This summer, I dipped my toe into electric vehicle land: It was hit or miss

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

This summer I bought a new used 2021 Prius Prime. I wanted to dip my toe into the world of electric vehicles and the Prime provided that opportunity. I call my purchase a “new used” because compared to my 2007 Prius, my Prime feels spanking new. I wanted a Prime because unlike a traditional Prius, it provides an electric charge for up to 25 miles; after the electric is used up, the car reverts to using fuel, albeit a very fuel efficient 62 mpg. My friend Sarah owns one and has been crowing since she bought it about filling up her tank a mere 4 times a year because that 25-mph charge takes her all over town and home in time to recharge. So, she uses no gas. That’s what I wanted!

But I do more than drive around town. I bought the Prime anticipating a road trip at summer’s end to the Maritimes in Canada where I would work remotely and be a tourist on weekends. I wanted my new car to get maximum fuel efficiency for the 4,000-mile trip so I pledged to charge the Prius whenever I could. I wasn’t quite sure how it would work, so part of my plan was to test out how average consumers with electric vehicles were faring.  I was committed to trying, even if it only gave me 25 miles on the electric charge.

What I discovered is that finding reliable electric charging stations is hit or miss. The Prime provides one advantage: it comes equipped with a charging cable that can be plugged into any 120-volt outlet. Granted, the 120-v plug in option takes over 5 hours for a full charge, but it’s better than no charge at all.

The problem is that when you’re on a car trip and staying in roadside hotels, finding a place to plug in a car even at a standard outlet isn’t easy. When you can find one, it takes longer but has the advantage of being free.

So, my adventure began. I picked up my Prius Prime on August 18 from a dealer outside of Philadelphia and headed north, first stop Norwalk CT. I had a hotel booked, but alas, when I arrived, I couldn’t find a charger at the hotel. I tried using the Apps but which ones to use? Flo? Charge Point? Are they the same company? It was hard to tell and plus, they tell you there’s a station, but the chargers might not be working at that station. So, I figured I would rely on the chain hotels I stayed at along the route and tried to stay in places which claimed to have chargers.

On to the next stop, Keene, NH. My Holiday Inn Express had no charging stations, so I went across the street to Hampton Inn, where I had to pay for the charge, $2.00 for a two-hour session, and I wasn’t told ahead of time what the cost was. Next stop was Rockland, ME. I googled and found a charging station but only at the public library. Again, if I’m like most consumers, I want to know what I’m being asked to pay before I decide to pay it. Again, no such luck here; you flash your credit card on the display at the charging station and hope it won’t break the bank; you get a green light and plug in your car. Thankfully, again it cost me only $1.50 to $2 for the full charge.  But I had to leave the car for 2 hours and go back to my hotel to kill time. It’s safe enough because you lock up and the charging port doesn’t provide any opportunity for theft or vandalism. Advanced planning would have allowed me to see the wonderful Farnsworth Museum in Rockland while my car was charging.  Another lesson learned!

The next overnight was Bangor, ME. The hotel staff pointed to the gas station next door; a guy sitting in a Kia was charging his SUV and I thought, great! Alas, neither of the charging ports fit my Prime. That was a surprise.  I went away dejected and googled for another possibility. I drove ten minutes to the public library downtown, which I read had received many thousands in infrastructure funding to put up charging stations. The display where you put your card was unresponsive. I couldn’t pay and couldn’t get the ports working. I called the phone number on the charging station and clueless operator picked up and thanked me for the report but said she couldn’t help me. I called Bangor city hall, and no one answered, so I left a message and my phone number – it was a Monday morning. No one ever called back. So I got no charge in Bangor.

Next, on to St. John, Canada. We were hoping the Canadians had figured it all out and the hotel would have the promised charging stations – they were there but neither was working. So, no charging in St. John.

Our next stop was Charlottetown, Prince Edward Island. The town is charming, and we were excited that the hotel advertised multiple charging stations; there were two and once again, neither was working. We got a maintenance guy to reset the charger and plugged in. Yes! A two-hour charge and for free!

The next evening though, we couldn’t get access to the charger because a van parked at the only working charging station from 6 pm till late the next morning and we had to hit the road. A woman in a Tesla next to me looked perturbed – she and her young daughter had rented a Tesla and had no access to a charger either. She reassured me she had another 30 kilometers of charge. But what if she didn’t have any charge to spare?  She’d have been SOL, as the saying goes.

Onto Sydney, Cape Breton, where the hotel had no charging stations, but they let us use a 120-v outlet in the parking lot and we happily charged up overnight for free.

Making our way around Nova Scotia, we landed in the lovely capital Halifax and our hotel advertised a free charging station. It worked for a change, but it wasn’t free. In fact, I made the mistake of plugging my car in overnight and waking up to a $12 charge on my credit card, even though the charge likely only took 2 hours. Again, I was never told about cost before plugging in. Another lesson learned! Don’t leave the car plugged in overnight when you don’t know the cost.

On the return to the US, we stopped again in St John for the night, at a different hotel which advertised charging stations. The stations were there, but both were out of order. A phone call to the customer service yielded no results. They took the report but couldn’t fix the problem. Again, no charge.

As the trip continued, I feel like I got smarter. Ask at the hotel for charging stations either on the property or in town. I learned to plan my day around charging – either the night before or in the morning, when I had things to do before hitting the road. If the hotel had a working station, great, I could get a fast charge. If not, find an outlet and go for the 5-hour charge. Move the car as soon as it is charged up. Working my way back to Washington DC, I used my newfound knowledge to find charging stations where I could. Several nights I just couldn’t find a way to charge.  Finally, I reached home and the relief of instant charging.

Two weeks later, I drove to see my son Durham, NC. Oh good, I thought, a town known for being part of the “Research Triangle” will be filled with techie EV owners and early adapters. I was wrong. The charging station in one trendy part of Durham was available but the chargers didn’t work for the Prime. We drove to a nearby garage where the guys said, “Sure, no problem, use our EV charger. Not sure it is working though.”  And it wasn’t. The hose was badly frayed and needed replacing. We drove all over town looking for a plain old 120 outlet outside. No luck, so no charge in Durham. So, my endless search for chargers on the east coast comes to a close.

Friends are enjoying my saga. Sally, they say, you’re only get 25 electric miles a day! I don’t care. I’m dedicated to reducing my carbon footprint and plus, it’s fun to drive around knowing you’re using no gas. That said, I would love to have a full EV, but I like to take road trips and I can’t trust the EV infrastructure and risk a car running out of juice. In fact, I don’t know exactly what happens if you do run out of charge.

I know that Tesla owners have better access and reliable charging stations, and for good reason.  According to JD Power, Tesla is the longest-running pure electric brand with about 114,000 vehicles delivered in the first quarter of 2022. Teslas also has two SUVs and two sedans, with a wide range of pricing points and sizes, The Model 3, Model Y, Model S, and Model X are apparently outselling many established gasoline-powered cars.[1]   But I can’t use a Tesla charger on my Prime because the nozzle doesn’t fit.

Plus, I personally refuse to buy anything from Elon Musk.

But other manufacturers are selling EVs, and I don’t know what drivers are doing for reliable charging. Maybe not taking road trips. Kia is second behind Tesla, with EV sales at 8,450 vehicles delivered in the first quarter of 2022.  Ford is third, with slightly over 7,400 electric vehicles delivered in the United States in the first quarter. They include the Ford Mustang Mach-E and the new electric Ford Lightning pickup has received 200,000 Lightning orders.

Hyundai is fourth, with 7,000 electric vehicles in the first quarter of 2022.

Some final thoughts on charging electric vehicles. Neither America nor Canada appears to be ready for prime time.  (Pun intended!) I was lucky to have a mostly gas vehicle. If I had relied on charging stations, I’d have been in trouble. As my tale of woe notes, they often aren’t working, don’t exist, are occupied, cost money but don’t tell you ahead of time how much, or aren’t located conveniently. In addition, NCL works on combatting child labor around the world, and EV battery production from China often involves materials mined in Congo where children work long hours in mines exposed to toxic chemicals. We support bills like that of Congressman Chris Smith (R-NJ) to ban the importation of “goods, wares, articles, or merchandise containing metals or minerals, processed, wholly or in part, by child labor or forced labor in the DRC.”

My experience prompted these questions.

  • despite the millions provided to US municipalities, why are so many stations not functioning?
  • Why can’t hotel chains like Marriott, Holiday Inn, Hilton and IHG guarantee working charging stations?
  • Who is accountable? The charging station companies were paid a lot of taxpayer money to put up devices that often don’t work?
  • Why can’t municipalities ensure their chargers are working? As I said, I never got a call back after my complaint to the city of Bangor.

My experience also prompted some possible solutions:

  • Require charging station manufacturers to guarantee that their stations are working and if they are not, are serviced quickly. They know exactly when a station is offline and if they have accepted municipal funds to build the station, they must be held accountable to keep it up and running or pay fines to the town or city.
  • Incentivize through taxes or otherwise major hotel chains and ensure that they build charging stations, post accurate information on how many charging stations they have, whether they are working and for what type of vehicle and what the cost will be to customers.
  • Rate the apps that give you nearby charging stations for accuracy – sure, there might be a station nearby, but is it in working order? is it occupied? Will it work for your vehicle?

The bottom line is that consumers don’t want to drive around for hours looking for working charging stations. The emphasis on building electric vehicles is admirable, but if we don’t vastly improve access to working charging stations, no one will want to own an electric car.

*Update* Since my trip I have enjoyed charging my car at daily at home and do in fact enjoy driving an electric car around town for my daily commute and errands!

[1] https://www.jdpower.com/cars/shopping-guides/what-percent-of-us-car-sales-are-electric

Unveiling the flaws in the 340B Drug Pricing Program: Hospitals, medical debt, and consumer struggles

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

In 1992, Congress created the 340B Drug Pricing Program to help ensure vulnerable patients would be able to access medications they need but may not be able to afford. This program provides steeply discounted drugs to health care providers – mostly hospitals – serving low-income patients with the intent that the providers would pass those discounts along to patients. Unfortunately, that is not what is happening. The National Consumers League (NCL) is increasingly concerned about this program, especially as it relates to hospitals’ abusive and aggressive debt collection practices, and how those practices lead to consumer medical debt. A recent letter from a bipartisan group of Senators underscores hospitals’ role in this growing problem.

We find it particularly troubling that many hospitals benefiting from 340B are not only nonprofit entities but are designated as charity hospitals – supposedly caring for low income and indigent patients. A 2022 report by the Alliance for Integrity and Reform of 340B found that charity care spending for nearly two-thirds of 340B hospitals was less than the national average for similar hospitals. Further, a December 2019 Government Accountability Office (GAO) report found that “some nongovernmental hospitals that do not appear to meet the statutory requirements for program eligibility are participating in the 340B program and receiving discounted prices for drugs for which they may not be eligible.” One report found that 82% of nonprofit hospitals spent less on community programs than the value of their tax exemptions.

Consumers are not benefiting from the 340B program in the way Congress intended. A patient whose income is above 200 percent of the Federal Poverty Level (FPL) is expected to pay full price for a drug they receive at the hospital, even though the care center from which they are “buying” the drug did not pay full price for it. Hospitals participating in the 340B program saved an average of $11.8 million per year, according to a 2019 report from Beckers Hospital Review, and multiple studies have found that a majority of hospitals markup medicines between 200-500 percent. Under the current program, an individual who makes $29,200 per year has to pay that price.

What is even more alarming is the fact that if a patient can’t pay, the hospitals that have benefited enormously from discounted drugs intended for vulnerable patients are aggressively suing these same patients. This illustrates a major disconnect between the intent of the 340B program and the way it is operating today.

While estimates differ, medical debt is believed to cause more than 60 percent of bankruptcies in America. Most consumers facing medical debt did not end up in that situation because of bad decisions or profligate spending. Most have had some kind of injury or unexpected illness and don’t have insurance – or don’t have sufficient insurance – to cover their medical and hospital costs. Patients who need financial assistance should be processed when entering the hospital for medical care. Many are not given the chance to do so and as a result, can be sued for debt after services are rendered. Medical debt collection practices are debilitating for low-income consumers and can destroy their credit ratings, subjecting them to subprime rates and a never-ending spiral of debt.

Even if patients don’t start out poor, because of excessive fees, penalties, and other costs added onto what may or may not be actual medical debt on the part of patients, aggressive debt-collection practices can leave them destitute. Many don’t have funds to hire a lawyer, and if summoned, they often don’t know they need to actually go to court; in fact, sometimes debt collectors advise them not to show up in court. As a result, default judgments are filed against them, leading to garnishments of wages, and liens on homes, cars, and other properties. In 2019, the Journal of the American Medical Association studied the garnishment of wages by hospitals in the state of Virginia and found that 71% of the hospitals were nonprofit and the gross mean annual revenue of hospitals engaged in garnishments was $806 million, with 8,399 patients having wages garnished.

Below are just a few stories illustrating hospitals’ medical debt collection practices playing out in communities throughout the nation.

  • A woman in Knoxville, Tennessee, was diagnosed with cancer and underwent surgery and chemotherapy. Even though she had health insurance, she was left with almost $10,000 in medical bills that she couldn’t pay. Financial counselors told her she couldn’t schedule cancer checkup appointments with her doctor until she has a plan to pay her bills, according to a December 2022 story by NPR.
  • As reported by the Washington Post in May 2019, an investigation by the Baltimore Sun found that 46 hospitals in Maryland filed more than 132,000 lawsuits for unpaid medical bills from 2003 to 2008 and won at least $100 million in judgments. In some cases, hospitals added annual interest at twice the rate permitted for other types of debts or placed liens against patients’ homes.
  • The Washington Post reported in 2019 that the University of Virginia (UVA) Health System sued former patients more than 36,000 times for over $106 million over a six-year period. During that time, UVA’s Medical Center earned a $554 million profit and held stocks and other investments worth $1 billion. One of the patients the UVA Health System sued was Heather Waldron. Following emergency surgery and other treatment in 2017 to address an intestinal malformation, Waldron received a bill from the University of Virginia Health System for $164,000, more than twice what a commercial insurer would have paid for the care. When she was unable to pay, the UVA Health System pursued her with a lawsuit and a lien on the home she shared with her then-husband and five children. In the fall of 2019, the family lost their home, and the “financial disaster” contributed to Waldron and her husband divorcing earlier that year.

We support the critical role hospitals play in communities across the country and understand many dutifully provide charity care to those who cannot pay. However, we believe that if hospitals are designated charity entities and are receiving 340B discounts, they should be required to prove that those discounts have been passed along to patients. The current situation is unacceptable and merits an in-depth investigation and tightening up of the 340B rules. Charity hospitals should not be able to both claim 340B status and drag the very populations they are pledged to serve into debt collection proceedings, taking their homes, their cars, and their possessions in the process. Changes need to be made to ensure that only eligible hospitals are allowed to participate in the 340B program and that the deep discounts for medicines are passed along to patients, as Congress intended.

NCL mourns the passing of Rhoda Karpatkin

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

The National Consumers League mourns the passing of consumer icon and President of Consumer Reports Rhoda Karpatkin.

Rhoda, who died last week, served as President of Consumer Reports (CR) and Consumers Union (CU)—having served for 26 years from 1974 to 2000.

I had the honor of working under Rhoda when I was hired in 1998 as Senior Product Safety Counsel in CU’s Washington office. I would use two nouns to describe Rhoda – fierceness and integrity. Rhoda maintained an unbending commitment to CR’s absolute independence from any outside influence or outside money, and that included corporations, individuals, labor unions, politicians, or media.

A visionary, Rhoda held to an unwavering moral compass. We all looked to her for ideas and guidance. She oversaw the work of Consumer Reports magazine in tumultuous times.

When I was hired, CR was being sued by two automakers whose cars did not pass CU’s rigorous safety testing. Consumer Reports won the lawsuit and neither auto company sells cars today.

Rhoda believed in a global consumer movement. She served two terms as president of Consumers International, a membership organization for consumer activist groups. She also helped to launch the Transatlantic Consumer Dialogue, which continues to this day. This past summer I represented NCL at the TACD meeting in Brussels. An inspiring organization, TACD brings together consumer groups from the U.S. and Europe to share strategies and collective initiatives.

In the name of Esther Peterson, the beloved and powerful consumer advisor to three presidents, Rhoda created a fellowship at CU’s Washington office. Gene Kimmelman, the director of the DC office, and I worked closely with Rhoda to bring candidates in for interviews and Rhoda loved the process and enjoyed coming to Washington from her Yonkers headquarters to participate in the interviews. She often asked candidates, “What are you reading?”—a question I have incorporated into my interviewing repertoire.

A central figure in the consumer movement of the 1970s, Rhoda nearly doubled the circulation of Consumer Reports to 4.2 million. By the time she left, its website was one of the largest paid subscription sites on the internet, with approximately 475,000 subscribers, according to the magazine. Rhoda grew the magazine’s operating budget and oversaw the redesign of the auto-test track and new research laboratories. She also supported the work of Dr. R. David Pittle, CU’s technical director, as we worked with Congress when product safety hazards made the headlines. Together we all tried to ensure that pro-consumer leaders had a place at federal safety agencies like the Consumer Product Safety Commission and the National Highway Traffic Safety Administration.

The consumer movement has had many great leaders, but Rhoda Karpatkin stands out for her kindness, integrity, and vision. I know I share the views of many of my colleagues who are deeply saddened to lose Rhoda. Her indelible influence lives on in all of us lucky enough to have worked with her.

Thank you, Rhoda. We will miss you.

New insurance schemes to carve out specialty drugs deserve skepticism and scrutiny

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

Employers seeking to cut healthcare costs should remember this simple rule of thumb: If an offer to save money seems too good to be true, it usually is. That seems to be the case with offers to try “Alternative Funding Programs” or AFPs.  This is a devious but growing cottage industry, which promises to cut employer costs for specialty medicines.

Specialty medicines are used to treat complex, chronic conditions like cancer and rheumatoid arthritis; they are drugs often offered to some of the sickest patients. While they represent a mere 2 percent of prescriptions, they add up to half of the estimated $500 billion spent each year in the U.S. on drugs. Thus, specialty drugs are hefty contributors to self-funded employers’ health plan costs. (Source: optum.com)

One “solution” offered by third party vendors peddling AFPs is to remove coverage of specialty drugs from the employer’s formulary. This immediately renders those employees “uninsured” as far as coverage for their needed drugs goes. The AFP vendor then matches the newly uninsured employee with a patient assistance program offered by drug manufacturers and other charitable foundations. The patient’s co-pay is fully covered by the assistance program, the employer saves money, and the vendor takes a cut of the savings.

We think this so-called solution is underhanded and dangerous for patients.  It is also unethical and possibly illegal.

First, the charitable programs being mined by the AFP vendors are meant for the truly needy—those who are uninsured or underinsured. If these sources of funding are being drained by the AFPs, they won’t be available for patients who really need the assistance.

These programs are having a predictable effect:  drug manufacturers are starting to tighten the eligibility criteria for their charitable programs, limiting them to patients who are truly uninsured. That means the AFPs won’t be able to fulfill their promise to find alternative sources to pay for the medicine. The inevitable will happen:  patients will be forced to go back to their employers’ insurance, causing dangerous delays in treatment and eliminating any savings.

Critically, the AFP process interrupts and delays care for patients. One of the AFP vendors, aptly named SHARx, with a logo shaped like the predatory creature its name invokes, admits the process can take 2 to 6 weeks. While trying to enroll the previously insured patient in an assistance plan, they’ll “do as much as they can” to help a patient access their medicine, sometimes demanding they sign over power-of-attorney to their company. In practice, that means patients can be left in limbo with no coverage for a period of time.

How can an employer ethically expose their employees with serious health conditions to that risk? (Source: sharxplan.com)

There are also ERISA and IRS legal and compliance risks to self-insured employers, too, according to an analysis by Vivio, a Public Benefits Corporation (Source: viviohealth.com)

And by some accounts, the AFP vendors are taking a huge cut of any savings, as much as 25 percent, on top of the administrative costs employers must pay to implement the program. (Source: drugchannels.net)

Nonetheless, according to a 2022 survey, 10 percent of self-insured employers with at least 5,000 U.S. employees are using alternative funding vendors. Some 8 percent said they were planning to use them within two years and 19 percent are considering their use in three to five years. (Source: optum.com)

It is easy to initially discount AFP critics as defenders of unfettered drug pricing. However, even Optum, a subsidiary of leading health plan provider United Health Care, has sounded the alarm. They advise their clients “to look past the short-term sales pitch and consider longer-term financial implications, compliance risk and ethics of alternative funding programs.” (Source: optum.com)

We are raising the voice of consumers in support of efforts in Congress to rein in other dubious co-pay assistance schemes deployed by Pharmacy Benefit Managers such as co-pay maximizers and accumulators.  In this case, employers should take the lead in standing up for their employees’ health by refusing to open the door when third party AFP vendors come calling.

National Consumers League Live Event Ticketing Principles

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By John Breyault, Vice President, Public Policy, Telecommunications, and Fraud

The ticketing industry is the gatekeeper to much of our nation’s arts, sports and culture. What should be an exciting moment—securing a seat for your favorite event —has become exceedingly frustrating for many consumers as they navigate a confusing ticket-buying process laden with hidden fees.

NCL works on behalf of fans for all live events to ensure that consumers get the best possible experience, the best bargain for their hard earned dollars and don’t feel they’ve been ripped off with gotcha added costs, like mandatory “convenience fees” “processing fees” “venue fees” or the like when purchasing live event tickets.

Consumers are at the mercy of a rigged ticket marketplace. One company – Live Nation Entertainment (LNE) — dominates the marketplace. The company was created after Ticketmaster and Live Nation were given the green light to merge by the Department of Justice in 2009, despite strong consumer and business opposition.  LNE today controls around 80% of primary ticketing services, owns or has exclusive rights to operate many venues, and has major positions in artist management and event promotion. In 2022, LNE reported $4.5 billion in revenue from ticket resale, more than double what it earned in 2019, making it one of the largest players in the secondary ticket market.

Not surprisingly, LNE engages in practices typical of monopolies, working to drive out competitors. NCL and other consumer groups are leading the charge to unwind the ill-advised 2009 merger of Live Nation and Ticketmaster and restore healthy competition to the marketplace.

NCL believes that ticket resale has a legitimate place in the live event marketplace. The availability of ticket resale services provides a hedge for consumers who buy season tickets or non-refundable tickets, and is also a source for ticket buyers to get bargains when supply outpaces demand, allowing them to save money on below-face value tickets.

Below are some general principles on ticketing that NCL supports.

  1. We want the DOJ and Congress to unwind the Ticketmaster-Live Nation merger.
  2. Hidden ticket fees, deceptive dark patterns, and other anticompetitive ticketing practices should be prohibited. “All in” ticket pricing should be required so that consumers can compare prices from one site to another.
  3. Ticket holdbacks (also known as allocations) should be disclosed to ticket buyers prior to purchase.
  4. Secondary ticket exchanges should be required to disclose the face value of tickets offered for sale on their platforms.
  5. Ticket resellers should be prohibited from engaging in deceptive practices that are deliberately intended to confuse consumers into believing they are buying tickets from the primary seller. Deceptive design practices such as using URLs or other indicia of affiliation with a venue, team, or artist and by paying for search engine optimization that results in resale websites appearing higher in search results than the official box offices should be prohibited.
  6. Secondary ticket exchanges should be required to closely monitor their ticket inventory to ensure that they are not listing tickets obtained in violation of federal or state laws.
  7. All stakeholders in the live event industry should be required to assist enforcement agency’s efforts to stop illegal automated ticket buying and resale.
  8. Federal or state law enforcement agencies should investigate how tickets appear on the secondary ticket market at prices far above face value before offered for sale by primary ticket sellers and whether such sales violate applicable laws.

To these ends, NCL has endorsed legislative reforms to protect ticket buyers and promote competition in the live event industry, such as the BOSS and SWIFT Act and the TICKET Act.

What’s going on with student debt cancellation?

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By Eden Iscil, Public Policy Manager

A few weeks ago, the US Supreme Court ignored the facts of the case in front of them and wrongfully ruled that President Biden’s first attempt at cancelling student debt was illegal. While the Court was misguided and seemingly hellbent on making life worse for millions of Americans, debt cancellation is not dead. Earning much less media coverage than the Court’s ruling, President Biden announced on that same day that his Department of Education had initiated a plan B for debt cancellation. Additionally, he revealed a 12-month “on-ramp” to repayment. Here’s what we know so far about these two programs. 

Plan B for cancelling student debt 

Over the past 60 years, Congress passed two laws giving the secretary of education the authority to cancel student debts—the Supreme Court’s ruling last month only applied to one of them. While there is still one more legal avenue available for the Education Department to broadly cancel student debt, the law requires a lengthy regulatory process to get there. Specifically, the department must initiate a negotiated rulemaking, seeking input from various stakeholders involved in student debt. From nominating and appointing negotiators to reaching a final recommendation for the Department, this stage will likely finish around the end of the year. 

Next, the Department will have to publish a proposed rule outlining the parameters of the debt cancellation plan. Currently, the administration has not spoken to how much debt will be cancelled under plan B and who will be eligible beyond an intention to deliver “debt relief for as many borrowers as possible.” This means that we shouldn’t expect to see the details of plan B until early 2024. And once the Department publishes its proposal, there will be a 60-90 day comment period for the public to submit their thoughts on the plan. Only after this comment period is finished (and the Department has read the public’s thoughts) can the program go into effect. Once all of these steps are completed, it will likely be around springtime next year at the very earliest. 

A 12-month “on ramp” to repayment 

Congress set September 30 as the last day of the federal loan payment pause. Without some form of debt cancellation, it is estimated that repayment will put over 9 million borrowers into default. Recognizing this reality and its legal inability to extend the current payment pause thanks to Congress, the Department will waive certain repayment related penalties from October 1, 2023 through September 30, 2024. 

Specifically, during this year-long period, missing a monthly federal loan payment: 

  • Will not result in default or delinquency 
  • Will not be reported to credit bureaus 
  • And will not be referred to debt collection agencies 

While both plan B and the 12-month on ramp are imperfect, the Department is taking steps to minimize harm and is still working to deliver debt relief. It’s important that we continue to show our support for debt cancellation, especially during the public comment period. We should not tolerate an educational system that results in lifelong debt and average monthly payments of $500. 

From class action to mass arbitration: Exposing corporate evasion in modern commerce

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

July 6, 2023: Several decades ago, clever lawyers for large corporations came up with a scheme to prevent their clients from being held accountable for wrongdoing. They did so by putting “forced arbitration clauses” in consumer and business contracts. The effect was to block consumers and others from getting access to the courts, and instead force them into arbitration, which is a private system for deciding legal cases that is controlled largely by the corporation itself.

It was a sad day for consumers when the Supreme Court gave its blessings to this underhanded scheme; today forced arbitration clauses are put into virtually every contract that we as consumers are forced to sign in exchange for services like cable, cell phone, credit cards, mobile homes, and car sales.

Class action lawsuits have served as a critical safeguard for consumers against powerful corporate interests; they remain an essential pillar of corporate accountability. These collective legal battles help to restore consumer rights and maintain marketplace ethics. Landmark cases such as the Enron scandal, which highlighted fraudulent accounting practices, class actions against the makers of addictive opioids and against those responsible for the Deepwater Horizon oil spill illustrate again the power of collective legal action.

But now, as consumers are fighting back and cleverly using forced arbitration in their favor, corporate America is crying foul. The very companies that championed forced arbitration and blocked class actions don’t much like it when they have a taste of their own medicine.

According to Consumer Reports, for example, a new strategy, mass arbitration, has already had a significant impact. It has pressured several corporate defendants—including Uber, DoorDash, Samsung, Chipotle, and DraftKings—to grapple with accusations they otherwise could have swatted away. And it reportedly led at least one corporate giant, Amazon, to remove mandatory arbitration provisions altogether from its retail website’s terms of use.

According to the magazine, a group of enterprising lawyers representing about 40,000 TurboTax customers employed a kind of legal jiujitsu: They simultaneously filed thousands of arbitration claims, swamping Intuit with fees, prompting the company into a hasty retreat. But it was too late for the company: Several judges have refused to let Intuit out of the arbitrations, with one commenting that the company has been “hoisted by [its] own petard.”

Sadly, the companies are nevertheless employing delaying tactics, exploiting loopholes, and resisting the system they once endorsed and in fact created, all of which points to the need for an overhaul of the system.

Recent arbitration reforms in California offer a glimmer of hope. They champion a justice system built on fairness, transparency, and accountability. Reforms must tackle forced arbitration clauses and corporations from exploiting system vulnerabilities and face strict penalties for stalling or refusing to engage with the system they created.

As consumers, employees, and members of society, we must insist on corporate transparency and accountability; giving consumers a fair shake is more important than ever. Only then can we end corporate evasion, restore balance in our dispute resolution processes, and protect individual consumer rights against corporate wrongdoing.

We must never forget the importance of vaccines

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

I have written before about being born into a family that experienced the agony of the polio epidemic. My uncle Roger Joseph’s battle with the disease—including his diagnosis in 1951 by my father, a practicing internist—devastated our entire family. My uncle, a golden boy, popular, handsome, brilliant, and kind, graduated from the University of Minnesota and Harvard Law School; he also won a silver star for his military service in WW2. Married with three daughters, he had a thriving law practice when he fell ill.

His case was severe and rendered him paralyzed. Confined to an Iron Lung for two years, the device was designed to stimulate breathing in patients whose lungs no longer functioned. With a great deal of therapy, my Uncle Roger, by then quadriplegic, moved to a motorized wheelchair that he ended up using for the rest of his life. He doted on his children, moved in with my grandmother, slept in a rocking bed to facilitate his breathing, and had an attendant on duty 24 hours a day. When we visited my grandmother, we visited our uncle too. He also came to our home for Sunday dinners, and I recall him taking breaths carefully before speaking, and when he did, he was wry and funny. He also had to learn to write again with his non-dominant hand. My mother, who had always idolized him, marveled at how his handwriting never changed.

My uncle lived 16 years with polio, thanks to a loving family, modern medicine, financial wherewithal, his wheelchair, and his attendant. Paralyzed from the neck down, he nonetheless spent these years productively, doting on his daughters, going to work every day, and attending baseball games, and even traveling abroad.

In 1954, U.S. physician Jonas Salk developed a vaccine to prevent the disease. The polio vaccine was first tested on 1.6 million children in Canada, Finland, and the United States before it was used more broadly. By 1957, annual cases had dropped from 58,000 to 5,600, and by 1961, only 161 cases remained. Had my uncle had access to the vaccine, he never would have gotten sick.

The powerful lessons about vaccines weren’t lost on anyone in my family. This explains why I feel obligated to confront head-on the dishonesty and lies of the anti-vaxxers. I have traveled to the CDC and the FDA numerous times to testify in support of childhood and adult vaccinations, and each time have been confronted by vaccine deniers.

Here’s the problem: Those of us with memories of family members with devastating diseases like polio are aging out. We are victims of our own success in wiping out childhood diseases. Younger generations have now been vaccinated for polio, measles, rubella, mumps, influenza, diphtheria, tetanus, and whooping cough so they do not know the trauma these illnesses caused to millions of families. Come to think of it, I’m in that category myself.

Florence Kelley, who in 1899 launched the National Consumers League, wrote in the 1880s about the dark days of “diphtheria”; she lost three young siblings to the disease, which sent her mother into lifelong depression. But I have never known anyone with diphtheria, thanks to vaccines.

My 27-year-old son never had measles—nor any of his friends. But my siblings and I all did, along with rubella, chicken pox, and the mumps. Measles alone is far more serious than often understood. In 2021 alone it killed nearly 128,000 unvaccinated children under age 5 around the world.

All of which leads me to the reason I have written this blog. Each year, Uncle Roger’s daughters proudly award the Roger E. Joseph Prize, (created by my Uncle Burton Joseph, in honor of his brother and their dad) and for this year’s prize, my cousin Linda produced a video; it tells a compelling story of her experience with her father’s illness. Hebrew Union College, which graduates reform rabbis, hosts the awards. Honorees have included Rosa Parks, Henry Louis Gates, Morris Dees, Sara Bloomfield, and the Center for Reproductive Rights. A complete list is at the link below.

Indeed, the Roger E. Joseph Prize is a point of immense pride for our family, but it also gives us the opportunity to talk about diseases like polio and, now Covid, and the critical importance of the vaccines developed to prevent them.

How truly fortunate we are to have a medical establishment that has helped to prevent families from suffering, the way ours did, when a loved one falls ill from an infectious disease.

As the anti-vaccine movement grows each year—a = movement that traffics in conspiracy theories and junk medicine—note Robert Kennedy Jr.’s anti-vaccine crusade, which his own family has denounced in this article published by Politico.

Now more than ever we need to have conversations about the critical importance of vaccines.

http://www.rogerejosephprize.org/about-the-prize

Nancy Glick

A message for National Minority Health Month: Take obesity seriously

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

As National Minority Health Month in April comes to a close, It is a good time to take stock of the health status of the more than 125 million Americans of color or 38.4 percent of the population now living in this country.

The good news is that improvements in disease prevention are saving lives. For example, more minority women are getting mammogram screenings for breast cancer, getting treatment with antibiotics earlier, and seeking counseling for smoking cessation.  As a consequence, Hispanic, American Indian, and Asian women all have lower death rates from heart disease when compared with white women and breast and lung cancer deaths have been declining steadily among African American women.

But while we can celebrate these advancements, now is the time to be even more mindful of the minority health problems that are often discounted and go untreated. And here, no problem needs our attention more than the disease of obesity, where people of color face an unequal burden of weight-related chronic conditions and premature death due to significant disparities in medical care.

In sheer numbers and its toll on death and disability, obesity has reached crisis proportions in the US. According to the Centers for Disease Control and Prevention, the adult obesity rate now exceeds 40 percent – the highest level ever recorded. And the costs are staggering.  Not only is obesity a serious disease by itself, but it worsens the outcomes of over 230 chronic conditions including type 2 diabetes, heart disease, and certain cancers. Thus, obesity is responsible for 300,000 premature deaths each year and costs the U.S. economy over $1.72 trillion annually in health costs.

But these statistics only begin to document the problem. Obesity disproportionately affects Black and Brown communities and is now one of the most serious health equity issues facing the nation. Due to higher rates of obesity among communities of color, Black adults are 1.5 times as likely to experience stroke, 40 percent are more likely to have high blood pressure and 60 percent are more likely to be diagnosed with diabetes than White adults. Additionally, Hispanics are 1.7 times more likely to have diabetes than Whites, Asian Americans are 40 percent more likely to be diagnosed with diabetes, and Native Hawaiians/Pacific Islanders are 2.5 times more likely to have diabetes and 3.9 times as likely to experience a stroke.

The threat is real, but hand ringing is not the answer. Obesity is a treatable disease, just like type 2 diabetes and hypertension. Yet obesity remains largely undertreated by healthcare providers.  As documented in a National Consumers League report issued in July 2022, 108 million adult Americans have obesity, but only 30 million adults have been diagnosed with the disease (source:  PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.).

Compounding the problem, only 2 percent of those eligible for treatment with FDA-approved anti-obesity medicines (AOMs) have been prescribed these drugs. This means that very few Americans with obesity are benefiting from a new class of safe and effective medicines that control appetite and cravings to achieve significant weight loss. According to a study published in the New England Journal of Medicine, use of one of these drugs resulted in more than a 20 percent reduction in obesity when added to lifestyle modification.

While there are many reasons why obesity is going undiagnosed and untreated, the most pernicious are insurance barriers that keep people from getting the care they need. This includes government policy that allows states to define what are the essential health benefits that must be covered under any Affordable Care Act (ACA) marketplace plan sold on state health insurance exchanges. Yet, despite the ACA’s guarantees of providing all essential health benefits to consumers, a 2016 analysis by the Obesity Care Advocacy Network (OCAN) found that 24 states excluded coverage for weight/obesity management services in their benchmark marketplace plans, resulting in blatant discrimination against people with obesity.

An equally troubling situation involves the Medicare program, which prohibits coverage for FDA-approved anti-obesity medicines based on a policy dating back to 2003 when these drugs did not exist. This resistance to change leaves millions of seniors, particularly members of Black and Latino communities, vulnerable to disability, disease and premature death due to lack of treatment. Moreover, the extent of the disparities in obesity care will only get worse in the coming years if the status quo remains. As documented in a March 2023 report from AmerisourceBergen, the total number of Black, Native American, Asian, and Hispanics eligible for Medicare is predicted to more than double by 2038, many of whom will have obesity and a different set of chronic conditions than what Medicare is currently prepared to address.

Then, there is the Medicaid program operated by the states, which covers about three in ten Black, American Indian and Native Hawaiians/Pacific Islanders under age 65 and more than two in ten Hispanic adults. While Medicaid has helped narrow longstanding disparities in health coverage and access to care for people of color, this is not true for those Medicaid beneficiaries living with obesity. Today, only 15 Medicaid programs cover anti-obesity medications in fee-for-service Medicaid, and only four additional programs cover anti-obesity medications under at least one Medicaid managed-care plan. Moreover, only two states cover anti-obesity medications in benchmark Marketplace plans.

Adding to these coverage disparities, 15 million people on Medicaid – 30 percent of whom are Hispanics and 15 percent are African Americans  – could lose access to their health coverage in the coming months. This is due to the end of a federal program that paid states to add more low-income and disabled residents to the Medicaid rolls during the COVID-19 pandemic.

Already, five states – Arizona, Arkansas, Idaho, New Hampshire, and South Dakota – have begun to disenroll people and by the end of June, 34 states and the District of Columbia will cut their Medicaid rolls, either due to their income status or for procedural reasons, such as not completing renewal forms. For this reason, advocates are using all available levers to help enrollees keep their Medicaid coverage and to assist those dropped from the program to find coverage through the Affordable Care Act’s marketplace or other options.

While this is a short-term solution, it is part of the national commitment by the public health community, minority health leaders, clinicians, patient advocates, and consumer organizations to change outdated and discriminatory policies that restrict coverage and access to obesity treatments. Our message is clear: the health of all Americans depends on taking obesity seriously and ensuring that those with the disease receive timely, comprehensive obesity care.

What will happen to President Biden’s student debt forgiveness plan?

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Sally Greenberg

By Sally Greenberg, Chief Executive Officer

Last week, I attended the oral argument in the Supreme Court challenging student debt forgiveness initiative launched by the Biden Administration. The states of Missouri, Nebraska and four others, along with two students, are challenging Biden’s proposal to forgive student loan debt for 40 million Americans.

During his campaign, President Biden promised to reduce the albatross of student debt burdening millions of young Americans through his Department of Education. His proposal only applies to federal loans and is narrowly tailored and means tested. The plaintiff states and students challenging the loan forgiveness plan are arguing that it exceeds federal law, and that “canceling hundreds of billions of dollars in student loans is a breathtaking assertion of power.” The administration countered that Education Secretary Miguel Cardona has the authority to forgive the debt under a 2003 law, the Higher Education Relief Opportunities for Students Act.

The debt forgiveness program would cancel up to $10,000 of debt for those who have federal student loans as long as they make under $125,000 or $250,000 for couples. Those getting Pell grants are eligible for an additional $10,000. Thus, 20 million students could see their debt totally wiped out; all told, it will cost taxpayers $430 billion.

Sitting in the courtroom, I was seeing the new members of the Supreme Court in action for the first time and that was fun. Each of the justices has their own distinct style. Some are far more engaged than others, like the newest member, Justice Katanji Brown Jackson, who fired away a series of questions to the AG from Missouri about whether the state had standing to challenge the law. Even conservative Justice Amy Coney Barrett questioned standing,  asking why those alleging injury weren’t plaintiffs in the case. Justices Sotomayer and Kagan also pressed the plaintiffs on both the broad language in the law and the standing problem.

Solicitor General Elizabeth B. Prelogar, whose argued the case for the Biden Department of Education, argued that the Department’s plan was exactly what Congress had in mind when it passed the 2003 law, giving the executive branch the power to … “waive or modify any statutory or regulatory provision.”  I Wiki’d Prelogar and learned some cool facts: she’s a Harvard Law grad who won Miss Idaho Teen USA of 1998!  She is fluent in Russian, and her father went to my alma mater, Antioch College in Yellow Springs, OH and oh yes, I was delighted to see that her dad served at one time as head of consumer protection for the North Carolina Attorney General.

I realize I’m not an unbiased observer, but I thought Prelogar had the better arguments, First, the law is broadly worded and gives a lot of latitude to the Executive Branch on student loan waivers. Second, the standing issue is a serious hurdle for the opponents. To challenge the loan forgiveness program, they need to show that they have suffered a specific, rather than generalized, injury that can be remedied by relief from the Court. Neither of the challengers can show direct harm.

The bottom line for the National Consumers League and the hundreds of groups that support this narrowly tailored loan forgiveness is that the $10,000- $20,000 debt for 40 million Americans can be crippling to families –the reality is that student debt prevents many young people from buying homes, starting families and getting on with their lives. We are therefore hoping against hope that the Supreme Court throws out this challenge and the student debt forgiveness proposal at last be implemented.