Solution and Salvation? Or Snake Oil.

“Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force:

“There are three kinds of lies: lies, damned lies, and statistics.”

     

     Mark Twain, 1904.

With these wise words echoing from one of the great American scribes, let us look at the manner in which residential treatment centers, and eating disorder treatment professionals in general, judge their long-term effectiveness. We trust our beloved children and loved ones to these centers at a time when, except for hospitalization, they need the most professional, thorough, and expert care available. As parents, spouses, children, we have a right to know.

Unfortunately, with regard to the long-term effectiveness of eating disorder residential treatment programs, there are no third party, objective studies and findings indicating their rate of long-term success or their recidivism rates.  There is not even a consensus on the most effective manner to determine post-treatment patient satisfaction. In a past study, a researcher found the following:

“Sixty-one percent of all programs reported using some type of data to evaluate the effectiveness of their treatment program. Of these 61%, 63.6% of programs used self-report surveys to gauge treatment effectiveness, 36.4% used outcome studies, 18.2% used laboratory tests, and 18.2% used program-initiated telephone calls. Some programs used more than one of the previous listed methods.

Greater than one third (36.4%) of the programs evaluating treatment effectiveness relied only on client-initiated post-treatment telephone calls for effectiveness measures. Thirty-nine percent of all programs did not provide information on the measures used to determine treatment effectiveness.”

As such, with no consensus and no oversight from state or federal agencies, centers are free to market or advertise their “success or satisfaction” rate in any manner they choose.

With regard to this marketing, every state in the United States has laws pertaining to "puffery." The Merriam-Webster Dictionary (which advertises that it has been in existence since 1828) defines "puffery" simply as, (n) - exaggerated commendation especially for promotional purposes.

The Council of Better Business Bureau’s Code of Advertising provides that an advertiser bears primary responsibility to ensure its advertisements are truthful and non-deceptive. The Code of Advertising specifically addresses the subject of “Superlative Claims—Puffery,” distinguishing objective, or factual, claims from subjective, or puffery, claims. It defines objective claims as those relating to “tangible qualities and performance values of a product or service which can be measured against accepted standards or tests.” Because objective claims are statements of fact, “such claims can be proved or disproved and the advertiser should possess substantiation.” Subjective claims, on the other hand, are “expressions of opinion or personal evaluation of the intangible qualities of a product or service.”

Therefore, to attract families and patients, treatment centers can advertise that they “provide the best care available,” or “their counseling methods are tried and true and supported by experts in the field,” or “our patients are very satisfied with the quality of our services.” Each of these statements are matters of opinion. They may be lies. They may even be damned lies. But, they are not actionable as misrepresentations or fraudulent statements because they are opinion based, lack statistical support and do not have an objective or factual basis. Most companies know the difference and steer clear of statistical representations.

But, there are a very few notable exceptions.

CCMP Capital Advisors d/b/a The Eating Recovery Center

CCMP Capital Advisors d/b/a The Eating Recovery Center represents to the general public that with regard to its Child & Adolescent Inpatient/Residential and Partial Hospitalization Programs, “… 99% of parents of child/adolescent patients report that treatment at Eating Recovery Center was helpful, and 97% would recommend Eating Recovery Center to other families in need of treatment.” [emphasis added] These statistical representations are made on their website.

Ninety-nine percent (99%)!  Ninety-nine percent (99%)! 

That number is really quite remarkable since the highest score awarded by the respected American Customer Satisfaction Index to any health care provider was… 76.

But, purportedly Ninety-nine (99%) of its patients report that the provided services helped. This statistical number, since it must be exactingly precise so as not to constitute a gross misrepresentation to the general public, was obviously computed only after CCMP d/b/a ERC developed a fool-proof system whereby 100% of its patients and their families not only stay in communication and remain responsive after they are discharged (or after the applicable insurance company decides to discharge their loved one and only pay for stepped down treatment) but 99% of them state that the treatment was helpful.  Or do they? Note that the representation does not mention “patients surveyed,” or that a reduced or limited class of patients was surveyed.  The very bold claim is that “ … 99% of parents of child/adolescent patients report …”

It is axiomatic that helpful treatment leads to recovery and ipso facto, an end to this insidious disease!  If these statistics are to be believed, this treatment center has in essence, discovered a cure for this insidious disease.  Imagine, no parents left devastated as their child relapses. Imagine, instead of one person being taken by this disease every 62 minutes, that number would be reduced to ... ZERO. That is truly salvation!

But wait.  Let us examine the manner in which CCMP d/b/a ERC compiled these numbers to try to determine their accuracy. It is well known that CCMP d/b/a ERC sends out a general survey to some of its patients or parents four weeks after discharge. Now, there are a number of eating disorder parent support groups on Facebook and other social media. An informal question to one group alone resulted in a significant number stating that they had not been contacted by CCMP d/b/a ERC at all. Other persons reported that they were most assuredly not satisfied with CCMP d/b/a ERC’s treatment program. That in itself is problematic since those dissatisfied persons, or persons who were not contacted at all, would significantly cut into that incredible 99% representation.

Further, any company with in essence a 100% customer satisfaction rating should be an incredible place to work. And yet, a well known website gauging employees’ satisfaction with their employer tells an alarmingly different story.

The following statements are representative of the work environment at CCMP d/b/a/ ERC as conveyed by former employees:

They say safety is a priority, yet the patient’s [sic.] go on pass and HARM themselves. ..

A very toxic and racist environment. The company as a whole steers clear of diversity in the workplace.

Non caring management, unrealistic expectations, lack of experience for some in management positions. Growth has made the management team not care about the people only money.

High turnover, lack of communication, company is all about making money, understaffed, underappreciated by management

Underpaid, understaffed, money hungry, has grown so big that patient care is compromised, not consistent, poor communication, as the founders/thought leaders retire the vision is being lost, I could go on

Reading all the other reviews is validating and a relief- working there and felt horrible about it almost daily. Lack of heartfelt, meaningful, engaged , or even pleasant lead management.

Management are removed from milieu and daily experiences of clients and staff, unsupportive and unprofessional management and supervisors,

Frequently told to bring in patients first with the highest reimbursement, regardless of health status of patient.

For-profit hospital- evident in every way that everything is about money

No care for mental health of staff, minimal supervision support, profit-obsessed to the point of being unethical

A large company that recently cut a ton of jobs "rightsizing" equals for profit care to the extreme. Horrible communication, terrible management, the worst work/life balance I have ever experienced.

I witnessed the quality of the services go down by changes made by management in Denver that never made it a point to see how operations run in the Sacramento location. Many of the changes appeared to focus more towards retaining revenue rather than investing in quality services

This company only looks at their financials and nothing else.

They're going around acquiring tons of treatment centers and slapping their name on them while laying people off, cutting pay and hours where existing sites are struggling

Not enough staff to provide any real treatment whatsoever. This is basically a fake treatment center that bills insurance companies for services NOT rendered. 

You are ruining everything that you stand for, or STOOD for, by being so money hungry.

They continue to expand without the infrastructure to support the growth leading to burnout because staff is just expected to cover extra shifts every week. It is all a numbers driven approach to admissions and you are expected not to question

The attitude from the top down is negative and untrustworthy. The emphasis is strictly on numbers in an effort to sell the company. 

Working for a private hospital comes with a focus on business, profit, and insurance, which may not appeal to some. 

Note that these complaints, yes albeit, anonymous, do not involve the usual employees' complaints about their employer being "mean" or evidence disgruntled employees with a personal axe to grind. These complaints focus on the overall toxic corporate environment, on the manner in which the Corporate Practice of Medicine is changing the environment at CCMP d/b/a ERC and that their mission has changed to become a revenue producing entity. And yet, we are naively supposed to believe the Ninety-nine Percent (99%) number is remotely accurate when it has been established that:

1. The manner in which CCMP d/b/a ERC computed this number is undisclosed and on the surface, cannot be verified;

2. The number itself is refuted by real life complaints and information provided by parents of patients;

3. The work atmosphere at CCMP d/b/a ERC is focused on the bottom line and making a profit, and not on the safety and welfare of the patients or employees.

And what started with great potential, a presumably honest representation of an incredibly important and material fact that could be relied upon by the millions of people suffering from this cruel, insidious disease, a possible salvation is simply another form of ... snake oil.

Ninety-nine Percent (99%)!

That appears to be more than just a lie.  That appears to be more than just a damned lie. That number is a hard and obviously false statistic... a misrepresentation of fact, and a statistic that could result in possible liability.

In the eyes of the court system, actionable representations must involve material facts, not mere opinion or puffery. See Prudential Ins. Co. of Am. v. Jefferson Assocs., 896 S.W.2d 156, 163 (Tex.1995). "A representation is `material' if it is important to the party to whom it is made in making a decision regarding the particular transaction." Burleson State Bank v. Plunkett, 27 S.W.3d 605, 613 (Tex.App.-Waco 2000, pet. denied). "`Material means a reasonable person would attach importance to and would be induced to act on the information in determining his choice of actions in the transaction in question.'" Id. (quoting Beneficial Pers. Servs. v. Porras, 927 S.W.2d 177, 186 (Tex.App.-El Paso 1996, writ granted, judgm't vacated w.r.m.)).

"When a speaker purports to have special knowledge of the facts, or does have superior knowledge of the facts—for example, when the facts underlying the opinion are not equally available to both parties—a party may maintain a fraud action." Paull v. Capital Res. Mgmt, Inc., 987 S.W.2d 214, 219 (Tex.App.-Austin 1999, pet. denied).

This snake oil statistic is designed to do one thing and one thing alone... drive fearful and desperate people to CCMP d/b/a ERC. And the overwhelming circumstances surrounding the operation of CCMP d/b/a ERC leads one to the only logical conclusion ... that that representation is not accurate and is designed to merely increase the company's bottom line.

When your medical practice is owned by a non-medical corporation driven to make the highest possible profit within a limited time window before selling to the highest bidder, the company's bottom line is the only importance and its patients become commodities to be churned into grist by the Private Equity Mill.

The Demon may still still laughing, but the winds of litigation war blow stronger.

Obamacare Struck Down ... What You Need to Know

On late Friday afternoon, December 14, 2018, United States District Court Judge Reed O’Connor struck down Obamacare, a/k/a the Affordable Care Act ruling that it was unconstitutional. Let us explore the reasoning behind the opinion and the possible ramifications and implications, both short term and long term of that decision.

Summary of Decision

Judge O’Connor issued a 55 page opinion which granted summary judgment for the plaintiffs in the case entitled Texas, et al v. United States, et al, Civil Action No. 4:18-cv-00167-O. (The case is generally known as “Texas v. Azar”) The plaintiffs were Republican State Officials from twenty (20) different states. The case was filed in February of 2018. The reason this date is significant will be discussed later in this article.

First, a summary judgment is a motion filed by a party which asserts that there are no disputed material facts in the case and that they are entitled to judgment as a matter of law. If the court agrees that there are no material facts, the judge then applies the law as established by prior cases, interprets the Constitution or statutes involved in the case and makes its ruling.

Judge O’Connor, predicting his ruling would be controversial started his historic opinion with these words: “The United States healthcare system touches millions of lives in a daily and deeply personal way. Health-insurance policy is therefore a politically charged affair – inflaming emotions and testing civility. But, Article III courts, the Supreme Court has confirmed, are not tasked with, nor are they suited to policymaking.”

The Court then struck down the entire Affordable Care Act (“ACA”) on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law could not stand without it. Judge O’Connor specifically held that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.”

The importance of Congressional taxing power

Judge O’Connor focused on Congress’s taxing power as the key issue because it was the issue the United States Supreme Court relied upon in upholding the constitutionality of the ACA in 2012. In the 2012 case, the Supreme Court said that Congress legally could impose a tax penalty on people who do not have health insurance.

In the 2012 case, the Justice Department under President Obama maintained that the individual mandate went hand-in-hand with the rules protecting people with pre-existing conditions and the insurance subsidies the law provides, and the individual mandate could not be eliminated without scrapping the entire law. This mandate was controversial and in a close 5 -4 decision, the Supreme Court placed great importance on this provision. The mandate provided that if an individual or family did not have health insurance, they would be subjected to a financial penalty of the greater of $695 per person per adult, or 2.5% of household income.

The Supreme Court, in its 2012 opinion written by usually conservative justice, Chief Justice John Roberts held that this “penalty” as referred to in the ACA was not in actuality, a penalty, but instead was a tax and as such, was a lawful, constitutional application of Congress’s taxation power. However, and in a significant glimpse of future battles, Justice Roberts also stated, “The Federal Government does not have the power to order people to buy health insurance.”

The Tax Reform Act of 2017

Enter President Trump and the Tax Reform Act of 2017. In this broad and sweeping reformation of the tax code, Congress eliminated the ACA’s individual mandate’s “penalties” as part of the new tax law. Because there are no tax penalties associated with the ACA and because, in part the Obama Administration argued the totality of the ACA must stand or fall on that basis, the plaintiffs in Texas v. Azar successfully argued that the basis for the Supreme Court’s decision in 2012 had been eliminated.

With the individual mandate now removed, the basis relied upon by the Supreme Court to uphold the constitutionality of the ACA became moot and the ACA was now susceptible to new attacks. These attacks came to fruition in February 2018 when Texas v. Azar was filed in the traditionally conservative Northern District of Texas.

With the reasoning of Judge O’Connor’s decision being explained in “civilian language” (hopefully), we can now examine the implications and ramifications.

Short-term impact?

The short-term impact of Judge O’Connor’s ruling is likely to be negligible. First, Judge O’Connor did not issue a “stay” order or grant injunctive relief to the extent that his ruling would be “stayed” pending final appeal. But, he also did not enter an injunction blocking its continued operation. So, technically, while the ACA is no longer the law of the land, it is likely to stay in force and effect pending final appeal through the Fifth Circuit Court of Appeals and then ultimately, the Supreme Court.

Further, Trump Administration officials who oversee the ACA exchanges went on record Friday night that the federal government will continue to enforce the ACA while the order is being appealed. Seema Verma, administrator of the Centers for Medicare and Medicaid Services tweeted, “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.” Verma also stated earlier this month that CMS had a plan to protect pre-existing conditions if the law was struck down.

Democratic State Officials from sixteen (16) states vowed to immediately appeal Judge O’Connor’s decision. Ordinarily, a case cannot be appealed until a final judgment is rendered in a case. Some dispute exists as to whether the summary judgment order from Judge O’Connor resolves all issues and disputes in the case. If so, appeal will be immediate and the defendants in Texas v. Azar undoubtedly will petition the Fifth Circuit Court of Appeals in New Orleans to issue a stay of the ruling pending all appeals.

Therefore, until a final decision by the Supreme Court, or until a new law is passed by Congress, the provisions of the ACA are likely to stay in force and effect.

Long Term Possible Impact and Ramifications

Assuming Judge O’Connor’s ruling is not overturned by the Supreme Court, and the ruling that the ACA is unconstitutional is allowed to stand, the long-term ramifications are potentially catastrophic for mental health. The ACA provided coverage regardless of pre-existing conditions. It provided financial assistance for private insurance. The ACA established rules which set forth a basic minimum set of benefits insurance policies must cover. Finally, the ACA provided health coverage for millions of Americans who previously could not qualify under privately operated insurance plans. These issues and concerns, and many others are back on the table and are jeopardized.

The Urban Institute, a left-leaning organization and think tank estimated that up to 17 million Americans could lose their health insurance. This includes the millions who gained coverage through the ACA’s expansion of Medicaid and millions more who received subsidized private insurance through the ACA’s online marketplaces. Insurers would no longer have to cover young adults up to age 26 under their parents’ plans. Insurers could place annual and lifetime limits on coverage. The cap on out-of-pocket costs would be taken away.

Arguably the most catastrophic loss would be coverage for people with pre-existing conditions, a condition which is prevalent with those suffering from eating disorders. More often than not, an eating disorder is a long term disease requiring years of counseling and treatment. Recovery is dependent on medical stabilization, addressing any environmental component, psychological and behavioral treatment, work and resiliency. Recovery for each person is as individual as the person him or herself. It is not unusual for treatment to take a number of years. All of this information is well known to insurance providers. With no legislative oversight or federal law in place, insurance providers could again rely upon the “pre-existing condition” exclusion to deny coverage for residential treatment, outpatient treatment, PHP, IOP … in short, all eating disorder treatment.

Treatment centers and counselors would necessarily become even more dependent on private pay patients as insurance coverage would be denied or limited. This could result in the growing manifestation of the self-fulfilling perception that eating disorders are merely a “rich little, white girl’s disease.”

Residential Treatment Centers could be impacted the most

Despite the passage of the ACA and Mental Health Parity Act of 2008, insurance providers have been carefully scrutinizing residential treatment for eating disorders for medical necessity. Weekly peer-to-peer reviews are not unusual. Insurance guidelines independent from those set forth in the DSM-V are adopted in insurance policies. In November 2017, the Milliman Group found that behavioral health care was four to six times more likely to be provided out-of-network than medical or surgical treatment. This study also found that insurance providers paid primary medical care professionals twenty percent (20%) more for the same types of care than they paid mental health care specialists, including psychiatrists.

After the ACA was signed into law and became effective in 2010, private equity companies went on a feeding frenzy of acquisition of residential treatment centers. Between 2011 and 2018, there were at least seventeen (17) different transactions in which residential treatment centers were bought by private equity firms. Most of the members of the Residential Eating Disorder Consortium (“Consortium”) are owned by PE firms. The acquired facilities include the Eating Recovery Center (twice), Timberline Knolls, Castlewood, Monte Nido, The Emily Program, Remuda Ranch and many others.

The take-over of residential care by PE firms was predicated upon both the Mental Health Parity Act of 2008 and the ACA. PE firms saw an economic opportunity arise from the absence of federal regulation and oversight of the mental health industry. They were emboldened by legislation requiring parity between mental health treatment and medical treatment. The ACA removing pre-existing conditions from the purview of insurance providers and mandatory insurance for all Americans resulted in a perfect storm in the mental health industry and the private equity firms capitalized.

Acquisitions were structured in a manner attempting to avoid corporate practice of medicine doctrines and doctors and owners of treatment centers listened to the seductive “Call of the Sirens,” and sold their practices to PE firms. However, these transactions are structured to be dependent on aggressive expansion and growth. This growth is necessary to increase the asset base of the treatment provider so that future debt obligations can be met. The transactions are also presumably dependent on the belief and necessity that the ACA would remain in place.

With the harsh reality that the ACA has now been ruled unconstitutional, the PE firms and their treatment centers face a new reality … that is, insurance providers will increase their scrutiny of claims for treatment, that they will rely upon the Court’s holding that the ACA is unconstitutional and will phase back in their denying claims because of pre-existing conditions or and will remove the cap on the maximum amount of out-of-pocket expenses incurred by insureds. This will require residential treatment centers to increase their dependence on private pay patients. These treatment centers may also be forced to need to increase their costs and expense to patients. They could also be forced to implement large cost reductions including laying off staff and professional personnel in order to meet their debt obligations.

In short, financial Armageddon could be at hand.

Possible Solutions

The Texas v. Azar decision constitutes a grave crisis impacting all Americans. This crisis could shake the very foundation of the Republic at a time when both major parties are more intent on promulgating the power of their own party and tearing apart the other party. Confidence in our political leaders is low. As for loyal opposition? Respect for those across the aisle? Working together in the spirit of compromise and collaboration while maintaining one’s own dignity and self-respect? These are all attributes which have become foreign to our so-called political leaders on the Hill and in every state capitol.

And yet, the only possible long-term solution is to rediscover that collaboration and come up with a bipartisan plan that results in health care being made available to all Americans at a cost which is affordable. Unfair insurance practices must be curtailed. The most vulnerable of our citizens must be provided with health care which is both substantive and affordable.

The crisis is here. At the same time, the opportunity for a greater future is similarly here.

Crisis or Opportunity? Our future depends on the answer to that question.

What Makes America the Greatest Country in the World?

In the very first scene in the award winning show, “The Newsroom,” Jeff Daniels, who is playing a cable newscaster, is appearing as a guest speaker at  Northwestern University. A young college student asks him the following question, “Can you sum up in one sentence or less ... what makes America the Greatest Country in the World?” After first dodging the question, he is pressed for an answer by the moderator of the event. His candid response follows:

And you—sorority girl—yeah—just in case you accidentally wander into a voting booth one day, there are some things you should know, and one of them is that there is absolutely no evidence to support the statement that we're the greatest country in the world. We're seventh in literacy, twenty-seventh in math, twenty-second in science, forty-ninth in life expectancy, 178th in infant mortality, third in median household income, number four in labor force, and number four in exports. We lead the world in only three categories: number of incarcerated citizens per capita, number of adults who believe angels are real, and defense spending, where we spend more than the next twenty-six countries combined, twenty-five of whom are allies. None of this is the fault of a 20-year-old college student, but you, nonetheless, are without a doubt, a member of the WORST-period-GENERATION-period-EVER-period, so when you ask what makes us the greatest country in the world, I don't know what the fuck you're talking about?! Yosemite?!!!

We sure used to be. We stood up for what was right. We fought for moral reasons, we passed and struck down laws for moral reasons. We waged wars on poverty, not poor people. We sacrificed, we cared about our neighbors, we put our money where our mouths were, and we never beat our chest. We built great big things, made ungodly technological advances, explored the universe, cured diseases, and cultivated the world's greatest artists and the world's greatest economy. We reached for the stars, and we acted like men. We aspired to intelligence; we didn't belittle it; it didn't make us feel inferior. We didn't identify ourselves by who we voted for in the last election, and we didn't scare so easy. And we were able to be all these things and do all these things because we were informed. By great men, men who were revered. The first step in solving any problem is recognizing there is one—America is not the greatest country in the world anymore.

That scene is one of the most impactful opening scenes of any television show in recent memory. And although fictional, is there any legitimate doubt as to the accuracy of those remarks ringing true today? Especially in the field of mental health and more specifically in the eating disorder industry.

But, we are not here today to bury America. Instead, we are here today to praise Australia.

On Sunday, December 9, 2018, Christine Morgan, the CEO of the Butterfly Foundation issued a press release stating that the Prime Minister of Australia announced an amendment to Australia’s Medicare Benefits Scheme designed to improve access and affordability of appropriate eating disorder treatment across Australia. One executive stated, “The socio-economic impact of eating disorders on a person’s life is one of the most severe and enduring in Australia. The introduction of a Medicare response into the health system is the most significant and necessary reform. Without a Medicare response other system reforms that are still needed could not be considered.” [emphasis added]

Australia’s new benefit scheme in part provides:

 · A dedicated single Medicare Benefits Scheme item number for eating disorder treatment for those with severe and complex illness, delivering up to 60 Medicare funded sessions of treatment – 40 psychotherapeutic and 20 dietetic across the range of eating disorders – anorexia nervosa, bulimia nervosa, binge eating disorder and atypical presentations.

· Diagnosis by a GP and mental health practitioner recognizing that these psychiatric illnesses have a significant physical impact and integrated treatment is essential.

The Press Conference announcing this new law was momentous as well. It included politicians, foundations, counselors, and family members all united as one. The transcript from this Press Conference can be found here:

https://www.pm.gov.au/media/press-conference-butterfly-foundation

Standing by itself, this achievement is incredibly note worthy. But,  this is only the latest event in what now appears to be a concerted government – private enterprise collaboration to address this insidious disease. Australia along with New Zealand has a recent history of being progressive, of confronting a problem head on and objectively seeking to find solutions. In 2014, The Royal Australia and New Zealand College of Psychiatrists issued new Clinical Practice Guidelines for the treatment of eating disorders. These Guidelines included policies and procedures for the admission of children and young adults, guidelines addressing in-patient management and outpatient care, hospital care, residential care. It was free of corporate bias with no specific economic agenda. Treatment will be made available for groups of people who previously would not have been able to obtain help.

Australians have been given hope. They know that their government listened to their concerns and fears and took affirmative, strong action. Research and treatment are not being driven by private corporations whose interest begins and ends with their profit margin.

Meanwhile, back in the United States

Status quo ante reigns, no progressive, affirmative bold conduct is being undertaken and our children continue to die. In the halls of Congress, strengthening and increasing the financial gains of the private equity overlords predominates lobbying efforts. Nowhere is this more obvious than in analyzing the 2018 payments to the eating disorder lobby and the specific bills being lobbied.

In 2018 alone through the end of October, the Eating Disorder Coalition, the Residential Eating Disorder Consortium (“Consortium”) and the National Eating Disorder Association (“NEDA”) paid their now unified lobbyist a combined $250,000.00. This number is expected to exceed $325,000 by years end. And what did the eating disorder industry buy with this money? The specific bills and resolutions the lobbyist was instructed to lobby involved:

1.             On behalf of NEDA, H.R. 1625, the “Consolidated Appropriations Act of 2018,” related Labor and Defense Appropriations Acts and House Resolution 428 and Senate Resolution 419 both of which recognize February 26, 2019 – March 4,2018 as “eating disorder awareness week.” NEDA paid the lobbyist $60,000 for this work.

2. The Consortium paid the lobbyist $100,000 to lobby on the following matters:

S. Amdt. 2222 "Bipartisan Health Care Stabilization Act of 2018" to H.R. 1625 "Consolidated Appropriations Act, 2018," all provisions. H.R. 4666 "Premium Relief Act of 2017," all provisions. S. 1835 "Lower Premiums Through Reinsurance Act of 2017," all provisions. Issues pertaining to Association Health Plans- 29 CFR Part 2510, RIN 1210-AB85, all provisions. Issues pertaining to Short-Term, Limited Duration Insurance- 26 CFR Part 54, RIN 1545-BO41, all provisions. P.L. 114-255 "21st Century Cures Act," all provisions. H.R. 6311 "Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018," all provisions. S. J. Res 63 "A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance", all provisions. H.R. 6898 "Maintaining Protections for Patients with Preexisting Conditions Act of 2018", all provisions. [emphasis added]

3. The ED Coalition paid $90,000 on the following issues: Senate Bill 3158, deemed the 2019 Department of Labor Appropriations Act and the aforementioned H.R. 1625, the “Consolidated Appropriations Act of 2018.

That is the totality.

That is what almost 1/3 of a million dollars in lobbying bills gets you. No additional treatment funding. No additional university based research funding. No mandatory increase in training on eating disorders in medical schools and internships. No new laws policing the out of control private equity firms who are running amuck in the eating disorder industry. 

So what do you receive? Lobbying to cut off much needed help for families.

Short-term, limited-duration insurance is a type of health insurance coverage that is primarily designed to fill gaps in coverage that may occur when an individual is transitioning from one plan or coverage to another plan or coverage, such as when they are between jobs.

The Rule proposed by the Secretary of the Treasury, Secretary of Labor and Secretary of Health and Human Services provides consumers with more affordable options for health coverage. Under this Rule, consumers would have the ability to purchase short-term, limited-duration insurance policies that: 

1.    Are less than 12 months in duration;

2. Contain important language to help consumers understand the coverage they are receiving, and;

3.   May be renewed for up to thirty-six (36) months.

Parents, moms, dads, families … The Residential Eating Disorder Consortium paid the unified lobbyist to oppose short term, limited duration insurance policies. You read that correctly. To reiterate, the Consortium paid the lobbyist to oppose short term, limited duration insurance policies.

These insurance policies could provide the ability to pay for life saving treatment for our loved ones. And yet, the Consortium opposes it? To double check, I looked at the specific language utilized in the Senate Joint Resolution 63. The totality of the language states:

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That Congress disapproves the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to “Short-Term, Limited Duration Insurance” (83 Fed. Reg. 38212 (August 3, 2018)), and such rule shall have no force or effect.

To triple check, I then looked at the language of the Rule submitted by the Secretaries and recorded at 83 Fed.Reg. 38212. The exact language  summarizing this rule states:

This final rule amends the definition of short-term, limited- duration insurance for purposes of its exclusion from the definition of individual health insurance coverage. This action is being taken to lengthen the maximum duration of short-term, limited-duration insurance, which will provide more affordable consumer choices for health coverage.

And all of the treatment centers who are included in the Residential Eating Disorder Consortium not only oppose this provision, but are paying a lobbyist to oppose short-term, limited duration insurance policies which would potentially provide payment for life-saving treatment.

Is it because if this type of insurance passed and became law, it would reduce the profits for the insurance providers while increasing their costs? Is it because it could make treatment decisions in accordance with insurance policy language and the DSM V more problematic for treatment centers? Is it because the private equity firms which now control the Consortium and ED Coalition are in bed with the insurance industry?

Whatever the reason, the daunting obstacles confronting families who suffer from eating disorders are being exacerbated by the greed of the private equity firms which own the treatment centers and the insurance industry. And the cost to pay for this greed? The lives of our loved ones at the rate of one death every 62 minutes. At this point, you may use whatever word you wish … reprehensible, unethical, disgusting, or vile to define the state of the eating disorder industry in the United States.

As the mantle of leadership and insight into treating and researching eating disorders is firmly grasped by Australia, they are to be commended and even admired for their vision and wisdom. And as for us? The reality of why America is not the greatest country in the world comes more into focus.