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Tuesday, November 19, 2024

Notes on Fighting Trumpism

To mobilize the abandoned working class, we need to revive the idea of solidarity.
November 18, 2024
Source: Boston Review


I am baffled, as I was in 2016, as to why so many liberals are still shocked by Trump’s victory—and why, in their efforts to dissect what happened, they can’t get beyond their incredulity that so many people would blindly back a venal, mendacious fascist peddling racism, misogyny, xenophobia, ableism, and so forth, while cloaking his anti-labor, anti-earth, pro-corporate agenda behind a veil of white nationalism and authoritarian promises that “Trump will fix it.”

We don’t need to waste time trying to parse the differences between the last three elections. In all three, he won—and lost—with historic vote tallies. The message has been clear since 2016, when Trump, despite losing the popular vote to Hilary Clinton, still won the electoral college with nearly sixty-three million votes, just three million fewer than what Obama got in 2012. Trump lost in 2020, but received seventy-four million votes, the second-largest total in U.S. history. For an incumbent presiding disastrously over the start of the Covid pandemic, that astounding number of votes should have told us something. And if we were honest, we would acknowledge that Joe Biden owes most of his victory to the uprisings against police violence that momentarily shifted public opinion toward greater awareness of racial injustice and delivered Democrats an unearned historic turnout. Even though the Biden campaign aggressively distanced itself from Black Lives Matter and demands to defund the police, it benefited from the sentiment that racial injustice ought to be addressed and liberals were best suited to address it.

I’m less interested in conducting a postmortem of this election than trying to understand how to build a movement.

Yet in all three elections, white men and women still overwhelmingly went for Trump. (Despite the hope that this time, the issue of abortion would drive a majority of white women to vote for Harris, 53 percent of them voted for Trump, only 2 percent down from 2020.) The vaunted demographic shift in the 2024 electorate wasn’t all that significant. True, Trump attracted more Black men this time, but about 77 percent of Black men voted for Harris, so the shocking headline, “Why did Black men vote for Trump?” is misdirected. Yes, Latino support for Trump increased, but that demographic needs to be disaggregated; it is an extremely diverse population with different political histories, national origins, and the like. And we should not be shocked that many working-class men, especially working-class men of color, did not vote for Harris. Keeanga-Yamahtta Taylor is right to point to the condescension of the Democrats for implying that sexism alone explains why a small portion of Black men and Latinos flipped toward Trump, when homelessness, hunger, rent, personal debt, and overall insecurity are on the rise. The Democrats, she explained on Democracy Now, failed “to capture what is actually happening on the ground—that is measured not just by the historic low unemployment that Biden and Harris have talked about or by the historic low rates of poverty.”

The Democratic Party lost—again—because it turned its back on working people, choosing instead to pivot to the right: recruiting Liz and Dick Cheney, quoting former Trump chief of staff John Kelly, and boasting of how many Republican endorsements Harris had rather than about her plans to lift thirty-eight million Americans out of poverty. The campaign touted the strength of the economy under Biden, but failed to address the fact that the benefits did not seem to trickle down to large swaths of the working class. Instead, millions of workers improved their situation the old-fashioned way: through strikes and collective bargaining. The UAW, UPS, longshore and warehouse workers, health care workers, machinists at Boeing, baristas at Starbucks, and others won significant gains. For some, Biden’s public support for unions secured his place as the most pro-labor president since F.D.R. Perhaps, but the bar isn’t that high. He campaigned on raising the federal minimum wage from $7.25 to $15.00, but, once taking office, quietly tabled the issue in a compromise with Republicans, choosing instead to issue an executive order raising the wage for federal contractors.

It is true that the Uncommitted movement, and the antiwar protest vote more broadly, lacked the raw numbers to change the election’s outcome. But it is not an exaggeration to argue that the Biden-Harris administration’s unqualified support for Israel cost the Democrats the election as much as did their abandonment of the working class. In fact, the two issues are related. The administration could have used the $18 billion in military aid it gave to Israel for its Gaza operations during its first year alone and redirected it toward the needs of struggling working people. $18 billion is about one quarter of the Department of Housing and Urban Development’s annual budget and 16 percent of the budget for the federal Supplemental Assistance Nutrition Program. They could have cut even more from the military budget, which for fiscal year 2024 stood at slightly more than $824 billion. Moreover, tens of thousands of Palestinian lives would have been spared, much of Gaza’s land and infrastructure would have been spared irreversible damage, and the escalation of regional war in Lebanon and Iran would not have happened—the consequences of which remain to be seen for the federal budget.

Workers improved their situation the old-fashioned way: through strikes and collective bargaining.

Of course, detractors will say that the Israel lobby, especially AIPAC, would not allow it. But the Democrats’ fealty to Israel is not a product of fear, nor is it simply a matter of cold electoral calculus. It is an orientation grounded in ideology. Only ideology can explain why the Biden-Harris administration did not direct UN representative Linda Thomas-Greenfield to stop providing cover for Israel’s criminal slaughter and support the Security Council’s resolution calling for an immediate ceasefire. And only ideology can explain why the administration and Congress has not abided by its own laws—notably the Arms Export Control Act and the Foreign Assistance Act, which prohibits the use of U.S. weapons in occupied territories and the transfer of weapons or aid to a country “which engages in a consistent pattern of gross violations of internationally recognized human rights”—and stopped propping up Israel’s military.

While candidate Trump had encouraged Netanyahu to “finish the job” in Gaza, don’t be surprised if President Trump “negotiates” a swift ceasefire agreement. (Reagan pulled a similar stunt when he secured the return of U.S. hostages from Iran on the same day he was sworn into office.) Such a deal would prove Trump’s campaign mantra that only he can fix it, strengthen his ties with his ruling-class friends in the Gulf countries, and permit the Likud Party and its rabid settler supporters to annex Gaza, in whole or in part, and continue its illegal population transfer under the guise of “reconstruction.” After all, the Biden-Harris administration and the Democrats have already done all the work of “finishing the job.” Gaza is virtually uninhabitable. Once we factor in disease, starvation, inadequate medical care for the wounded, and the numbers under the rubble, the actual death toll will be many times higher than the official count. And with nearly three-quarters of the casualties women and children, the U.S.-Israel alliance will have succeeded, long before Trump takes power, in temporarily neutralizing what Israeli politicians call the Palestinian “demographic threat.”

The 2024 election indicates a rightward shift across the county. We see it in the Senate races, right-wing control of state legislatures (though here, gerrymandering played a major role), and in some of the successful state ballot measures, with the exception of abortion. But part of this shift can be explained by voter suppression, a general opposition to incumbents, and working-class disaffection expressed in low turnout. I also contend that one of the main reasons why such a large proportion of the working class voted for Trump has to do with what we old Marxists call class consciousness. Marx made a distinction between a class “in itself” and a class “for itself.” The former signals status, one’s relationship to means—of production, of survival, of living. The latter signals solidarity—to think like a class, to recognize that all working people, regardless of color, gender, ability, nationality, citizenship status, religion, are your comrades. When the idea of solidarity has been under relentless assault for decades, it is impossible for the class to recognize its shared interests or stand up for others with whom they may not have identical interests.

The Democratic Party lost—again—because it turned its back on working people.

So I’m less interested in conducting a postmortem of this election and tweaking the Democrats’ tactics than trying to understand how to build a movement—not in reaction to Trump, but toward workers’ power, a just economy, reproductive justice, queer and trans liberation, and ending racism and patriarchy and war—in Palestine, Sudan, Congo, Haiti, and elsewhere, in our streets masquerading as a war on crime, on our borders masquerading as security, and on the earth driven by the five centuries of colonial and capitalist extraction. We have to revive the idea of solidarity, and this requires a revived class politics: not a politics that evades the racism and misogyny that pervades American life but one that confronts it directly. It is a mistake to think that white working-class support for Trump is reducible to racism and misogyny or “false consciousness” substituting for the injuries of class. As I wrote back in 2016, we cannot afford to dismiss


the white working class’s very real economic grievances. It is not a matter of disaffection versus  racism or sexism versus  fear. Rather, racism, class anxieties, and prevailing gender ideologies operate together, inseparably. . . . White working-class men understand their plight through a racial and gendered lens. For women and people of color to hold positions of privilege or power over  them is simply unnatural and can only be explained by an act of unfairness—for example, affirmative action.”

There have always been efforts to build worker solidarity, in culture and in practice. We see it in some elements of the labor movement, such as UNITE-HERE, progressive elements in SEIU, National Nurses United, United All Workers for Democracy, Southern Worker Power, Black Workers for Justice, and Change to Win. Leading these efforts has been the tenacious but much embattled Working Families Party (WFP) and its sister organization, Working Families Power. Their most recent survey found that growing working-class support for Trump and the MAGA Republicans does not mean working people are more conservative than wealthier Americans. Instead, it concluded, working people are “uniformly to the left of the middle and upper classes” when it comes to economic policies promoting fairness, equity, and distribution. On other issues such as immigration, education, and crime and policing, their findings are mixed and, not surprisingly, differentiated by race, gender, and political orientation. Most importantly, the WFP understands that the chief source of disaffection has been the neoliberal assault on labor and the severe weakening of workers’ political and economic power. Over the last five decades we’ve witnessed massive social disinvestment: the erosion of the welfare state, living-wage jobs, collective bargaining rights, union membership, government investment in education, accessible and affordable housing, health care, and food, and basic democracy. In some states, Emergency Financial Managers have replaced elected governments, overseeing the privatization of public assets, corporate tax abatements, and cuts in employee pension funds in order to “balance” city budgets. At the same time, we have seen an exponential growth in income inequality, corporate profits, prisons, and well-funded conservative think tanks and lobbying groups whose dominance in the legislative arena has significantly weakened union rights, environmental and consumer protection, occupational safety, and the social safety net.

And the neoliberal assault is also ideological; it is an attack on the very concept of solidarity, of labor as a community with shared interests. David Harvey, Ruth Wilson Gilmore, David McNally, Nancy Fraser, Wendy Brown and many others have all compellingly articulated this challenge. In response to the 1970s strike wave and the global slump that opened the door for the neoliberal turn, the Thatcherite mantra that “there is no such thing as society; there are individual men and women” took hold. For decades unions have been disparaged as the real enemy of progress, their opponents insisting that they take dues from hardworking Americans, pay union bosses bloated salaries, kill jobs with their demand for high wages, and undermine businesses and government budgets with excessive pension packages. Remember Mitt Romney’s presidential campaign talking points: workers are the “takers,” capitalists are the “makers” who should decide what to pay workers. Neoliberal ideology insists that any attempt to promote equality, tolerance, and inclusion is a form of coercion over the individual and undermines freedom and choice. Such regulatory or redistributive actions, especially on the part of government, would amount to social engineering and therefore threaten liberty, competition, and natural market forces.

The idea of solidarity has been under relentless assault for decades.

Generations have grown up learning that the world is a market, and we are individual entrepreneurs. Any aid or support from the state makes us dependent and unworthy. Personal responsibility and family values replace the very idea of the “social,” that is to say, a nation obligated to provide for those in need. Life is governed by market principles: the idea that if we make the right investment, become more responsible for ourselves, and enhance our productivity—if we build up our human capital—we can become more competitive and, possibly, become a billionaire. Mix neoliberal logic with (white) populism and Christian nationalism and you get what Wendy Brown calls “authoritarian freedom”: a freedom that posits exclusion, patriarchy, tradition, and nepotism as legitimate challenges to those dangerous, destabilizing demands of inclusion, autonomy, equal rights, secularism, and the very principle of equality. Such a toxic blend did not come out of nowhere, she insists: it was born out of the stagnation of the entire working class under neoliberal policies.

That diagnosis points toward an obvious cure. If we are going to ever defeat Trumpism, modern fascism, and wage a viable challenge to gendered racial capitalism, we must revive the old IWW slogan, “An injury to one is an injury to all.” Putting that into practice means thinking beyond nation, organizing to resist mass deportation rather than vote for the party promoting it. It means seeing every racist, sexist, homophobic, and transphobic act, every brutal beating and killing of unarmed Black people by police, every denial of healthcare for the most vulnerable, as an attack on the class. It means standing up for struggling workers around the world, from Palestine to the Congo to Haiti. It means fighting for the social wage, not just higher pay and better working conditions but a reinvestment in public institutions—hospitals, housing, education, tuition-free college, libraries, parks. It means worker power and worker democracy. And if history is any guide, this cannot be accomplished through the Democratic Party. Trying to move the Democrats to the left has never worked. We need to build up independent, class-conscious, multiracial organizations such as the Working Families Party, the Poor People’s Campaign, and their allies, not simply to enter the electoral arena but to effectively exercise the power to dispel ruling class lies about how our economy and society actually work. The only way out of this mess is learning to think like a class. It’s all of us or none.


Robin D. G. Kelley
is Gary B. Nash Professor of American History at UCLA and a contributing editor at Boston Review. His many books include Freedom Dreams: The Black Radical Imagination.  Kelley has described himself as a Marxist surrealist feminist.

Labor’s Resurgence Can Continue Despite Trump
November 19, 2024
Source: Jacobin

Image by Kire1975, public domain

Does Trump’s reelection mean that the US labor resurgence is over? Not necessarily.

It’s true that the new administration is preparing major attacks against workers and the labor movement. And many union leaders will assume that the most we can hope for over the next four years is to survive through purely defensive struggles.

But unions are actually still well-positioned to continue their organizing and bargaining momentum. Here are seven positive factors that should ward off despair — and that should encourage unions to invest more, not less, in organizing the unorganized:

1. The economic forces fueling Trumpism also favor labor’s continued resurgence. After the pandemic laid bare the fundamental unfairness of our economic system, workers responded with a burst of union organizing and the most significant strike activity in decades. The same underlying economic forces — chronic economic insecurity and inequality — helped propel Trumpism to a narrow victory in the 2024 elections. But Trump’s actual policies will inevitably exacerbate economic inequality, undermining the Republican Party’s hollow populist rhetoric.

Stepping into the breach of Trump’s fake populism, unions remain workers’ best tool to provide a real solution to economic insecurity. And projected low unemployment will continue to provide a fertile economic environment for new organizing. As long as we remain in a tight labor market, employers will have less power to threaten employees who dare to unionize their workplaces and workers will have more bargaining leverage against employers, increasing the chances of successful — and headline-grabbing — strikes.

2. Unions can still grow under Republican administrations. It’s certainly true that the organizing terrain will be significantly harder under Trump and a hostile National Labor Relations Board (NLRB). But it’s still possible to fight and win even in these conditions.

It’s worth remembering that US labor’s current uptick began with the statewide teachers’ strikes that swept across red states in 2018 during Trump’s first term. And NLRB data show that putting major resources toward new organizing can go a long way in counterbalancing the negative impact of an adverse political context.

Unions organized significantly more workers under George W. Bush’s administration than under Barack Obama. Why? The main reason is that the labor movement in the early 2000s was still in the midst of a relatively well-resourced push to organize the unorganized, whereas by the time Obama took office, labor had mostly thrown in the towel on external organizing, hoping instead to be saved from above by lobbying establishment Democrats to pass national labor law reform. Labor can grow over the coming years if it starts putting serious resources toward this goal.

3. Labor has huge financial assets at its disposal. According to the latest data from the Department of Labor, unions hold $42 billion in financial assets and only $6.4 billion in debt. These assets — the vast majority of which are liquid assets — can help defend against the coming political attack and be deployed in aggressive organizing drives and strikes. Unions have the financial cushion to go on the offensive while simultaneously defending themselves from regulatory and legislative attacks.

4. Unions remain popular and trusted. According to a September 2024 Gallup poll, 70 percent of Americans approve of labor unions, the highest support since the 1950s — even 49 percent of Republicans these days support unions. Overall, Americans trust organized labor far more than the president, Congress, big business, and the media.

When workers have the opportunity to vote for a union at their workplace, unions win 77 percent of those elections. The American public also supports strikes. According to a poll by YouGov in August, 55 percent of Americans believe that going on strike is an effective strategy for workers to get what they want from management, compared to 23 percent who say no. Similarly, 50 percent of Americans believe it is unacceptable to scab, while only 26 percent say it is acceptable. Strong public support for labor continues to provide fertile ground for a union advance.

5. Organized labor is reforming. The bad news: most union officials remain risk-averse and their failure to seriously pivot toward organizing new members — despite exceptionally favorable conditions since 2020 — helped pave the way for Trump’s inroads among working people. The good news: the “troublemakers” wing of the labor movement is larger than ever, as seen in the dramatic growth of Labor Notes, the election of militants to head a growing number of local and national unions, and the emergence of much-needed rank-and-file reform movements in unions like the United Food and Commercial Workers.

Most notably, a reformed United Auto Workers (UAW) led by Shawn Fain is going full steam ahead with its push to organize the auto industry across the South — an effort that will soon get a big boost when unionized Volkswagen workers finalize their first contract. Rank-and-file activists across the country can continue to point to the UAW, as well as other fighting unions, as an example that their unions should be emulating.

6. Young worker activism is not going away. Most of the labor upsurge since 2020 has been driven forward by Gen Z and millennial workers radicalized by economic inequality, Bernie Sanders, and racial justice struggles. And contrary to what some have suggested, the 2024 election did not register a major shift to the Right among young people, but rather a sharp drop in young Democratic turnout.

7. The (latent) power of unions to disrupt the political and economic system is high. Despite declines in union membership and density (the percentage of the workforce in a union), union members still have significant representation in critical sectors of the economy.

Labor’s existing power provides a base for beating back the worst of Trump’s attacks and expanding union representation to nonunion workers in the semiorganized sectors. In addition, coordinated strikes or labor unrest in any of these sectors would significantly disrupt the functioning of the economy or public services, providing a potent tool for workers and unions. While logistically and legally difficult, workers and their unions have the power to shut down critical sectors of the economy if they so choose — an approach that could repolarize the country around class lines instead of Republican-fueled scapegoating.

8. Republicans may overplay their hand, creating new openings for labor. A scorched-earth legislative, regulatory, and judicial attack on labor law may create unintended opportunities. For example, if the Supreme Court follows Elon Musk’s bidding by throwing out the National Labor Relations Act — the primary law governing private sector organizing — states would have the power to enact union-friendly labor laws and legal restrictions on strikes and boycotts could be loosened. As Jennifer Abruzzo, the NLRB’s general counsel, told Bloomberg, if the federal government steps away from protecting the right to organize, “I think workers are going to take matters into their own hands.”


Conclusion

Labor’s decades-long tendency to defensively hunker down is one of the major factors that has led our movement — and the country — into crisis. Turning things around will depend on pivoting to a new approach.

The strongest case for labor to scale up ambitious organizing efforts and disruptive strike action is not just that it’s possible, but that it’s necessary. Without increased initiatives to expand our base and to polarize the country around our issues, union density is sure to keep dropping. Organized labor’s last islands of strength — from K-12 public education and the federal government to UPS and Midwest auto — will become extremely vulnerable to attack. And unions will be forced to fight entirely on the political terrain chosen by Republicans, who will paint them as a narrow interest group of privileged employees beholden to “union bosses,” Democratic leaders, and “woke” ideology.

Sometimes going on the offense is also the best form of defense. The best way to expose Trump’s faux populism is by waging large-scale workplace battles that force all politicians to show which side they’re on.

Nobody has a crystal ball about what lays ahead, nor should anybody underestimate the importance of defending our movement — and all working people — against Trump’s looming attacks. But it’s not factually or tactically justified to dismiss the potential for labor advance over the next four years.

Conditions overall remain favorable for labor growth, despite Trump’s reelection. Political contexts matter, but so do factors like the economy, high public support for unions, labor’s deep financial pockets, the growth of union reform efforts, labor’s continued disruptive capacity, and the spread of young worker activism. Rebuilding a powerful labor movement remains our best bet to defeat Trumpism, reverse rampant inequalities, and transform American politics. Now is not the time for retreat.


Chris Bohner is a union researcher and activist.

Thursday, November 14, 2024

FOR PROFIT HEALTHCARE U$A

How the nation's largest oxygen distributor became a multibillion-dollar Medicare scofflaw


Photo by Alexander Grey on Unsplash
man in blue hoodie wearing eyeglasses
November 13, 2024

Reporting Highlights
Decades of Misbehavior: Lincare has repeatedly landed on Medicare’s equivalent of probation; the company has a dismal history of exploiting the government and ailing patients.
Too Big to Ban: Despite Lincare’s track record, Medicare, which provides most of the company’s revenues, has never sought to bar the company from the Medicare system.
Tolerating Wrongdoing: Faced with $60 billion a year in fraud, Medicare spends millions chasing companies but accepts penalties that are only a fraction of the profits made on misbehavior.

These highlights were written by the reporters and editors who worked on this story.

For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business.

The company, the largest distributor of home oxygen equipment in the United States, admitted billing Medicare for ventilators it knew customers weren’t using (2024) and overcharging Medicare and thousands of elderly patients (2023). It settled allegations of violating a law against kickbacks (2018) and charging Medicare for patients who had died (2017). The company resolved lawsuits alleging a “nationwide scheme to pay physicians kickbacks to refer their patients to Lincare” (2006) and that it falsified claims that its customers needed oxygen (2001). (Lincare admitted wrongdoing in only the two most recent settlements.)

Such a litany of Medicare-related misconduct might be expected to provoke drastic action from the Department of Health and Human Services, which oversees the federal health insurance program that covers 1 in 6 Americans. Given that most of Lincare’s estimated $2.4 billion in annual revenues are paid by Medicare, HHS wields tremendous power over the company.

Sure enough, as part of the 2023 settlement, HHS placed Lincare on the agency’s equivalent of probation, a so-called corporate integrity agreement. The foreboding-sounding document includes a “death penalty” provision: Any “material breach” of the probation agreement, which runs for five years, “constitutes an independent basis for Lincare’s exclusion from participation in the Federal health care programs.” Such a ban could effectively kill Lincare’s business.

That sounds dire. Except that before that corporate integrity agreement was signed in 2023, Lincare was under the same form of probation, with the same death penalty provision, from 2018 to 2023, and violated its terms. From 2006 to 2011, Lincare was similarly on probation and also violated the terms, according to the government. And before that — well, you get the picture. Lincare has been on probation four times since 2001. And despite a pattern not only of fraud, but of breaking its probation agreements, Lincare has never been required to do more than pay settlements that amount to pennies relative to its profits.

This is not an aberration. While HHS routinely imposes the death penalty on small operations, it has never barred a national Medicare supplier like Lincare from continuing to do business with the government. Some companies, it seems, are too big to ban.

Lincare’s lengthy record of misbehavior isn’t a surprise to people in the medical equipment business. What is surprising is the federal government’s willingness to pull its punches with a company that has fleeced taxpayers and elderly customers again and again.

Federal officials have never pursued the company executives who oversee this behavior even though two of them, Chief Operating Officer Greg McCarthy and Chief Compliance Officer Jenna Pedersen, have worked at Lincare through all four of the company’s probationary periods. No one has faced criminal charges for activity the government’s own investigators deemed fraud.

Medicare has continued to pay Lincare billions even as many of the company’s customers revile it. Evaluations on customer-review websites are lacerating, and complaints to state attorneys general abound. On the Better Business Bureau’s website, 888 reviewers gave Lincare an average score of 1.3 out of 5. They cite dirty and broken equipment, charges that continue even after equipment has been returned, harassing sales and collection calls, and nightmarish customer service. As one person wrote in April, Lincare is “running a scam where they have guaranteed income” and “the customer can’t do a thing.”

HHS has always been reluctant to cut off big suppliers. Medicare’s first objective is to make sure nothing interrupts the flow of medications, devices and services to beneficiaries. And were HHS to seek to ban Lincare, the company would surely launch a long, costly legal war. But even if the cost of such combat reached many millions of dollars, it would still be a tiny fraction of the amount lost to fraud, which is yet another contributor to the soaring medical costs that bedevil the country. “This is taxpayer money,” said Jerry Martin, a former U.S. attorney who represented an ex-Lincare executive in a whistleblower suit against the company. “We need to pay people that don’t have four corporate-integrity agreements.”

Weak enforcement is not the only problem. Lincare is paid to rent oxygen equipment to patients, with HHS covering most of the monthly bills. But those rental fees often add up to many times what it would cost simply to buy the equipment. “If this were a rational country,” Bruce Vladeck, who ran Medicare from 1993 to 1997, told ProPublica, “the government would buy a million [oxygen] concentrators and pay Amazon or somebody to deliver them.”

In a seven-month investigation, ProPublica examined how Medicare’s largest provider of home medical equipment has managed to take advantage of its customers for a quarter of a century while fending off meaningful enforcement. ProPublica interviewed more than 60 current and former employees and executives, Medicare and Justice Department officials, patient advocates, and health care experts. ProPublica also reviewed dozens of court cases involving Lincare and thousands of pages of internal company documents, sales presentations and emails.

The investigation reveals a dismal picture of a company with a sales culture that depends on squeezing infirm and elderly patients and the government for every penny. Lincare employees are pressured to sell — whether a customer needs a product or not — on pain of losing their jobs.

And the company’s record of misbehavior and conflict extends far beyond its sales and billing practices. Lincare has paid $9.5 million in settlements for data breaches and mishandling patient and employee records. It has faced claims of violating wage rules, harassing customers with sales and collection calls, and tolerating racist comments to an African American employee. (Lincare lost the latter suit at trial and is appealing.) The company has repeatedly sparred in court with former executives, including a 2017 suit in which longtime executive Sharon Ford claimed that the company had cheated her out of a $1 million bonus. (A judge ruled in favor of Ford at trial before the case was overturned on appeal.) Ford testified that Lincare had earned an industry reputation as “The Evil Empire.” And when Lincare’s CEO, Crispin Teufel, resigned last year to become CEO of a rival company, Lincare sued him for breach of contract and misappropriating trade secrets. Teufel ultimately admitted to downloading confidential company records and was blocked from taking the new job. (Teufel did not respond to requests for comment. His replacement, Jeff Barnhard, took over as Lincare’s CEO in July 2023.)

Lincare declined multiple requests to make executives available for interviews. After ProPublica provided a lengthy document listing every assertion in this article, along with separate such letters to executives McCarthy and Pedersen, the company responded with a three-paragraph statement. It asserted that Lincare is “committed to delivering high-quality and clinically appropriate equipment, supplies, and services” but acknowledged “missteps in the past.” The company said its “new leadership” had “commenced a comprehensive review of our policies and procedures to help ensure we are complying fully with all state and federal regulations” and that “investments and enhancements we have made over the last several months will help prevent these issues from repeating in the future.” Lincare did not respond to follow-up questions requesting examples of the steps the company says it’s taking, including whether it has terminated any executives as part of this push.

When ProPublica asked a top Medicare enforcer why Lincare had eluded banishment, her answer suggested she views probation as a continuing ed class rather than a harsh punishment. “It’s like taking a college course,” said Tamara Forys, who is in charge of administrative and civil remedies for HHS’ Office of Inspector General. “At the end of the day, it’s really up to you to change your corporate culture and to study, to learn to pass the class … to embrace that and take those lessons learned and move them forward.” A spokesperson for the Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment on Lincare but said the agency “is committed to preventing fraud and protecting people with Medicare from falling victim to fraud.”

There’s little incentive to refrain from misbehaving in an environment that tolerates bad behavior, said Lewis Morris, who was chief counsel to HHS’ Office of Inspector General from 2002 to 2012. “As long as that [settlement] check is less than the amount you stole, it’s a good business proposition."

Indeed, Lincare has counted on the government’s tepid response, two former company executives told ProPublica. Top management, they said, responds to fraud warnings by conducting a cost-benefit analysis. “I’ve sat in meetings where they said, ‘We might have $5 to $10 million risk — if caught,’” said Owen Kirk Staggs, who ran one of Lincare’s businesses in 2017 and fell out with the company. “‘But we’ve made $50 million. So let’s go for it. The risk is worth the reward.’”

Libby, Montana, provides a glimpse of the way Lincare operates. Oxygen is an urgent need in this mountain town of 2,857. Libby suffers from the lingering effects of “the worst case of industrial poisoning of a whole community in American history,” in the words of the Environmental Protection Agency. An open-pit vermiculite mine, which operated from 1963 to 1990, coated the area — and residents’ lungs — with needle-like asbestos fibers. More than 2,000 Libby citizens have been diagnosed with respiratory diseases since then; some 700 have died.

Hundreds of ailing residents relied on Lincare for home concentrators, which provide nearly pure oxygen extracted from room air. Medicare and Medicare Advantage plans (which the government also funds) covered 80% of the monthly rental of about $135; patients paid the remaining 20%.

In 2020, Brandon Haugen noticed something suspicious in Lincare’s bills. Haugen was a customer service representative at the company’s local distribution site, one of 700 such locations around the country. (Lincare serves 1.8 million respiratory patients in 48 states.)

Lincare was allowed to charge patients and their insurers for a maximum of 36 months under federal rules. After that point, patients could use the equipment without further charge. Lincare, however, kept billing local patients and their Medicare Advantage plans far beyond 36 months — in some cases, for years. To Haugen, this looked like fraud.

Haugen conferred with center manager Ben Montgomery. The two, who had grown up in the area, had been buddies since seventh grade, after getting to know each other at summer Bible camp. Then 38, earnest and just beginning to gray out of their boyishness, the two men were concerned. The patients the men dealt with were their neighbors.

A regional Lincare manager assured them that charging beyond 36 months for Medicare Advantage patients “is the correct way to bill.” Skeptical, Montgomery raised the issue with Lincare’s headquarters in Clearwater, Florida. Lincare’s compliance director told him, according to Montgomery, that “it’s the patients’ problem to fix it if they want it to stop”; that was “just how it worked.” Further questions, sent to Lincare’s chief compliance officer, Pedersen, went nowhere. “It seemed pretty obvious they were well aware of this,” Montgomery told ProPublica. “For me, these were my customers that you were screwing over.”

Among them was Neil Bauer, now 80, who lives in a ramshackle house “out in the boondocks,” as he put it, 38 miles southeast of Libby. Bauer spent his career as a barber, head of investigations for the county sheriff’s department and a member of the local school board. He’s been on oxygen for more than a decade and quickly gets short of breath. “I can’t do stuff so much now,” he said. His wife is on oxygen, too. “We just have a sick family,” Bauer said.

Lincare had kept billing Bauer for his concentrator for seven years after it was supposed to stop. The monthly copays weren’t huge, but they added up to $2,325 that he shouldn’t have been charged over that period, a daunting sum for Bauer, who lives on a fixed income — and a hefty mark-up over the cost of the equipment, which can be purchased online for $799. For its part, Medicare Advantage paid Lincare $9,299 for Bauer’s concentrator during this period, along with another $5,760 for the months Lincare was legally permitted to bill. All told, the rental payments to Lincare, during authorized and unauthorized periods, were $16,547 for that one $799 piece of equipment. “We paid forever,” said Bauer. “Never was I told that we could have one without having to pay anything.”

Haugen and Montgomery studied billing records. Among the customers in their tiny office, Lincare was improperly charging at least 33 people and their Medicare plans. The two began to wonder how far this problem extended. An employee in Idaho confirmed the same practice was occurring there. “In my mind,” Montgomery said, “I went, ‘This is Libby, Montana. Multiply that by every center in the country. This is obviously a lot bigger deal.’”

Montgomery and Haugen had seen enough. On Jan. 18, 2021, they emailed a joint resignation letter to Lincare’s top management, recounting their concerns about billing that “likely affects thousands of patients company wide.” Citing the lack of response from corporate officials, they wrote, “we can only conclude that this is a known issue that is being covered up by Lincare.”

Haugen had 10 children. Montgomery had four. Neither man had another job lined up. “Had this not happened,” said Montgomery, who had been at the company for 13 years, “I would have seen myself retiring from Lincare.”

Instead, they became whistleblowers. They retained a law firm and sued Lincare in Spokane, Washington, the site of Lincare’s regional headquarters. After federal prosecutors decided to back the case, Lincare settled in August 2023. The company admitted to overbilling Medicare plans and patients across the country for years and paid $29 million to settle the matter, with $5.7 million of that going to Montgomery, Haugen and their lawyers. Dan Fruchter, the assistant U.S. attorney leading the government’s case, told ProPublica that the overbillings likely involved “tens of thousands” of patients.

Lincare agreed to its fourth stint of probation with HHS; the new corporate-integrity agreement took effect on the day after the previous one expired. The conduct Montgomery and Haugen flagged had gone on for years while the company was already on probation. But Lincare got the government lawyers to agree that nobody would try to impose the Medicare death penalty. Lincare asserted in the settlement that it had installed software (which it did only after learning of the government investigation) that will prevent billing beyond 36 months. Lincare promised to ensure “full and timely” compliance with the agreement and prevent future wrongdoing.

Medicare fraud, including in the “durable medical equipment” category that Lincare operates in, has long been an intractable problem. It cost the U.S. Treasury an estimated $60 billion in 2023 alone.

The government deploys large sums to try to stop it. HHS’ inspector general’s office has a $432 million budget and a staff of 1,600. Those resources are effectively extended by whistleblowers — most of the cases against Lincare have been such suits — who can receive a percentage of a civil settlement if they reveal wrongdoing, and by federal prosecutors, who can also bring cases or join those filed by whistleblowers. Last year HHS recovered $3.2 billion from fraudulent schemes.

But the agency’s enforcers have wielded their biggest deterrent almost entirely against small perpetrators. In 2023, they banned 2,112 small firms and individuals from Medicare reimbursement.

HHS hasn’t done the same with companies that operate on a national scale. Forys, the agency enforcer, said she worries that expelling a big provider from Medicare could leave customers in the lurch. In April, Inspector General Christi Grimm defended her office’s work in congressional testimony but also asserted that its resources are inadequate. A lack of staff keeps it from even investigating “between 300 and 400 viable criminal and civil health care cases” annually, she testified, as well as more than half the fraud referrals from Medicare’s outside audit contractors.

A different reason for going easy on big companies was suggested by Vladeck, the former Medicare chief. Seeking to bar a large supplier for repeatedly violating probation would require exhaustive documentation and years of litigation against squadrons of well-paid corporate lawyers. As a result, Vladeck said, “there’s a real incentive, from a bureaucratic point of view, to just slap their wrist, give them a kick and make them apologize. … It’s a cost of doing business.”

There are steps enforcers could take, but almost never do, that would make companies take notice, according to Jacob Elberg, a former federal prosecutor who is now a professor at Seton Hall Law School. (Among his publications is a 2021 law review article titled “Health Care Fraud Means Never Having to Say You’re Sorry.”) Elberg’s research shows that HHS and prosecutors tend to negotiate far smaller civil settlements than the law allows, and they rarely prosecute company executives. They also almost never take cases to trial. In short, enforcers have long signaled to companies that they’re looking for a smooth path to a cash payment rather than a stern punishment for a company and its leaders. “It is generally a safe assumption,” Elberg said, “that the result will be a civil settlement at an amount that is tolerable.”

For its part, Congress may soon be weighing a new law that would reshape how the oxygen industry is paid by Medicare. But rather than clamp down on corporations, the legislation seems poised to do the opposite. A new bill called the SOAR (Supplemental Oxygen Access Reform) Act would hand companies like Lincare hundreds of millions more, by raising reimbursement rates and eliminating competitive bidding among equipment providers. Advocates say the legislation will help patients by making some forms of oxygen more available and improving service. But along the way it will reward Lincare and its rivals.

Congress has a history of treating oxygen companies generously. For years, lawmakers set Medicare reimbursements for oxygen equipment at levels that even HHS, in 1997, characterized as “grossly excessive.” Over the succeeding decade and a half, Lincare took advantage, snatching up hundreds of small suppliers and becoming the industry’s largest player.

In 2006, under pressure to reduce costs, Congress approved steps to curb oxygen payments, including the introduction of competitive bidding and the 36-month cap on payments for equipment rentals. But even those strictures were watered down after the industry poured money into political contributions and lobbyists, who warned that cuts would harm elderly patients.

Lincare compensated by amping up strategies that generated profits, with little apparent regard for Medicare’s rules, which say it will reimburse costs for equipment only when there is evidence of “medical necessity.” The company aggressively courted doctors and incentivized sales, through bonuses the company paid for each new device “setup.” According to a 2016 commission schedule, reps could earn $40 for winning an order for a new sleep apnea machine, $100 for a new oxygen patient and $200 for a noninvasive ventilator. The entire staff of each Lincare center could receive a small bonus for signing up a high percentage of new patients for automatic monthly billing. Patients who refused auto-billing, a company document advised, should be warned they might face “collection activity” and service cutoffs. “Sales is our top priority!” declared a 2020 PowerPoint to train new hires.

Once it had a customer, Lincare would pitch them more costly products and services. One way Lincare did this was through a program called CareChecks. Promoted as a “patient monitoring” benefit, CareChecks were aimed, according to a company presentation, at generating “internal growth.” If a patient exhibited a persistent phlegmy cough, Lincare could persuade their doctor to prescribe a special vibrating vest to loosen chest mucus. Nebulizer patients might be candidates for home oxygen. Patients using apnea devices were potential candidates for ventilators. “We’d make patients think we were coming in clinically to assess them,” a former Lincare manager said, “when really it was to make money off of them.”

Selling replacement parts could also be lucrative. At Lincare call centers that sold items like hoses, masks and filters for CPAP machines (used to treat apnea), hundreds of commissioned agents in Nashville, Tennessee, and Tampa, Florida, were equipped with programs displaying what items each patient was eligible for under Medicare. By law, patients had to request replacement parts. But frequently, that wasn’t what happened, according to Staggs, who oversaw the CPAP business in 2017. He discovered that top salespeople, whose bonuses could total $8,000 a month, averaged just a few minutes on the phone per order. That wasn’t nearly enough time to identify what items, if any, customers actually needed. Staggs listened to recorded calls and found that, after reaching customers, agents often placed them on hold until they hung up, then ordered them every product that Medicare would cover.

At Lincare, results were closely tracked and widely shared in weekly emails displaying the best and worst performers in each region. Notes taken by one manager show supervisors’ performance demands during weekly conference calls: “Unacceptable to miss goal … stop the excuses … If this is not being done, wrong [center manager] in place … If you’re not getting O2 and not getting Care Checks — you shit the bed. Stop accepting mediocre, lazy responses ….”

“If we didn’t meet our quota, they were going to chop our heads,” said former Illinois sales rep Sandra Gauch, who worked for Lincare for 17 years before joining a whistleblower suit and quitting in 2022.

One salesperson was so fearful of missing her quota, according to Gauch, that she signed her mother up for a ventilator that she didn’t need. A company audit in 2018 found that only 10 of 56 ventilator patients at one center were using them consistently. Some patients hadn’t used their devices for years. Yet Lincare kept billing Medicare.

Only one thing mattered as much as maximizing new equipment rentals, according to former employees and company documents: minimizing customers’ attempts to end rentals. A call to retrieve breathing equipment meant that it was no longer wanted or being used, and Lincare was supposed to retrieve it and promptly stop billing Medicare and the patient. The person’s health might have improved. They might have gone into the hospital — or died. The reason didn’t matter; at Lincare, “pickups” were a black mark, deducted from employees’ performance scores, jeopardizing their bonuses and jobs.

As a result, employees said, such requests were dreaded, delayed and deterred. Clinical staff were sent to “reeducate” customers to keep using their devices. Patients were told they’d need to sign a form stating they were acting “against medical advice.”

Lincare managers made it clear that pickups should be discouraged. In a 2010 email, an Ohio center manager instructed subordinates: “As we have already discussed, absolutely no pick-ups/inactivation’s are to be do[ne] until I give you the green light. Even if they are deceased.” In 2018, an Illinois supervisor emailed her deputies that pickups were barred without her explicit approval: “Not even Death that I don’t approve first.”

In February 2022, Justin Linafelter, an area manager in Denver, responded to the latest corporate email celebrating monthly “Achievement Rankings” for oxygen sales by pointing out that almost all of the centers atop the rankings had at least 150 “pending pickups,” customers who weren’t using their equipment but whom the company appeared to still be billing. “Some of these centers are just ignoring pickups to make this list.”

That was only one of Linafelter’s concerns. In July of that year, he emailed headquarters, saying he no longer had “the resources to be successful at my job.” The customer service staff in Denver had been cut in half, Linafelter explained, and he’d been barred from hiring replacements. Denver’s remaining staff was “at a point of exhaustion,” threatening patient care.

The morning after Linafelter expressed concerns to Lincare in 2022, he was summoned to a conference call with the head of HR and fired, for what he was told was a “corporate restructuring.” Linafelter, who had worked at Lincare for nine years, said, “I got thrown away like a piece of trash.”

Other former employees offer similar accounts. In 2020, Jillian Watkins, a center manager in Huntington, West Virginia, repeatedly alerted supervisors that Lincare was improperly billing for equipment that patients weren’t using. Lincare blocked her from firing a subordinate who’d falsified documents supporting the charges, then fired Watkins, citing “inadequate direction and leadership.”

Then came a series of turns. Pedersen, the chief compliance officer, effectively confirmed Watkins’ assertions, belatedly alerting the government about $486,000 in improper billings by Lincare. But Pedersen blamed the billings on Watkins, writing to Medicare that the company had “terminated” her to “prevent [the problem] from recurring.” After Watkins sued, Pedersen admitted in a deposition that Watkins’ firing “had nothing to do with the overpayment.” In April 2024, a federal judge ruled that Watkins had presented “a prima facie case of retaliation.” The suit was privately settled in mediation.

Staggs, too, was ousted, he said, after he warned top Lincare executives about improper practices at the CPAP call centers. Staggs emailed a Lincare HR officer: “Patients are being shipped supplies that they never have ordered. … This is fraud and I have gotten zero support or attention to this matter when I raise the issue to my leadership.” Only months after starting, he was fired in November 2017. He later filed a whistleblower suit; Lincare denied wrongdoing. After the U.S. attorney’s office in Nashville declined to join the case in 2022, Staggs withdrew the action.

Staggs’ account of improper billings matches an industry pattern that appears to continue to this day. In a 2018 report, HHS’ inspector general estimated that Medicare had paid more than $631 million in improper claims for CPAP and other supplies over a two-year period. Another HHS analysis identified an additional $566 million in potential overpayments for apnea devices.

The agency’s oversight “was not sufficient to ensure that suppliers complied with Medicare requirements,” the 2018 report concluded. Six years later, HHS has not taken public action against Lincare relating to CPAPs.

Today, fraudulent billing among Medicare equipment providers remains a “major concern,” according to the inspector general. The agency says it continues to review the issue.


Doris Burke contributed research.

Wednesday, October 30, 2024

Boeing Might Be Quitting Space With A Potential Division Sale To Jeff Bezos

Ryan Erik King
Mon, October 28, 2024

Photo: Miguel J. Rodriguez Carrillo (Getty Images)

Despite helping NASA first reach the Moon in 1969, Boeing could be tapping out of NASA’s upcoming return to the lunar surface and space entirely. The aerospace giant is considering selling its space division amid its struggles to get the Starliner certified to fly. The spacecraft’s fault-riddled crewed test flight stranded two astronauts in space into next year and scrapped its use in upcoming missions for the foreseeable future.

Boeing is juggling its space crisis with several others that are impacting its core commercial airliner business. In the aftermath of the 737 Max door plug blowout in January, Boeing’s production quality faced unprecedented scrutiny from federal regulators. The Department of Justice deemed that Boeing violated its 2021 settlement for the 737 Max’s two fatal crashes, forcing the planemaker to pay nearly $700 million. Boeing was also forced to spend $4.7 billion in July to acquire Spirit AeroSystems, a vital 737 Max contractor once part of the manufacturer.

The Boeing Starliner cost the company $250 million last quarter, adding to $1.8 billion in program overruns, according to Simple Flying. These losses are compounded by over 33,000 Boeing machinists going on strike for more reasonable compensation. The ongoing strike began in September and halted production on 737, 767 and 777 planes, costing Boeing billions.

With the catastrophic condition of Boeing, Dave Calhoun stepped down as the company’s CEO in August. Kelly Ortberg is now at the helm with the task of fixing basically everything. He told the Wall Street Journal that he’s willing to sell off as much of Boeing as possible to right the ship:

Ortberg, who took over as Boeing CEO in August, said he was weighing asset sales and looking to jettison problematic programs. Beyond the core commercial and defense businesses, he said, most everything is on the table.

“We’re better off doing less and doing it better than doing more and not doing it well,” Ortberg said in a call this week with analysts. “What do we want this company to look like five and 10 years from now? And do these things add value to the company or distract us?”

Ortberg also confirmed that Boeing is in discussions with Blue Origin, Amazon founder Jeff Bezos’ private space company, for a potential sale of its space division. Both companies are NASA contractors for the Artemis program and collaborate with rocket development. The sale would make Blue Origin a more competitive rival to SpaceX overnight. It would also mark the end of Boeing’s legacy in space, from being a vital Apollo program partner to building the American core of the International Space Station.


Boeing Is Losing a Staggering Amount of Money on Its Dismal Starliner Failure

Victor Tangermann
Fri, October 25, 2024 

Imcoster Syndrome

Embattled aerospace giant Boeing is in even bigger trouble after its plagued Starliner spacecraft left two NASA astronauts stranded earlier this year.

The project's costs have continued to spiral over six weeks after the capsule returned to Earth without any astronauts on board. As SpaceNews reports, Boeing took a massive $250 million hit on the Starliner program in its third-quarter earnings, according to a filing with the Securities and Exchange Commission.

That's in addition to a $125 million write-off related to Starliner in the company's second fiscal quarter this year.

The total cost of the failed commercial crew program has ballooned to around $1.85 billion, a stunning sum considering the company has been working on the spacecraft for over a decade and has yet to successfully deliver and then return astronauts to the space station.

The project, which is directly competing with SpaceX's far more successful Crew Dragon spacecraft, is on thin ice, and Boeing has remained suspiciously vague about its future.

"We’ve got some tough contracts and there’s no magic bullet for that," Boeing CEO Kelly Ortberg, who took over the reins in August, told investors during a recent earnings call, as quoted by SpaceNews. "We’re going to have to work our way through some of those tough contracts."
Contracted

Ortberg, however, appeared defiant that Boeing will continue working on its much-maligned Starliner, saying that walking away from the project isn't a "viable option for us."

"Even if we wanted to, I don’t think we can walk away from these contracts," he told investors, caveating a possible scenario where a given program goes from one phase of a contract to another.

It's far from just Starliner that Boeing has to worry about. The company has plenty of other major fires to put out these days, including a commercial jet business in crisis and a massive industrial worker strike.

Overall, the company's quarterly losses have surged to $6 billion, with Ortberg promising a "fundamental culture change."

"This is a big ship that will take some time to turn, but when it does, it has the capacity to be great again," he told investors, as quoted by Reuters.

Where that leaves the future of Starliner remains unclear at best. Earlier this month, NASA announced it would make use of SpaceX's Crew Dragon for two upcoming crew rotation missions to the space station, the latter of which was originally scheduled to make use of Starliner.

"Clearly, our core of commercial airplanes and defense are going to stay with The Boeing Company in the long run," Ortberg said, "but there’s probably some things on the fringe that we can be more efficient with or that just distract us from our main goals."

More on Starliner: NASA Abandons Boeing's Cursed Starliner for Upcoming Missions to the Space Station




Boeing considers selling its space business, including Starliner: report

Elizabeth Howell
Mon, October 28, 2024 

Boeing’s Starliner spacecraft is pictured docked to the Harmony module’s forward port at the International Space Station. | Credit: NASA

Boeing may sell off its space business, including its Starliner program, amid large financial losses for the company, a media report suggests.

The discussions are said to be "at an early stage," according to an exclusive in the Wall Street Journal. The reported talks come less than two months after Starliner completed its first astronaut test flight on Sept. 6 by touching down in New Mexico autonomously, without its two crewmembers.

Boeing is known for decades of work with NASA, including being the prime contractor for the International Space Station. (The company continues engineering support services for ISS to this day.) But Boeing is facing mounting financial issues this year, including a protracted strike by its largest labor union and significant deficits in the Starliner program.

The WSJ report emphasizes, however, that discussions about selling the company's space business — spurred by Kelly Ortberg, Boeing’s new chief executive officer, who was appointed Aug. 8 — are "at an early stage."

And it's uncertain how much of the business may be sold, if a sale happens at all. For example, Boeing may keep its role in leading the Space Launch System (SLS) rocket for NASA's Artemis program of moon exploration, the WSJ report noted. The SLS successfully launched the Artemis 1 uncrewed mission to lunar orbit in 2022 and will launch astronauts around the moon as soon as 2025, with Artemis 2.

Boeing also has a 50% stake, along with Lockheed Martin, in United Launch Alliance, a national security focused-launch provider whose Atlas V rocket launched the Starliner mission on June 5. Lockheed and Boeing have reportedly been looking to sell ULA, as the joint venture moves into launches with a next-generation rocket known as Vulcan Centaur. Vulcan completed its second-ever launch on Oct. 2.

Starliner's development has resulted in financial losses for Boeing. In a filing with the U.S. Securities and Exchange Commission on Oct. 23, for example, Boeing reported a $250 million charge in the third quarter of its fiscal year "primarily to reflect schedule delays and higher testing and certification costs" for Starliner. Boeing's second-quarter results showed an additional $125 million loss on the program.

The spacecraft is a small part of Boeing's defense, space and security business, which reported $3.1 billion in losses (against $18.5 billion in revenues) in the first nine months of 2024, according to Boeing's Q3 results. Boeing's head of the division, Ted Colbert, was removed in September, according to multiple media outlets, including the Associated Press.

a rocket blasting off with blue sky behind

Starliner received the lion's share of Boeing coverage in space circles this year, however, following its Starliner astronaut test flight. As a developmental ISS mission, issues were expected, and schedules were not necessarily set in stone.

That said, propulsion problems during the capsule's journey to the ISS surprised the team, given that Starliner's engineers had already addressed thruster issues that cropped up during uncrewed flights in 2019 and 2022. Five out of 28 thrusters in Starliner's reaction control system for in-space maneuvers failed on the recent astronaut mission, which was known as Crew Flight Test (CFT).

Starliner managed to dock successfully to the ISS on June 6 despite the thruster problems. Boeing and NASA examined the thruster issues for nearly two months and repeatedly delayed Starliner's departure from the ISS. But they could not find the root cause and remedy, and NASA ultimately decided that bringing the astronauts back to Earth on Starliner was too much of a risk.

The two astronauts assigned to Starliner, former U.S. Navy test pilots Butch Wilmore and Suni Williams, saw their expected 10-day mission extended to at least eight months as their spacecraft departed. They are now expected to return home in February 2025 aboard the other commercial craft used by NASA, SpaceX's Crew Dragon.

NASA awarded both SpaceX and Boeing multi-billion dollar contracts in 2014 to ferry astronauts to and from the ISS. Crew Dragon was based on the successful cargo Dragon craft that first flew to space in 2012, while Starliner is a completely new spacecraft. Crew Dragon has now launched on nine operational astronaut missions to the ISS for NASA since its 2020 crewed test flight.

Starliner was supposed to fly its first operational mission, known as Starliner-1, in 2025 with three astronauts on board. Recently, however, Richard Jones, deputy program manager of NASA's Commercial Crew Program at Johnson Space Center in Houston, said the agency is still determining next steps after the troubled test flight.

"We're just starting that — just trying to understand how to correct and rectify the issues that are on the table," Jones said on Oct. 25. "The schedules associated with how long, and what will be required in that area, [are] in front of us, and we'll be working hard on that to know."