By Katheryn Houghton and Arielle Zionts, KFF Health News (TNS) Tescha Hawley learned that hospital bills from her son’s birth had been sent to debt collectors only when she checked her credit score while attending a home-buying class. The new mom’s plans to buy a house stalled. Hawley said she didn’t owe those thousands of dollars in debts. The federal government did. Hawley, a citizen of the Gros Ventre Tribe, lives on the Fort Belknap Indian Reservation in Montana. The Indian Health Service is a federal agency that provides free health care to Native Americans, but its services are limited by a chronic shortage of funding and staff. Hawley’s local Indian Health Service hospital wasn’t equipped to deliver babies. But she said staff there agreed that the agency would pay for her care at a privately owned hospital more than an hour away. That arrangement came through the Purchased/Referred Care program, which pays for services Native Americans can’t get through an agency-funded clinic or hospital. Federal law stresses that patients approved for the program aren’t responsible for any of the costs. But tribal leaders, health officials, and a new federal report say patients are routinely billed anyway as a result of backlogs or mistakes from the Indian Health Service, financial middlemen, hospitals, and clinics. The financial consequences for patients can last years. Those sent to collections can face damaged credit scores, which can prevent them from securing loans or require them to pay higher interest rates. The December report , by the federal Consumer Financial Protection Bureau, found these long-standing problems contribute to people in Native American-majority communities being nearly twice as likely to have medical debt in collections compared with the national average. And their amount of medical debt is significantly higher. The report found the program is often late to pay bills. In some cases, hospitals or collection agencies hound tribal citizens for more money after bills are paid. Hawley’s son was born in 2003. She had to wait another year to buy a home, as she struggled to pay off the debt. It took seven years for it to drop from her credit report. “I don’t think a person ever recovers from debt,” Hawley said. Hawley, a cancer survivor, still must navigate the referral program. In 2024 alone, she received two notices from clinics about overdue bills. Frank White Clay, chairman of the Crow Tribe in Montana, testified about the impact of wrongful billing during a U.S. House committee hearing in April. He shared stories of veterans rejected for home loans, elders whose Social Security benefits were reduced, and students denied college loans and federal aid. “Some of the most vulnerable people are being harassed daily by debt collectors,” White Clay said. No one is immune from the risk. A high-ranking Indian Health Service official learned during her job’s background check that her credit report contained referred-care debt, the federal report found. Native Americans face disproportionately high rates of poverty and disease , which researchers link to limited access to health care and the ongoing impact of racist federal policies . White Clay is among many who say problems with the referred-care program are an example of the U.S. government violating treaties that promised to provide for the health and welfare of tribes in return for their land. The chairman’s testimony came during a hearing on the Purchased and Referred Care Improvement Act, which would require the Indian Health Service to create a reimbursement process for patients who were wrongfully billed. Committee members approved the bill in November and sent it for consideration by the full House. A second federal bill, the Protecting Native Americans’ Credit Act , would prevent debt like Hawley’s from affecting patients’ credit scores. The bipartisan bill hadn’t had a hearing by mid-December. The exact number of people wrongfully billed isn’t clear, but the Indian Health Service has acknowledged it has work to do. The agency is developing a dashboard to help workers track referrals and to speed up bill processing, spokesperson Brendan White said. It’s also trying to hire more referred-care staff, to address vacancy rates of more than 30%. Officials say problems with the program also stem from outside health providers that don’t follow the rules. Melanie Egorin, an assistant secretary at the U.S. Department of Health and Human Services, said at the hearing that the proposed legislation doesn’t include consequences for “bad actors” — health facilities that repeatedly bill patients when they shouldn’t. “The lack of enforcement is definitely a challenge,” she said. But tribal leaders warned that penalties could backfire. Related Articles Health | How America lost control of the bird flu, setting the stage for another pandemic Health | How to kick back, relax and embrace a less-than-perfect holiday Health | New childhood leukemia protocol is ‘tremendous win’ Health | For some FSA dollars, it’s use it or lose it at year’s end Health | Norovirus is rampant. Blame oysters, cruise ships and holiday travel White Clay told lawmakers that some clinics already refuse to see patients if the Indian Health Service hasn’t paid for their previous appointments. He’s worried the threat of penalties would lead to more refusals. If that happens, White Clay said, Crow tribal members who already travel hours to access specialty treatment would have to go even farther. The Consumer Financial Protection Bureau report found clinics are already refusing to see any referred-care patients due to the program’s payment problems. The bureau and the Indian Health Service also recently published a letter urging health care providers and debt collectors not to hold patients accountable for program-approved care. White, the Indian Health Service spokesperson, said the agency recently updated the referred-care forms sent to outside hospitals and clinics to include billing instructions and to stress that patients aren’t liable for any out-of-pocket costs. And he said the staff can help patients get reimbursed if they have already paid for services that were supposed to be covered. Joe Bryant, an Indian Health Service official who oversees efforts to improve the referral program, said patients can ask credit bureaus to remove debt from their reports if the agency should have covered their bills. Leaders with the Confederated Tribes of the Colville Reservation in Washington state helped shape the proposed legislation after their citizens were repeatedly harmed by wrongful billing. Tribal Chairman Jarred-Michael Erickson said problems began in 2017, when a regional Indian Health Service office took over the referred-care program from local staff. It “created a domino effect of negative outcomes,” Erickson wrote in a letter to Congress. He said some tribal members whose finances were damaged stopped using the Indian Health Service. Others avoided health care altogether. Responsibility for the Colville Reservation program transferred back to local staff in 2022. Staffers found the billing process hadn’t been completed for thousands of cases, worth an estimated $24 million in medical care, Erickson told lawmakers . Workers are making progress on the backlog and they have explained the rules to outside hospitals and clinics, Erickson said. But he said there are still cases of wrongful billing, such as a tribal member who was sent to collections after receiving a $17,000 bill for chemotherapy that the agency was supposed to pay for. Erickson said the tribe is in the process of taking over its health care facilities instead of having the Indian Health Service run them. He and others who work in Native American health said tribally managed units — which are still funded by the federal agency — tend to have fewer problems with their referred-care programs. For example, they have more oversight over staff and flexibility to create their own payment tracking systems. But some Native Americans oppose tribal management because they feel it releases the federal government from its obligations. Beyond wrongful billing, access to the referred-care program is limited because of underfunding from Congress. The $1 billion budget this year is $9 billion short of the need, according to a committee report by tribal health and government leaders. Donald Warne, a physician and member of the Oglala Sioux Tribe in South Dakota, called the proposed legislation a “band-aid.” He said the ultimate solution is for Congress to fully fund the Indian Health Service, which would reduce the need for the referred-care program. Back in Montana, Hawley said she braces for a fight each time she gets a bill that the referral program was supposed to cover. “I’ve learned not to trust the process,” Hawley said. ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.Courtesy of De Beers Group | View & Download NEW YORK , Dec. 20, 2024 /PRNewswire/ -- About the Forever Present Campaign De Beers Group launches a new marketing campaign, 'Forever Present,' for the holiday gifting season in the U.S. Highlighting a diverse array of gifting opportunities for natural diamonds this holiday season, the campaign celebrates familial, friendship and romantic relationships under the premise that 'natural connections deserve natural diamonds,' making them the ideal choice for celebrating special moments with special people. The campaign reinforces the notion that natural diamonds are a store of emotional value that enable precious memories to remain 'forever present.' The campaign features diverse real-life couples, illustrating unforgettable moments and key milestones worth celebrating with the most special people in our lives, bringing the true essence of their relationships to life on screen. 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SEOUL, South Korea (AP) — A South Korean legislative push to impeach President Yoon Suk Yeol over his short-lived imposition of martial law fell through on Saturday after most lawmakers from his conservative governing party boycotted the vote. The defeat of the motion is expected to intensify public protests calling for Yoon’s ouster and deepen political chaos in South Korea, with a survey suggesting a majority of South Koreans support the president’s impeachment. Yoon’s martial law declaration drew criticism from his own ruling conservative party, but it is also determined to oppose Yoon’s impeachment apparently because it fears losing the presidency to liberals. Impeaching Yoon required support from two-thirds of the National Assembly, or 200 of its 300 members. The opposition parties who brought the impeachment motion had 192 seats, but only three lawmakers from PPP participated in the vote. The motion was scrapped without ballot counting because the number of votes didn’t reach 200. National Assembly Speaker Woo Won Shik called the result “very regrettable” and an embarrassing moment for the country’s democracy that has been closely watched by the world. “The failure to hold a qualified vote on this matter means we were not even able to exercise the democratic procedure of deciding on a critical national issue,” he said. Opposition parties could submit a new impeachment motion after a new parliamentary session opens next Wednesday. There are worries that Yoon won’t be able to serve out his remaining 2 1⁄2 years in office because his leadership took a huge hit. Many experts say some ruling party lawmakers could eventually join opposition parties’ efforts to impeach Yoon if public demands for it grow further. If Yoon is impeached, his powers will be suspended until the Constitutional Court decides whether to remove him from office. If he is removed, an election to replace him must take place within 60 days. Woo repeatedly urged ruling party members to return to the chamber to participate in the vote, waiting several hours for them to come. At one point, Democratic Party leaders visited a hall on the floor below the main chamber where PPP lawmakers were gathered, attempting to persuade them to vote. After being blocked from entering, they angrily accused the conservatives’ leadership of preventing its lawmakers from voting freely. Earlier Saturday, Yoon issued a public apology over the martial law decree, saying he won’t shirk legal or political responsibility for the declaration and promising not to make another attempt to impose martial law. He said would leave it to his party to chart a course through the country’s political turmoil, “including matters related to my term in office.” “The declaration of this martial law was made out of my desperation. But in the course of its implementation, it caused anxiety and inconveniences to the public. I feel very sorry over that and truly apologize to the people who must have been shocked a lot,” Yoon said. Since taking office in 2022, Yoon has struggled to push his agenda through an opposition-controlled parliament and grappled with low approval ratings amid scandals involving himself and his wife. In his martial law announcement on Tuesday night, Yoon called parliament a “den of criminals” bogging down state affairs and vowed to eliminate “shameless North Korea followers and anti-state forces.” The turmoil resulting from Yoon’s bizarre and poorly-thought-out stunt has paralyzed South Korean politics and sparked alarm among key diplomatic partners like the U.S. and Japan. Tuesday night saw special forces troops encircling the parliament building and army helicopters hovering over it, but the military withdrew after the National Assembly unanimously voted to overturn the decree, forcing Yoon to lift it before daybreak Wednesday. The declaration of martial law was the first of its kind in more than 40 years in South Korea. Eighteen lawmakers from the ruling party voted to reject Yoon’s martial law decree along with opposition lawmakers. Yoon’s speech fueled speculation that he and his party may push for a constitutional amendment to shorten his term, instead of accepting impeachment, as a way to ease public anger over the marital law and facilitate Yoon’s early exit from office. Lee Jae-myung, the leader of the main liberal opposition Democratic Party, told reporters that Yoon’s speech was “greatly disappointing” and that the only way forward is his immediate resignation or impeachment. His party called Yoon’s martial law “unconstitutional, illegal rebellion or coup.” The passage of Yoon’s impeachment motion appeared more likely Friday when the chair of Yoon’s party called for his removal on Friday, but the party remained formally opposed to impeachment. On Saturday, tens of thousands of people densely packed several blocks of roads leading up to the National Assembly, waving banners, shouting slogans and dancing and singing along to K-pop songs with lyrics changed to call for Yoon’s ouster. Protesters also gathered in front of PPP’s headquarters near the Assembly, angrily shouting for its lawmakers to vote to impeach Yoon. A smaller crowd of Yoon’s supporters, which still seemed to be in the thousands, rallied in separate streets in Seoul, decrying the impeachment attempt they saw as unconstitutional. Lawmakers on Saturday first voted on a bill appointing a special prosecutor to investigate stock price manipulation allegations surrounding Yoon’s wife. Some lawmakers from Yoon’s party were seen leaving the hall after that vote, triggering angry shouts from opposition lawmakers. On Friday, PPP chair Han Dong-hun, who criticized Yoon’s martial law declaration, said he had received intelligence that during the brief period of martial law Yoon ordered the country’s defense counterintelligence commander to arrest and detain unspecified key politicians based on accusations of “anti-state activities.” Hong Jang-won, first deputy director of South Korea’s National Intelligence Service, told lawmakers in a closed-door briefing Friday that Yoon had ordered him to help the defense counterintelligence unit to detain key politicians. The targeted politicians included Han, Lee and Woo, according to Kim Byung-kee, one of the lawmakers who attended the meeting. The Defense Ministry said Friday it suspended three military commanders including the head of the defense counterintelligence unit over their involvement in enforcing martial law. Vice Defense Minister Kim Seon Ho has told parliament that Defense Minister Kim Yong Hyun ordered the deployment of troops to the National Assembly after Yoon imposed martial law. Opposition parties accused Kim of recommending to Yoon to enforce martial law. Kim resigned Thursday, and prosecutors imposed an overseas travel ban on him.Excerpts from Manmohan Singh’s 1991 budget address: The problem, the path and the pain...
The interior of Notre Dame Cathedral is seen before France’s iconic cathedral is formally reopening its doors for the first time since a devastating fire ( Ludovic Marin, Pool via AP) Howling winds could not stop Notre Dame’s heart from beating again. With three resounding knocks on its doors by Paris Archbishop Laurent Ulrich, wielding a staff carved from fire-scorched beams, the cathedral roared back to life on Saturday evening. For the first time since a devastating 2019 blaze, the towering Gothic masterpiece reopened for worship, its rebirth marked by song, prayer, and awe beneath its soaring arches. While the ceremony was initially planned to begin on the forecourt, unusually fierce December winds whipping across the central Paris island, flanked by the River Seine, forced all events inside. Yet the occasion lost none of its splendour. Inside the luminous nave, choirs are singing psalms, and the cathedral’s mighty organ, silent for nearly five years, is thundering to life in a triumphant interplay of melodies. The evening’s celebration, being attended by 1,500 dignitaries, including President-elect Donald Trump, US First Lady Jill Biden, Britain’s Prince William, and Ukrainian President Volodymyr Zelensky, underscores Notre Dame’s enduring role as both a spiritual and cultural beacon. For President Emmanuel Macron, who championed the ambitious five-year restoration timeline, it was a rare moment of unity amid profound political crises and threats to his presidential legacy.
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