to 40% 

From Chatbox

• David Ward, Trinity Church Wall Street asked: If the Supreme Court limits the ability of the EPA to make some regulations without congressional approval, that could pave the way to limiting all agencies ability to act without congress.  Might that require congress to approval this?
• Daniel Pichinson, Ryan Chelsea Clinton, notes that: Requiring congress to have more oversight of executive departments could cut both ways.  Conservative congresses may stymie liberal or left of center presidents and their executive departments from taking action to protect rights or expand rights if more needs to be run by Congress
• Claire Cohen points out it is important Congress is made aware. It was Diane Archer, Investigative reporter for Medicare, who made Jayapal and Dr Rogers aware of the fraudulent direct contracting scheme. It may have been missed if Diane did not make them aware, hence it’s important to make congress aware
• David Ward, Trinity Church Wall Street, notes: That’s right, Dan.  This could really have an adverse effect on the EPA’s ability of fight climate change.  The matter of congressional approval is verydicey, and should be legislated very thoughtfully

ACTIONS

• MSCC Health committee to work on next steps including the single payer 
• Claire Cohen will talk with MSCC and Health Committee in the future about steps forward
• Allen Oster will contact Claire Cohen about the retirees’ case.
• Clair Cohen referred to PNHP.org/stopDCEs to protest this fraudulent practice
• Make Congress aware of this issue
• Sign the Individual petitions to send to HHS to stop the program. There are also organization letters, write letters, and sign on, go to PNHP.org site and keep up with the fight
• Monitor the PNHP.org website to stop the privatization of Medicare, work with the Medicare protectors to have congress people to sign on to be Medicare protectors to advocate to stop the privatization of Medicare and to expand it instead
• Connect with Claire Cohen and her network to fight the privatization at cmcmd80@gmail.com  and at PNHP.org/stopDCEs 
• Instead of privatizing Medicare, we need to expand Medicare to include dental, vision and hearing
• Contact Diane Archer, investigative reporter for Medicare

ADAPTIVE REUSE: HOTELS TO HOUSING

Ted Houghton, President of Gateway Housing

• The Governor reintroduced regulatory relief for permanent conversions in the budget. This budget is expected to pass on April 1, 2022. If it passes the relief will help facilitate some hotel conversions
• HONDA ACT of 2020,  money has not been used yet, but the legislature may add more money to this fund also
• Several hotels are on the market but they difficult to convert into housing because of lack of regulatory relief and cost
• California converted 93 hotels and have 6,000 units for permanent housing for the homeless last year. New York is still talking! (Use as a Social Media talking point)

John Mudd, MSCC

• There may be an opportunity for a hotel to be converted to a respite bed facility, John Mudd, Ted Houghton and network are working on this

Ted Houghton, President of Gateway Housing

• Hotels can be converted overnight into shelters or a respite center
• The regulatory relief is not as necessary in these cases
• A hotel owner in the area may be very interested in repurposing 

RALLY HIGHLIGHTING THE INEQUITIES & BAD POLICIES

John Mudd, MSCC: Rally planning group for 4 points in Midtown: near Port Authority, Hudson Yards, NYCHA and Penn Station. Please contact John if you are interested in the planning committee for this rally

PUBLIC CONCERNS

Serafina Payne, LMSW Serafina.payne@cucs.org – Manhattan Outreach Consortium at CUS

• Contact Serafina Payne for Homeless concerns in Manhattan
• BRC does the HOPE count, numbers may be available from BRC

Marni Halasa, Activist , MSCC member

• What is being talked about hotel conversions in the city so that are closer to people’s services?
• A NYCHA tenant needs a hospital bed. If an insurance company is not giving a client what a doctor prescribes then lodge a complaint at City Services, Financial Services 

Ted Houghton, President of Gateway Housing

• Not sure of what is happening in Adams’ campaign. There are many advocates against congregate settings, and who are also advocating for places for people with mental health concerns
• NYS is making more scattered sites for housing. It is helping NFP to support people needing housing and services
• Difficult to find rental properties these days
• Hoping NYS and NYC will prioritize people living in the subways
• The mayor in the campaign was specific about outer borough hotels, and sensitive to concerns to Trades Unions Hotels. Our preference is to convert non-union hotels into housing so we can keep the union jobs and tourism
• Most of the hotels are in Manhattan, hopefully when the opportunity presents itself, decisions are made project by project
• 500 safe haven beds is a good start

Maria Ortiz, Transportation Equity for Children, pistnyc@gmail.com

• Announced their march over the Brooklyn Bridge on Saturday March 19, 2022, for children using buses. The rally is for transportation inclusion, Equity and reform for students and to stop violations of access to education See Addendum G: Parents to improve Transportation

MSCC PLANNING

John Mudd, MSCC

Working with consultants to progress the work we are doing and how we work with other similar NFPs

PROGRAM UPDATES

John Mudd, MSCC

• Street Sheets: Midtown Community Court is helping with the distribution and printing
• Urban Garden; Starting today to prep for the new season

NEXT Meeting Homeless and Housing Meeting: 

• Discussing the 421-A Tax Credit, its use and delivering unaffordable housing rather than affordable
• 9:30 AM Tuesday, April 5, 2022. Always the 1^st Tuesday of every month. Contact hello@localhost for more information and your Zoom invitations

ADDENDUM A:

HOMELESS & HOUSING Policy MEETING RECAP MARCH 1, 2022

8:30 am-9:30 am via Zoom: Please note there is no recording of this meeting and minutes are done from memory

SUMMARY

Committee development, Medicare v Managed Care, Rally discussion and organization

John Mudd, MSCC, discussed:

• The purpose of committees and the roles each would play
• The progress of the Health Committee and its work on Medicare v Managed Care
• The planned rally for Penn Station and the recent developments
• MSCC has worked on a new mission and vision and description.
• Mission: Midtown South Community Council strives to dismantle the causes of homelessness by building an equitable, just, and sustainable social infrastructure to ensure dignity, health, and home for all. 
• Vision: Midtown South Community Council envisions a city where homelessness and poverty are eradicated.
• Midtown South Community Council (MSCC), a 501 (c) (3), was established in 1983 to enhance New York’s Midtown’s quality of life by addressing the concerns of its residents and local businesses. MSCC is a visionary organization with transformative ideas and processes, delivering high-quality services to bring people together to share resources, lobby for improved housing, health access, and other quality of life attributes to ensure dignity, and empower people to reach their full potential
• Dan Pinchinson, Ryan Chelsea Clinton discussed:
• The health concerns at Ryan health and the information he understands regarding managed care
• Steps forward for health guidance and Covid
• Meeting closed 9.30am. Next Policy Meeting at 8.30 AM on Tuesday April 5, 2022

ADDENDUM B: The text of the letter sent to Congress by Katie Porter and Mark Pocan in May 2020 to stop Direct Contracting Entities Pilot program

May 13, 2020

The Honorable Xavier Becerra                                                          

Ms. Liz Richter, Acting Administrator, Department of Health and Human Services  Centers for Medicare and Medicaid Services

200 Independence Ave, S.W. , Washington, D.C. 20201

7500 Security Boulevard, Baltimore, MD 21244

Dear Secretary Becerra and Acting Administrator Richter:

We write to express concern with the Centers for Medicare and Medicaid Innovation (CMMI) Direct Contracting Entities (DCE) pilot program. We appreciate that you paused implementation of the Geographic model, and we were also pleased to see CMMI stop enrollment for any new providers in the Global and Professional Direct Contracting (GPDC) model. However, we remain worried that the 53 DCEs participating in the GPDC model, a policy launched under the Trump Administration lacks oversight to protect Medicare beneficiaries’ care.

Under this model, beneficiaries who have deliberately chosen traditional Medicare over Medicare Advantage (MA) will be auto-enrolled in private plans offered by insurer DCEs within traditional Medicare. It remains unclear how CMS will ensure beneficiaries will be able to switch back to traditional Medicare, or even how CMS will notify beneficiaries that they have been auto-enrolled into an insurer DCE. We are concerned that funneling people into Medicare Advantage-like plans not only eliminates beneficiary choice, but also erects more barriers and provides fewer consumer protections for beneficiaries. It is also unclear how CMS will monitor impacts to beneficiary access to care, the impact on current Accountable Care Organization (ACO) models, or possible excess payments made to insurer DCEs.

We are also concerned that the insurer DCE model creates additional risk for beneficiaries without adding any value. This model has less accountability than Medicare Advantage plans, which have been overpaid $143 billion between 2008 and 2020 according to MedPAC. The insurer DCE model offers a similar opportunity to maximize reimbursement through inflated Hierarchical Condition Category (HCC) codes. For example, one insurance company served 98 million people in 2020, compared to 96 million one year ago, and revenue per consumer served increased 29 percent in year-over-year for 2020 driven by the expansion of people served in value-based care arrangements and the increasing acuity of the care services provided.^[1] Because of the pervasive nature of this practice in risk scores, we are alarmed that the insurer DCE may significantly increase costs without providing any value.

As members of Congress committed to protecting Medicare beneficiaries, we ask that CMS immediately freeze the harmful CMMI DCE pilot program including the Geographic model and the Global and Professional Direct Contracting Model and evaluate the impact to beneficiaries. We look forward to your response.

Sincerely,

ADDENDUM C: Jayapal and Dr Susan Rogers Op-Ed in the Hill, Dec 10, 2021

Jayapal to Biden: Stop Trump-Era Medicare Privatization Scheme ‘While We Have the Chance’

“Since Direct Contracting is a pilot program, it can and should be stopped in its tracks by the Biden administration.”

JAKE JOHNSON

December 10, 2021

U.S. Rep. Pramila Jayapal on Thursday joined the growing chorus of physicians and advocates urging the Biden administration to immediately end Direct Contracting, a Trump-era pilot program that could result in the total privatization of traditional Medicare by the end of the decade.

In an op-ed for The Hill, Jayapal and Dr. Susan Rogers—president of Physicians for a National Health Program (PNHP)—called Direct Contracting (DC) “the biggest threat to Medicare you’ve never even heard of,” alluding to how little attention the pilot program has received from the press and members of Congress, few of whom have spoken out against it.

 “Wall Street investors are already tripping over themselves to get into the DC program.”

“Starting this year, millions of seniors are quietly being enrolled into a program run by third-party middlemen,” the pair wrote Thursday. “This is occurring without their full knowledge or consent. If left unchecked, the DC program could radically transform Medicare within a few years, without input from seniors or even a vote by Congress.”

Established by the Center for Medicare and Medicaid Innovation (CMMI) at the tail-end of the Trump administration, the DC model places so-called Direct Contracting Entities (DCEs) between traditional Medicare and healthcare providers—a business-friendly alternative to traditional Medicare’s direct reimbursement model.

DCEs—which can be Wall Street-backed startups, private insurance giants, and other corporate interests—are paid monthly by the Centers for Medicare and Medicaid Services (CMS) to cover a defined portion of a patient’s medical care. Because DCEs can pocket what they don’t spend on patients, critics fear the pilot will incentivize the contracting entities to provide lower-quality care.

As Jayapal and Rogers noted in their op-ed, “Wall Street investors are already tripping over themselves to get into the DC program.” A recent analysis published in Health Affairs pointed out that 28 of the 53 DCEs currently operating in 38 states are controlled by investors, not healthcare providers.

“This should be a huge red flag for taxpayers and anyone concerned about funding Medicare for future generations,” Jayapal and Rogers wrote. “While traditional Medicare spends an impressive 98% of its budget on patient care, Direct Contracting Entities only spend 60% of our tax dollars on patient care—keeping up to 40% of revenues for their own profit and overhead.”

“Since Direct Contracting is a pilot program, it can and should be stopped in its tracks by the Biden administration while we have the chance,” they added. “After our experience with commercial Medicare Advantage plans, we already know that inserting a profit-seeking middleman into Medicare ends up costing taxpayers more, with fewer choices and worse outcomes for seniors.”

Jayapal and Rogers’ call came nearly two weeks after physicians from across the country traveled to Washington, D.C. to call on the Department of Health and Human Services (HHS) to immediately halt the sprawling DC experiment.

“The Direct Contracting pilot model has been greenlighted by the Biden administration to completely privatize Medicare by 2030,” Dr. Ana Malinow, the former president of PNHP, warned during a rally last month outside HHS headquarters, where physicians attempted to deliver 13,000 petition signatures demanding an end to the DC pilot.

“The innovation center has the authority to scale up any model that fulfills its criteria to all of Medicare, without congressional oversight or approval,” Malinow added. “If we don’t act now, there won’t be any Medicare for All left to fight for.”

ADDENDUM D: Bio of Claire M. Cohen, M.D. 

Dr. Claire Cohen is an African American child and adolescent psychiatrist who has been practicing in the Pittsburgh since 1984. She grew up in Philadelphia, PA where she attended Hahnemann Medical College (now Drexel University Medical School) and did her General Psychiatry Residency at the University of Chicago. She then moved to Pittsburgh to do her Child and Adolescent Fellowship at the University of Pittsburgh’s Western Psychiatric Institute. She fell in love with Western Pennsylvania and has practiced here ever since. She has worked in a variety of settings, including community mental health clinics, partial hospitals, school- based settings and, currently, an inpatient hospital setting. 

In addition to her career, Dr. Cohen has always been very active in her community. In the late 1980s, she was involved in supporting the strike of the Pittston coal miners. In the 1990s, she was a member of the group that fought to get a Civilian Police Review Board in Pittsburgh. More recently she has been involved in efforts to stop the school-to-prison pipeline on the Pittsburgh Public Schools , a founding member of the Pittsburgh Green New Deal, on the advisory board of the Pittsburgh Black Workers Center and is fighting for Medicare For All as a member of Physicians For A National Health Program, the Western PA Coalition for Single Payer Healthcare, and National Single Payer. She is also on the Medicare 4 All Committee of Democratic Socialists of America. 

ADDENDUM E: LEGISLATION ACTIVISM

Alex HS Yong, WESNA Member, reports:

It’s my pleasure to share info. As I told Natalie, legislation is now my favorite part of activism. Here are some we like…

• A8899 (I’m over-the-moon thrilled this bill is even introduced) It asks for Rent Stabilization in perpetuity for the 3 major “types†of 421a tenants. I’ve created a white paper re: 421a shenanigans, which mentions the 3 types. I can send that to you if you’d like. It’s a GoogleDoc
• A7265/S6384 Purpose: To audit 421a so that its rampant fraud/abuses, focus on luxury, and its overall failure to give New Yorkers affordability can be laid bare for all to see (This bill complements A1931/S260A and would give it real legs)
• S3082/A5573 Good Cause Eviction, the bill on which the “Right To Remain†campaign is based. This one I know you know about already. Fyi in case you haven’t heard: Landlord groups and landlord cronies are now actively phone banking against S3082. I support Good Cause Eviction as well as A8899; I feel it’s sensible to support both;
• A5988 Punish landlords who warehouse apartments. The punishment would be fines and the fines would begin at a reasonable level but would go up up up the longer the warehousing continues. There is also a component within the bill designed to help the homeless. Sue Susman has a sharper understanding of the bill overall, including that component.

ADDENDUM F: PHYSICIANS ADVOCACY NYC

Physicians Advocacy NYC are responding to the Mayor’s Subway Safety Plan so far, if you have thoughts, please forward.  They’ll shop it around for signatures soon.
There’s also a housing advocacy day in Albany 3/9 if you want to sign up, let Betty know bettykolod@gmail.com.

ADDENDUM G: PARENTS TO IMPROVE TRANSPORTATION

Sara Catalinotto, Parents to Improve School Transportation

https://www.facebook.com/groups/pistnyc/
http://pistnyc.org/home.aspx
https://www.facebook.com/pistnyc/
https://twitter.com/pistnyc

2/4/22 Campaign Talking Points
As IPV survivors, my child and I know what it’s like to navigate the NYC shelter system. We experienced firsthand the inequities of this shattered system. 

• Students in temporary housing, particularly students with different abilities are at a greater disadvantage
• Pupil transportation is not attainable for many students due to procedural roadblocks and prevalent bureaucratic measures
• Students in temporary housing miss much needed instruction and services due to transportation inequality, compared to their peers
• Students with disabilities suffer a higher cost, they regress months and even years of learning, compared to their neurotypical peers
• All this, in violation of IDEA.
• We know first hand what it’s like to not receive a bus route for weeks on end due to a lack of a simple address change
• We know what it’s like to have to travel long distances in frigid temperatures by train and bus to and from a specialized program, but not have enough cents for the fare back
• We understand what it feels like to only be provided two way metro cards each day regardless of the student’s travel needs
• We know what it’s like to be kicked out of a DV shelter at night as retaliation for having the audacity to request a 7-day unlimited metro card
• The temporary housing system in NYC is broken, and deteriorating even more
• We were some of the privileged ones. There are a lot of families out there today who are facing greater odds than we ever did
• Transportation is a human and civil right for students in temporary housing

-Maggie Sanchez