DL Open Thread: Wednesday, September 9, 2026

How Delaware’s ‘Not-For-Profit’ Hospitals Stash $$’s In The Cayman Islands.  An absolute must-read, award-worthy article:

(W)hen hospitals write checks to those allegedly harmed by their care, most would think the funds come from somewhere within their expansive and comprehensive budgets.

But for years, Delaware’s nonprofit hospitals have quietly operated secretive, for-profit insurance companies in the Caribbean, where they’ve stashed hundreds of millions of dollars for such legal payouts. (You know who had to be aware of this arrangement? In fact, likely an enthusiastic participant?  Ray Seigfried, former ChristianaCare exec, pretending to run as a ‘health care professional’.  But, I digress.)

Hospitals also are able to reinvest profits from the insurance companies back into the health system without any real oversight. Typically, hospitals are required to invest their excess revenues back into the health system to advance their mission.

By sending regulated nonprofit revenues offshore, the hospitals are able to, in theory, bring those revenues back onshore as dividends to spend on what they choose.

“Once that money leaves the nonprofit, that restriction is gone,” said Jason Schupp, a lawyer who challenged the practice in Maryland. “That’s unrestricted money.”

The hospitals have established what are called “captive insurance companies,” which they use to pay out medical malpractice and worker’s compensation claims, domiciling them in the Cayman Islands.

The tiny British territory with fewer than 100,000 residents has been a boon for nonprofit hospitals’ captive insurance companies because itdoes not impose taxes on premiums or capital gains. Nothing about the practice is illegal, and it’s quite common for hospitals looking to insure their complex, risky businesses.

Hospital lobbyists in Maryland insisted that when a health system sends millions of dollars to what it reports is an insurance company, it is not actually purchasing insurance. Instead, they believe they are simply setting aside their revenues in the event of any payouts.

Schupp argues this claim is simply a way for hospitals across the country to skirt what would otherwise become hefty tax liabilities. Hospitals also have no incentive to domicile in the United States because of the taxes they can circumvent by remaining in the Cayman Islands, Schupp explained.

The Internal Revenue Service did not say if any Delaware captives or their parent hospitals have paid federal taxes that apply to foreign insurance companies covering United States organizations. State insurance authorities also declined to say whether the captives have paid state insurance taxes. (Because the Insurance Commissioners, past and present, are part of the Delaware Way.)

Nonprofit hospitals already receive enormous tax breaks. They pay next to no taxes annually, and at times, are able to generate hundreds of millions of dollars in excess revenues from their patient care alone.

After reviewing the most recent tax returns for each of the state’s hospital systems, Spotlight Delaware only found one hospital that did not run an offshore insurance company – Beebe Healthcare in Lewes.

All the state’s other hospital systems, including ChristianaCare, Bayhealth, Nemours Children’s Health, Trinity Health, and TidalHealth, have captives domiciled in the Cayman Islands. In their tax returns, the hospitals claim these companies as “organizations taxable as a corporation or trust.”

Delaware’s hospital systems, excluding Trinity, control more than $257 million within their offshore captives, according to their most recent tax returns and financials. With Trinity included, that total jumps to more than $1.1 billion.

It’s important to note Trinity is a massive, national health system operating in 23 states, and that it established its captive in 1989, making it the longest-running of the group. The system operates St. Francis Hospital in Wilmington, but does not break out state-specific information in its tax returns.

Call it what it is–a massive tax dodge that puts the lie to hospital systems’ purported ‘not-for-profit’ status. 

Oil Hits $100 A Barrel. Rethug hopes plummet.  Remember, kids, Trump’s attack of Iran was a War of Choice:

The global price of oil reached $100 a barrel on Wednesday for the first time since July as tensions in the Middle East escalated. That’s nearly 40 percent higher than on the eve of the war in Iran.

The rise reflects investors’ concerns about how long the war, now in its seventh month, will last; tensions have snarled a large chunk of global oil shipments.

Brent crude, the global benchmark for oil prices, briefly surpassed $100 a barrel in July. In the early months of the war, Brent peaked near $120 a barrel. The price of West Texas Intermediate crude, the U.S. benchmark, is up 41 percent since the start of the war, at $95 a barrel.

Crude oil is the primary ingredient for fuels like gasoline and diesel. Rising oil prices have pushed the average price of gasoline in the United States past $4 a gallon, according to the AAA motor club, while diesel this month hit a record high, surpassing its previous peak set four years ago. Diesel is now nearly $6 a gallon, up more than 55 percent since the start of the war.

“For now, lower-than-expected supply, declining inventories and geopolitical uncertainty will likely keep oil price risks high in the near term,” the Bank of America analysts said. They added that a cease-fire deal could result in a “swift reversal” but that a broader conflict resulting in major damage to energy infrastructure could push prices as high as $150 a barrel.

Trump Expands Trade War With Canada:

U.S. President Donald Trump is banning the import of Canadian alcohol, motorcycles and various other products into the U.S.

Trump signed five proclamations on Tuesday night, which will ban those Canadian imports as of Sept. 29, and slap 50 per cent tariffs on a series of other products starting next week.

Whey products and molasses are also included in the new ban, while certain dairy products, paper and wood products, aluminum products, furniture and mattresses will be subject to 50 per cent levies.

This is the latest move in an escalating trade war between Canada and the U.S. and comes after Canadian retaliatory tariffs, promised after trade talks fell apart last month, came into force on Tuesday.

What can I say?  He’s insane. Everybody knows it.

Veteran Political Handicapper Charlie Cook On Why Rethugs Could Face A Tsunami.  Believe me when I tell you, he is very conservative when it comes to predicting anything like he sees coming this time:

“Midterm election dynamics happen for a reason, and that is, you get two years into a presidency, and people in the president’s party are generally lethargic. They may be satisfied, but obviously sometimes they’re just not terribly motivated. The other side’s on fire, particularly in this era of hyperpartisanship. And the pure independents are really, really fickle, and tend to get buyer’s remorse. So that’s sort of the normal stuff.

You look at what Bill Clinton had done prior to ‘94, what George W. Bush had done prior to 2006, what Barack Obama had done prior to 2010—you could take all that combined and not quite get the level of sort of radioactivity that you see with many of the things that President Trump has done. And so it shouldn’t be surprising.

I mean, you take Iran—after promising no more wars and all that—but fuel, fertilizer, no more wars, you take tariffs, and all this goes to the heart of his base, of, you know, small-town, rural, farm, all of that. Redecorating the White House in Washington, self-aggrandizement, alienating allies, depleting military stockpiles. I mean, it’s just, like, all coming together. But it’s manifesting itself in places that you wouldn’t have expected.

I mean, bases, as I talked about a little while ago, bases are always hard. But to have the people that are generally the most enthusiastic for you uniquely hurt—now, that’s new territory. And previous presidents have sort of given some degree of license to their members, that if you need to put some distance between us, go ahead. And that’s just not Donald Trump’s MO.

But President Trump is basically radioactive with independent voters, with pure independents. And because so few of the congressional districts are in competitive places, and so few of the Senate races were in even states that ought to be competitive at all, that seemed likely to limit the potential damage for Republicans.

But we’re looking at extraordinary numbers, like in Alaska and Iowa and Ohio and Texas. And meanwhile, where Democrats seem to be struggling, it’s largely self-inflicted injuries, like Maine and Michigan. So it’s a fascinating situation to see. I’ve never seen anything quite like it.”

Speaking of a rural state like, say, Kansas–Roger Marshall’s got some ‘splainin’ to do:

It was Easter weekend in 2007 when a police car pulled up to Joe Vasquez’s home in rural Kansas.

A doctor had filed a lawsuit against him and his wife over an unpaid $4,561 bill from her emergency hysterectomy three years earlier. They had missed a court date, and the doctor’s lawyers asked the court to issue an arrest warrant.

The police took the couple into custody as their grandchildren prepared for an egg hunt, Mr. Vasquez said. They spent two days in jail before their son could borrow the money to post bond.

“We had no money to pay,” said Mr. Vasquez, now 68. At the time, his wife was working at a manufacturing plant and he was on disability, he said.

The doctor who sued the couple was Roger Marshall, now a senator from Kansas. Mr. Marshall, a Republican who is seeking re-election this fall, filed lawsuits against more than 700 patients with outstanding bills during his decades-long career as an obstetrician-gynecologist, according to a New York Times analysis of Kansas court records.

Patients were arrested in 81 of those cases for missing court dates, the records show. In an additional 13 lawsuits, Mr. Marshall’s lawyers sought warrants but it is unclear whether an arrest occurred.

They also garnished patients’ paychecks and bank accounts. They routinely charged patients an 18 percent annual interest rate.

The unpaid bills ranged from several thousand dollars to as little as $101. About half the lawsuits were filed under Mr. Marshall’s name and the rest by Heartland Regional OBGYN, the medical practice he solely owned from 1998 to 2012 and then co-owned with another doctor from 2013 to 2019.

Some facing lawsuits were new mothers with outstanding bills from their deliveries. Most lived in Barton County, a rural area with above-average uninsured and poverty rates. Some patients the Times spoke with lacked insurance; others had health coverage but were responsible for part of their bill.

Court records show that Mr. Marshall’s lawyers repeatedly requested arrest warrants, including in Mr. Vasquez’s case. They filed dozens of briefs arguing that warrants were needed because of the defendant’s “refusal to obey Court orders.”

Neale Mahoney, an economist at Stanford University, has conducted research in one state finding that lawsuits against patients are relatively rare, with about 1.7 percent of hospital stays resulting in litigation.

“It’s not surprising there are outliers but this does seem to be an extreme case,” in terms of how far a doctor went to pursue debt, Mr. Mahoney said.

Marshall’s campaign plays The Victim:

“Sixty days before an election, The New York Times has decided that a rural doctor keeping the hospital’s lights on is some kind of scandal. Kansans know better.”

I’m guessing that the Marshall campaign had better hope that Kansans don’t know better.

What do you want to talk about?