(jimmywayne22, Flickr)

North Dakota is on its way to becoming the first state in the country to have an operating health insurance exchange, which is required under the Affordable Care Act.

The Grand Forks Herald reports that North Dakota’s bill was drafted by a dedicated Health Care Reform Review Committee after the regular session ended.

Pam Sharp, director of the North Dakota Office of Management and Budget, said it will include a new website to allow residents to compare costs and benefits of health insurance plans.

The Center on Budget and Policy Priorities released a report (.pdf) earlier this summer that 39 states and the District of Columbia have introduced some form of legislation promoting exchange implementation.”

“Among the 34 states where the legislation would fully establish a state exchange program, ten states enacted such bills into law,” the group reports.

Most states should have some infrastructure in place by January 2013 for an exchange. Minnesota has yet to make the required adjustments, with Republicans in the legislature blocking legislation, leading Prof. Larry Jacobs of the University of Minnesota Humphrey Institute to conclude that “many Minnesotan Republicans appear to equate any action with political and constitutional abdication.”

Gov. Mark Dayton created two committees at the end of October that are charged with forging and implementing the state’s health exchange plan, according to Politics in Minnesota. But Republicans are questioning whether he has the authority to move without the legislature.

Only 11 states have not introduced any legislation to establish a state exchange program. The Center on Budget and Policy Priorities says that “Florida, Kansas, Louisiana, New Hampshire and Oklahoma reportedly will return exchange grant funds.”

Iowa State University politics professor Steffen Schmidt referenced the defeat of an Ohio ballot measure that would have limited labor unions: “Democrats scored and unions and liberals maybe scored some pretty significant victories over conservative policies.”

Another conservative-backed ballot measure in Mississippi, which would have banned all abortions and some forms of birth control, was also defeated.

“Mississippi’s refusing to basically ban all abortions was fairly remarkable because Mississippi is one of the most, and perhaps the most conservative state in the country,” Schmidt said. “And if they don’t want to go that far on some of these social issues like that then that tells you there is a limit to how far voters are willing to go on some of these issues, even when they generally agree on the question of abortion.”

But Republicans had some victories as well, Schmidt said, and that means it wasn’t a clear-cut message from voters. Voters in Ohio rejected the individual mandate in the Patient Protection and Affordable Care Act, and another measure pushed by conservatives in Mississippi that requires identification to vote was accepted.

“I think the message was more that they don’t want Republicans and especially conservatives kind of ramming things down the throat of voters,” Schmidt said.

University of Iowa politics professor Tim Hagle agreed that both parties can find some positives to take away from the Nov. 8 elections. Hagle said the rejection of those two incongruous measures in Ohio could be read as voters rejecting extreme issues, especially the collective bargaining measure which he said was “an example of Republicans overreaching a little bit.”

“You had people turn out in Ohio to reject the collective bargaining measure, these were folks that were union folks, that were liberals, and yet a lot of these same people also rejected Obamacare,” Hagle said.

But Hagle said it’s hard to say how much people were paying attention to elections in an off year, which also makes it difficult to reach too many conclusions on which way the political winds are blowing.

“Basically the bottom line is this is a mixed bag and nobody can really say it’s a great trend one way or another,” Hagle said.

Drake University politics professor Dennis Goldford said the election shows Democrats are organizing better as of late than they did in 2010.

“If they work hard and get their base turned out they can win an election,” he said. “They just don’t always do a good job of getting that turnout.”

Members of Minnesota’s congressional delegation signed onto a letter urging the Food and Drug Administration (FDA) to speed up the approval process for medical devices.

It was signed by 41 members of Congress, including Sen. Amy Klobuchar, Rep. Betty McCollum, Sen. Al Franken, Rep. John Kline, Rep. Michele Bachmann and Rep. Erik Paulsen, who the Minnesota Independent previously reported is a major recipient of the industry’s campaign donations.

The letter notes that medical devices are appearing in Europe months or years before they’re approved in the United States.

“Unless we make significant improvements to the predictability and transparency of the regulatory process, we will lose the industry, the jobs that go with it, and the innovation to transform our healthcare system,” the letter states.

The members of Congress offer some changes to the FDA’s approval process in the letter, including instituting a new tracking system and changing conflict of interest requirements of those serving on advisory panels.

“We recognize the need to balance risk and benefit; we all share patient safety as our primary concern, but there must be a “least burdensome approach” to achieve this without crippling an industry,” the letter states.

The medical device industry is a major backer of Paulsen, with donations from industry Political Action Committees (PACs) and executives helping to make him the lead fundraiser in Minnesota’s House delegation.

The New York Times later noted that efforts to reform the agency’s procedures are part of a push from venture capitalists investing in the industry. Congressional hearings on the subject have been overloaded with industry supporters, paying little attention to the potential dangers of medical devices.

The letter from Klobuchar and other signatories:

Dear Dr. Hamburg,

The bipartisan, bicameral Congressional Medical Technology Caucus, and other members of Congress join together to express our concerns about regulatory issues facing the medical device industry. This is an industry that has become increasingly important as dramatic improvements over the last decade have revolutionized healthcare and improved the quality of life for millions of Americans.

We share your commitment to ensuring safe and effective medical devices are available to patients. However, we are very concerned about recent declines in FDA performance. Increased review times, inconsistent expectations, and poor communication from the FDA are causing a lack of confidence and instability in the industry.

From the President’s own Jobs Council report released this month

“Today, however, our medical innovation ecosystem is in jeopardy. Investment in the life sciences area is declining at an alarming rate because of the escalating cost, time and risk of developing new drugs and devices. While many factors have contributed to this decline – including challenges around reimbursement and the general state of the economy – an important factor is the uncertain FDA regulatory environment. These concerns come at a time when Europe, China, and India continue to entice companies to take their medical research and development enterprises abroad, putting at risk our ability to keep private investment and jobs here at home.” [1]

Dissatisfaction with the approval process is no longer just anecdotal: data shows the average time to approve a 510(k) application has increased by 43% from the 2003-2007 period to 2010.[2] The average time to approve a PMA application has increased 75%.[3] The total review times for both 510(k)s and PMAs are now actually longer than they were before the user fee program was instituted.[4]

It has also become significantly more costly to get new products approved. Companies spend an additional $520,000 a month as they wait for FDA approval of a 510(k) product and $740,000 each month for a PMA product.[5] This is simply unsustainable.

Today, the United States accounts for 40 percent of the global medical technology market[6] and the industry indirectly creates two million American jobs.[7] Maintaining American leadership in this field is essential for jobs and for patients. Unless we make significant improvements to the predictability and transparency of the regulatory process, we will lose the industry, the jobs that go with it, and the innovation to transform our healthcare system.

We recognize the need to balance risk and benefit; we all share patient safety as our primary concern, but there must be a “least burdensome approach” to achieve this without crippling an industry. We urge you to make every possible improvement to cut down device approval time by:

• Recognizing and correcting the disparity between “FDA time” versus real time when tracking device approvals
• Considering potential benefits of harmonization with international testing standards
• Addressing the unintended consequences of the conflict of interest rules for advisory panels
• Creating a transparent tracking and review system for applications and clearance decisions

These are just some of the ways the FDA can improve the process.

We appreciate the FDA’s efforts in developing an Innovation Agenda and we recognize these changes will not take place overnight. However, stakeholders from innovators and patients, to investors and physicians all note that if the FDA does not restore regulatory certainty, predictability, and transparency, investment in the industry will continue to decline and this uniquely American success story could disappear.

Sincerely,

Anna G. Eshoo                                                           Erik Paulsen
Amy Klobuchar                                                          Scott P. Brown
Richard Lugar                                                             Al Franken
Debbie Stabenow                                                        Brian Bilbray
Jay Inslee                                                                    David Drier
Michael Honda                                                           Dan Burton
Betty McCollum                                                         Marlin Stutzman
Bob Filner                                                                   Ken Calvert
Jason Altmire                                                              Charles Bass
Andre Carson                                                              Mary Bono Mack
Susan Davis                                                                Michael Burgess
Joe Donnelly                                                               Todd Young
Pat Tiberi                                                                     Michael Rogers
Marsha Blackburn                                                       Jim Gerlach
John Kline                                                                   Michael R. Turner
Charles Dent                                                               Cathy McMorris Rodgers
Michele Bachmann                                                     Brett Guthrie
Aaron Schock                                                             Glenn Thompson
Anne Marie Buerkle                                                    Chris Gibson
Bill Huizenga                                                              Patrick Meehan
Todd Rokita

cc: Kathleen Sebelius, Secretary of Health and Human Services

In the run-up to last month’s Senate vote that likely denied the USDA the right to limit potatoes in school lunches, U.S. Sen. Al Franken and eight other Democratic senators from potato-growing regions pushed hard on the federal agency.

In a letter to USDA Secretary Tom Vilsack (below), the eight senators proposed that potatoes are healthier if topped with broccoli. The letter recommends that the USDA consider food preparation when compiling guidelines.

A Senate amendment to take away the agency’s ability to limit potatoes passed on Oct. 18, and will likely be merged with a House version.

The proposed rule limited kids’ lunches to one cup of starchy vegetables every week, which includes white potatoes, corn, lima beans and peas. The rule would also have removed starchy vegetables from breakfasts, limit sodium intake and mandate more non-starchy vegetables during lunches, among other nutritional improvements.

Franken said the rule change could “disproportionately affect” agricultural producers “without necessarily improving student nutrition,” according to a post Monday on his Senate site.

“While I applaud the USDA’s efforts to improve vegetable variety in our nation’s schools, it’s important that we consider the possible consequences of this rule on our farmers, and its disproportionate effect on Minnesota,” Franken said in the statement. “That’s why I urged the USDA to give our children the nutritious foods they need without making dramatic cuts to the dietary staples provided by Minnesota’s agricultural producers.”

The letter to Vilsack proposed that potatoes can be healthier if topped with broccoli. The letter recommends that the USDA consider food preparation when compiling guidelines.

The cost of the entire proposed rules, which covers many areas of nutrition, could have reached an addition $6.8 billion over five years, according to the USDA report. The revisions are designed to combat the childhood obesity epidemic and prevent related health problems.

Groups like the Physicians Committee for Responsible Medicine have advocated for healthier school lunches. Other advocates, like Chef Ann Cooper of the Food Family Farming Foundation, have said opposing the new limits on starchy vegetables doesn’t serve the best interest of children’s nutrition.

111031_USDA_vegetable_letter

The brief was filed by the American Center for Law and Justice, a conservative Christian legal outfit founded by televangelist Pat Robertson.

The amicus brief asks the high court to take on a case previously ruled on in Florida that said the new federal health plan’s individual mandate was unconstitutional. the ACLJ called the issue one of “national importance.”

The ACLJ said that the conservative Florida judge that ruled the individual mandate unconstitutional got that part correct, but the judge shouldn’t have singled the individual mandate out. It erred when it didn’t rule the entire new health plan unconstitutional.

“Even though the United States Court of Appeals for the Eleventh Circuit correctly held that the individual mandate is unconstitutional, it wrongly severed only the individual mandate from the ACA,” the ACLJ wrote.”The individual mandate, by the Federal Government’s own admission, is the essential component of the ACA. Should this Court also rule the individual mandate unconstitutional, it should decide to what extent (if any) the individual mandate can be severed from the rest of the ACA.”

The ACLJ was created by Robertson as a response to the American Civil Liberties Union which Robertson said is “hostile to traditional American values.”

The group has been at the heart of many controversial cases including a successful effort in Minnesota’s Anoka-Hennepin School District to drive a transgender teacher out of her job. Though the group maintains that it defends religious liberties, the organization has also assisted local communities in attempting to stop the construction of Muslim mosques.

Jay Sekulow, leader of the ACLJ has made a lot of money in his activism. The Associated Press reports that he and his family have taken in more than $33 million in the last decade.

Bachmann, Kline and Cravaack are signers of the court document along with 102 other Republicans. Rep. Erik Paulsen was the only Republican member of Minnesota’s delegation to decline to sign on.

Here’s the full list:

Paul Broun, Robert Aderholt, Todd Akin, Rodney Alexander, Steve Austria, Michele Bachmann, Spencer Bachus, Joe Barton, Rob Bishop, Diane Black, Marsha Blackburn, Larry Bucshon, Michael Burgess, Dan Burton, Francisco “Quico” Canseco, Eric Cantor, Steve Chabot, Howard Coble, Mike Coffman, Tom Cole, Mike Conaway, Chip Cravaack, Geoff Davis, Scott DesJarlais, Jeff Duncan, Blake Farenthold, Stephen Fincher, Chuck Fleischmann, John Fleming, Bill Flores, Randy Forbes, Virginia Foxx, Trent Franks, Cory Gardner, Scott Garrett, Bob Gibbs, Phil Gingrey, Louie Gohmert, Bob Goodlatte, Tom Graves, Tim Griffin, Michael Grimm, Ralph Hall, Gregg Harper, Andy Harris, Vicky Hartzler, Jeb Hensarling, Wally Herger, Tim Huelskamp, Bill Huizenga, Randy Hultgren, Lynn Jenkins, Bill Johnson, Walter Jones, Jim Jordan, Mike Kelly, Steve King, Adam Kinzinger, John Kline, Doug Lamborn, Jeff Landry, James Lankford, Robert Latta, Billy Long, Cynthia Lummis, Connie Mack, Donald Manzullo, Kenny Marchant, Kevin McCarthy, Michael McCaul, Tom McClintock, Thaddeus McCotter, Cathy McMorris Rodgers, Gary Miller, Jeff Miller, Randy Neugebauer, Alan Nunnelee, Pete Olson, Ron Paul, Steve Pearce, Mike Pence, Joe Pitts, Ted Poe, Mike Pompeo, Bill Posey, Tom Price, Ben Quayle, Reid Ribble, Scott Rigell, Phil Roe, Todd Rokita, Dennis Ross, Ed Royce, Steve Scalise, Jean Schmidt, Adrian Smith, Lamar Smith, Marlin Stutzman, Lee Terry, Tim Walberg, Joe Walsh, Daniel Webster, Lynn Westmoreland, Joe Wilson, and Don Young.

Source: Flickr; Republicanconference (www.flickr.com/photos/republicanconference)

On the heels of the Minnesota Independent story last week about U.S. Rep. Erik Paulsen’s cozy financial relationship with the medical device industry, the New York Times reported Tuesday that some health professionals are alarmed by Paulsen’s push to relax Food and Drug Administration (FDA) oversight.

“They have this unwritten assumption that every new device is innovative,” Dr. Rita Redberg, who is the editor of the Archives of Internal Medicine, said, referring to the venture capital funds. But some devices, she said, “are killing people or causing significant harm.”

The Times reports that 10 bills to speed up the FDA’s medical device approval process have already been introduced by House Republicans this month. In the Senate, Sen. Amy Klobuchar has introduced a similar bill.

The U.S. House of Representatives has held four hearings on F.D.A. device approval procedures since February, with the vast majority of witnesses being “investors, entrepreneurs, industry consultants, trade group officials or patients who said that agency delays in approving a device had harmed them or a loved one,” according to the New York Times. No one who was harmed by a faulty device was invited to testify.

As the Minnesota Independent reported last week, Paulsen has been rewarded for his advocacy for the industry with campaign donations from company PACs and executives. The Congressman is currently sitting on $900,000, according to Federal Election Commission records. The medical device and drug industry gives more generously to Paulsen than to other candidates or PACs in the district, according to an analysis by the Center for Responsive Politics.

The Times story shows a steep increase in donations from venture capitalists with an interest in health care after Paulsen testified to Congress in June that FDA processes should be streamlined.

As the Minnesota Independent reported, Paulsen has seen substantial increases in donations from the entire medical device industry since he became a member of the influential House Ways and Means Committee, with one medical private equity firm crowing that “his increasingly high profile in Congress may help bring additional visibility to the medtech sector.”

Sen. Al Franken introduced a bill Friday that would offer seniors who receive long-term care at home the same protections from abuse as those afforded to seniors living in nursing homes.

The bill, which Franken expects to roll into the Older Americans Act later this year, would require states to pass a Home Care Bill of Rights that protects consumer rights, safety and access to information.

“It became very clear to me after meeting with seniors from Moorhead to Winona that remaining independent and at home is a top priority for our seniors,” Franken said in a press statement. “But in order to keep our seniors in their homes we have to make sure they’re safe. This legislation would ensure that seniors who choose to receive long-term services and supports in their homes and communities have the same rights and protections from elder abuse that seniors living in nursing homes already have.”

The bill would also create a voluntary ombudsman to deal with complaints about the system, as well as the development of a set of standards that the public could use to assess the quality of long-term care services.

As co-chair of the House Medical Technology Caucus, U.S. Rep. Erik Paulsen has battled for the medical devices industry since he took office in 2009. Industry Political Action Committees (PACs) and executives have responded to his advocacy with a deluge of campaign donations, helping to make Paulsen the lead fundraiser in Minnesota’s House delegation.

Influx of medical device and drug industry cash
Already in this election cycle, Paulsen is the ninth most favored candidate in the House of Representatives for the drug and medical device industry, according to a breakdown by the Center for Responsive Politics. Paulsen was recently appointed to the powerful House Ways and Means Committee. In the 2012 election cycle, he’s already showing a 68 percent increase in donations from individuals and PACs associated with the pharmaceutical and medical device industries over the 2010 cycle.

A substantial portion of Paulsen’s fundraising this election cycle has come from executives at companies like Medtronic, Boston Scientific and 3M’s medical division. In the last financial quarter, which ended at the close of September, five executives at Medtronic pitched in $2,750, supplementing the additional $3,000 from the company’s PAC. Boston Scientific executives pitched in $4,500. Paulsen also received donations from smaller operations, like the $1,750 given by a manager at Hampshire Labs, which sells prostate and “male enhancement” supplements.

Thomas Fogarty also maxed out his yearly contribution to the candidate at $5,000, according to quarterly disclosure records filed with the Federal Election Commission. Although Fogarty lists himself on Paulsen’s disclosure as a self-employed physician, he’s also president of Fogarty Research & Development and has founded or co-founded 30 companies related to medical technology or devices, according to his bio at Stanford University, where he’s a professor.

A host of medical PACs also contributed to Paulsen’s war-chest this last financial quarter. WellPAC run by WellPoint, a health plan company that’s part of the Blue Cross and Blue Shield Association, gave $2,500. Zimmer Inc. PAC, which pushes the interests of an Indiana-based company that creates artificial joints and other medical technology, gave $1,000.

Paulsen now has more than $900,000 on hand, according to Federal Election Commission records released last weekend. Donations from the medical device and drug industry, which gives more generously to Paulsen than to other candidates or PACs in the district, according to an analysis by the Center for Responsive Politics, helped put Paulsen at the top of the heap in terms of the Minnesota House delegation’s fundraising.

Source: Flickr; Republicanconference (www.flickr.com/photos/republicanconference)

“Tireless efforts” to support medical device industry
By all accounts, Paulsen has been a good advocate for the industry, which has deep roots in Minnesota. Last year, he received the 2010 Medical Device Manufacturer’s Association (MDMA) Chairman’s Award for “his tireless efforts to support the innovative and job-creating medical device industry.”

Paulsen has also increased the visibility of the medical device caucus, launching a website this March that a press release said ”expands our connectivity and engagement with medical technology companies, industry experts, and doctors and patients who use the innovative products the industry creates.”

In an Oct. 3 editorial at Roll Call, Paulsen condemned what he described as a “new medical device excise tax that will eliminate more than 40,000 well-paying jobs and imperil America’s global competitiveness in one of our leading industrial and technological sectors.”

Paulsen has introduced legislation aimed at speeding up the Food and Drug Administration approval process. And in speeches to industry groups, Paulsen has vowed to revamp the agency, according to a MinnPost account of Paulsen’s May speech to “400 venture capitalists, entrepreneurs and industry professionals” at the MedTech Investing Conference.

Paulsen told Minnesota Public Radio this week that Washington doesn’t have “too many strong voices” supporting the industry.

“We’re going to propose legislation that modernizes the FDA so that this industry remains strong,” he said. “Companies don’t mind if [FDA review] is rigorous. They want to make sure it’s relevant.”

A March posting on a medical private equity firm’s blog noted the new medical technology caucus website and Paulsen’s appointment to the House Ways and Means Committee at the end of last year: “Rep. Paulsen has proven himself dedicated to innovation and the issues facing the medical device industry, and his increasingly high profile in Congress may help bring additional visibility to the medtech sector.”

The Money Trail will be a regular feature looking at the special interests that fund our state’s politicians. If you have tips or suggestions, please sent them to tips@minnesotaindependent.com.

Source: Flickr, 710928003

Aleshia Napier was 18 years old in 2006 when she hung herself with a bed sheet at the Broward Correctional Institution in Fort Lauderdale, Fla., after being placed in solitary confinement despite her diagnosis of clinical depression and bipolar disorder.

The attorney hired by the young woman’s devastated family, Randall Berg Jr., the executive director of the Florida Justice Institute, points to two culprits for ignoring the medical and mental health needs of Napier: the private prison health-care companies PHS Correctional Healthcare and MHM Services.

Napier’s family recently settled with the companies for $500,000, but Berg said this case is part of a larger trend.

“My main concern is the profit motive taking precedence over patient care,” said Berg, who has taken out more than ten lawsuits against private health care companies. “The second one is that once the government entity contracts with the private provider, the government entity doesn’t provide any oversight.”

The outsourcing of health care in prisons to private companies is just one multi-billion dollar industry that has grown up around incarceration in the U.S. With that expansion has come mounting evidence of injury or death from improper medical care, or under-qualified or understaffed medical teams at prisons.

Mel Wilson, assistant director of Officer Workforce Studies at the National Association of Social Workers, says he is aware of “a lot of gaps in services” in for-profit private health care in prisons, especially for inmates with chronic conditions like HIV. Prisoners with HIV were found to die of the disease at twice the rate than that of the general population, according to HIV Symptoms, an information site on HIV.

The federal government outsources at least some aspects of their health-care operations, according to a spokesperson from the Bureau of Prisons, but they don’t completely hand over entire health-care operations in any of their facilities.

On the state level, however, the outsourcing of all health-care needs in a facility is more widespread. Those states include: Alabama, Connecticut, Delaware, Georgia, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Mexico, New York, Pennsylvania, Tennessee, Texas, Utah, Ohio, Louisiana, Colorado, Indiana, Florida, Illinois, Alaska, Mississippi, Kansas, Nevada and Virginia.

In Minnesota, Correctional Medical Services has “provided medical and psychiatry staffing services to the Minnesota Department of Corrections since 1998″ at each of the state’s ten prisons, according to the company’s website.

The models of companies big and small

The companies that take these contracts are diverse in size, including small contractors, subsidiaries of larger private-prison firms and products of large-scale mergers. They include Corizon Healthcare, the result of combining PHS Corrections and Correctional Medical Services; MHM Services Inc.; Armor Correctional Health Services Inc.; Correct Care Solutions; the Birmingham, Ala.-based NaphCare and GEO Group’s GEO Care.

The recent merger that created Corizon Healthcare shows the scope of the industry. Prior to the merger, PHS Corrections had 57 contracts in 150 jails across 19 states, serving about 165,000 inmates, and Correctional Medical Services served 250,000 inmates in 19 states. Since the two companies merged, Corizon Healthcare has become the largest prison health-care provider in the country. It “provides quality healthcare services at over 400 correctional facilities across the country serving approximately 400,000 inmates in 31 states.”

The smaller private health-care companies also have no shortage of clients. MHM Services provides care for over 280,000 individuals in 14 states; GEO Care is in more than 60 facilities in more than 20 states and Correctional Care Solutions “cares for more than 57,000 lives” in 17 states.

Alex Friedman, associate editor at the anti-privatization Prison Legal News, said there are two funding models for privatized health care in prisons. There is the cost-plus model, in which a vendor is reimbursed at a specific rate that includes actual costs and profit, and the flat-fee model, under which a company is given a flat-rate amount of money and everything they don’t use is profit, giving them the most incentive to cut costs.

“Medical care in public prisons isn’t great either,” said Friedman. “Prison medical care in general is pretty abysmal, just even more abysmal in the private sector.”

Martin Ricketts, deputy director of Rehabilitation Programs at the New York City Department of Health and Mental Hygiene and a contracted clinical social worker with a New York-based private prison health-care firm, said many of the people entering prison have had little or no health care throughout their lives.

Though privatized health care is not a new concept for American society -– 70 percent of Americans get their health coverage through some form of private insurer — what makes the risks of privatized health care in prisons particularly worrisome is that prisoners have no other options.

“If you take all the bad parts of the HMO [Health Maintenance Organization] and put it in a monopoly situation, and you have the private prison medical-care industry,” said Friedman. “But prisoners can’t go to another clinic, can’t pick a plan.”

Though Ricketts said the profit motive in private prison health care does disturb him, he sees the move to private care happening now because “the system is in transition anyhow.”

“Our whole system is more profit-driven than it used to be,” said Ricketts, who has been with the New York City Department of Health and Mental Hygiene for 25 years. “And health provides are being squeezed especially hard by the government as there are cuts in programs like Medicare and Medicaid.”

Garnering contracts in an age of cost-cutting

According to the ACLU Prison Project, it cost some states up to $47,000 to house a prisoner, and in a time of budget crisis, some legislators argue that outsourcing health-care services is cost efficient. Most recently, the Michigan Department of Corrections floated a proposal to privatize its entire prison health-care services, hoping to save up to $20 million.

“As a result of the economic downturn, states are taking steps to reduce their expenditures,” said Friedman, though he doesn’t think it’s ever been proven or shown that costs are reduced by privatizing health care.

The New York Department of Corrections, for example, signed a 6-year contract with Correctional Medical Services in 2005 for $5,419,000, and then extended the contract for six months in February 2011 for $2,910,480, according to its contracts site. Not long after the CMS contract, NYDC also signed two contracts with NapCare Inc. in 2006 for more than $1 million each, and extended them at the start of 2011 for more than $1 million each.

The Correctional Medical Services contract was signed in 2005, only a year after a New York Times exposed widespread abuses and deaths of prisoners at Rikers Island under the care of Prison Health Service.

In Texas, the state is looking for a cheaper alternative to contracting prison healthcare with the University of Texas, the Texas Independent reported, but “the idea didn’t get too far with the Texas Legislature, in part because state Rep. Jerry Madden (R-Plano) kept reminding everyone there was no evidence privatization would save any money at all.”

Because there are “very few companies in competition,” said Friedman, “they just gain other contracts” when one state kicks them out.

Prison Health Service (PHS) got its largest contract ever in 2000, $253 million for three years, from New York City after both Florida and Pennsylvania began official investigations of PHS into treatment of those states’ inmates. At the same time it received the contract, PHS was paying millions in legal fees.

Expansion

The range of health-care services provided by private companies has continued to broaden. PHS and Corizon also run nationwide pharmacies to supply their respective operations.

This makes cases like that of Ashley Ellis, who died in a PHS-run facility in Vermont from a lack of a vitamin that could be bought over the counter, all the more sad. Ellis, 23, died three days into her 30-day sentence. PHS did not have potassium in stock at the prison, and during Ellis’ stay, there was no doctor on staff and only one registered nurse, during just one shift.

Prison Legal News is currently involved in a lawsuit with PHS to release details of any lawsuits PHS has settled in Vermont, including the case of Ashley Ellis. PHS left the state the following January. The Northfield News reported Vermont was then off to look for its fifth private company in 14 years to run its prison health-care system.

“It’s tragic,” Friedman said of Ellis’ death, “but illustrates that these companies are interested in only one thing.”

In their quarterly filings with the Federal Election Commission, NARAL Pro-Choice America disclosed that they put some of their resources up against GOP presidential contender and U.S. Rep. Michele Bachmann in September.

NARAL spent $8,406 to rent lists of Bachmann’s prospective supporters in September. It also spent another $1,175 in September to oppose her reelection in Minnesota’s 6th Congressional District. Most of that money was spent on web ads and consulting, according to filings with the Federal Election Commission.

Bachmann, a longtime opponent of abortion rights, filed a bill titled the “Heartbeat Informed Consent Act” in early October. Her struggling presidential campaign has recently refocused on Bachmann’s anti-abortion credentials, hoping to draw conservative supporters.

The pro-choice group also spent $1,834 to print up mailings opposing Bachmann last financial quarter. She’s the only presidential candidate the group has disclosed spending against so far this election cycle.

Bachmann has a long history of anti-abortion activism and took part in a National Right to Life conference in Florida this summer.