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Four days before Donald Trump’s inauguration, financial technology startup Ramp published a pitch for how to tackle wasteful government spending. In a 4,000-word blog post titled “The Efficiency Formula,” Ramp’s CEO and one of its investors echoed ideas similar to those promoted by Trump and his billionaire ally Elon Musk: Federal programs were overrun by fraud, and commonsense business techniques could provide a quick fix.

Ramp sells corporate credit cards and artificial intelligence software for businesses to analyze spending. And while the firm appears to have no existing federal contracts, the post implied the government should consider hiring it. Just as Ramp helped businesses manage their budgets, the company “could do the same for a variety of government agencies,” according to the blog and company social media posts.

It didn’t take long for Ramp to find a willing audience. Within Trump’s first three months in office, its executives scored at least four private meetings with the president’s appointees at the General Services Administration, which oversees major federal contracting. Some of the meetings were organized by the nation’s top procurement officer, Josh Gruenbaum, commissioner of the Federal Acquisition Service.

GSA is eying Ramp to get a piece of the government’s $700 billion internal expense card program, known as SmartPay. In recent weeks, Trump appointees at GSA have been moving quickly to tap Ramp for a charge card pilot program worth up to $25 million, sources told ProPublica, even as Musk’s Department of Government Efficiency highlights the multitudes of contracts it has canceled across federal agencies.

Founded six years ago, Ramp is backed by some of the most powerful figures in Silicon Valley. One is Peter Thiel, the billionaire venture capitalist who was one of Trump’s earliest supporters in the tech world and who spent millions aiding Vice President JD Vance’s Ohio Senate run. Thiel’s firm, Founders Fund, has invested in seven separate rounds of funding for Ramp, according to data from PitchBook. Last year Thiel said there was “no one better positioned” to build products at the intersection of AI and finance.

To date, the company has raised about $2 billion in venture capital, according to startup tracking website Crunchbase, much of it from firms with ties to Trump and Musk. Ramp’s other major financial backers include Keith Rabois of Khosla Ventures; Thrive Capital, founded by Joshua Kushner, the brother of Trump’s son-in-law Jared Kushner; and 8VC, a firm run by Musk allies.

The special attention Gruenbaum paid to Ramp raised flags inside and outside the agency. “This goes against all the normal contracting safeguards that are set up to prevent contracts from being awarded based on who you know,” said Scott Amey, the general counsel with the bipartisan Project on Government Oversight. He said career civil servants should lead the process to pick the best choice for taxpayers.

A senior GSA official, who requested anonymity for fear of retribution, said the high level attention Ramp received was unusual, especially before a bid had been made public. “You don’t want to give this impression that leadership has already decided the winner somehow.”

GSA told ProPublica it “refutes any suggestion of unfair or preferential contracting practices,” with a spokesperson adding that the “credit card reform initiative has been well known to the public in an effort to address waste, fraud, and abuse.”

Ramp did not respond to requests for comment.

Rabois, one of Ramp’s earliest investors, is part of an influential group of tech titans known as the “PayPal Mafia.” Leaders of the early payments company include several influential players surrounding the Trump administration, including Musk and Thiel. Rabois and his husband, Jacob Helberg, hosted a fundraiser that pulled in upwards of $1 million for Trump’s 2024 campaign, according to media reports. Trump has nominated Helberg for a senior role at the State Department.

Rabois sits on Ramp’s board of directors. He has said he had no plans to join the Trump administration, instead telling CNBC: “I have ideas, I can spoon-feed them to the right people.” He told ProPublica his comments to CNBC were about big-picture policy ideas and that he had “no involvement in any government-related initiatives for the company.” Ramp “could be a great choice for any government that wants to improve its efficiencies,” Rabois added.

Helberg said he has no involvement “in anything related to Ramp whatsoever.”

Thrive Capital, Kushner’s firm, did not respond to a request for comment. A spokesperson for Thiel did not provide a comment. 8VC did not respond to a request for comment, nor did the White House or Musk; previously, Musk has said “I’ll recuse myself” if conflict-of-interest issues arise.

Ramp’s meetings with Gruenbaum — who comes from private equity firm KKR and has no prior government experience — came at an opportune moment. GSA will decide by year’s end whether to extend the SmartPay contract, and preparations are afoot for the next generation of the program. SmartPay has been worth hundreds of millions of dollars in fees for the financial institutions that currently operate it, U.S. Bank and Citibank.

Gruenbaum and acting GSA administrator Stephen Ehikian entered the agency with a strong belief that SmartPay and other government payment programs were rife with fraud or waste, causing huge losses, sources within GSA say — an idea echoed in Ramp’s January memo.

Yet both GOP and Democratic budget experts, as well as former GSA officials, describe that view as ill-informed. SmartPay, which provides Visa and Mastercard charge cards to government employees, enables the federal workforce to purchase office supplies and equipment, book travel and pay for gas.

The cards typically are used to fund travel and purchases up to $10,000.

“SmartPay is the lifeblood of the government,” said former GSA commissioner Sonny Hashmi, who oversaw the program. “It’s a well-run program that solves real world problems … with exceptional levels of oversight and fraud prevention already baked in.”

Jessica Riedl, a GOP budget expert at the conservative Manhattan Institute think tank, said the notion that there was significant fraud in the charge card technology was far-fetched. She had criticized waste in government credit card programs before the latest SmartPay system was implemented in 2018.

“This was a huge problem about 20-25 years ago,” she said. “In the past 15 years, there have been new controls put into government credit card purchases.”

A 2017 audit of the program by the Government Accountability Office concluded there was “little evidence of potential fraud” in SmartPay small purchases, though it found documentation errors. More recent government audits found some instances where officials did not always use anti-fraud tools.

GSA’s new leaders are convinced SmartPay is entirely broken, a view they shared in private meetings, sources said. In February, they put a temporary $1 limit on government cards and severely restricted the number of cardholders, choking off funds to workers in the field.

Chaos ensued across the government, news organizations reported: Staff at the National Institutes of Health were reportedly unable to purchase materials for experiments, Federal Aviation Administration workers worried they would be unable to pay for travel to test systems in the field, and National Park Service employees could not travel to oversee road maintenance projects.

At the time, GSA released a statement saying the limitations were “risk mitigation best practice” and internally began moving to revamp SmartPay.

Ramp’s first bite of the SmartPay business could come through a pilot program worth up to $25 million that GSA announced several weeks after agency leadership began meeting with the company.

At the tail end of the Biden administration, GSA had sent out a request for information, or RFI, seeking industry input about how to improve the next iteration of SmartPay. But some industry players who submitted responses said they did not hear back from the government. Instead, GSA started meeting with Ramp.

GSA put out a new RFI for the pilot program on March 20, 2025, leaving it open for less than seven business days.

John Weiler, co-founder of the nonprofit research group the IT Acquisition Advisory Council, said such a short window appeared unusual. “A week is nothing, it gives the impression they had already picked the winner,” said Weiler, who has worked with Republican Sen. Chuck Grassley to investigate IT contracting issues.

Ramp is the clear-cut “favorite,” to secure this work, one source inside GSA and another former official told ProPublica. The winner has not yet been announced.

Procurement experts told ProPublica that consulting with industry leaders before a major overhaul is good practice — but that the fact-finding process must be evenhanded and led by professional contracting officers.

The GSA spokesperson said that “any and all communications with potential vendors, of which there were multiple, has been a part of market research in order to provide the best solution for American taxpayers.” The agency declined to answer questions about whether Ramp had already been chosen internally for SmartPay work.

The pilot program is unique because it uses a special GSA purchasing authority known as commercial solutions opening. This process has been used by the Pentagon to help speed up the acquisition of products for fighters in armed conflict zones. The designation means the chosen contractor can be selected faster and without the same level of controls.

It’s not clear how Ramp originally secured private meetings with GSA leaders. Nor is it clear if Ramp will ultimately take over the entire SmartPay contract from Citibank and U.S. Bank. Spokespeople for U.S. Bank and Citibank declined to comment.

It is clear that Ramp has never had a client like the federal government. The only public-sector partner listed on its webpage is a charter school network in Nashville, Tennessee.

Still, even before the RFI was publicly announced, Ramp had begun reaching out to contacts in the payment industry asking about the special bank identification numbers required to process government payments, said an industry source. Such steps, two former GSA officials said, were another sign that Ramp was preparing to work on the program.

Ramp’s meetings with GSA come as the agency is poised to take on a more significant role in spending decisions across government. The same day the SmartPay pilot was announced, Trump issued an executive order that seeks to centralize much of government procurement inside of GSA. The DOGE initiative has been effectively headquartered out of the agency — staffers have installed beds and dressers for overnight stays in the building, and Musk’s right-hand man Steve Davis is a key adviser to the agency’s leadership.

The SmartPay contract negotiation has so far flown under the radar. But changes to the credit card program could further transform daily life for federal employees and fundamentally change how agencies operate. It also represents a giant business opportunity.

“There’s a lot of money to be made by a new company coming in here,” said Hashmi, the former GSA official. “But you have to ask: What is the problem that’s being solved?”

Doris Burke contributed research.

This content originally appeared on ProPublica and was authored by by Christopher Bing and Avi Asher-Schapiro.

A West Papuan doctoral candidate has warned that indigenous noken-weaving practices back in her homeland are under threat with the world’s biggest deforestation project.

About 60 people turned up for the opening of her “Noken/Men: String Bags of the Muyu Tribe of Southern West Papua” exhibition by Veronika T Kanem at Auckland University today and were treated to traditional songs and dances by a group of West Papuan students from Auckland and Hamilton.

The three-month exhibition focuses on the noken — known as “men” — of the Muyu tribe from southern West Papua and their weaving cultural practices.

• READ MORE: Other West Papua noken reports

It is based on Kanem’s research, which explores the socio-cultural significance of the noken/men among the Muyu people, her father’s tribe.

“Indigenous communities in southern Papua are facing the world’s biggest deforestation project underway in West Papua as Indonesia looks to establish 2 million hectares  of sugarcane and palm oil plantations in the Papua region,” she said.

West Papua has the third-largest intact rainforest on earth and indigenous communities are being forced off their land by this project and by military.

The ancient traditions of noken-weaving are under threat.

Natural fibres, tree bark
Noken — called bilum in neighbouring Papua New Guinea — are finely woven or knotted string bags made from various natural fibres of plants and tree bark.

“Noken contains social and cultural significance for West Papuans because this string bag is often used in cultural ceremonies, bride wealth payments, child initiation into adulthood, and gifts,” Kanem said.

“This string bag has different names depending on the region, language and dialect of local tribes. For the Muyu — my father’s tribe — in Southern West Papua, they call it ‘men’.

In West Papua, noken symbolises a woman’s womb or a source of life because this string bag is often used to load tubers, garden harvests, piglets, and babies.

“My research examines the Muyu people’s connection to their land, forest, and noken weaving,” said Kanem.

“Muyu women harvest the genemo (Gnetum gnemon) tree’s inner fibres to make noken, and gift-giving noken is a way to establish and maintain relationships from the Muyu to their family members, relatives and outsiders.

“Drawing on the Melanesian and Indigenous research approaches, this research formed noken weaving as a methodology, a research method, and a metaphor based on the Muyu tribe’s knowledge and ways of doing things.”

Hosting pride
Welcoming the guests, Associate Professor Gordon Nanau, head of Pacific Studies, congratulated Kanem on the exhibition and said the university was proud to be hosting such excellent Melanesian research.

Professor Yvonne Underhill-Sem, Kanem’s primary supervisor, was also among the many speakers, including Kolokesa Māhina-Tuai of Lagi Maama, and Daren Kamali of Creative New

The exhibition provides insights into the refined artistry, craft and making of noken/men string bags, personal stories, and their functions.

An 11 minute documentary on the weaving process and examples of noken from Waropko, Upkim, Merauke, Asmat, Wamena, Nabire and Paniai was also screened, and a booklet is expected to be launched soon.

• The exhibition is at the Pacific Collaborative Space, L1, Herenga Matauranga Whanui, General Library Waipapa Taumata Rau, University of Auckland, until July 3.

This content originally appeared on Asia Pacific Report and was authored by APR editor.

Three weeks ago, federal education officials eliminated access to income-driven repayment (IDR) plans—student loan repayment options that give millions of people the right to make loan payments they can afford—by removing the application form from ED’s website and secretly ordering student loan servicers to halt all processing. In addition to providing millions of borrowers with the ability to tie their monthly payment to their income and family size, IDR plans are the only way for public service workers to benefit from PSLF—a critical lifeline for teachers, nurses, first responders, and millions of other public service workers across the country.

“By effectively freezing the nation’s student loan system, the new administration seems intent on making life harder for working people, including for millions of borrowers who have taken on student debt so they can go to college,” said AFT President Randi Weingarten. “The former president tried to fix the system for 45 million Americans, but the new president is breaking it again.

“The AFT has fought tirelessly to make college more affordable by limiting student debt for public service workers and countless others—progress that’s now in jeopardy because of this illegal and immoral decision to deny borrowers their rights under the law,” continued Weingarten. “Today, we’re suing to restore access to the statutory programs that are an anchor for so many, and that cannot be simply stripped away by executive fiat.”

The new lawsuit, AFT v. U.S. Department of Education, was filed in federal court in Washington, D.C. and seeks a court order to restore borrowers’ access to IDR and PSLF. The AFT is represented by the Student Borrower Protection Center (SBPC) and Berger Montague PC.

A copy of AFT’s complaint in AFT v. U.S. Department of Education is available here:

https://protectborrowers.org/aft-v-u-s-department-of-education-lawsuit-complaint/

A fact sheet outlining AFT’s case against the U.S. Department of Education is available here:

https://protectborrowers.org/aft-v-u-s-department-of-education-lawsuit-fact-sheet/

“Student loan borrowers are desperate for help, struggling to keep up with spiking monthly payments in a sinking economy, all while President Trump plays politics with the student loan system,” said Mike Pierce, SBPC Executive Director. “Borrowers have a legal right to payments they can afford and today we are demanding that these rights are enforced by a federal judge.”

“Congress required that the Department of Education offer IDR plans and provide borrowers access to these plans,” said E. Michelle Drake, Executive Shareholder at Berger Montague PC. “We look forward to restoring borrowers’ access to these vital, necessary, and required programs.”

Background

The Trump Administration’s decision to block access to affordable student loan payments diverges from the longtime bipartisan consensus around the importance of IDR. In 1992, 1993, and again in 2007, Congress passed bipartisan higher education legislation creating and then expanding access to IDR plans. The 2007 College Cost Reduction and Access Act, signed into law by President George W. Bush, created an IDR option that has never been challenged in court and is not affected by any of the right-wing lawfare that has jeopardized other aspects of the student loan safety net. This option, known as Income-Based Repayment, was nonetheless halted by the Trump Administration when it decided to remove all IDR applications from ED’s website and issue the illegal February 2025 stop-work order.

ED claims the decision to remove all IDR applications is responsive to the 8th Circuit’s February 18th decision in the appeal of the preliminary injunction in the case challenging the Saving on a Valuable Education repayment plan (the SAVE plan), one of the IDR plans. The order—which was issued in an appeal of the lower court’s preliminary injunction of the SAVE plan and which expanded that earlier injunction—blocks millions of student loan borrowers from accessing lower monthly payments and cancellation under only the SAVE plan. However, ED’s choice to interpret the 8th Circuit’s decision in such a maximalist way has wreaked havoc on millions of borrowers and their families who are in desperate need of affordable monthly payments.

Prior to the Trump Administration’s decision to remove IDR applications and halt application processing, more than 1 million borrowers remained in a backlog waiting for their application to be processed. The Department has not provided any guidance to borrowers as to when applications will be restored and when borrowers can expect to see their payments lowered.

This content originally appeared on Common Dreams and was authored by Newswire Editor.

The warning signs are unmistakable. Despite the Federal Reserve’s aggressive rate-hiking campaign over the past two years, inflation remains stubbornly above target. February’s Consumer Price Index showed prices still rising at 3.2%, while previous months have delivered unwelcome upside surprises. Meanwhile, GDP growth has begun to sputter, at just 1.6% in the first quarter, down sharply from 3.4% in late 2023.

Even more alarming, the Atlanta Federal Reserve’s closely watched GDPNow forecast model has recently slashed its second-quarter growth projection. When the Fed’s regional banks signal economic deceleration while inflation persists, the stagflation alarm bells should be ringing loudly.

This toxic combination represents the classic stagflation recipe: prices rise faster than paychecks while economic momentum simultaneously loses steam. Conventional economic models struggle to address this scenario, as policies that fight inflation typically hamper growth, while growth-boosting measures often exacerbate inflation.

Stagflation is particularly pernicious because it confounds traditional economic remedies. When inflation and unemployment rise simultaneously, policymakers face an impossible choice between fighting one problem while exacerbating the other.

The warning signals extend beyond inflation and growth statistics. Federal agencies have begun implementing hiring freezes and initiating workforce reductions as budget pressures mount. The Bureau of Labor Statistics reported that federal government employment declined by 5,000 jobs in January alone, with more cuts potentially looming. These job losses contribute to economic stagnation without addressing the underlying inflation problem.

Meanwhile, fiscal austerity measures designed to address budget deficits have reduced government spending across multiple agencies. While necessary for long-term fiscal health, these spending cuts remove economic stimulus precisely when private sector growth is already slowing, amplifying stagflationary pressures.

Perhaps most concerning for millions of Americans is the resumption of student loan payments after a three-year pandemic pause. With average monthly payments of $200-$300, the Department of Education estimates that borrowers collectively face over $7 billion in monthly payments—essentially a massive consumer spending tax that dampens economic activity without addressing supply-side inflation drivers. For many households, these payments come on top of significantly higher housing costs, energy bills, and grocery expenses.

Labor markets offer another concerning indicator. Despite headlines touting low unemployment, job growth has slowed considerably. In contrast, wage growth hasn’t kept pace with inflation in many sectors. Companies are increasingly caught in a vise between rising costs and consumers unable or unwilling to absorb higher prices.

The roots of our current predicament are not hard to identify. Years of extraordinary monetary accommodation followed by trillions in pandemic stimulus created excess liquidity. Supply chain disruptions, geopolitical tensions, and energy price volatility fueled the fire. We’re left with an economy where growth is cooling, but prices refuse to follow suit.

For investors, the stagflation playbook requires a dramatic departure from conventional wisdom. The investment landscape of the next several years will reward those willing to adapt and punish those clinging to outdated strategies.

First and foremost, commodities deserve a prominent place in any stagflation-resistant portfolio. During the 1970s stagflation, the S&P GSCI commodity index delivered a staggering 586% return over the decade. Gold performed even more spectacularly, rocketing from about $269 per ounce in 1970 to over $2,500 by 1980.

Why do commodities shine in stagflationary environments? They represent tangible assets with intrinsic value that tend to rise with inflation. Hard assets become monetary safe havens when currencies weaken through policy interventions or economic uncertainty.

Treasury Inflation-Protected Securities (TIPS) also merit serious consideration. Unlike conventional bonds, which suffered brutal losses during the 1970s with approximately negative 3% annualized actual returns, TIPS adjust their principal value based on the Consumer Price Index. This built-in inflation protection can preserve purchasing power when conventional fixed-income investments crumble.

Investors should pivot decisively toward defensive sectors within equities—consumer staples, healthcare, and utilities. These industries provide essential goods and services people need regardless of economic conditions, and many possess the pricing power to pass inflation through to consumers. During past stagflationary episodes, U.S. consumer staples delivered average quarterly returns of +7.9%, while consumer discretionary stocks declined by 1.3%.

The dangers of stagflation extend far beyond investment portfolios. The most insidious aspect of stagflation is how it methodically erodes societal living standards. When prices rise faster than wages for extended periods, everyday purchases become increasingly painful. Essentials consume a growing share of household budgets, leaving less for discretionary spending, savings, or investments in the future.

The psychological toll shouldn’t be underestimated either. During the 1970s stagflation, consumer confidence plummeted to record lows as Americans believed economic malaise was permanent. This pessimism affected everything from marriage rates to entrepreneurship, creating a downward spiral of reduced risk-taking and investment precisely when the economy needed it most.

Stagflation particularly punishes those on fixed incomes especially retirees whose pension or Social Security benefits fail to keep pace with true living costs. It also penalizes savers, and those with traditional fixed-income investments, who watch their purchasing power diminish monthly.

For younger Americans already grappling with housing affordability challenges and now facing resumed student loan payments, stagflation compounds financial stress. Many millennials and Gen Z workers entered a labor market already characterized by stagnant real wages; persistent inflation threatens to erase what little progress they’ve made.

Businesses suffer, too, caught between rising input costs and price-sensitive consumers. Profit margins contract, leading to reduced hiring, investment cuts, and, in many cases, layoffs. Small businesses with less pricing power and financial cushion are particularly vulnerable, potentially leading to increased market concentration as only the largest firms survive.

Stagflation will eventually end through successful policy intervention or economic adjustment, but the transition may prove lengthy and painful. The 1970s stagflation persisted for nearly a decade before Paul Volcker’s Federal Reserve crushed inflation, with interest rates approaching 20%.

Today’s policymakers face a similar dilemma, but even higher debt levels constrain their options. The Fed has signaled reluctance to cut rates while inflation remains elevated, yet maintaining restrictive policy risks further dampening growth—the very definition of our stagflationary trap.

Preparation means building financial resilience for individuals: reducing high-interest debt, maintaining emergency savings, and seeking opportunities to increase skills and income potential. Homeowners with fixed-rate mortgages benefit from what amounts to an inflation discount on their housing debt, while renters may need to budget more aggressively as housing costs continue climbing.

Though difficult, stagflation is ultimately a surmountable challenge. Following the 1970s ordeal, America entered a period of extraordinary growth and prosperity. The pain of adjustment, while real, eventually gave way to renewed economic vitality. The same can happen again if we make the difficult choices necessary to restore price stability while fostering sustainable growth.

The stagflation monster may be back, but America has faced and overcome economic challenges throughout its history. By understanding the nature of the threat and taking appropriate actions both as individuals and as a society, maybe we can weather this economic storm and emerge stronger on the other side. The alternative of ignoring the warning signs until a crisis forces our hand will only prolong the pain and deepen the eventual reckoning. The time for clear-eyed assessment and deliberate action is now.

Whilst observing the questionable economic decisions of our elected officials, it seems that no one will bury stagflation back in the graveyard.

This content originally appeared on Dissident Voice and was authored by Elliott Lipinsky.

• Nov. 21, 2024: The CFPB finalizes a rule enabling the agency to proactively supervise digital payment apps
• Nov. 27, 2024: Musk tweets “Delete CFPB”
• Jan. 28, 2025: X CEO announces that X Money will debut with a partnership with Visa
• Feb. 7, 2025: Musk’s DOGE staffers enter the CFPB and kick off an effort to shut it down
• March 5, 2025: The Senate is set to vote on legislation to revoke the CFPB’s digital payments rule

Every step of the way, Musk has gotten closer to launching X Money without a watchdog to ensure that the platform adheres to federal rules mandating data security standards, disputes for fraudulent payments, consumer protections against debanking and more. Demand Progress has been a strong supporter of the CFPB’s efforts to supervise digital payment platforms.

The following is a statement from Emily Peterson-Cassin, corporate power director at Demand Progress:

“Elon Musk wants to cripple consumer protections for digital payment apps and the U.S. Senate is doing his bidding. Not only does Musk want X, a platform swarming with bots and crypto scams, to be able to reach into your bank account, he also wants to defang and ‘delete’ the agency responsible for ensuring that X Money follows federal standards for data security and fradulent payment disputes. Senators must side with American consumers, and not online scammers, by voting ‘NO’ on this dangerous bill.”

This content originally appeared on Common Dreams and was authored by Newswire Editor.

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It is one of the enduring myths of the U.S. child support system: that payments made by fathers actually make it to their families. And yet, every year, hundreds of millions of dollars in child support is instead intercepted by federal and state governments — as reimbursement for the mother having received welfare at some point.

But that may be changing. Since a 2021 ProPublica investigation found that child support payments totaling $1.7 billion annually were taken from families and redirected into state coffers, at least six states have rewritten their laws and policies to allow the money to flow directly to kids.

New Mexico, where we focused our reporting, made such a change shortly after our story was published. From Wyoming to Illinois, Michigan to Vermont to California, more child support is now going to children. And several other states are considering similar reforms during their upcoming legislative sessions.

This July, Illinois will start “passing through” all child support paid by fathers to their families, instead of pocketing it as repayment for welfare. “The intent of this change is for more families to receive more support,” said Jamie Munks, spokesperson for the Illinois Department of Healthcare and Family Services. A state’s child support system should not be funded by withholding child support from the lowest-income families being served, she said.

“Not passing through money to a family who is already experiencing financial difficulties will likely exacerbate those difficulties and may make them more reliant on government assistance,” Munks added.

Nicole Darracq, assistant director at the California Department of Child Support Services, said that under a new state law her agency has roughly doubled the amount of child support that it is passing through to families currently receiving welfare. There was roughly a $44 million net increase in payments to families from 2019 to 2022, she said.

Darracq added that starting this week, another piece of new state legislation will allow child support that fathers pay to mothers who’ve previously received welfare to go to those moms and their kids, instead of being intercepted. This change will send an additional $160 million to families each year, she said.

According to the National Conference of State Legislatures’ most recent analysis of state laws, at least 26 states and Washington, D.C., pass through some or all child support payments made by fathers to their families that have received welfare, also known as Temporary Assistance for Needy Families. In the other states, the government takes the cash.

The practice of confiscating child support from poor families persists in part because some conservative policymakers believe that welfare provided to single mothers should be considered a loan from taxpayers, to later be repaid by the patriarch of the family.

“Legislators suggest to me that if a family gets both [welfare] and child support, they’re ‘double-dipping,’” Jim Fleming, past president of both the National Council of Child Support Directors and the National Child Support Enforcement Association, told ProPublica in 2021. “That argument is still out there,” he said, although it is “becoming more and more of a minority view.”

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This content originally appeared on Articles and Investigations - ProPublica and was authored by by Eli Hager.

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When Noelle Geraci lost her job at a private investment firm this year, she did everything she could to protect her most important asset: the house she owns with her mother in a Las Vegas suburb.

That same day she started applying for work and signed up for unemployment benefits. Then she called her mortgage company, Flagstar Bank, to see if it would reduce or pause her payments until she found another job. The bank recommended she apply to the Nevada Homeowner Assistance Fund, a pandemic-era program to help the unemployed with their mortgage payments.

Geraci and her mother, Shirley, who had co-signed the loan for the 2,300-square-foot stucco house in 2011, were reluctant to ask for help. Under Nevada’s program rules, the assistance is paid as a loan that’s forgiven after three years if the homeowner stays in their house.

They were also unsettled that the program required a three-year lien in exchange for the assistance. The lien was meant to ensure that the program would be reimbursed if they tried to sell the house or take out equity within three years, but it also could deprive them of flexibility in tough financial times.

But with Shirley Geraci retired, her daughter job hunting in a city with one of the highest unemployment rates in the nation and interest rates too high to make a loan modification work, they decided to apply. They qualified for up to a year’s worth of mortgage payments. The small nonprofit that runs the program in Nevada would make the monthly payments for them. It felt as if an unbearable weight was lifted.

Then a foreclosure notice arrived in the mail. The money that was supposed to flow from the U.S. Treasury, through Nevada’s assistance program and to their bank hadn’t reached Flagstar. And Noelle Geraci couldn’t get anyone to explain what was going on.

“It’s a complete nightmare,” she said. “My mom is a senior. Me losing my job has impacted us in a severe way. The one and only thing we have is our home. Everything we have is about to be gone.”

To distribute its share of the federal money, the state had chosen the Nevada Affordable Housing Assistance Corporation, a small nonprofit with a troubled history of administering federal assistance.

To keep their home, the Geracis were relying on NAHAC to deliver money to their mortgage servicer on time each month. But the bureaucratic chain connecting the Treasury, state agencies and banks can create delays. They soon learned that when payments are late, homeowners bear the risks.

Nevada’s isn’t the only program plagued by issues. This year, The Wall Street Journal detailed problems in multiple states similar to those the Geracis would face. In Pennsylvania, those seeking help used the same word as Noelle Geraci to describe the program: nightmare.

After the Geracis were approved for up to a year’s worth of assistance in May, NAHAC told them to stop paying their mortgage because the program would do it for them.

The foreclosure notice came in July: “Flagstar Bank is hereby notifying you that your above described loan is in default because the required payments have not been made,” the letter read.

Shirley Geraci panicked.

“I don’t want to lose my house,” she told ProPublica soon after the notice arrived. “I don’t want to end up in an apartment and lose everything we built.”

“It’s our investment,” she added. Eventually it will be her daughter’s if “life plays out the way it is supposed to.”

The foreclosure warning spurred a round of phone calls that elicited conflicting information from her bank and NAHAC. A NAHAC representative told Noelle Geraci not to worry about the notice, but the bank said if the family didn’t pay the arrears the foreclosure would proceed.

When Geraci told NAHAC that “the foreclosure is real; the clock is ticking,” the nonprofit was unable to tell her when or how much it had paid Flagstar and why the payment hadn’t yet been applied to her account, she said. And it wouldn’t provide anything in writing.

Shortly after a ProPublica reporter called the bank, a Flagstar representative contacted Geraci to assure her she wouldn’t be foreclosed on but, like NAHAC, told her it couldn’t provide that assurance in writing. A few days later, the bank called Geraci to say it had received payments for May and June, but the amounts were less than required. She also was told that if the bank didn’t soon receive payments for July and August, she would likely receive another foreclosure notice. In August, a letter informed her that she was again behind on payments.

“I don’t have any certainty,” Geraci said.

A Flagstar spokesperson said in a statement to ProPublica that despite the late and incorrect payments, the Geracis won’t face foreclosure. She said Flagstar will work directly with NAHAC to bring the mortgage current and will stay in contact with the Geracis.

Flagstar later confirmed it had received funds to bring the Geracis’ mortgage current.

“We would also like to clarify that no foreclosure was ever started on the loan, and that no negative credit reporting was made,” the spokesperson said.

The spokesperson said Flagstar is a “strong supporter” of the assistance program.

Verise Campbell is NAHAC’s chief executive officer. She was appointed in 2016 to improve the nonprofit after a federal audit found previous leadership had squandered federal aid to homeowners caught up in the 2008 foreclosure crisis.

Campbell said it isn’t unusual for the program to make late payments and for participants in the assistance fund to receive foreclosure notices. The program makes payments in bulk to banks on behalf of multiple clients, and there’s a lag between the bank receiving the money and applying it to individual accounts.

“It’s not just, ‘Oh, I got approved and then I get the money,’” Campbell said of the program. “There’s a whole machine behind all of this.”

NAHAC was supposed to make its first payment — covering May and June — to Flagstar on July 1. But Campbell said a staffing change caused the nonprofit’s late payments to banks in July. Flagstar didn’t receive the July 1 payment until July 28, two days after ProPublica contacted NAHAC about the Geracis’ situation.

The nonprofit also paid the wrong amount because the money needed to bring the loan current and the regular monthly payment amount had both changed between the time the Geracis were approved for the program and when the first payment was made, according to Campbell.

She said late payments and shortages are reconciled at the end of each month to keep individual mortgages current.

After ProPublica began asking questions about the Geraci case, Campbell had her staff reach out to Flagstar to speed up that reconciliation process. She said the bank assured NAHAC that it would not initiate foreclosure proceedings because of the late and inaccurate payments but that it was obligated to continue sending the notices to the Geracis. Federal consumer protection regulations require lenders to notify borrowers of delinquencies.

According to the most recent Treasury data, Nevada has been slow to enroll people and disburse the $120 million it was awarded for the program. At the end of the first quarter, it had distributed $17 million — less than 14% of its total award — ranking it 43rd among the states for getting money to homeowners.

As of Aug. 15, according to NAHAC’s data, Nevada had distributed an additional $12 million. And Campbell said the state is now on target to disburse all of its funds by Sept. 30, 2025, when the program comes to an end.

U.S. Sen. Catherine Cortez Masto, D-Nev., who the Geracis also reached out to for help, has been a proponent of NAHAC and worked to improve it when its earlier troubles came to light in 2016. Her spokesperson, Josh Marcus-Blank, declined to comment on the Geracis’ situation but said Cortez Masto continues to support the program.

“Senator Cortez Masto is focused on making sure Nevadans can stay in their homes, and she will continue working to make sure programs like NHAF are serving communities across the state by improving and streamlining their processes,” Marcus-Blank said.

Federal regulators have discouraged banks like Flagstar from foreclosing on homeowners who apply to or have been approved for the assistance program. In March, the Consumer Financial Protection Bureau promised “increased scrutiny” of mortgage servicers who foreclose on program participants. While the Geracis ultimately were not foreclosed on, neither states nor the federal government track whether foreclosures are occurring, said Stacey Tutt, a National Housing Law Project senior staff attorney who works with states to improve their program.

In some cases, federal regulators have erected guardrails to protect program participants from foreclosure prompted by delays in the program. Fannie Mae and Freddie Mac loan servicers are required to pause foreclosure proceedings against participants for 60 days, but when it comes to servicers of FHA-insured loans, that guidance is only a suggestion. And often the program delays are much longer than 60 days, Tutt said.

“It’s just not enough time,” she said.

States can fix the problem by requiring banks to halt foreclosures on participants. NAHAC’s Campbell said servicers participating in Nevada’s program have voluntarily agreed to postpone foreclosures.

Tutt said participants who do receive a foreclosure notice while in the program can get help from trained housing counselors or, in some cases, legal aid centers, which also get money from the program.

“It’s a lot to navigate,” she said. “Most of our homeowners are in a crisis and are working in jobs they can’t take time off from to keep monitoring and putting pressure on these different entities.”

Tutt also criticized Nevada’s decision to require a three-year lien in exchange for helping homeowners because it delays the process, adds to administrative costs — county recorders charge fees to record liens — and scares homeowners.

“They would say it ensures homeowners don’t just take this money, turn around and sell the home and get a windfall,” Tutt said. “That’s just devoid of the reality of what these homeowners are going through.”

Campbell said the requirement was included to “assist with housing stabilization.” Homeowners who sell their houses within three years, or refinance their mortgage to take cash out from the equity, would be required to repay the assistance in order to remove the lien. She denied the requirement causes delays and described the recording fees as “minimal.”

Despite the challenges, Tutt said the federalHomeowner Assistance Fund remains the best option for those who face losing their homes. Homeowners should take advantage of housing counselors to help them through the process instead of “giving up on the program,” she said.

Shirley Geraci feels differently. States are “flying by the seat of their pants” to run the program and “people are suffering,” she said.

In the month it has taken to resolve the payment issues, Noelle Geraci found a new job. The Geracis are eligible for three more months of assistance, but the stress of participating in the program has made them unsure of whether to accept it.

“People shouldn’t have to go through this,” Shirley Geraci said.

This content originally appeared on Articles and Investigations - ProPublica and was authored by by Anjeanette Damon.

Advocates for student debt relief are raising the alarm over a controversial part of the bipartisan deal to raise the U.S. debt ceiling that would end the freeze on student loan repayments by the end of August. The moratorium has been in place since 2020. Meanwhile, the fate of the Biden administration’s plan to forgive up to $20,000 in student debt for borrowers is going to be decided by the Supreme Court, where it is likely to face skepticism from the conservative majority. “This is President Biden turning his back on student debtors,” says Braxton Brewington, press secretary of the Debt Collective.

This content originally appeared on Democracy Now! and was authored by Democracy Now!.

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In the suburbs of Maryland, Dr. Jeffery Dormu’s presence is hard to miss. He’s a regular on the local TV station, which has featured him and his practice five times over the past five years. And he smiles down from an electronic billboard outside a three-story vascular center he calls The Watcher. “It has a biblical reference, which is to watch over the community,” he said at its 2018 opening. In response to the country’s “tragedy of cardiovascular disease,” the center trademarked the phrase “vascular devastation,” a slogan frequently invoked in its marketing, along with a claim to have “saved over 34,000 lives and limbs.”

Dormu and his group, the Minimally Invasive Vascular Center, have been a magnet for people with leg pain who worry they have peripheral artery disease, a condition that afflicts more than 6.5 million Americans and happens when fatty deposits narrow the arteries and block blood from flowing to the legs.

But Dormu’s portrayal of his practice as a heroic refuge hid a distressing statistic: The vascular surgeon was performing an invasive leg treatment more often than almost any other doctor in the country, even when his patients didn’t need it and even as evidence of harm mounted.

One man had to have his leg amputated after Dormu administered multiple invasive treatments for mild pain, according to legal filings. A 62-year-old grandmother bled out and died shortly after Dormu cut into her, according to another lawsuit.

Dormu’s go-to procedure, the atherectomy, involved shaving blockages with blade-topped catheters. Best practices recommend that doctors hold off on invasive procedures like these, which can lead to complications including limb loss, on patients in the earliest stages of disease; doctors should first see how the patients do with exercise and medication. Dormu defaulted to atherectomies almost immediately, patient legal and medical records show.

Four years ago, leading researchers warned the Centers for Medicare and Medicaid Services that some doctors were potentially abusing interventions. The researchers implored the government insurer to scrutinize its own data to identify overuse, noting that some of the doctors could present an “immediate threat to public safety.”

There is no public evidence that CMS meaningfully responded.

But a ProPublica analysis of CMS data suggests that if the agency had reviewed its own figures, it would have discovered that Dormu was part of a small pool of physicians performing a disproportionate number of treatments. From 2017 to 2021, the analysis shows, the top 5% of doctors conducting atherectomies — about 90 physicians overall — accounted for more than a third of all procedures and government payments, totaling nearly a billion dollars.

Near the top of the list sits Dormu, logging more atherectomies — and making more money from them — than almost every other doctor in America.

CMS paid Dormu more than $30 million in the past decade for vascular procedures he performed on hundreds of patients.

Dormu declined to be interviewed and did not respond to emailed questions.

But a chorus of experts told ProPublica that the federal government’s decision to provide unconditional payments for vascular procedures — and then not pay attention to what happened — is a prime example of what’s wrong with the American health care system.

“The government is really to blame for setting these tremendously high reimbursement values without looking into whether these procedures are helping people or are just worthless procedures or, in fact, are hurting people,” said Dr. Dipankar Mukherjee, a vascular surgeon and chief of vascular surgery at Inova Fairfax Hospital in Virginia.

CMS kicked off the problem 15 years ago, when it tried to rein in the swelling hospital costs for vascular care. Over the past few decades, advances in technology allowed patients with serious circulation problems to avoid open surgery and instead undergo minimally invasive treatment with cutting-edge devices. As they flocked to hospitals for these procedures, patients with clogged leg arteries became even more expensive than patients with clogged heart arteries.

In 2008, recognizing that the procedures could be done safely and more efficiently outside hospitals, CMS officials turbocharged payments to doctors’ offices that deployed balloons and stents to widen arteries. And in 2011, they began to reimburse those offices for atherectomies.

Before the change, an office provider inserting a stent could make about $1,700 from Medicare; deploying a balloon could bring in roughly $3,800. By 2011, the payments rose to about $6,400 and $4,800 respectively. But nothing compared to the payout for atherectomies conducted in offices: about $13,500 per procedure, as opposed to roughly $11,450 in a hospital.

Instead of saving money, the government started a boom.

Atherectomies increased by 60% from 2011 to 2014; Medicare’s overall costs for peripheral vascular treatments climbed by nearly half a billion dollars, or 18%.

The government insurer didn’t change course in 2014, when research began to indicate that atherectomies may not be more effective than cheaper alternatives, or in 2019, when experts warned the procedure may be associated with a higher risk of complications.

From 2013 to 2021, the most recent year of Medicare data, the number of atherectomies has doubled and payments to doctors have nearly tripled, totaling about $503 million in 2021.

“There’s definitely places where atherectomy is very helpful,” said Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine. “But it’s definitely being used inappropriately, and that’s when bad things happen.”

Experts fear patients are being caught up in a new era of profit-driven procedure mills, in which doctors can deploy any number of devices in the time it takes to drill a tooth and then bill for the price of a new car.

The generous reimbursements have created a conflict of interest for doctors running their own practices, who are supposed to make unbiased medical decisions while also being responsible for a lease, overhead and staff. And unlike hospitals, which have panels and administrators who spot adverse events and questionable billing, these offices don’t face such scrutiny.

CMS, experts say, should step up: It could reduce its reimbursements or even investigate doctors with outsized procedure patterns.

ProPublica reached out to CMS more than two weeks ago, listing the facts in this story, asking questions and requesting an interview. CMS did not make an official available to talk or provide any written answers.

“Vascular medicine now is the frontier of the Wild West,” said Dr. Marty Makary, a professor of surgery and health care quality researcher at Johns Hopkins University School of Medicine. “People are flying blind walking into the clinics of these doctors with egregious practice patterns, and we know that their pattern is indefensible.”

It was at the cusp of this lucrative new era in vascular medicine that Dormu, an ambitious young doctor from Washington, D.C., entered the scene.

After earning his medical degree at the New York Institute of Technology College of Osteopathic Medicine and completing an additional eight years of training in New York and New Jersey hospitals, including a residency in general surgery and two fellowships in cardiothoracic and vascular surgery, he received his license to practice medicine in Maryland in 2007. That year, he founded the Minimally Invasive Vascular Center.

“People in general are just afraid of surgery,” he later told a local TV journalist. “They can get by with minimally invasive surgery, a needle puncture without having to be cut, without having to worry about an amputation. They walk in and within hours they walk out, and pretty much healed.”

Dormu opened several vascular offices in the region. At one point, his group also partnered with the Washington, D.C., Department of Aging and Community Living, providing hundreds of free vascular screenings for elderly patients at senior centers and residences across the capital.

But according to public records and lawsuits, as his profile and his practice grew, so, too, did evidence of harm.

In March 2016, while he was performing an elective aorta repair at Providence Hospital, the patient began to hemorrhage, according to a District of Columbia Board of Medicine document on the incident. After trying to control the bleeding, Dormu transferred the patient to the intensive care unit for resuscitative efforts and then left the hospital for his private practice and other appointments.

He was gone for more than two hours, and in that time, hospital staff couldn’t reach him. The hospital patient died in the recovery room from hemorrhage and organ failure, the report said. Six years later, the District of Columbia Board of Medicine would reprimand him for the incident alongside a $5,000 fine, finding that he abandoned a patient in need of further emergency care, “knowing the high risk of mortality and without adequate communication to other hospital staff.”

The death of the patient did not interfere with his medical license or appear to slow his career.

Nine months later, a mechanic sought his care for mild leg pain. As the owner of his shop, Steve Rosenberg clocked long hours, six days a week, repairing anything with wheels or an engine. But as he reached his mid-50s, the long days of standing under vehicle lifts had begun to strain his legs.

His primary care doctor suggested that he see a vascular specialist and handed him a list of physicians to choose from. Dormu happened to have an office in the same plaza as Rosenberg’s auto shop, between a jujitsu studio and a dentist’s office.

He first visited Dormu’s practice that December.

Instead of starting with more conservative treatment, Dormu deployed a trifecta of interventions on both of Rosenberg’s legs within three months, widening his arteries with stents and balloons, and debulking his vessels with atherectomy devices, according to later legal filings.

Shortly after one of the procedures, Rosenberg’s left foot grew numb and was cool to the touch. He went to the emergency room, where doctors discovered that one of his stents had clogged, hindering his vessel from carrying blood.

Angioplasty: A compact balloon is inserted into a blood vessel and inflated to flatten plaque against its walls.

Stent: A metal mesh tube is implanted into a narrowed blood vessel to hold open its walls.

Atherectomy: A catheter, often capped with a blade or laser, is inserted into a blood vessel and removes plaque off its walls.

Dormu called him back to his office, where he repeated the procedures: shaving the blockages, ballooning the artery walls and installing another stent.

The next day, he repeated the procedures again, ballooning his vessels and installing yet another stent.

Dormu sent Rosenberg to Providence Hospital in Washington, D.C., for further treatment. Within a day, his left foot had grown cold, a sign that blood likely no longer flowed freely through his vessels.

According to the terms of a legal settlement in a malpractice suit against Dormu, Rosenberg cannot comment on his care. However, public documents filed in his case, including assessments from medical experts, illuminate the cascade of procedures and the outcome.

A vascular surgeon Dormu retained for his defense, Dr. Garry Ruben, said the interventions were warranted; he said Rosenberg had been prescribed an anti-platelet medication, which he did not consistently take. In legal filings, Dormu blamed Rosenberg’s injuries on his preexisting medical conditions and circumstances outside his control.

However, after reviewing medical records and diagnostic studies, Dr. Christopher Abularrage, an expert retained by Rosenberg and a professor at Johns Hopkins who specializes in vascular and endovascular surgery, found several “breaches of the standard of care.” Dormu had failed to prescribe conservative therapy and lifestyle modifications first, he found, and “persisted with unindicated, endovascular interventions in the face of persistently poor outcomes and diminishing returns.”

In less than six months, Rosenberg had been transformed from a patient with mild leg pain to one with a high risk of limb loss, he concluded.

Rosenberg spent nearly a week at Providence Hospital, the life slowly draining from his leg, before he was transferred to Washington Hospital Center on April 8, 2017, according to records. By then, his left leg was gangrenous and had no pulse. All of the stents had become blocked.

Without better options, doctors amputated his leg.

Between 2013 and 2017, Dormu earned about $14.5 million from Medicare — more than 99% of other vascular surgeons across the country — for treating hundreds of patients a year, the vast majority of them in his clinics.

In 2018, he was able to afford an upgrade.

The Watcher was not like other surgical centers. In its entrance stood a juice bar that could serve organic cold-pressed drinks to patients. Crystal chandeliers adorned its hallways. Moist air was pumped through its vents. And more than a dozen original modern paintings lined its walls, making it feel like an art gallery. “We wanted it to give that shock and awe,” Dormu said in a video interview from the facility’s opening day.

His clinic provided a litany of medical services, including treatments for uterine fibroids, erectile dysfunction and varicose veins, as well as elective nonsurgical fat reduction.

The expansive facility boosted Dormu’s earnings. From 2018 through 2021, he earned nearly $18 million in Medicare payments for all of his clinic’s activities.

One procedure stood out from the rest: Nearly $12 million of that came from atherectomies, according to Medicare data.

He performed one on Alice Belton, a high school nursing teacher who sought help in 2018 for lower extremity pain, numbness and tingling. Her artery blood flow was normal; even Dormu noted that she didn’t have severe leg pain, according to an ongoing lawsuit. And yet, he conducted multiple procedures over about a year, shaving plaque, ballooning her vessels, treating her veins and running invasive scans; the procedures were unnecessary, according to a medical expert retained in her case.

Belton says she has since developed permanent nerve damage in her leg, which has prevented her from working full time. In legal filings, Dormu denied the allegations and claimed that the alleged injuries were caused by preexisting conditions.

“The experience with Dr. Dormu has shaken my confidence in health care practitioners and more importantly in myself,” she said. “I feel duped that this surgeon convinced me, a nurse, that my problems required such radical surgical interventions.”

And then there was John Malinich, who had no leg pain but wanted to get his circulation checked in 2019 after he saw Dormu’s billboard. At first, Malinich didn’t question Dormu’s treatments; the doctor’s confident demeanor and lavish facility impressed him and put him at ease.

“After surgery on both of my legs, they wanted me to go back and do it over again,” he said. “After that, I started getting suspicious.”

He said he got a second opinion from another vascular surgeon who informed him that the prior procedures, which involved balloons, an atherectomy and a stent, had been unnecessary. To ensure his stent doesn’t collapse or clog, doctors now have to annually monitor Malinich. He filed a lawsuit against Dormu, who has denied allegations of overtreatment. The case is ongoing.

“I trusted the guy,” Malinich said. “But it was just to make money.”

The next year, Heather Terry was looking forward to her mother’s return home after a six-month stint rehabilitating in a nursing home. For years, Heather had helped take care of 62-year-old Linda Terry, who had debilitating epilepsy. After a fall down a flight of stairs and subsequent back surgery, Terry was left paraplegic and unable to walk.

Just before she was supposed to be discharged from the nursing home in August 2020, the staff told Heather Terry that her mother had leg pain and ulcers on her heels that needed treatment. According to her family, Linda Terry had no prior circulation issues. The procedure was simple, the staff said, and would be conducted in a clinic just down the road.

On Aug. 13, Terry was transferred to Dormu’s center, where he started an atherectomy procedure, inserting the small tube capped with blades into her vessels to shave the plaque from her artery walls.

Less than 15 minutes into the treatment, her blood pressure began to drop.

With atherectomy, there’s always a risk that the device may dissect the vessel, which would require immediate care.

Dormu aborted the procedure and brought Terry into the recovery area. She was drowsy and her blood pressure continued to waver, signs that she may have been bleeding internally, according to her family’s attorney. Instead of being rushed to the emergency room, legal filings show, she was sent back to the nursing home, where she became unresponsive.

The nursing home called an ambulance, which ferried her to the emergency room at the University of Maryland Laurel Medical Center. Three hours later, she was pronounced dead, according to the lawsuit, a consequence of severe anemia due to internal blood loss.

For the aborted procedure, according to the family’s attorney, Dr. Zev Gershon, Dormu charged her insurance about $20,000.

Heather Terry believes that if Dormu had treated her mother with appropriate care and transferred her directly to the hospital, she might have survived. “It went from ‘She’s going to come home tomorrow’ to ‘She’s dead,’” said Terry, whose ongoing malpractice case against Dormu is set to go to trial this year.

In legal filings, Dormu denied any involvement in her mother’s death. He said in a deposition that he did not see evidence of bleeding and that Linda Terry’s anemia could have been due to a prior fall. He said he also gave a directive to send her to the hospital after the aborted procedure, despite EMS records obtained by the family’s attorney showing that Terry was sent back to the nursing home.

“I trusted doctors,” Heather Terry said, “but now I’m starting to think that maybe they shouldn’t be as fully trusted.”

By 2021, Dr. Kim Hodgson, a former president of the Society for Vascular Surgery, recognized that unfettered profiteering in his field was not just a threat to patients, it also stood to damage the credibility of his speciality. Notably, abuse in outpatient vascular facilities was the No. 1 complaint he had received from members. That August, the vascular surgeon stood before hundreds of doctors at the society’s annual conference and made a plea.

“Somebody has to address what should never have been allowed to get to this level of threat to us and our patients in the first place,” he said. “We can play whack-a-mole every time the bad actors surface until the cows come home, but that leaves a trail of harmed patients and wasted resources.”

In dozens of slides, he laid out evidence exposing the magnitude of the crisis: the Medicare incentive, the explosive growth of procedures in clinics and the potential for inappropriate treatment. Most critically, he warned about the risk of patient harm. In recent years, researchers have found that patients in early stages of vascular disease had less than a 2% risk of amputation after five years. However, with aggressive interventions, that risk could surge up to 5% or even 10%.

“The problem is that these behaviors — unindicated early interventions and overuse of unproven technologies — still have costs and more often than not, those costs are borne by our patients,” he said. “We can and should do better, otherwise we are also enablers.”

The issue has magnified into a crisis that has splintered the specialities that conduct these procedures, which include interventional radiologists, cardiologists as well as vascular surgeons. Some physicians do not view overuse as an urgent problem and feel the recent academic attention unfairly stigmatizes private practice doctors.

“The majority of operators are doing the right thing,” said Dr. Jeffrey Carr, an interventional cardiologist and the founding president of the Outpatient Endovascular and Interventional Society, which represents physicians working in outpatient settings. “We need to call out the bad actors, but to cast a narrative that puts us all in the same arena is wrong.”

Other doctors recognize a need for considerable reforms.

CMS could reverse the change that kicked off the entire problem, some experts said, by reducing its outpatient reimbursement rates. “If you shut off the money, the whole thing will stop tomorrow,” Mukherjee, the Virginia vascular surgeon, said.

But such cuts might hurt doctors practicing responsibly and could even nudge the least scrupulous ones into higher gear to make up the financial difference. “You could incentivize people to do more procedures, and some of them may be inappropriate,” said Dr. Peter Lawrence, the former chief of vascular and endovascular surgery at the University of California, Los Angeles, who developed an outpatient center connected to the university.

More critical than payment cuts, Lawrence said, is greater oversight of office-based facilities. Many states don’t require doctors in those settings to have special vascular training or hospital privileges in case of complications, he said. “You could be a psychiatrist and do these procedures,” he said.

Many physicians also support improved data collection, particularly for newer technologies like atherectomy, to ensure that they’re not only safe but result in improved outcomes.

“Many of the vascular procedures that are done are relatively safe or can be done with good short-term results, but the failures are long term — it’s what happens in two to five years,” Lawrence said. “Unless you have a reimbursement system, which not only pays you for the initial procedure, but whether or not it’s durable, you can have procedures done in our society that have great short-term results but have poor long-term results.”

CMS could require physicians to participate in patient registries, said Dr. William Schuyler Jones, an interventional cardiologist and associate professor of medicine at Duke University School of Medicine. “That type of required reporting would make our system better,” he said, “and would ultimately put the onus on all of us to do more appropriate care.”

For Dormu, patients were the ones to prompt accountability, airing their grievances to the Maryland Board of Physicians. Among them was a woman who sought his care for excessive leg itching and said he tried to pressure her into an invasive artery scan. When she sought a second opinion, the doctor concluded that her itching likely stemmed from a reaction to an insect bite.

The medical board examined the records of 11 of Dormu’s patients. Two peer reviewers, board certified in vascular surgery, independently concluded that Dormu had performed “medically unnecessary and invasive vascular procedures” and failed to meet appropriate standards of care for 10 of the 11 patients, “exposing them to potential risks such as bleeding, infection, blood vessel injuries which could acutely or chronically worsen the patient’s circulation, and limb loss.”

One patient who sought Dormu’s care to evaluate blockages in their legs could walk a mile before treatment, but after the procedures, they could not walk at all.

“There exists a substantial likelihood of risk of serious harm to the public health, safety, and welfare in Dr. Dormu’s continued practice,” the board’s executive director, Christine Farrelly, concluded.

Last October, the board found him in violation of state medical law, citing his overuse of procedures and his failure to uphold standards of care. It fined him $10,000, suspended him and put him under a two-year probation, during which he must be supervised and enroll in an ethics course.

Maryland Department of Health spokesperson Chase Cook said the agency’s Office of Health Care Quality, which is responsible for oversight of the state’s surgical centers and licensed Dormu’s current facility, was not aware of his sanctions nor the allegations of harm. The office “will follow-up in accordance with federal and state regulations,” Cook said.

Despite lacking an active license to practice medicine in Maryland, Dormu is still listed on his clinic’s website as the lead vascular surgeon, “currently available for office visits and in-patient consultations.”

When ProPublica called Dormu’s office to inquire whether he was still practicing, the receptionist said he was no longer seeing patients and that “Dr. Seibles” was providing all the same services. According to the Virginia Board of Medicine’s directory, Dr. Ayana Jonelle Seibles spends 20% of her time practicing at Dormu’s center in Maryland.

An emergency medicine physician who does not have specialty training in vascular surgery, Seibles appears to have a close relationship with Dormu; according to county property tax records, they have owned a home together since at least 2017. Seibles did not respond to ProPublica’s questions that were sent by email.

In a lawsuit deposition last month, Dormu said that he stopped doing surgery this year as a “personal choice.” When asked the name of his supervisor, he stated that he couldn’t recall it. He also couldn’t recall how many times he had been sued for malpractice, any of the details of the cases, nor the names of the attorneys representing him. He also couldn’t specify how many atherectomies he had performed, only estimating that he had done more than 100.

According to Medicare data, over the past decade, he has done at least 3,400.

For most of his life, Rosenberg trusted doctors; his own father was one. But the mechanic has lost faith in medicine. Memories of his 2017 amputation have been largely buried by the trauma, but he recalls lying in his hospital bed after the operation, the remnants of his left leg wrapped in a cloud of white bandages. “Life isn’t supposed to turn out like this,” he said.

He was discharged to his three-story colonial home, where two steps led to the front door and 13 steps gave way to the second floor; he could only ascend them by crawling backward. Eventually, he sold the house and his family moved into a flat, ranch-style home.

He tried to maintain his auto shop, relying on his wife and teenage stepson to help out. But with his limited mobility, first in a wheelchair and later maneuvering with his prosthetic and a cane, he could not repair cars like he used to and was forced to sell his business and retire.

Before, he could get dressed and out the door in less than 30 minutes; it now takes more than an hour. He used to prepare meals for his family, but after, his stepson had to learn how to cook. In the months following the surgery, he often fell asleep by 7:30 p.m., tired from carrying his body around all day. Discomfort would awaken him by 4 a.m.

Half of his days are now spent navigating the complex web of amputee providers, arguing with insurance agents, attending physical therapy and meeting with specialists to keep his vascular system in check.

Above all, managing the pain has remained a lingering burden. Even though he lost most of his left leg, its memory has been indelibly burned into his brain, haunting him like a phantom. Sometimes the bottom of his missing foot itches or a jolt surges down his absent calf.

“And there’s nothing anyone can do about it,” he said, “because it’s not there.”

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

This content originally appeared on Articles and Investigations - ProPublica and was authored by by Annie Waldman.

After the termination of Qorvis Communications and Vatis, Prime Minister Sitiveni Rabuka has indicated that attention has now shifted to the state-run Fiji Broadcasting Corporation (FBC) and Fiji Sun newspaper.

He revealed this while addressing the nation on Friday afternoon.

“We made it clear in our manifestos that implementation of certain promises would be dependent on the true state of Fiji’s economy,” Rabuka said.

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“We will be conducting mandatory audits and associated checks and balances. Until these are completed, we will be curtailing what we consider to be wasteful spending in areas that are not a priority.

“We’ve started an investigation into what appears to be excessive spending in the Department of Information, through payments to the [US-based] public affairs company Qorvis, the local communications company Vatis, the Fijian Broadcasting Corporation (FBC) and the Fiji Sun newspaper.

“In fact, there are many looming issues to address.”

He said that in the past 14 days they had made progress with ministers establishing themselves in their respective ministries.

Questions sent to FBC chief executive officer, Riyaz Sayed-Khaiyum, and Fiji Sun acting chief executive officer Rosi Doviverata remained unanswered when this edition of the Fiji Times went to press.

Wata Shaw is a Fiji Times reporter. Republished with permission.

This content originally appeared on Asia Pacific Report and was authored by Pacific Media Watch.

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This content originally appeared on KPFA - The Pacifica Evening News, Weekdays and was authored by KPFA.

This content originally appeared on openDemocracy RSS and was authored by Chaminda Jayanetti.

With only two weeks before a pandemic-related pause on federal student loan payments expires, progressive lawmakers and organizations on Wednesday reiterated demands for U.S. President Joe Biden to finally take sweeping debt cancellation action.

While Biden only campaigned on forgiving $10,000 per borrower and has reportedly considered setting an income cap for relief, activists and members of Congress have called for canceling at least $50,000 per person—or even all federal student debt.

Noting the rapidly approaching deadline, U.S. Rep. Pramila Jayapal, chair of the Congressional Progressive Caucus (CPC), said Wednesday that "we must deliver immediate relief to more than 45 million Americans by canceling student debt."

Similar calls came from Reps. Jamaal Bowman (D-N.Y.), Cori Bush (D-Mo.), Barbara Lee (D-Calif.), and Ro Khanna (D-Calif.), who declared that "the clock is ticking."

Former Democratic Ohio state Sen. Nina Turner warned that Biden's failure to act on the nation's student debt crisis could hinder Democrats at the ballot box in November's midterm elections—when the GOP hopes to retake Congress.

Turner cited recent polling that shows the number of voters under age 45 who said they would support a Democrat running for Congress in their district notably rose from mid-July to mid-August—which some observers tied to recent successes such as the Inflation Reduction Act (IRA).

Advocacy groups and leaders also pressured Biden to act on student debt Wednesday.

After Our Revolution executive director Joseph Geevarghese tweeted, "'Medical debt' is simply not a phrase you should hear in a functioning society," the group added, "Same goes for 'student loan debt.'"

Highlighting footage of Biden handing Sen. Joe Manchin (D-W.Va.)—who negotiated the IRA with Senate Majority Leader Chuck Schumer (D-N.Y.) after months of blocking bolder packages—a pen after signing the compromise legislation Tuesday, Public Citizen told Biden, "That very same pen could cancel student debt."

Some borrowers are frustrated. "It's just been radio silence from the Biden administration," Scott Heins, a 33-year-old freelance photographer in Brooklyn who owes more than $20,000, told CNBC. "It's frustrating and stressful."

During a Tuesday appearance on "CBS Mornings," U.S. Education Secretary Miguel Cardona said that "while I don't have an announcement here today, I will tell you we're having conversations daily with the White House and borrowers will know directly and soon from us when a decision is made."

"The president has been very clear about making sure we're leading with students first, and we've been proud of the $28 billion in loan forgiveness up to this point and the policies that we've changed to fix a broken system," he said. "We recognize that Americans are waiting and we'll be communicating with them as soon as we can."

As the U.S. Department of Education on Tuesday announced $3.9 billion in debt cancellation for 208,000 borrowers who took out loans to attend ITT Technical Institute from January 2005 through its closure in September 2016, Cardona declared that "It is time for student borrowers to stop shouldering the burden from ITT's years of lies and false promises."

"The evidence shows that for years, ITT's leaders intentionally misled students about the quality of their programs in order to profit off federal student loan programs, with no regard for the hardship this would cause," he noted, adding that the administration "will continue to stand up for borrowers who've been cheated by their colleges, while working to strengthen oversight and enforcement to protect today's students from similar deception and abuse."

In a statement from the Debt Collective, several former ITT students shared how they expect the move to positively impact their lives—including Joseph White, who said that "canceling my loans would make me free of this debt trap so I can continue saving for my future."

"Over the past seven years of my debt strike, I was able to save money in my retirement account," White added. "It's up to Biden now to permanently erase student debt for everyone. The country's middle class cannot afford $1.7 trillion dollars in student loan debt."

This content originally appeared on Common Dreams - Breaking News & Views for the Progressive Community and was authored by Jessica Corbett.

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A dozen years ago, a Santa Monica, California, pain doctor named Gerald M. Sacks emerged as one of the pharmaceutical industry’s top paid speakers — anointed to extol the virtues of a variety of drugs, even though several experts in pain medicine said they’d never heard of him.

His drug company haul had occurred largely under the radar until 2010, when ProPublica started digging into what the firms were paying physicians to deliver talks and consult on their pills. That’s when we consolidated the payments from seven companies, most of which had been forced by government settlements to make them public, in a database we called Dollars for Docs.

Sacks turned out to be a big winner, and we wrote about how little in his resume explained why. He was even a focus of an op-ed we wrote in the Los Angeles Times about how patients are often unaware of the relationships their doctors have with drug companies.

Nevertheless, companies continued to pay Sacks large sums. From 2015 to 2021, he received more than $2 million from companies to speak and consult on their behalf, including spending on travel and meals, federal data shows.

But last month — 12 years since we first wrote about him — Sacks’ puzzling role as one of the drugmakers’ chosen pain doctors took a different turn: Federal prosecutors allege he’d been paid to prescribe.

Sacks agreed to pay more than $270,000 to resolve allegations by the U.S. Department of Justice that he’d accepted kickbacks from drug companies Purdue Pharma and DepoMed to prescribe their products. Purdue is the maker of OxyContin and pleaded guilty in 2020 to, among other things, conspiring to provide kickbacks to doctors. The Anti-Kickback Statute prohibits doctors from prescribing drugs in exchange for speaking or consulting payments from drug manufacturers.

From 2015 to 2018, Purdue paid Sacks more than $70,000 for speaking and consulting. DepoMed, which changed its name to Assertio Therapeutics in 2018, paid him more than $285,000 for speaking and consulting from 2015 to 2018, according to the federal government’s Open Payments database. Neither Assertio nor its predecessor, DepoMed, has been accused by the government of wrongdoing.

Sacks writes a few thousand prescriptions a year, including refills, to patients in the federal Medicare program. Among the tally in years past were hundreds of prescriptions for the drugs for which the government accused him of taking kickbacks.

Sacks denied wrongdoing in the settlement and did not return phone calls seeking comment. Neither Purdue Pharma nor Assertio returned emails seeking comment.

“Physicians are prohibited from accepting kickbacks designed to influence their decision making,” Deputy Assistant Attorney General Michael D. Granston said in a news release. “Adherence to this prohibition is especially crucial with regard to dangerous drugs like opioids.”

The allegations against Sacks relate to his prescribing of the drugs Butrans, Hysingla and OxyContin, made by Purdue, to patients on Medicare between December 2010 and October 2021. They also cite his prescribing of the drugs Gralise, Lazanda and Nucynta, made by DepoMed, to Medicare beneficiaries in 2016.

Experts say the evidence is now overwhelming that there is a strong association between drug company payments and doctor prescribing. This link is worrisome, they say, because doctors should prescribe medications solely based on what’s best for the patient, not because they receive money from the company that makes a drug. Some prescription drugs may be more expensive or have greater side effects than cheaper or generic alternatives.

Today, the federal government collects information on payments from all drug and device makers in its Open Payments database. Researchers say such payments show that patients and regulators need to be on guard.

In a research article last month in the Journal of Health Politics, Policy and Law, the authors note it’s not just one study that found a troubling link between drug company cash and what doctors prescribe. “Every published, peer-reviewed study that has evaluated the association between payments and prescribing using a causal inference framework has found evidence that receipt of industry payments increases physicians’ prescribing,” they wrote. They call on a variety of parties, including doctors, the drug industry and regulators, to take action to reduce these conflicts.

Dr. Aaron Mitchell, one of the authors and an oncologist at Memorial Sloan Kettering Cancer Center, said the ever-growing list of research findings upends the presumption that payments to physicians, particularly small ones like meals, don’t influence doctors’ prescribing.

“The legal interpretation of a kickback has long been that industry payments and other transfers of value to physicians are OK as long as they don’t influence prescribing,” he said. “We now have overwhelming data that such payments do influence prescribing. In light of that we need to seriously reexamine the status quo.”

Mitchell suggested that regulators, like the Office of Inspector General of the U.S. Department of Health and Human Services, review their guidance related to industry payments and “be clear to everyone that these are going to be under increased scrutiny and increased risk of prosecution than they have in the past.”

The OIG’s Office of Counsel said in a statement that it “has long expressed concerns over the practice of pharmaceutical manufacturers providing anything of value to physicians in a position to make or influence referrals to manufacturers’ products.” The office issued a special fraud alert in 2020 that discussed the risks of speaker program payments to physicians and other practitioners by drug and medical device companies.

“OIG has pursued, and will continue to pursue, abusive financial relationships between pharmaceutical manufacturers and physicians,” the statement said.

In 2021, the most recent year for which there is publicly available data on payments to doctors, drug companies paid Sacks more than $84,000.

This content originally appeared on Articles and Investigations - ProPublica and was authored by by Charles Ornstein.

The move has sparked heated online debate, with many suggesting that repeated rounds of mass COVID-19 testing has emptied out government healthcare coffers, leaving regular people to foot the bill.

When the scheme started, women in the southern province of Guangdong were paying into the scheme for a maximum of 20 years, and men for 25 years.

The longer compulsory contribution period for all employees took effect from July 1, 2022.

A resident of the central Chinese city of Wuhan surnamed Gao said he has been asked for additional contributions by his employer to make up the shortfall in minimum contributions.

"In the past, medical insurance payments were limited to 15 years, and you could enjoy lifelong medical cover after that," Gao told RFA. "Before, both men and women paid for 15 years."

"Now that the regulations have been revised, the burden on ordinary people will be heavier, whether they can afford it or not," he said. "This has a huge impact; some people have shorter working lives, and it's simply not possible for them to contribute for 30 years."

Mass COVID-19 testing

Gao blames the incessant rounds of mass testing for COVID-19, which has drained government coffers of more than 300 billion yuan, he said.

The government is now seeking to make up the shortfall in funding with extended contributions from employees, he said.

"There must be a problem with funding; otherwise it wouldn't skyrocket like that all of a sudden," he said.

Guangdong-based sociologist Zhang Yang said the problem is now very serious, because not many people are in a position to pay into the system for three decades.

"Many people can't even get work by the age of 25 nowadays," Zhang said. "Graduates or doctors are of necessity over 30 years old [due to the length of their studies or training]."

"Now the government is asking people to keep paying out for 30 years, but you only pay social and medical insurance if you have a job," he said. "If you don't have a job, you can't pay in."

The eastern province of Shandong was the first to lengthen minimum contribution times at the end of 2021.

Spreading across China

Zhang said similar moves are now afoot across China, and will leave more people forced to pay out of pocket for their own medical care.

"It's like going back to where we were 20 years ago ... when there was no rural cooperative medical care period, so farming communities had no coverage," he said. "That was gradually sorted out under President Hu Jintao."

"But now, what they are asking people to pay for medical care may be too much," Zhang said.

The government is also seeking to cut costs by excluding certain types of drugs from insurance coverage.

According to China's National Medical Insurance Administration, 995 kinds of drugs, including non-steroid anti-inflammatory drug (NSAIDs) and herbal Ganmaoling capsules, have been excluded from the list of reimbursable drugs.

A social welfare researcher who gave only the surname Mao said the moves have been on the cards for some time now.

"The cost of PCR testing in various places is paid from the medical insurance fund," Mao said. "They have gone through the medical insurance premiums paid in by employees and have to extend the payment period for medical insurance to make up for it."

Translated and edited by Luisetta Mudie.

This content originally appeared on Radio Free Asia and was authored by By Gu Ting for RFA Mandarin and Chingman for RFA Cantonese.

This content originally appeared on Radio Free Asia and was authored by By Gao Feng.

Forgiving at least some student loan debt is one of the few popular policy ideas that President Biden could implement on his own with the stroke of a pen. A recent national tracking poll from Morning Consult and Politico found that 64% of respondents supported the idea. Yet when the president announced on Thursday that he is "considering dealing with some [student] debt reduction," it was clear that he hasn't yet recognized the urgency of this issue. President Biden's announcement came with an immediate caveat: "I am not considering $50,000 debt reduction," he said in reference to last month's proposal from Senators Chuck Schumer, Elizabeth Warren and others.

Interest keeps the borrower in a cascading cycle of debt, from which they are often unable to escape.

The president made a mistake by ruling out canceling $50,000 of student loan debt per borrower. But even if he changes course and does so, that alone would not solve the key problem behind the student debt crisis.

In 2021, the student loan debt collectively owed by 45 million borrowers reached a record $1.7 trillion. This number is projected to increase to $2 trillion by 2024 and $3 trillion by 2038. Add to this crippling debt the skyrocketing prices of housing, healthcare, food, gas and other essentials, and it's not surprising that a quarter of borrowers are currently estimated to be in default or delinquency on their student loans. According to a Brookings Institute report, that number is expected to rise to 40% by 2023—and that report was conducted prior to the COVID-19 pandemic.

One of the primary reasons why student loan debt is so damaging to so many millions of Americans is the presence of interest. Interest keeps the borrower in a cascading cycle of debt, from which they are often unable to escape. Interest on student loans is particularly predatory because it tends to target individuals who are just starting out in life. Before they are able to secure jobs and careers, millions of Americans are being saddled with debt they may never have the means to pay off.

The interest is the problem. That's why dozens of Muslim organizations called on President Biden to waive all interest payments on current and future loans by establishing principal-only loans, in addition to extending the moratorium on payments until January 1 2023 and forgiving borrowers whose repayment history equals or exceeds their principal.

Implementing this proposal would not only provide much needed relief to the millions of Americans caught in the debt trap and offer borrowers an affordable way to pay back their student loans, it would also provide a boost to the economy at a time of significant inflation and instability. Broad student loan debt forgiveness would also advance racial justice, as 48% of Black students owe an average of 12.5% more than what they initially borrowed. Black and Latino students are also more likely to default on their loans than students from other communities.

Ending interest-based debt would be a positive step toward empowering students from communities of faith. Islam, Christianity, Judaism and other religions prohibit usury as a destructive and immoral practice. This means that many students of faith are forced to either delay higher education or compromise on their values. Principal-only loans would enable them to pursue their education freely and without taking on debt that conflicts with their firmly-held beliefs. 

Student loan debt has been a burden and source of suffering for millions of Americans for decades. People and organizations have been calling for student loan reform for just as long, and for the first time, those in power are unable to ignore them. But President Biden will not be able to solve the crisis at hand or satisfy the demands of the American people with a half-baked approach. It's time to remove the burden from the backs of the American people—it's time to put an end to interest-based student loan debt.

This content originally appeared on Common Dreams - Breaking News & Views for the Progressive Community and was authored by Robert McCaw, Ismail Allison.

Nearly 100 congressional Democrats on Thursday urged President Joe Biden to extend a pause on federal student loan repayments through at least the rest of the year, while calling on him to ultimately "provide meaningful student debt cancellation" for millions of indebted Americans.

"Your administration must act as quickly as possible to extend the pause and make clear to the American public your intention to cancel a meaningful amount of student debt."

"The payment pause has been a significant federal investment throughout the pandemic, providing essential relief to millions of families during the economic and public health crisis, and saving them an average of $393 per month," the bicameral lawmakers wrote in a letter to the president, adding that most borrowers "are not financially prepared to shoulder another bill as they face skyrocketing costs for necessities like food and gas."

The letter urging Biden to "cancel student debt now" was led by Sens. Chuck Schumer (D-N.Y.), Elizabeth Warren (D-Mass.), Alex Padilla (D-Calif.), and Raphael Warnock (D-Ga.); Reps. Ayanna Pressley (D-Mass.), Ilhan Omar (D-Minn.), Pramila Jayapal (D-Wash.), and James Clyburn (D-S.C.); with more than 80 other congressional Democrats as signatories.

Noting that "Black students, in particular, borrow more to attend college, borrow more often while they are in school, and have a harder time paying their debt off than their white peers," and that "they are more than three times as likely to go into default within four years on their federal loans as white borrowers," the letter asserts that "canceling student debt is one of the most powerful ways to address racial and economic equity issues."

"The student loan system mirrors many of the inequalities that plague American society and widens the racial wealth gap," the legislators state in their letter. "Student debt cancellation must be one of the key actions in your comprehensive approach to advance equity as our nation works to rebuild a stronger and more equitable economy."

While campaigning for president, Biden promised, "I'm going to eliminate your student debt if you come from a family [making less] than $125,000 and went to a public university."

Biden also vowed he was "going to make sure everyone gets $10,000 knocked off of their student debt" in response to pandemic-related economic hardship.

On Tuesday, more than 1,000 U.S. college and university professors sent a letter to Biden imploring him to cancel all outstanding federal student loan debt via executive action.

Student loan payments and interest on federally held debt have been suspended since March 2020 during the Trump administration. Biden extended the pause last December. As many as 45 million student debtors have benefited from the suspension, which according to the New York Federal Reserve has seen an estimated $195 billion in payments waived through April.

The current pause is set to expire May 1.

"Given the fast-approaching deadline for borrowers to resume payments, your administration must act as quickly as possible to extend the pause and make clear to the American public your intention to cancel a meaningful amount of student debt," the lawmakers stress. "We look forward to supporting your administration in getting it done."

This content originally appeared on Common Dreams - Breaking News & Views for the Progressive Community and was authored by Brett Wilkins.

An Auckland nurse says a lucrative incentive payment has not fixed the city’s dire hospital staffing shortage in Aotearoa New Zealand’s current covid-19 outbreak.

Nurses, midwives and others employed by the region’s district health boards (DHBs) have been entitled to an extra $500 on top of their normal pay for extra shifts overnight.

The scheme is being reviewed today and the clinical director in charge of co-ordinating the city’s health response, Dr Andrew Old, said it would continue if it was needed to address staffing shortages.

• LISTEN TO RNZ: ‘We’re in the eye of the storm now’ – Dr Andrew Old
• ‘We are tired, we are exhausted, we are short-staffed’ – Di McCulloch
• ‘The level of care you might expect [in hospital] is not as good’ – Sarah Dalton
• ‘It’s almost chaotic in terms of the response at this time’ – Tevita Funaki
• READ MORE: Ten deaths, 930 people in hospital, 19,566 new community cases

Dr Old said going into the pandemic Auckland’s hospitals had about 15 percent staff vacancies across the board which meant starting from a challenging position.

“So you then layer on top of that the challenge of Covid and it really has stretched the city.”

A nurses’ union delegate at Waitematā DHB, Di McCulloch, said while the $500 incentive scheme was popular, it had not been good for nursing overall because it led to exhausted workers and did not fix the staffing problems.

She said the nursing situation was dire.

Influx of unwell patients
“We continue to have an influx of unwell patients that normally enter the hospital and this has been compounded by omicron.”

She said once the subsidy ends the nursing shortages will continue and the DHBs will continue to redeploy non-clinical staff to fill the staffing gaps in wards.

Dr Old acknowledged how tired hospital staff in Auckland are.

“You know this has been going on for two years and the intensity has really stepped up in the last couple of weeks and I think certainly the city and the country are incredibly well served by the professionalism of the health workforce.”

Dr Old said the $500 payment was being reviewed today and there was the potential for it to be extended.

It aimed to ensure staff were available, particularly for hard to fill shifts such as overnights, he said.

“Look, we recognise people are tired, we’re asking them to go above and beyond and it’s just a recognition of the fact that actually everyone is really stretched.”

Hospitals just managing
Association of Salaried Medical Specialists executive director Sarah Dalton described the current situation as a crisis and said hospitals were only just managing.

“People are going above and beyond, they’re doing everything they can to keep it safe for patients, but that doesn’t mean it’s not a crisis, it doesn’t mean that the entrenched short staffing that we were trying to deal with before covid hasn’t made this almost impossible to deal with.”

It was not just Auckland and a lot of surgery and outpatient appointments were being cancelled around the country, she said.

McCulloch said the border closure had made the nursing shortages worse because in the past there had been a reliance on internationally qualified nurses (IQN).

“So it’s become an ongoing issue, this has been going on for years within nursing and the nursing voice are saying that we are tired, we are exhausted, we are short-staffed daily on the ground.”

But McCulloch said that had “not been heard by the powers that be”.

In terms of dealing with New Zealand’s ongoing nursing shortage, McCulloch said New Zealand needed to keep its new nursing graduates working here.

She said that could mean bonding newly qualified nurses to working in New Zealand for a minimum of two years.

Auckland hospitals put care on hold
Auckland hospitals have put all but the most urgent care on hold to allow them to focus on covid-19 patients.

At the same time they are managing with 25 percent fewer staff as covid-19 cases continue to rise.

There were 19,566 cases and 930 people in hospital with the virus yesterday, more than two thirds of them in Auckland. Ten new covid-related deaths were also reported, taking the total to 151.

Dr Old said the region was grappling with peak hospitalisations and staff shortages due to the omicron outbreak.

“We’re in the eye of the storm now, so with cases thankfully coming down a bit but peak hospitalisations coinciding with near peak staff needing to be off to support their own family or off with covid themselves.”

But Dr Old said the number of staff vacancies due to covid-19 was starting to come down as coronavirus numbers start to drop and he was hopeful that things would improve this week.

He said there had been some limited cases of covid-19 positive staff working at Auckland hospital’s as the region dealt with the peak.

Serious challenges
“Those have been people where without them coming back we would have had serious challenges keeping those services going and so yes, coming back into environments where they’re only dealing with covid positive patients.”

Dalton said it was appalling to be in a position where in limited circumstances employers are encouraging staff unwell with covid-19 to go back to work.

“What they’re saying is they’re only doing that in covid settings and where otherwise there would be risk to life and limb effectively, so it’s a life preserving service.

“But to think that we’re in such a fragile state in terms of staffing that that has to be part of cover at the moment is really distressing.”

Dr Old stressed that urgent care was still available at the region’s hospitals.

“But anything that can be deferred essentially over the last couple of weeks really has been, so that’s pretty much all out-patient activity … and almost all planned surgery as well.”

Challenging to get support to South Auckland families
Auckland Pacific health and social service provider The Fono said it was run off its feet keeping up with the demands of a community struck by covid-19.

Chief executive Tevita Funaki said the service was looking after more than 900 active cases at one time.

“It’s not just the health challenges but also the whole welfare support and food and also other needs of the families.”

The service also had a number of staff getting sick or isolating due to covid-19.

The Fono had been using the network of churches in the Pacific community to distribute what was needed for families, Tevita said.

This article is republished under a community partnership agreement with RNZ.

This content originally appeared on Asia Pacific Report and was authored by APR editor.

This article was produced for ProPublica’s Local Reporting Network in partnership with the Miami Herald. Sign up for Dispatches to get stories like this one as soon as they are published.

In a legislative session highlighted by culture war battles and redistricting, Florida lawmakers gave a measure of mercy to a group of parents whose children died of catastrophic birth-related brain injuries.

Following up on action taken last year, the Legislature voted to give $150,000 stipends to parents whose children were once enrolled in a state program called the Birth-Related Neurological Injury Compensation Association, or NICA, but had been dropped from the rolls when the children died.

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Families of surviving NICA children received identical stipends last year as part of a comprehensive slate of reforms, but the families of children who died were left out, even though some had spent themselves into poverty trying to keep their children alive.

The reforms were implemented after a series of stories by the Miami Herald and ProPublica documented how parents in NICA had to beg for help from the program, which was supposed to provide “medically necessary” care to certain children left severely disabled by oxygen deprivation or spinal injury at birth. Parents complained that they had to plead, often in vain, for medication, specially equipped vans, in-home nursing care and home modifications, to which they were entitled under the NICA statute.

In addition to the $150,000 supplement, last year’s reform package provided a $40,000 increase in the program’s death benefit, a $10,000 annual stipend for family mental health care, an increase in the lifetime subsidy for home modifications from $30,000 to $100,000, and money for wheelchair-accessible vans, among other things.

Advocates claimed the reforms didn’t go far enough, and Sen. Lauren Book, a Democrat who leads her party in the upper chamber, filed a bill this year with several provisions designed to rectify that.

The bill, however, failed to secure a single sponsor in the House of Representatives, and Senate leaders declined to present it to any of the three committees to which it was assigned.

Supporters of the bill, including NICA’s current director, Melissa Jaacks, persuaded lawmakers to include a few provisions in a separate, sprawling bill that modified the statute governing the state Department of Health. The most significant measure was the one-time $150,000 payment to the families whose children had died.

The Health Department legislation that passed, which still must be signed by Gov. Ron DeSantis, also bolsters NICA’s ability to collect dues from doctors who are required to help financially sustain the program.

An August 2021 report by the Florida Auditor General, an independent watchdog who reports to the Legislature, said that, since 2016, administrators failed to collect more than $14.4 million in delinquent assessments from doctors. NICA staff told auditors that it didn’t make financial sense for the agency to collect from doctors individually but that it would file batches of lawsuits against them. No lawsuits had been filed since January 2018, the audit said.

Lawmakers created NICA in 1988 in response to demands from doctors who claimed high medical malpractice premiums were driving them from practicing medicine in Florida. The law immunized obstetricians from the consequences of a bad outcome by precluding families from filing malpractice suits. In exchange, parents were steered into NICA.

Obstetricians who participate in the program must pay $5,000 annually in order to be granted immunity from lawsuits. Other doctors licensed in the state are required to pay $250 each year to support the program, and hospitals pay $50 for every live birth. The assessments are invested, helping the fund grow.

The Herald-ProPublica series documented how NICA had amassed nearly $1.7 billion in assets while denying or delaying care to children who suffered profound brain damage at birth — often as the result of negligence.

To parents like Ruth Jacques of Orlando, who was prevented from holding anyone responsible for the 2018 death of her son, Reggie, this year’s legislation is a long-overdue acknowledgment of her pain.

“I am sad about my son,” she said. “I am strengthened to know that the voices of a few can be so loud.”

After her story was told by the Herald, Jacques attended NICA board meetings and spoke with state insurance regulators seeking to include the parents of deceased children in the ongoing NICA reform.

“It gives me hope for tomorrow,” said Jacques, who has given birth to two sons since Reggie died. “It is this strength and perseverance that I wish to leave as my kids’ greatest legacy.”

Providing the $150,000 supplement to parents like Jacques had been the “number one legislative priority” for NICA administrators after Book’s reform bill failed to gain any traction, Jaacks said. Still, the director added, there is much unfinished business, and “we will absolutely pursue additional legislation next year.”

Jaacks was hired in October​ when the program’s then-director, Kenney Shipley, resigned amid pressure. (Shipley has declined comment.) Jaacks and the new NICA board, brought in after the Herald-ProPublica investigation, are considering whether to extend to the parents of deceased children another benefit from last year: allowing them to have their mental health care covered.

“What these families have been through should never have happened,” Jaacks said of the 209 families who lost a child as a consequence of a birth injury.

Leanne Lewis, 28, of Keystone Heights, about 25 miles from Gainesville, lost her son, BradyJ Lee Yarbrough, on April 20, 2019. Brady had been born with severe brain damage and had suffered unrelenting seizures as a consequence.

Like Jacques, Lewis attended several meetings with NICA’s new director and worked for months to convince lawmakers that her suffering was no less real than that of parents whose living children still are clients.

“We begged them to view us as parents and to stop viewing our children as just another case,” Lewis said. “We wanted them to see us as human beings, not as a dollar sign. We cried to them.”

The supplement, she said, can never compensate her for her loss. But it will help her get on with her life.​

“There are 209 families that are going to be reminded that their children have not been forgotten,” Lewis said. “When your child dies, the only thing you want from other people is to remember them.”

This content originally appeared on Articles and Investigations - ProPublica and was authored by by Carol Marbin Miller and Daniel Chang, Miami Herald.

Comprehensive coverage of the day’s news with a focus on war and peace; social, environmental and economic justice.

• President-elect Joe Biden slams the Trump administration’s roll out of COVID-19 vaccines.
• Stay at home orders for Southern California extended as hospitals reach a crisis.
• Senate leader blocks vote to increase stimulus payments to $2,000 despite President’s push.
• As coronavirus surges in prisons across the country, family of incarcerated people speak out.
• Vice President-elect Kamala Harris receives first Moderna COVID-19 vaccine.
• New York Governor signs nations toughest eviction moratorium amidst pandemic.

The post President-elect Joe Biden slams Trump administration’s vaccine release ; Shelter in place orders extended in southern California, as hospitals hit a crisis; Senate leader blocks vote to increase stimulus payments to $2,000 appeared first on KPFA.

This content originally appeared on KPFA - The Pacifica Evening News, Weekdays and was authored by KPFA.

• COVID-19 stimulus payments may not reach families until August.
• President Donald Trump bows to pressure and mandates production of PPE.
• House Speaker Nancy Pelosi proposes House oversight of COVID-19 stimulus.
• California’s governor urges businesses to apply for COVID-19 stimulus.
• Lawsuit seeks release of California prisoners vulnerable to coronavirus.
• San Francisco supervisors call for action after city’s first homeless coronavirus case.
• San Jose passes most progressive paid sick leave in nation.
• Santa Clara County health officials prepare for surge in coronavirus cases.

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