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NPR and ProPublica have been reporting about nonprofit hospitals that seize the wages of lower income and working-class patients. Now, Sen. Chuck Grassley, the chairman of the Senate Judiciary Committee, says hospitals could be breaking the law by suing these patients and docking their pay. And he wants some answers.

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When Nonprofit Hospitals Sue Their Poorest Patients

NPR and ProPublica looked across six states, and in each, we found nonprofit hospitals suing hundreds of their patients. One hospital in particular jumped out — Heartland Regional Medical Center in St. Joseph, Mo. Thousands of patients a year are getting their paychecks docked by the hospital and its debt collection arm.

One family we interviewed in our story has been getting their wages seized for nearly 10 years, but still owes $25,000 and feels trapped — in part because Heartland is charging 9 percent interest on that debt.

This family, and others we spoke to, should have qualified for free medical care under the hospital's own charity care policy based on their income. But that didn't happen. We also documented that hundreds of patients with low-wage jobs at McDonald's, Wal-Mart and elsewhere had their pay seized by this hospital.

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Sen. Chuck Grassley, R-Iowa, says nonprofit hospitals could be breaking the law by suing patients and docking their pay. Andrew Harnik/The Washington Times/Landov hide caption

itoggle caption Andrew Harnik/The Washington Times/Landov

Sen. Chuck Grassley, R-Iowa, says nonprofit hospitals could be breaking the law by suing patients and docking their pay.

Andrew Harnik/The Washington Times/Landov

Grassley: Hospitals Could Be Breaking The Law

Grassley, R-Iowa, told NPR and ProPublica he was "astounded" by these collection practices. For more than a decade, Grassley has been working to make nonprofit hospitals more accountable for the huge tax breaks they get. They don't pay federal income tax or local property tax. Grassley says that to justify their tax-exempt status, nonprofit hospitals have to "earn" it by "taking care of people who couldn't provide for their own health care."

Grassley worked on voluntary standards. But he also authored language in the Affordable Care Act requiring hospitals to do more to provide charitable care.

After he saw NPR and ProPublica's reporting on Heartland Hospital (which is changing its name to Mosaic Life Care), Grassley decided to get involved.

He says that under the ACA, a hospital has a responsibility to make a determination: Can a person or a family pay, or can they not. "It seems like Mosaic turned [the law] on its head," he says.

Grassley says the ACA requires that hospitals take the initiative to determine whether patients qualify for financial aid. The hospital is not supposed to shift that burden onto the patients. But in Heartland/Mosaic's case, Grassley said, "It seems to me they have not taken the initiative and they have not abided by the law."

Tougher Rules Required?

This story was reported in partnership between NPR News Investigations and ProPublica, an investigative journalism organization.

For more from this investigation:

From NPR: When Nonprofit Hospitals Sue Their Poorest Patients

From ProPublica: How Nonprofit Hospitals Are Seizing Patients' Wages

From NPR: Millions Of Americans' Wages Seized Over Credit Card And Medical Debt

From NPR: With Debt Collection, Your Bank Account Could Be At Risk

From ProPublica: Wages Of Millions Seized To Pay Past Debts

From ProPublica: Weak Laws Offer Debtors Little Protection

Heartland/Mosaic's board is reviewing its practices as a result of our earlier reporting. Grassley has now sent a letter to the hospital saying he wants to be briefed on the results of that review by Jan. 30. Grassley wrote that the hospital "may not be meeting the requirements to be a nonprofit."

And Grassley hopes his letter sends a wider message to other nonprofit hospitals that are being too aggressive collecting bills from patients who can't afford to pay. "Well, I think some hospitals, you hit them over the head with a 2x4 and they still don't get the message," he said.

Grassley says the health care law may need to be strengthened in order to force nonprofit hospitals to offer financial assistance to poor patients. "If they don't get the message now, we'll have to work towards getting the ideal language in the legislation," Grassley told NPR and ProPublica.

Tama Wagner, a Mosaic Life Care spokesperson, says the hospital will quickly respond to the senator's request and that the hospital's goal is to "do the right thing."

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Affordable Care Act

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Two days after the State of the Union address, President Obama will sit down for a round of unusual interviews. There's a good chance he'll get a question that none of his predecessors have ever had to answer.

One distinct possibility: "Mr. President, is you OK? Is you good? 'Cuz I wanted to know."

That's the signature greeting of GloZell Green, the self-dubbed "Queen of YouTube." Green is one of three YouTube sensations — the others are Bethany Mota and Hank Green — who will interview the president at the White House about the policies outlined in his speech. Viewers can follow along on the White House YouTube account, and ask questions via social media using the hashtag #YouTubeAsksObama.

The practice of bypassing traditional media outlets in favor of more unconventional forums is a familiar one for the Obama White House. Obama famously appeared on actor and comedian Zach Galifianakis' web-based parody talk show "Between Two Ferns" last year to plug government health care, primarily to young Americans.

The webisode has logged about 28 million views since it first launched on humor site Funny Or Die on March 11, 2014. The next day, healthcare.gov experienced a 40 percent bump in traffic, according to a message from the verified Twitter account for the website.

Here's a look at the three YouTube personalities who will be interviewing the president live on Thursday:

GloZell Green

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Self-proclaimed "Queen of YouTube" GloZell Green. YouTube hide caption

itoggle caption YouTube

Self-proclaimed "Queen of YouTube" GloZell Green.

YouTube

Green is a California-based entertainer who shot to fame after posting comedy videos on YouTube, which soon went viral. A video of her coughing and sputtering after consuming a ladle full of cinnamon garnered more than 42 million views.

According to her online biography, GloZell has posted more than 2,000 videos online, has over 3 million subscribers to her YouTube channel and about 529 million total page views. She has leveraged her internet fame to appearances on television shows including the Dr. Oz Show and Showbiz Tonight, and secured a book deal.

Bethany Mota

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Bethany Mota's YouTube videos feature makeup tips, DIY projects and home decoration advice aimed at teen girls and young women. YouTube hide caption

itoggle caption YouTube

Bethany Mota's YouTube videos feature makeup tips, DIY projects and home decoration advice aimed at teen girls and young women.

YouTube

Nineteen-year-old Mota has more than 8 million subscribers to her YouTube account, which features makeup tips, DIY projects and home decoration advice aimed at teen girls and young women. In a video discussing her favorite October beauty products, Mota mentions immediately putting up Christmas decorations after Halloween because she "...just decided that my room looked really sad."

In a January 2014 article, Business Insider reports that the fashion maven earned about half a million dollars through her videos, and had more Instagram followers than Vogue, Marie Claire, Elle, Glamour and Cosmopolitan magazines combined.

Hank Green

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Hank Green has used his online stardom to promote and raise funds for charity. YouTube hide caption

itoggle caption YouTube

Hank Green has used his online stardom to promote and raise funds for charity.

YouTube

More than 2 million YouTubers subscribe to the vlogbrothers channel to watch Hank Green and his brother John Green, author of The Fault in our Stars, rant about Harry Potter, Hong Kong, net neutrality and farting. The project began when the brother realized they were only communicating through text messages and email, and decided to create video blogs for each other to stay in touch.

They have since used their online stardom to promote and raise funds for charity. Project for Awesome, which has taken place every December since 2007, challenges viewers to create innovative videos showcasing the work of their favorite charities. In 2014, the effort raised more than $1.2 million for several charitable organizations including Save the Children and Partners in Health.

YouTube

President Obama

State of the Union

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A gold-mining barge docks along the Madre de Dios river. Courtesy of Duke University hide caption

itoggle caption Courtesy of Duke University

A gold-mining barge docks along the Madre de Dios river.

Courtesy of Duke University

Picture this: A rickety, barge about the size of a garden shed is floating on the Madre de Dios River in eastern Peru. A stream of tan sludge pours off a conveyor belt on one side of the platform. Smoke from a generator belches from the other. The sound of a massive pump thuds across the water. And dangling over the side of the barge is a thick tube to suck sediment up from the riverbed.

Welcome to wildcat gold mining in the 21st century, Peruvian-style.

"Somebody will dive down to the bottom of the river with a scuba suit or some kind of tube to breathe," says Bill Pan, an assistant professor in the Global Health Institute at Duke University. "They'll be on the bottom sucking up the dirt."

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A miner holds a nugget of mercury mixed with gold. The mercury is used to extract gold from river sludge. Rodrigo Abd/AP hide caption

itoggle caption Rodrigo Abd/AP

A miner holds a nugget of mercury mixed with gold. The mercury is used to extract gold from river sludge.

Rodrigo Abd/AP

The miners sift through the dirt searching for flecks of gold and use a ball of mercury to extract tiny specks of specks of the precious metal from the sludge.

In this process, tiny beads of mercury end up getting dumped back into the river along with the leftover mud.

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Sarah Diringer, a Ph.D. student at Duke University, examines fish samples from the Madre de Dios river for potential mercury exposure. Courtesy of Duke University hide caption

itoggle caption Courtesy of Duke University

Sarah Diringer, a Ph.D. student at Duke University, examines fish samples from the Madre de Dios river for potential mercury exposure.

Courtesy of Duke University

Pan and his colleagues at Duke are showing in a new research paper that these illegal mining boats, along with open-pit artisanal mines, are responsible for toxic levels of mercury not just near the miners, but also hundreds of miles downstream.

Over the last decade, tens of thousands of people have moved to this remote area of the Amazon jungle in hopes of striking it rich — or at least making a bit more money than they were before. Not all of them work on floating barges. Some of the miners clear trees from riverbanks and sift the soil in search of gold. The destruction of the forests has been widely documented. This new study shows the extent of the mercury contamination. And the study clearly shows the link between mining and the elevated levels of mercury in the environment.

"There's definitely a strong correlation between where the mining is occurring and where people are at risk for mercury toxicity," Pan says. "And that risk remains elevated for hundreds of miles."

A study in 2013 from the Carnegie Institute found mercury in fish and people in the region at levels far above what the World Health Organization views as acceptable. Mercury exposure can lead to neurological damage. It's particularly dangerous for pregnant women and young children. Heileen Hsu-Kim, an associate professor of environmental engineering at Duke who worked on the study with Pan, says it's clear that mercury levels in fish and people have been going up as mining has expanded.

The government of Peru has attempted to crack down on illegal miners operating on the Madre de Dios river. The Peruvian Navy has even blown up some of the barges. But with gold prices well above $1,000 an ounce, laborers continue to flock to the boats and open-pit mines where they can earn far more than in the other jobs that are available to them in the country.

gold mining

mercury

Peru

The wedding of Leslie Knope (Amy Poehler) and Ben Wyatt (Adam Scott) was one of Parks And Recreation's greatest moments. So was the wedding of April Ludgate (Aubrey Plaza) and Andy Dwyer (Chris Pratt). But Tuesday night, Parks spent the second half of its hour-long double episode on its greatest love story: the friendship of Leslie and Ron Swanson (Nick Offerman).

To recap: This final season has involved a time jump, such that it takes place in 2017. We learned at the start of the season premiere that there had been a falling out between Leslie, the good-government liberal, and Ron, the skeptical-of-government libertarian, that had broken their unlikely but profound bond and made them enemies. It involved something they kept referring to as "Morningstar," and happened sometime after they stopped being colleagues at the Pawnee Department Of Parks And Recreation and Leslie went to work for the National Park Service while Ron went off to start his own business, the Very Good Building Company. This season, Ron and Leslie found themselves facing off over land she wanted for a park and he wanted for the new headquarters of Gryzzl (a tech company that we learned last night has a Vice President Of Cool New Shizz), but they had turned on each other long before that.

In last night's episode "Leslie And Ron," their friends got tired of seeing them at war with each other and locked them in their old office, vowing to leave them there overnight to force them to work things out. And they did, which came as a relief, since seeing them fight was really stressing me out, you guys.

The origin story of Parks is now familiar: it was originally rumored to be a spinoff of The Office, it had a central boss who was weird enough that it originally seemed to actually be a local-government version of The Office, but it gradually grew into one of the most emotionally rich shows on TV — not only in broadcast or in comedy or in broadcast comedy, but overall. One of (many) things that separates it from The Office, though, is the underlying fact that working in a midsize paper company really was, in and of itself, a job in which it was hard to find real meaning, which is part of why the relationships were so important. But Parks has a point of view about working in government, and that point of view is unapologetically that it is possible for people in government to do things that are meaningful — hard, but possible.

There's a scene in a very early episode in which city planner Mark Brendanawicz — who later left the show — explains with some misery that his latest accomplishment is getting a speed bump lowered two inches. Leslie, as always, had the bright side covered: "You fixed a problem," she says. "That's what we're supposed to do."

But beyond its theory of government, the show has always had a more fundamental optimism that, particularly on the night of the State Of The Union, seemed more subversive than ever: it has been committed from the start to the idea that people with very different politics can love each other, and that humanity is a kind of universal solvent that doesn't undo disagreements but can clean off enough other stuff for surprising connections to happen. It isn't optimistic about everything — Leslie had to ship a couple of male penguins out of town to quiet the uproar after she inadvertently married them to each other a few seasons back. Leslie has lost a lot. She lost the seat on the City Council that it had been her pinnacle as a human to win, and she has remained in administrative and not elective office ever since. The Pawnee government is full of problems (and weirdos).

The beating heart of the show, though, is this hard-won (and beautifully acted and written) friendship that has not placed Ron and Leslie in full agreement, but eventually made them allies as far as they agree and respectful opponents when they don't. Leslie has learned to respect Ron's brand of happiness instead of bulldozing him for what she perceives to be his own good — she didn't try, for example, to force a surprise party on his birthday, but arranged for him to spend the evening blissfully alone, as he actually wanted.

In the end, a little bulldozing did have to be employed. When Ron wouldn't talk and Leslie was ready, she employed an escalating series of discomforts to force his hand. He withstood a fan blowing on his ear, being covered in Post-Its and having water dripped on his mustache, but when Leslie blasted "We Didn't Start The Fire" and made up her own lyrics ("Freddy Krueger bought some pants/Oprah has a turtle farm/Peter Piper pee pee poopy/Daddy ate a squirrel") he broke. (Poor Billy Joel.) So they talked.

This is not the obvious kind of "love conquers all," but it is a love story nonetheless — earnest and unpredictable and built on the same series of advances and retreats as any love story in fiction. And it was a story with higher emotional stakes than the great majority of romances that television and film will ever come up with, to be hoenst. Rather than futz around with the ridiculous question of whether men and women can be friends (spoiler alert: yes), Parks has devoted itself to the specifics of this relationship, these people, this office, and this town, and the fact that they matter to each other.

It was still very, very funny — Leslie's coercion tactics, those alt lyrics, Ron detonating what he believed to be a real land mine in order to break out of the office, only to discover that it was ... not a land mine. There's no trade-off between writing with feelings and writing with goofs except when writers choose to make one, and this particular episode was a welcome return to the Parks world as it should be: Ron and Leslie loving each other with all the platonic purity of purpose that Peter Piper could ever ask for.

Note: Thursday morning on WNYC at about 11:40 a.m., I'll be talking to The Brian Lehrer show about this episode and the other one that aired last night, "William Henry Harrison."