Real World: DA’s Office

By Juliana Keeping, communications manager
 

What’s happening: Private equity firms are investing aggressively in health care. According to the consulting firm Bain & Co., total health care investment ballooned to $151 billion in 2021 — from $66 billion the year before. The impact of that investment has been acutely felt in the nursing home industry, which has long been targeted and gutted by private equity.

Anisha Agrawal, health care manager for the complex care portfolio, profiled Robert Tyler Braun, Ph.D., assistant professor and health researcher at Weill Cornell Medical College. and an AV grantee, to get at the heart of the issue.

Why it Matters: Private equity is a for-profit entity that aims to extract money from investors in a short time period, typically three to seven years, and with an average return of 20%, Braun explains. Cutting staffing and supplies, pressuring doctors to bill for unnecessary services, and upcoding claims are the typical hallmarks of how private equity juices its investments for profits. But there is even more at stake when it comes to nursing homes: These facilities receive approximately 85% of their revenue from Medicare and Medicaid — the taxpayer-funded health insurance programs that cover people over the age of 65, people with disabilities, and those with low incomes. 
 

What’s Next: Braun’s groundbreaking work researching private equity’s expansion in nursing facilities is helping to illuminate the need for more public sector scrutiny. It’s estimated private equity firms own more than one in 10 nursing homes in the United States. “When you have undercapitalized nursing homes seeking external investment, high-profit motivations from private equity, and lack of government accountability in how money is being spent on direct care for residents, this creates an environment of misaligned incentives that do not necessarily benefit the residents receiving care,” Braun told Arnold Ventures.
 

Arnold Ventures is actively investing in more research to define the scope of the problem and educate policymakers and the public on its impact. 
 

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By Clare McCann, Higher Education fellow

What Happened: Over the last week, the U.S. Department of Education published two sets of final higher education regulations on a range of issues. These rules took about a year to produce through a process called negotiated rulemaking and are covered by hundreds of pages of text. Broadly, these rules determine who and how people are eligible for student loan discharges and accountability for the colleges that students attend using their federal financial aid.
 

Why it Matters: Students need protection from predatory schools, and schools need to provide a quality education. These new rules support that: They fortify and improve upon long-standing efforts to hold institutions accountable for misconduct and failure to meet federal rules, as well as protecting students, borrowers, and taxpayers. Three of them in this newly approved set stand out: borrower defense, the 90/10 rule affecting veterans, and change in ownership regulations.
 

What’s Next: With these regulations now in place, U.S. Department of Education will move to implement the changes over the coming months so that they take effect at the start of the next federal financial aid award year (July 2023).
 

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Criminal Justice

• Heed this warning from NPR: Look out for "zombie newspapers" waging a propaganda war against a new Illinois law that replaces cash bail with risk-based detention.
   
• In The Nevada Current, Jillian Snider and Lisel Petis of R Street call on voters to pay attention to facts, not partisan campaign ads, when it comes to public safety.
   
• After weeks of fearmongering by media and politicians, there were approximately zero reported instances of opioids showing up in candy this Halloween, reports The Appeal. Consider this a regular a reminder that the press needs to do a better job factchecking drug-panic narratives.
   
• A new Texas law mandating wealth-based detention for certain felonies in contributing to a record number of deaths in the Harris County jail, reports Houston Public Media in a story that quotes AV grantee Texas Jail Project.

Health Care

• A new piece from Washington Monthly makes a strong case for focusing efforts to rein in health care costs on hospitals.
   
• Private equity has been moving aggressively into health care for the last decade. What does that mean for patients? Kaiser Health News explains in a new video.
   
• Kaiser Health News explores in its ongoing Diagnosis Debt  series how Knoxville's Black community has endured deeply rooted racism. And now, medical debt.
   
• A damning report released by the North Carolina State Employee Health Plan undercuts a common refrain the hospital industry uses to justify the higher prices: It must charge the privately insured more to make up for losses in Medicare. The North Carolina report found the majority of more than 100 hospitals made money off of Medicare between 2015 and 2020. The situation in North Carolina is a microcosm for hospital behavior around the nation. Nonprofit hospitals get billions in tax breaks to provide community benefits and then charge privately insured patients excessively high prices for care.

Higher Education
 

• NPR explains the recent updates to the Public Service Loan Forgiveness program (PSLF), which make it simpler for borrowers to file.
  
   

Contraceptive Choice and Access

• The Conversation connects the role of pharmacists to reproductive health care, as over-the-counter birth control makes its way through the FDA application process.
   
• The Kaiser Family Foundation released two publications from the 2022 Women’s Health Survey: “Contraception in the United States” report, and a brief highlighting interest and support of over-the-counter oral contraceptive pills. 
   

Democracy

• In the Washington Post, David Montgomery proposes ranked-choice voting as one of the ways to save American from extremism. (free link)
   
• Katherine Gehl points out the strengths of final four voting in the Chicago Tribune. "According to Unite America, so far only 8% of eligible voters this year 'cast ballots in primaries that effectively decided 84.8% of Congress.'"
   
• Congressman Dan Crenshaw (R-TX) interviewed Nick Troiano, executive director of Unite America, on his podcast "Hold These Truths" about ranked choice voting as a way to better reflect the electorate. Says Crenshaw: “I’m utterly convinced it makes more sense in a primary election.”

Evidence-Based Policy

• The Urban Institute recently published a series of resources on conducting rigorous evaluations in child welfare, including  Ten Key Design Elements for Rigorous Impact Evaluations in Child Welfare: A Desk Reference for Evaluators and A Guide to Writing High-Quality Evaluation Reports in Child Welfare. These two resources make reference to Social Programs that Work, which seeks to share programs that have been found in RCTs to produce sizable positive impacts on participants.

Journalism

• As commercial journalism falters, independent, nonprofit news is having a moment. The model "works more readily and in more places than it used to," Nieman Lab reports.
  
  Related: The pace of nonprofit startups has been rising at a steady clip, filling in gaps left behind by legacy newspapers.
   
• Newsrooms have been criticized for their "horse race" coverage of elections — many nonprofit nonpartisan news outlets are rethinking this playbook and focusing instead on providing information that is most helpful to voters.

The “Our Voice” podcast goes on the road to the nation’s capital, Washington, D.C. for its latest episode. Special guest host and AV grantee Sheena Meade, executive director of Clean Slate Initiative, welcomes Holly Harris, board member at the Justice Action Network. Watch as these two influential criminal justice reform leaders address a question fundamental to ending America’s mass incarceration problem, "What is justice on the federal level?"
 

On CNN this week, Jake Tapper examined the disconnect between the perception of rising crime and the reality, and how this divide has only grown during the 2022 midterms.
 

Last Week Tonight With John Oliver aimed its usual scrutinous snark at the broken cash bail status quo, explaining how wealth-based detention does little to secure safety while life-shattering decisions of freedom and detention are made in a matter of minutes, often without defense counsel present. “I don’t know exactly how long it should take to put a price on someone’s freedom, but it probably shouldn’t fit neatly into an Instagram story." Oliver also points to research supported by Arnold Ventures that found that largely eliminating cash bail in Harris County misdemeanor courts actually resulted in a decline in recidivism rates. Also, make sure to watch for clips of the cringeworthy ads produced by the for-profit cash bail industry.

On Wednesday, Nov. 9, at 1 p.m. E.T., the Council of State Governments (CSG) Justice Center, Arnold Ventures, and the Institute for Municipal and Regional Policy (IMRP) at the University of Connecticut are hosting a webinar: "Reducing Racial Bias in Traffic Stops Outreach." Learn from experts about how states can use funds available through the Bipartisan Infrastructure Law to implement policy changes to help reduce racial profiling. Register here.

On Wednesday, Nov. 16, AV grantee Power to Decide is hosting a Twitter Storm for #ThxBirthControl Day. To participate, use the #ThxBirthControl hashtag between 2 to 3 p.m. ET on Wednesday, Nov. 16. This date was originally two days before the FDA's scheduled (now postponed) hearing for over-the-counter birth control. Learn more here.

• Nature is for everyone, Outdoor Afro founder Rue Mapp states in her new manifesto "Nature Swagger," which connects Black joy and the outdoors.
   
• Some procrastinating monarch butterflies are getting a travel assist from FedEx.
   
• If you're like us, you have a sad looking jack-o-lantern wilting on your porch. Instead of tossing it in the bin this year, compost it, make a bird feeder, or give a gift to a hungry pig.
   
• Four years ago, they changed the face of the Texas judiciary. Now, four years later, ELLE magazine gathered the "Sister Judges" — 14 of whom are up for reelection. Can they do it again this November? 

The Provider Payment Incentives team, on behalf of AV grantee the Center for Health Care Strategies and in partnership with The Commonwealth Fund, is requesting applications for a new opportunity for up to five Medicaid agencies to design and implement a new primary care population-based payment (PBP) model or to improve an existing one. Medicaid Primary Care Population-Based Payments Learning Collaborative is an 18-month program open to Medicaid agencies in all states, commonwealths and territories. States participating in the collaborative will also incorporate approaches to advance health equity within their models. Applications are due Nov. 10, 2022. Details and application materials are here.

The Higher Education and Evidence-Based Policy teams have created a request for proposals for rigorous impact evaluations of programs and practices (“interventions”) to promote college success in the United States. Learn more about the RFP here.

The Criminal Justice and Evidence-Based Policy teams at Arnold Ventures are teaming up to learn more about what works in criminal justice reform in an ongoing request for proposals for randomized controlled trials (RCTs) that will test programs and practices. There is no deadline for submissions.

The Evidence-Based Policy team invites grant applications to conduct randomized controlled trials (RCTs) of social programs in any area of U.S. policy. Details are here.

View our RFPs here.