Health care

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The Millionaire CEOs Trying To Crush Nurses

Published by Anonymous (not verified) on Tue, 13/09/2022 - 7:12am in

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Health care

In what is likely the largest nurses strike in American history, 15,000 Minnesota nurses today went on strike for better pay and benefits after working short-staffed through the pandemic. Hospital CEOs insist they can’t afford the increases: “They left with wage demands at 29 percent to 30 percent, which we’ve told them repeatedly is unreasonable and is unaffordable,” their chief negotiator told Minnesota local news.

But the five CEOs of the largest hospitals now pleading poverty have raked in a payout of more than $25 million over the three most recently available tax years. In just the last year alone, they paid themselves the following:

  • David Herman, CEO of Essentia Health: $2,697,603
  • James Hereford, CEO of M Health Fairview: $2,621,429
  • Andrea Walsh, CEO of HealthPartners: $2,444,428
  • Marc Gorelick, CEO of Children’s Minnesota: $1,459,584
  • J. Kevin Croston, CEO of North Memorial: $1,274,710

Meanwhile, nurses in Minneapolis average just $86,690 per year, according to the Bureau of Labor Statistics. The hospitals are also spending millions of dollars on extremely costly strike-replacement nurses.

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It seems like for hospital CEOs, “unaffordable” is just a code word for “fair compensation.”

Theory and homelessness

Published by Anonymous (not verified) on Wed, 07/09/2022 - 5:08am in

I’m writing an open access e-textbook on homelessness.

Chapter 2, focused on theory, has just been published.

The full chapter is available here: https://nickfalvo.ca/wp-content/uploads/2022/09/Falvo-Chapter-2-Theory-a...

A ‘top 10’ overview of the chapter can be found here: https://nickfalvo.ca/theory-and-homelessness%ef%bf%bc/

A French version of the ‘top 10’ overview can be found here: https://nickfalvo.ca/theorie-et-itinerance/

All material related to the book is free of charge and available here: https://nickfalvo.ca/book/

Theory and homelessness

Published by Anonymous (not verified) on Wed, 07/09/2022 - 5:08am in

I’m writing an open access e-textbook on homelessness.

Chapter 2, focused on theory, has just been published.

The full chapter is available here: https://nickfalvo.ca/wp-content/uploads/2022/09/Falvo-Chapter-2-Theory-a...

A ‘top 10’ overview of the chapter can be found here: https://nickfalvo.ca/theory-and-homelessness%ef%bf%bc/

A French version of the ‘top 10’ overview can be found here: https://nickfalvo.ca/theorie-et-itinerance/

All material related to the book is free of charge and available here: https://nickfalvo.ca/book/

Amazon Joins The Medicare Privatization Spree

Published by Anonymous (not verified) on Fri, 22/07/2022 - 8:31pm in

Amazon Joins The Medicare Privatization Spree

Amazon, the $1.25 trillion company founded and led by Washington Post owner Jeff Bezos, has announced that it is acquiring One Medical, a private equity-backed primary care provider that generates over half of its revenue from Medicare.

While Amazon’s profits from its core consumer retail business are dwindling, in part because of heightened competition from brick-and-mortar retailers that were shut down at the beginning of the COVID-19 pandemic, the corporation’s cloud computing division, Amazon Web Services, continues to enjoy robust profits thanks in part to generous government contracts. Now Amazon could be attempting to build on that federal largesse by seeking to milk revenue from Medicare, the national health insurance program for seniors and people with disabilities.

Amazon, which has broad market power, reach, and influence, could use its new platform to advance the cause of Medicare privatization at a much more aggressive pace. The consequences wouldn’t just mean more taxpayer dollars funneled to the mega-corporation, but also Medicare recipients facing a health care system with ever more resources being allocated to profit instead of care.

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The deal must go through normal regulatory approval processes. Advocates have pledged to oppose it.

“Amazon has no business being a major player in the health care space, and regulators should block this $4 billion deal to ensure it does not become one,” said Krista Brown, a senior policy analyst at the American Economic Liberties Project, which advocates on antitrust issues, in a statement.

She added in an interview, “It won’t make Amazon the largest player in healthcare, but will further dissolve integrity that is already on shaky territory with the health care system.”

As The Lever reported in April, President Joe Biden’s Center for Medicare and Medicaid Services (CMS) has expanded a Medicare privatization scheme launched under former President Donald Trump. That program, which is currently referred to as ACO REACH, involuntarily assigns Medicare patients to private health plans operated by for-profit companies, like One Medical subsidiary Iora Health.

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Medicare provides set payments to provide care for these patients, much like insurance. This arrangement incentivizes Iora and other privatization entities to limit the amount of care that seniors receive.

Continued expansion of Medicare privatization seems integral to One Medical’s business model.

The company’s most recent quarterly report shows that more than half of its revenue comes from Medicare. This includes Medicare Advantage plans operated by private health insurers, traditional Medicare fee-for-service payments, and the ACO REACH program.

One Medical’s most recent annual report notes, “A significant portion of our revenue comes from government health care programs, principally Medicare,” including specifically the ACO REACH privatization model.

The filing adds, “Any changes that limit or reduce the [ACO REACH model or] Medicare Advantage could have a material adverse effect on our business, results of operations, financial condition and cash flows.”

Like many mergers, both parties in Amazon’s new acquisition benefit from the arrangement. Amazon gets a more stable revenue source just as its retail segment is faltering, while One Medical gets Amazon and Bezos’ considerable political power. That power has led Congress to seriously consider granting Bezos a $10 billion subsidy for his Blue Origin space exploration boondoggle, and has led Senate Majority Leader Chuck Schumer (D-N.Y.) to stall on holding a vote to hold a vote on bipartisan antitrust legislation being championed by Sen. Amy Klobuchar (D-Minn.).

Amazon has a suite of powerful lobbyists at its disposal, including the lobbying firm run by the brother of Steve Ricchetti, who is the counselor to the president. The tech giant is the eighth-highest spender on lobbying in the country this year, according to data collected by OpenSecrets.

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The Congressional Progressive Caucus has led the charge against the ACO REACH model. Rep. Pramila Jayapal (D-Wash.) said in May, “The ACO REACH program is Medicare privatization, hidden in layers of bureaucracy. Essentially, seniors are put into this program, which allows a profit-seeking third party like a health insurer or private equity-backed firm to step in and get paid by Medicare to manage the care that they get. Taking for themselves the profit that is whatever they don’t want to spend on the patient.”

But despite opposition from progressives, Biden, Health and Human Services Secretary Xavier Becerra, and CMS Administrator Chiquita Brooks-LaSure, have resisted this pressure and continued to implement the program.

Observers also have concerns about the privacy impacts of Amazon acquiring One Medical.

“Allowing Amazon to control the health care data for another 700,000+ individuals is terrifying,” said Brown at the American Economic Liberties Project. “It will also pose serious risks to patients whose sensitive data will be captured by a firm whose own Chief Information Security Office once described access to customer data as ‘a free-for-all.’”

Junk Science Is Being Used To Attack Trans Youth

Published by Anonymous (not verified) on Mon, 11/07/2022 - 8:31pm in

Junk Science Is Being Used To Attack Trans Youth

Abortion services aren’t the only health care services under direct attack by the GOP. In Florida, the Republican-controlled health care agency recently used junk science from a concentrated disinformation campaign to declare that gender-affirming care for minors is “experimental and investigational.” The determination opens the door for the state to not cover these services under Medicaid, potentially go after the medical licenses of practitioners who provide gender-affirming care in the state, and even possibly force transgender people to de-transition.

The policy is part of a wider Republican offensive on transgender Americans. In March, NBC News reported that a record 238 anti-trans bills had been filed this year in state legislatures across the country.

And in late June, following the Supreme Court’s overturning of Roe v. Wade, Alabama asked a federal appeals judge to allow it to enforce a ban on health care for trans youth. As the state’s Republican attorney general argued in the brief, the high court’s recent rulings on abortion and concealed carry prove that “no one — adult or child — has a right to transitioning treatments that is deeply rooted in our nation’s history and tradition… The state can thus regulate or prohibit those interventions for children, even if an adult wants the drugs for his child.”

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The Florida development, which occurred a few weeks earlier, illustrates how conservatives are working to short-circuit laws banning health care discrimination based on gender identity.

Early last month, the Florida Agency for Healthcare Administration (AHCA), which regulates the state’s Medicaid program and health facilities, declared: “Several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers — are not consistent with generally accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects.”

This determination flies in the face of scientific consensus. The American Academy of Child & Adolescent Psychiatry, the American Academy of Pediatrics, and the American Medical Association are just a few of the many medical associations that deem gender-affirming care crucial for transgender youth.

The AHCA based its rejection of gender-affirming care on information obtained from isolated fringe studies. According to the Human Rights Campaign, the country’s largest LGBTQ+ advocacy group, the state agency’s findings “dismisses a recent explainer by the U.S. Department of Health and Human Services (HHS) on the medical need for gender-affirming care” and “rejects the science, medicine, and evidence-based approach of the HHS, instead dangerously cherry-picking select research to assert their claims.”

Policies like this that make social and medical transitioning difficult or impossible for young people could have disastrous effects on trans youth, who are already at very high risk of suicide.  A 2021 peer-reviewed study by The Trevor Project, a nonprofit that supports LGBTQ+ teens, published in the Journal of Adolescent Health, found that gender-affirming hormone therapy led to significantly lower rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth.

What’s worse, these legislative efforts are already having a psychological impact.

“The record wave of anti-LGBTQ bills across the country, and the ugly rhetoric surrounding them, are taking a toll on LGBTQ youth’s mental health,” Dr. Jonah DeChants, research scientist with The Trevor Project, told The Lever.

According to DeChants, Trevor Project research has found that 85 percent of transgender and nonbinary youth said recent debates about anti-trans laws have negatively impacted their mental health, and 93 percent of such young people said they worry about transgender people being denied access to gender-affirming care due to state or local laws.

How Florida Is Targeting Trans People

The Affordable Care Act (ACA), Democrats’ signature 2010 health care law, created a set of essential health benefits that plans must cover and stated that people with pre-existing conditions can’t be denied coverage. And while the federal law specifically prohibits the discrimination of care based on gender identity, it empowers states to determine whether certain treatments are experimental and therefore not covered if the state so chooses.

In response, Republicans and conservative think tanks are now helping invent junk science that says that gender-affirming care is not proven to work, thus allowing states to not cover the care under Medicaid and ban such services.

In the case of Florida, where Republicans control the state legislature and the governorship, the AHCA based its conclusions about gender-affirming care on several studies that defy the medical consensus on gender-affirming care.

For example, one study the state agency used to argue that many young people de-transition didn’t actually look at transitioning youth, but instead focused on conversion therapy, an unethical and harmful practice that seeks to “convert” gay people to heterosexuality.

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The state’s findings also noted that “studies do not show that the use of puberty blockers improves mental health.” But in fact, an abundance of studies conclude the use of puberty blockers, which essentially pause puberty so trans youth and families can decide the best path forward, does improve mental health outcomes. These improvements include a reduction in suicidal ideation, self-harm, and psychological distress.

Such anti-trans “science” is expanding. On June 13, the Heritage Foundation, a conservative think tank, released a study titled “Puberty Blockers, Cross-Sex Hormones, and Youth Suicide,” which claimed: “By 2020, there are about 1.6 more suicides per 100,000 people ages 12 to 23 in states that have a policy allowing minors to access health care without parental consent than in states without such a policy.”

Yet the study, which was not peer-reviewed, doesn’t look at gender-affirming care, as it claims. Instead, its authors deceptively examined suicide rates among young people in states that allow access to any kind of health care without parental consent. The states with higher suicide rates include Alaska, Oklahoma, and Montana, all of which have very little access to gender-affirming care for trans youth. These same states have loose gun regulations and higher gun ownership, and both have been shown to lead to an increase in suicides.

A Coordinated Attack On Trans Rights

Florida’s new policy is part of a larger coordinated attack against the trans community.

In Alabama, the state’s attorney general is using the end of Roe v. Wade and a ruling invalidating gun control laws to try to implement a recent bill passed by the Republican-controlled state legislature that would make it a felony to prescribe puberty blockers or use hormone therapy to anyone under 19 years old. Those who are found guilty could face up to a 10-year prison sentence.

In Texas, Governor Greg Abbott has directed the Department of Family and Protective Services to investigate gender-affirming care as child abuse, a non-binding directive but one that the agency has been following. While a recent injunction has been put into place to stop the directive, the judicial decision only covers families who were directly involved in the case, not the families of all trans youth in the state.

What’s more, 15 states already restrict life-saving gender-affirming care in some way.

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The common refrain in defense of these attacks is that they are about protecting children. Many anti-trans activists argue that trans kids can wait until adulthood to decide what’s best for them.

But for many people, gender-affirming care cannot wait.

In January, a study from the Stanford University School of Medicine found that participants who began hormone treatments in late adolescence were nearly two times less likely to experience severe psychological distress than those who began hormone treatments during adulthood. What’s more, participants who began such treatments in early adolescence were roughly six times less likely to have had suicidal thoughts in the previous year than those who began treatments as adults.

Meanwhile, The Trevor Project has found that ready access to gender-affirming care and support can be transformative for young people.

As DeChants noted, “We also found that LGBTQ youth who lived in an accepting community, had access to LGBTQ-affirming spaces, and/or felt high social support from family and friends reported significantly lower rates of attempting suicide in the past year.”

The DNC’s Disastrous Post-Roe Message

Published by Anonymous (not verified) on Fri, 01/07/2022 - 6:31am in

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Health care

The DNC’s Disastrous Post-Roe Message

One of the Democratic National Committee’s (DNC) first paid efforts to influence public opinion surrounding the Supreme Court’s decision last week to overturn Roe v. Wade and limit abortion access for tens of millions of Americans demonstrates a dispiriting level of apathy and ignorance.

Instead of mobilizing voters to support abortion rights, the DNC’s new digital ad campaign could mislead viewers into believing that the threat to abortion rights is still hypothetical and hasn’t fully arrived at their doorsteps.

Perhaps this messaging shouldn’t come as a surprise, considering Democrats knew for seven weeks that the Supreme Court was ready to overturn Roe, yet they appeared completely unprepared for the decision when it came down last Friday. So far, party leaders have not offered any national strategy to ensure that people in red states can get abortions, outside of urging Americans to vote harder and deliver more contributions to their campaign committees.

The DNC started running its new ad on Wednesday, five days after the court released its decision in Dobbs v. Jackson Women's Health Organization. So far, the ad has aired in Arizona, Florida, Georgia, Nevada, New Hampshire, North Carolina, Pennsylvania, and Wisconsin, according to data from AdImpact.

According to a press release, the DNC is putting five figures behind the digital ad as part of its so-called “MAGA Hot Mic” campaign. The Hill reported that the “ad buy will target 18- to 55-year-old women on Facebook and YouTube.”

A DNC spokesperson did not respond to The Lever’s request for comment.

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The DNC ad first gives the impression that the Supreme Court could soon overturn Roe, despite justices already having done so. It leads with video of former Vice President Mike Pence (R) crowing: “We may well be on the verge of an era when the Supreme Court sends Roe v. Wade to the ash heap of history where it belongs.”

The Pence video is from last November. The Supreme Court has already tossed Roe, with support from a dark money group founded by Pence. It’s unclear why Democrats would use this quote from Pence given his prediction has already been realized — indeed, the ad could easily give some viewers the misleading impression that the court hasn’t actually overturned Roe yet.

Next, the ad pivots to warning that Republicans might try to impose a national abortion ban. This is a threat to be sure, but this ad is running in several states that already have abortion bans on the books, including Arizona, Florida, Georgia, and Wisconsin. With the dismantling of Roe, the threat has already arrived in these states.

Abortions are now mostly banned in Arizona, with no exceptions for rape or incest, unless necessary in an emergency to save a mother’s life, according to Republican state attorney general Mark Brnovich. On Wednesday, Brnovich declared the state abortion law is back in effect now that Roe has been overturned.

The DNC’s Disastrous Post-Roe Message

NEW PODCAST: The Man Who Bought The Supreme Court

On this week’s Lever Time: David exposes the dark money network that has been bankrolling conservative judicial nominees, speaks with lawmakers about how governments can protect abortion access post-Roe, and breaks down the upcoming Supreme Court case that could limit the EPA’s ability to regulate carbon emissions.

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Wisconsin has a nearly 200-year-old abortion law on the books, which, similar to Arizona, makes no exceptions for rape or incest and only allows abortion to save a mother’s life. This law is now in effect since Roe was overturned. According to the law, doctors who perform abortions could face up to six years in prison and $10,000 fines. Clinics in the state have stopped performing the procedure.

Wisconsin Democratic Gov. Tony Evers and Attorney General Josh Kaul announced a lawsuit this week to block enforcement of the state ban, arguing that Wisconsin’s post-Roe laws conflict with the 1849 law, and that the ban has not been enforced for several decades.

"We're talking about returning Wisconsin to the 19th century. This law was passed well before women had the right to vote. It was passed before the Civil War," said Kaul in a news conference.

The DNC’s muddled messaging extends beyond its ad campaigns and into its media talking points.

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On Wednesday, Wispolitics.com published a DNC press release in which a committee spokesperson said: “While Democrats work to ensure health care decisions stay between a woman and her doctor, Republican lawmakers in Wisconsin and across the country are signaling that bans with no exceptions for rape or incest are next on their extreme agenda.”

Such a ban is already in effect in Wisconsin.

The DNC used similar language in its Florida statement, saying that “Republican lawmakers in Florida and across the country are signaling that bans with no exceptions for rape or incest are next on their extreme agenda.”

Florida passed an abortion law in April banning most abortions after 15 weeks, including in cases of rape or incest. That law was set to take effect Friday, though it was halted by a judge on Thursday — at least temporarily.

The DNC ad is also running in Georgia, where Republicans passed a so-called “fetal heartbeat” law in 2019 banning most abortions at six weeks. The law, which includes exceptions in cases involving rape or incest or threatening the life of a mother, was blocked by a judge in July 2020.

Georgia Republicans are now requesting that an appeals court allow the law to take effect.

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Hospitals Are Flouting — And Fighting — Price Transparency Rules

Published by Anonymous (not verified) on Mon, 27/06/2022 - 8:31pm in

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Health care

Hospitals Are Flouting — And Fighting — Price Transparency Rules

The vast majority of U.S. hospitals are ignoring a new bipartisan federal law that requires the facilities to make their service prices available to the public, new research shows, and the Biden administration is facing growing criticism for not doing enough to enforce compliance with the landmark rule.

Now one state, Colorado, has taken matters into its own hands, passing an innovative law to bring its hospitals into compliance with the federal price transparency requirements — despite health care lobbyists’ efforts to sink the legislative effort.

The state of affairs reveals just how far health care interests are willing to go to prevent consumers from making informed financial decisions about their medical care — but also hints at a potential way forward to finally force hospitals to reveal their prices, a first step in making health care more affordable for all.

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The federal price transparency law, written into the Affordable Care Act, became effective last January, after former President Donald Trump’s Centers for Medicare and Medicaid Services (CMS) finalized and codified it in federal regulations. Per the rule, each hospital in the U.S. must provide its pricing information as both “a comprehensive machine-readable file with all items and services” and “a display of shoppable services in a consumer-friendly format.”

According to CMS’ description of the rule: “This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.”

But despite raking in record profits in 2019 and remaining profitable even during the COVID-19 pandemic, in part because of taxpayer-funded COVID relief, hospitals nationwide have largely ignored the rule. According to a new CMS report, six to nine months after the final rule went into effect, only 6 percent of U.S. hospitals — out of a sample of more than 5,200 — were fully complying with the requirement to make prices available to the public.

Hospitals, particularly hospital chains with market power, are a key driver of sky-high health care costs in the United States. According to a RAND Corporation study of medical claims from the privately insured, while some states had relative prices below 175 percent of Medicare prices, other states — including Colorado — had average hospital charges that were at least 300 percent of the Medicare rate for the same care.

Some Colorado hospitals, including HCA Healthcare’s North Suburban Medical Center in Thornton and Centura Health’s St. Anthony Hospital in Lakewood, charged nearly 400 percent or more, on average, than what Medicare pays.

While consumers can aid enforcement efforts by submitting a complaint to CMS if a hospital is not in compliance with the federal price transparency rule, such a mechanism is likely limited in effectiveness, given polling last summer showing just 1 in 10 U.S. adults were aware of the rule.

During his nomination hearing last February, Health and Human Services Secretary (HHS) Xavier Becerra, whose nomination was backed by the country’s largest hospital industry lobbying group, responded to a question about price transparency, saying that: “The American people are entitled to know what they’re buying, especially if it’s a life-or-death situation. We will do robust enforcement to make sure that price transparency is there for all Americans because for far too long, people have never had an idea of what they’re going to pay if they walk into a hospital.”

More recently, when asked about his agency’s enforcement of the law in an NBC News interview, Becerra said, “There’s got to be a new sheriff in town. If I can implement this the right way, then I’ll… try to do something about it.”

Sure enough, earlier this month, the federal government levied its first fines against a pair of hospitals in a Georgia-based health system for failing to comply with the price transparency law.

But some argue Becerra and HHS have been too soft on hospitals since the rule went into effect.

“The federal government has been slow in enforcing this regulation, but the two cases so far are a great start in at least signaling the federal government’s seriousness in pushing hospitals to disclose the price,” Ge Bai, a Johns Hopkins University professor of accounting and health policy and management, told The Lever. “We did not know whether the federal government was waiting to put in extra effort to push hospitals to comply. So that actually sent the wrong signal to hospitals, saying it’s fine if you don’t disclose — we won’t even enforce it.”

“By Hiding The Price, They Might Gain More Revenue”

Despite strong support for price transparency across the aisle, hospitals nationwide have tried to stave off such mandates. In 2019, the American Hospital Association, the national hospital industry lobbying group, joined forces with several other organizations to sue the Trump administration in order to stop the federal price transparency rule from going into effect.

According to The Washington Post, “The trade group sued, arguing that forcing the disclosure of rates is anticompetitive and won’t actually help patients make more informed decisions. But a federal appeals court let the rules go into effect.”

And when the rules went into effect, hospitals and health systems were quick to attribute their adherence struggles to “the high cost and complexity of implementation.”

But while the cost of compliance could be challenging for some small hospitals, a lack of resources doesn’t seem to be the main reason that many hospitals aren’t complying with the new rule. A recent study of 1,000 hospitals by the consumer advocacy group Patientrightsadvocate.org found that just 0.5 percent of hospitals owned by HCA Healthcare, CommonSpirit Health, and Ascension — the three largest hospital systems, with a combined 2021 revenue of $119 billion — were complying with the federal requirements.

At Johns Hopkins, Bai suggested there might be other reasons why hospitals would be reluctant to come into compliance.

“Some hospitals might believe that if they disclose their price, their revenue would be affected negatively,” she said. “So they think it’s better to not disclose.”

Bai added, “For those large systems, their compliance cost is trivial because they’re huge, have a very large budget, and they already have a very large IT infrastructure. Therefore we can say the reason they do not [comply] is because it is more likely for strategic considerations. By hiding the price, they might gain more revenue or be less likely to lose revenue.”

Caitlin Donovan, senior director at the National Patient Advocate Foundation, agrees. “One of the big problems with the federal transparency law has been that a lot of the major hospital systems make enough money that it costs them less, or it’s more worth their while to just pay the fine rather than actually post prices,” Donovan told The Lever.

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According to Bai, another reason hospitals don’t want to disclose pricing is because it could help payers more effectively negotiate prices for care. That’s because the new federal rule requires that hospitals publicly disclose secret rates they negotiate with insurance companies — which are often far cheaper than what they charge patients without coverage.

Donovan has also heard reports of hospitals posting their prices, but doing so in a way that’s difficult for health care consumers to navigate. “They are doing all sorts of different things that make it really difficult for anyone to look up something in their everyday parlance and figure out what something should cost,” she said.

The American Hospital Association responded to The Lever’s request for comment with a link to the organization’s latest blog post, titled “Hospitals and Health Systems Are Working to Implement Price Transparency Policies and Help Patients Understand Costs.” The post notes that outside groups have “reached wildly different conclusions about the status of implementation across the hospital field.”

“Give The Federal Law A Lot More Teeth And Force Hospitals Into Compliance”

Against the backdrop of limited federal enforcement, Colorado is leading the charge on creatively bringing hospitals into compliance, thanks to a new state law: House Bill 1285.

The law, recently signed by Gov. Jared Polis (D) and effective starting this August, has dual goals of accelerating the timeline on which hospital systems must meet the federal mandate, and curbing the crippling medical debt that plagues more than 100 million Americans.

The measure adds a state-level enforcement mechanism by requiring that hospitals be in compliance with the federal pricing transparency act in order to send Coloradans to collections for medical bills.

David Silverstein, founder and chairman of patient advocacy organization Broken Healthcare, wrote the bill and spearheaded the effort to get it across the finish line.

“H.B. 1285 was our effort to say we have an opportunity to use state law to give federal law a lot more teeth and force hospitals into compliance,” Silverstein told The Lever. “It needs to be a model for the rest of the country so 49 other states can enact similar legislation.”

Virginia, Massachusetts, Alaska, and Minnesota have also recently passed legislation to require hospitals to post their prices, but unlike in Colorado, those bills stop short of tying compliance to medical debt collections actions.

The Colorado bill passed with overwhelming bipartisan support, mirroring the bipartisanship such efforts have enjoyed at the federal level. Presidents Trump, Barack Obama, and Joe Biden have all been vocal in their support of hospital price transparency.

The bill’s chances might have been helped by the fact that Colorado’s hospital prices rank among the highest in the nation.

“Medical debt is a big problem in Colorado,” Bethany Pray, legal director at the Colorado Center on Law and Policy, a consumer group that supported HB22-1285, told The Lever. “I think the percentage of medical debt has surpassed other kinds of debt in terms of what kinds of debt people face. It used to be that medical debt was smaller. Now it’s larger. That’s a national trend.”

The new law could be life-changing for some patients, said Isabel Cruz, policy manager at the Colorado Consumer Health Initiative, a nonprofit helping Coloradans access affordable health care.

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“We as consumer advocates always have to think about what the consequences are for patients when hospitals aren’t in compliance with these laws,” said Cruz, “and think about the real financial consequences of when hospitals give egregiously large bills to people that are not in alignment with what would have been posted if they were in compliance.”

“Just One Patient Taking Action On This Would Galvanize The System”

House Bill 1285 didn’t pass without a fight. The Colorado Hospital Association (CHA), several of its member hospitals, and the Colorado and Denver Chambers of Commerce all lobbied against the bill during the legislative session, according to the Secretary of State website. In total, CHA paid their contract lobbying firm, Brandeberry McKenna Public Affairs, roughly $47,000 to lobby on state bills between February and May.

Hospital and business interests argued that since the federal government wrote the rules, they alone should handle enforcement, and that the law could result in frivolous lawsuits, since it allows patients to sue hospitals that sent them to collections while being out of compliance with the price transparency rule.

HCA, the largest hospital corporation in the U.S., also lobbied on the bill. In total, HCA paid the lobbying firms The Fulcrum Group and Husch Blackwell Strategies roughly $75,000 to work on their behalf during the legislative session.

HCA was one of the sponsors of a dark money group called Colorado’s Health Care Future, which fought Colorado’s public option bill. HCA’s hospitals charge some of the highest prices in Colorado. Their Colorado facilities have been featured in national and local news stories about exorbitant medical bills.

The investor-owned health conglomerate also owns Medicredit, a medical debt collection firm that filed collection lawsuits against nearly 8,000 patients in Colorado between 2010 and 2019. HCA Healthcare’s former chief executive officer was paid a record-breaking $109 million in 2018. And earlier in the COVID pandemic, the hospital corporation undermined a nurse union election in North Carolina.

Denver Health, a safety-net health system that appears to be in at least partial compliance with the federal law, also lobbied against House Bill 1285. According to Pray at the Colorado Center on Law and Policy, it’s not the first time the organization has opposed such a measure.

“Denver Health has done a lot of great work,” said Pray. “They also, though, were one of the opponents of a bill several years ago that would have… ensured that people don’t get sent to collections when they’re on Medicaid. Denver Health thought it was going to be too cumbersome, which was really distressing to hear, because it’s a core part of their mission to serve people who are on public benefits or uninsured.”

Ultimately, some concessions were made to the industry. That included stripping out a section  of the bill that would have allowed state regulators to use price transparency compliance as a factor in the hospital license renewal process. The bill was also amended to provide a longer timeline for so-called Critical Access Hospitals — certain rural hospitals with a special designation from CMS — to come into compliance with the federal rule.

But even with these concessions, Silverstein at Broken Healthcare was pleased by the final version of the bill. As he put it, “They didn’t get anything that I thought gave them any advantage.”

Now, thanks to the law, patient advocates believe hospitals across Colorado and beyond might finally change their ways.

“I think it will be helpful,” said Donovan at the National Patient Advocate Foundation. “There’s a good chance just one patient taking action on this would galvanize the system into just posting its prices.”

CHA did not respond to The Lever’s request for comment. And while a review of 17 Colorado hospitals by the consumer advocacy group Patientrightsadvocate.org bolstered the new CMS report’s finding that roughly 6 percent of state hospitals are following the price transparency rule, Katherine Mulready, chief strategy officer at the Colorado Hospital Association, recently told The Denver Post that she believed 85 to 90 percent of hospitals in the state were in compliance.

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The Health Crisis In Joe Manchin’s Backyard

Published by Anonymous (not verified) on Mon, 20/06/2022 - 8:31pm in

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Health care

The Health Crisis In Joe Manchin’s Backyard

In early June, Charles Combs traveled 50 miles to attend a free pop-up health clinic in Charleston, West Virginia, to have some teeth extracted.

He pulled down his facemask, revealing a patchwork of missing teeth, and pointed to a damaged tooth in the center that needed to be removed.

A resident of Lincoln County, Combs said he’s disabled from a head injury he sustained years ago as a laborer and does not have health or dental insurance. He told The Lever he has resorted to extracting his own teeth because dental care is too expensive.

“I’ve been doing them myself,” Combs said. “I’ve been offing them out with a hammer and a knotter.”

The Health Crisis In Joe Manchin’s Backyard

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Combs was sitting on bleachers in a school gymnasium that had been temporarily converted into a COVID-safe dental clinic. A maze of white tents, connected to one another by snaking air ducts, spread across the tarp-covered floor, looking like something out of the film E.T. Some volunteers nearby checked patients in and brought them to their appointments, while others emptied out buckets of blood and hazardous materials.

Combs was one of hundreds of patients who had congregated here, at Charleston’s Bible Center School, to attend a Remote Area Medical (RAM) clinic designed to offer free medical, dental, and vision services to people in need. The operation was taking place just a few miles away from the riverfront home of Sen. Joe Manchin (D-W.Va.).

Manchin last year blocked Democrats’ plan to expand Medicare to provide all seniors with dental and vision benefits, arguing it would be too expensive. Manchin’s opposition was a victory for the health insurance industry, which ran TV ads praising him for protecting their lucrative privatized Medicare plans.

But the Charleston clinic made clear just how badly people need such care — and not just seniors, and not just West Virginians. Combs, for instance, is still in his 50s, while the clinic saw patients of all ages driving hours from Ohio, Kentucky, and Virginia.

The RAM clinic hinted at the kind of universal health care system America could have, if not for senators like Manchin and their health care industry donors. The organization doesn’t ask patients about what its team calls the “three I’s”: identification, income, or insurance. Patients are treated with kindness, compassion, and professionalism — and fairly quickly. All services are free.

But instead of being replicated from coast to coast, this vital work is relegated to a small operation that many don’t know about. RAM, which has been operating for more than three decades, reported just $6.4 million in revenue in 2020, and only has roughly three dozen clinics planned for this year. The organization relies in large part on volunteers, especially volunteer physicians, nurses, dentists, and hygienists.

The problems RAM is working to address are staggering. Some patients at the Charleston clinic were living in constant pain, due to a lack of professional dental care. Their ailments would have been easier to manage or less severe had they received care sooner — if only they had been able to afford it.

Combs, and his self-directed dental surgery, illustrates the issue. “When I had this last one pulled, it cost me $400,” he said. “That’s too much.”

“All We Ask Of The Patients Is Time And Patience”

Founded in 1985, RAM was originally designed to provide health care services to people living in inaccessible regions, like the Amazon rainforest. The nonprofit quickly started receiving requests to hold events in the United States.

RAM still holds international clinics and hosts events in areas affected by natural disasters, but its work is primarily centered around filling gaps here at home. The organization hosts two- and three-day clinics all over the country, where patients receive medical, dental, and vision services free-of-charge. Glasses are made on site, same-day.

Patients can start signing up at venues at midnight the night before clinics start, and many stay in their car until it’s their time for care. Doors open at 5:30 a.m., and services start at 6 a.m.

The Health Crisis In Joe Manchin’s BackyardPatients lining up for the Charleston RAM clinic. (Andrew Perez)

“We take care of the acute problem — if somebody needs to have an eye exam, they can’t afford to go to the doctor, or they can’t afford their deductible,” said Vicki Gregg, RAM’s clinic manager, as she was overseeing the Charleston event. “Our clinics are first come, first served. All we ask of the patients is their time and patience, and we will take care of them to the best of our ability.”

Based in Rockford, Tennessee, RAM goes where they are invited to partner with community health groups. So far this year, RAM has held clinics in Florida, Kentucky, North Carolina, Ohio, Pennsylvania, Tennessee, and Virginia. They’re scheduled to host more events in California, Georgia, Iowa, Nevada, New York, and Oklahoma.

Since 2017, RAM has worked with West Virginia Health Right, a local charitable clinic, to host the Charleston event. Patients at the June event were asked to choose between either vision or dental, while every attendee was offered medical services.

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“The majority is dental — always,” said Gregg. “Dental is about 65 percent, roughly. Vision comes in second. Medical, we’re looking at about five to eight percent.”

It’s easy to understand why dental and vision services would be in such high demand: Neither Medicare nor private health insurance plans cover routine dental or vision care. State Medicaid plans generally only cover dental extractions or emergencies, and only limited vision services if they do at all. Private dental insurance plans and Medicare Advantage plans that offer dental coverage do not in reality cover much, because they often include annual maximums of $1,000 or $2,000; once the insurer pays that much, you’re on your own.

Millions of Americans suffer from visual impairment or blindness due to not having glasses, which are exponentially more expensive in the U.S. than in poorer countries. Meanwhile, more than a quarter of American seniors end up with no remaining natural teeth. The dental crisis is particularly acute in West Virginia — according to 2021 data, the state has the highest percentage of seniors with no natural teeth of anywhere in the country.

That worsening crisis did not deter Manchin from blocking an expansion of dental coverage: While consistently voting for ever-larger military budgets, he said he opposed “spending trillions more on new and expanded government programs,” calling it “the definition of fiscal insanity.”

“My Teeth Hurt Every Day — What I Got Left”

Robert sat on the Bible Center School’s gym bleachers, waiting nervously for his dental appointment. He had come to the RAM clinic to get a broken tooth extracted — but he needs the rest out, too.

“I was sent a couple of months ago to an oral surgeon to have my teeth removed,” said Robert, who did not give his real name. “They’re all bad. They want $3,000 to remove them. I’m on Disability Social Security, and I don’t have $3,000. And one of my teeth is broken in the back, and it’s cutting my jaw, the side of my jaw really bad.”

Robert, who was born and raised in Charleston, said he can’t work due to several health issues — he has heart disease and high blood pressure, making it hard to stand for long periods of time. He’s also bipolar and said he is on many medications.

The Health Crisis In Joe Manchin’s BackyardA RAM van at the Charleston clinic. (Andrew Perez)

He said he lives in constant pain due to the state of his teeth, and doesn’t have the money to take care of them.

If it weren’t for the clinic, Robert said, “There’s nothing I really could do. I have no way of raking up that kind of money. Ain’t no way. With bills, rent, car insurance, food, gasoline, there’s nothing there to save with what I make a month. I couldn’t afford it. I can’t save money.”

“My teeth hurt every day — what I got left,” he added. “So I have to deal with them.”

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Patients often travel long distances to RAM events. Some patients at the Charleston clinic were from Kentucky, where the dental crisis is roughly as bad as West Virginia’s — and potentially even worse, by some estimates.

Laura McDavid and her teenaged son drove around 80 miles to the RAM clinic from northeast Kentucky, at the urging of a local social services organization. She said she’s suffering from a degenerative bone disease and needs to get all of her teeth removed.

“I’ve always had perfect teeth until the last probably four years,” she said.

McDavid said she hoped the clinic would mean being “on the road to hopefully getting all of them pulled so I can get dentures.” She said some of her teeth must be removed surgically, “but the least number of them that they have to do, the better.”

Working as a grocery store cashier, McDavid said she doesn’t have health or dental coverage. “I work a minimum-wage job,” she said. “We have no insurance.”

“I Fell In Love”

The Charleston clinic was manned by RAM’s small staff, plus dozens of volunteers. They did this work because they wanted to help people who are in pain — and because they believe everyone deserves to be treated with dignity.

“What got me was [RAM’s mission] to prevent pain and alleviate suffering,” said Ronnie Hatfield, RAM’s senior volunteer coordinator in an interview before the clinic. “I wanted to be a part of an organization that, with everything they do, they try to help people. I went to one clinic to kind of try it out and see how I liked it, and I fell in love.”

The Health Crisis In Joe Manchin’s BackyardEntrance to the RAM dental clinic in Charleston. (Andrew Perez)

Loni Maughan, who previously worked for RAM, traveled from southeastern Ohio to volunteer at the Charleston event.

“People have to put their health care on the backburner sometimes, and there’s major trickle-down effects when that happens,” she said in between guiding patients to various treatment spaces. “So when RAM comes in and is able to help fill that gap, they’re not just helping that person for the day, but they’re helping them to really pick themselves up in lots of different areas — for their family, for their community, for their job. That’s why I come out to volunteer with them, and to step in where I can to help the patients and help them get the care they need.”

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Andrea Board, a longtime surgical technician in operating rooms, drove from Winchester, Virginia, to help out at the RAM event. “I still have family here,” she said while walking through the vision clinic, a darkened room with stained-glass windows where people sat quietly waiting for eye exams. “I wanted to give back to the community where my family is deeply rooted.”

Board said she’s volunteered at several RAM events because “they don’t discriminate, they don’t ask questions, it’s very non-judgmental, and they’re here to help everybody who needs help.”

“Sometimes, this is the only health care that people will get for the entire year,” she noted, adding, “I love the fact that people get these new glasses that are life changing.”

Christy Barnett volunteered at the RAM clinic as a representative of a local church, helping feed RAM’s staff and volunteers. She said she chose to volunteer because of both religious conviction and a personal connection, explaining that West Virginia Health Right — the community health group partnering with RAM — helped her get her life back following a mental health crisis.

“They were there for me at a time that was my darkest, when I had no insurance and nowhere else to turn,” she said. “They treated me with dignity and respect, they gave me prescriptions, and had it not been for them, I don’t know that I would be as strong as I am today.”

“A Wonderful Thing In A Harsh World”

Melina, who only gave her first name, traveled from Conneaut, Ohio. She sat on a stage near the vision clinic for a long interview with the RAM communications team.

“​​Years ago, I thought I had a career with a major oil company,” said Melina. “I worked for them for over a decade, and then I realized they don't care about you. So now I think everybody should find what they're good at, and do it. Financially, it's rough. It's better, though. But it means that there's gaps in things like bank accounts.”

Melina said she first went to a RAM clinic shortly before the start of the COVID-19 pandemic, at a mall in Ashtabula, Ohio.

“I had a tooth that desperately needed to be taken out, and I was in excruciating pain,” she said. “Everyone was kind to everyone. I just have never seen people treat indigent people in particular with this much care, regard, and decency. They just treated us like we were valuable human beings and deserve good care.”

While she had been scared to have the tooth removed, Melina said the procedure ended up being “almost pleasant” and “the best dental care I ever had.” She said the Ashtabula RAM clinic helped set her up with an appointment to get bloodwork, and those lab results revealed she had anemia and needed to race to the emergency room.

“I think they saved my life,” she said.

Melina said she went back to another Ashtabula RAM event this year and got a filling, and she traveled around five hours to attend the Charleston event for a dental cleaning and women’s health services.

“When I get everything else fixed, I’m coming back to volunteer,” she said, calling RAM “a wonderful thing in a harsh world.”

WATCH NOW: Biden’s Medicare Premium Hike

Published by Anonymous (not verified) on Wed, 15/06/2022 - 6:05am in

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 Biden’s Medicare Premium Hike

The Biden administration recently reaffirmed its decision to enact the highest Medicare premium hikes in history — just before this year’s midterm elections.

And as our new video demonstrates, the president is, at the same time, moving forward with a plan to funnel significantly more Medicare money to for-profit insurance companies and further privatize the government insurance program for older Americans and those with disabilities.

Watch our new video about the White House’s troubling Medicare scheme — and then share it on social media and forward this email to friends and family.

We don’t answer to corporations. We’re a reader-supported news outlet — which is why we can produce this video and report stories like this and this that corporate interests would rather keep out of public view.

The only way for those in power to do right by all of us is to continue lifting the veil on these kinds of inconvenient truths. Thanks for supporting our accountability journalism and for encouraging others to subscribe. And remember: If you want to help us do more, you can always use our tip jar or give a gift subscription.

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International Student Mental Health and General Well-Being: why it’s time for policy action

Published by Anonymous (not verified) on Tue, 14/06/2022 - 6:00am in

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Blog, Health care

International students fared worse than most in Australia during the COVID restrictions, especially because they were excluded from the financial assistance offered to citizens and permanent residents in 2020. At the height of the pandemic, media outlets across Australia published stories of international students struggling to make ends meet. Yet these students were barely mentioned in the recent federal election campaign. There is a hidden assumption, with international education arrangements returning to ‘normal’, that action to address international student wellbeing is no longer necessary.

The problem with this assumption is that international student wellbeing was a problem well before the pandemic. Pre-pandemic policy did not meaningfully address the significant challenges faced by international students outside of the classroom setting. Policy solutions are eminently possible, and long overdue.

 

Pre-Pandemic: Challenges Faced by International Students Before COVID-19

Since the early 1990s, when Australia started accepting international students in large numbers, successive governments have chosen to allow market forces to determine services and supports for international students to receive. Policy-makers have left it to educational institutions to determine the level and the range of services offered to international students. All too often, this approach has allowed a vulnerable group to fall between the cracks.

International students are at increased risk of poor mental health compared to local students, and have long been so. A government-commissioned Orygen report, drawing on data collected immediately before COVID-19 reached Australia, found that the drivers of poor mental health among international students include isolation, high expectations and performance pressures, financial stress, precarious housing and employment, and experiences of discrimination and racism. Moreover, international students find it difficult to access services due to stigma, language barriers, and lack of knowledge concerning services available – for example, supports relating to employment, housing, education and health. The combination of stressors and inadequate assistance means that international students are often left to deal with challenges on their own, which can contribute to feelings of stress, anxiety, and depression. Concerningly, international students are significantly less likely to access mental health services than domestic students, and tend only to seek help when symptoms become debilitating. By the time they access support (if indeed it is available), they are often struggling with complex and serious mental disorders.

 

2020: The Shock of Lockdowns and the (Continuing) Pandemic

The global pandemic did not create an international student mental health crisis, but it did expose and exacerbate existing fault-lines in Australia’s approach to international education.

On the 3rd of April 2020, as the nation locked-down during the first wave of COVID infections, (then) Prime Minister Scott Morrison announced that international students would be excluded from the pandemic-related financial assistance measures offered to Australian permanent residents and citizens. Some higher education institutions stepped-up to offer assistance, but the supports offered were generally limited. This risk-aversion was in part a consequence of an anticipated drop in revenues as many international students left the country. For public universities (which is almost all of them), being excluded from the JobKeeper subsidy heightened financial concerns. Universities could only surmise that their finances were imperilled. Some commentators estimate that there have been 40,000 job losses in the sector since 2020.

Local NGOs and State Governments offered ad hoc packages to international students during the 2020 lockdown. This included food vouchers and parcels, and free legal and other services. But the services and financial assistance offered were not systematic or ongoing. To add to the uncertainty, classes were temporarily moved exclusively online. This exacerbated the sense of social exclusion that many international students already felt.

The impacts of these stressors on international students’ mental and general wellbeing were significant. A 2020 study by Alan Morris and colleagues found that ‘loneliness’ among international students doubled between 2019 and 2020, with 61 percent of those surveyed reporting feelings of loneliness during the main 2020 lockdown. Twenty-eight percent of survey respondents indicated that they were at least ‘somewhat worried’ about losing their accommodation, while 46 percent said that this fear was having an impact on their studies. Only 26 percent of students said that their landlord or real estate agent was ‘sympathetic’ to their situation. Almost half (45 percent) had to borrow money from friends or family, and 29 percent went without meals. Twenty-five percent pawned or sold something to pay for basic life expenses.

An international study conducted by Sarah Van de Velde and colleagues around the same time found that the students most at risk of depression during the pandemic were those from migrant backgrounds, those with few social supports, and those experiencing socioeconomic disadvantage. In 2020, international students were more fitting of this description than they had ever been. A survey of Australian university students during the first wave of the pandemic found similarly, that 65 percent of students were experiencing low or very low wellbeing. International students fared particularly badly, reporting significantly higher future anxiety and accessing more pandemic-related supports than local students.

 

2021: The Seeds of Hope

Educational instruction in Australia remained mainly online during 2021, and there were longer lockdowns during the second half of the year. But the situation began to improve for many. International students were finally able to access Disaster Payments, which helped to alleviate financial stress. Vaccines were also developed overseas, and enough were eventually purchased by the Australian government to cover the Australian population. Vaccination rates increased rapidly, and by October public health restrictions began to ease. Overseas-based international students were not yet allowed to return to Australia, but by December, some were returning in small-scale trials.

While the crisis thus appeared to be almost over, distress levels remained high. Students who had stayed in Australia and had to self-isolate during lockdowns, reported high levels of loneliness, COVID-19 related stress, and insomnia. International students locked outside Australia by border closures also struggled. A 2021 survey of those students by the Council of International Students Australia (CISA) found that almost half were facing financial stress as they continued to pay bills and cover the costs of storing their belongings in Australia. Worryingly, 30 percent of them reported thoughts of self-harm, and 27 percent reported clinically diagnosed anxiety or depression.

 

2022: Back Where We Began?

As of Semester 1 in 2022, Australia’s borders have been fully open to international students, although some are still studying remotely and living overseas. There is optimism across the higher education sector, as well as among students, that borders will remain open so that life and work can continue uninterrupted. However, entrenched legacy issues concerning international student wellbeing remain, and there is a pressing need for the new Albanese ALP Government to tackle them. The challenges include the propensity to view international students as a source of revenue, while ignoring their material and psychological needs.

The Morrison Coalition Government’s International Education Strategy did make mention of “mental health and wellbeing issues” among international students. Notably, the Strategy also foreshadowed a review of the Education Services for Overseas Students Act and the National Code of Practice for Providers of Education and Training to Overseas Students. As it currently stands, the ‘ESOS Framework’ (as these documents are called in combination) acknowledges the importance of support services to underwrite student wellbeing, but it does not compel the Government or educational institutions to actually provide services to international students. Instead, information provision on services is all that is required.

Under ‘support services’, Standard 6 of the Code states that institutions “must support the overseas student in adjusting to study and life in Australia by giving the overseas student information on or access to an age and culturally appropriate orientation program that provides information about” a range of services. Specifically, the Code mentions “English language and study assistance programs”; “legal services”; “the registered provider’s facilities and resources”; “student complaints and appeals processes”; “requirements for course attendance and progress”; any factors “adversely affecting’ individual students” education; and “employment rights and conditions” for students who are employed casually or part-time in Australia. In addition, institutions must have “critical incident policies” in place for all students. However – with the exception of students under 18-years-old, where there are more specific terms – there is little detail on the Government and/or institution’s substantive responsibilities for the material living conditions of international students. In essence, the ESOS Framework does little to ensure international students have access to the basic services and resources they need to maintain wellbeing.

The pandemic brought the human costs of Australia’s approach to international education into sharp relief, but the problems faced by international students are more longstanding. International students deserve the improved life-chances that would emanate from meaningful structural and policy reform.

The post International Student Mental Health and General Well-Being: why it’s time for policy action appeared first on Progress in Political Economy (PPE).

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