Super PACs and other outside groups made possible by the U.S. Supreme Court’s 2010 Citizens United decision spent more than $1 billion on advertising in federal races through Election Day, with 10 organizations accounting for more than half the total.

Conservative groups accounted for roughly 70 percent of spending, including more than $440 million on the presidential race alone, a sum that helped keep Republican Mitt Romney competitive in his bid to unseat President Barack Obama.

The spending wasn’t enough to put the former Massachusetts governor in the White House — nor was it enough for Republicans to wrest control of the Senate away from the Democrats, despite the proliferation of Senate and House candidate-specific super PACs.

The Center for Public Integrity analyzed spending data from the Center for Responsive Politics, gathered from the Federal Election Commission.

David Keating, the president of the Center for Competitive Politics, which favors campaign finance deregulation, says this gusher of spending by outside groups was a boon for democracy.

"There were a lot of competitive races, and super PACs were one of the key reasons why," said Keating, who added that the nascent groups "helped keep Romney competitive," especially between April, when GOP rival Rick Santorum dropped out of the presidential primary race, and the Republican National Convention in August.

The well-funded re-election efforts of Obama — who did not face a serious primary challenge — were fueled to a large degree by small-amount donors, while Romney relied on wealthier patrons, many of whom also shelled out to pro-Romney super PACs.

The challenger needed the help.

Obama's campaign raised more than $632 million in the 2012 election through mid-October, 62 percent more than Romney's $389 million. Even when including money raised by the Democratic and Republican National Committees, Obama still led by $166 million: $924 million to $758 million.

The Big 3

Three GOP-aligned groups accounted for nearly a third of all spending by outside groups, according to the Center’s analysis.

Restore Our Future, the super PAC founded by Romney allies to aid his presidential quest, spent more than $140 million — more than any other outside group. While the $40 million Restore Our Future spent during the GOP primary played a pivotal role in helping Romney win the party’s nomination, the $100 million it sank into the presidential election wasn’t enough to oust Obama.

American Crossroads and Crossroads GPS, the super PAC and nonprofit co-founded by GOP strategist Karl Rove, ranked second and third, respectively, among outside spenders.

American Crossroads spent nearly $105 million on the 2012 election, including more than $91 million on the presidential race and more than $12 million on high-profile Senate races. Crossroads GPS reported spending about $71 million, 55 percent on Senate races, 14 percent on House races and 31 percent on the presidential contest.

The groups’ top congressional target was the U.S. Senate race in Virginia, where they reported spending a combined $11 million aiding Republican George Allen, who was narrowly defeated by Democrat Tim Kaine. Allen was also assisted by a super PAC called Independence Virginia PAC, which spent nearly $5 million on attacks against Kaine.

The groups also spent more than $7.4 million in Wisconsin, where Democratic Rep. Tammy Baldwin bested former Gov. Tommy Thompson; more than $7 million in Nevada, where incumbent Republican Sen. Dean Heller prevailed over Democratic challenger, Rep. Shelley Berkley; and about $6.4 million in Ohio, where incumbent Democratic Sen. Sherrod Brown successfully fended off a challenge by Republican Josh Mandel.

The fourth-most prolific outside spender was Priorities USA Action, the primary super PAC supporting Obama’s re-election efforts. It spent more than $67 million — all of it on attacks on Romney.

One of the group’s most notable ads featured a worker who described how building the stage on which officials announced a plant’s closure, after it was bought by Romney’s Bain Capital, was like building his “own coffin.”

According to Bob Biersack, a senior fellow at the Center for Responsive Politics, the phenomenon of candidate-specific super PACs won't be going away anytime soon.

"Everybody's going to want a Restore Our Future or a Priorities USA Action," Biersack said. "Everybody's going to want that."

Tuesday marked the first presidential election under the new campaign finance regime installed following the 2010 Citizens United U.S. Supreme Court decision and a lower-court ruling.

The high court's 5-4 decision paved the way for super PACs and nonprofits, allowing them to accept unlimited contributions from individuals, corporations and unions, which could be spent on advertising backing or opposing candidates.

Some of Democrats who prevailed Tuesday despite the onslaught of spending against them noted this during their victory speeches.

In Ohio, Brown applauded his supporters for fighting back "against secretive, out-of-state forces that wanted to impose their will on us," while in Virginia, Kaine contended that his victory proved that "it’s the number of people who stand behind you, not the number of zeroes behind the check.”

Andrea Fuller and Alexandra Duszak contributed to this report.

The explosion of outside spending unleashed at the federal level by the 2010 Citizens United Supreme Court ruling also rocked state races.

Contests for the top executive and judicial spots, in states whose bans on corporate outside spending were invalidated by the ruling, were newly shaped by unlimited cash from out-of-state corporate and union treasuries.

The D.C.-based governors’ associations led the way, nearly keeping pace with candidate spending in several close races. Governors’ races in Montana, Washington and New Hampshire were neck-and-neck as voters were besieged by ads financed by outside spending groups through Election Day.

Montana governor's race

Republican Rick Hill held a slim lead in his race against Democrat Steve Bullock for governor of Montana in a race that had not been determined at this writing. The Republican Governors Association used a super PAC, created in the wake of Citizens United, to support Hill.

RGA Right Direction PAC ran ads in Montana attacking Bullock, and also used its super PAC to funnel millions directly to candidates and parties on the state level.

The candidates both raised about $2million according to Montana-based campaign finance watchdog the National Institute on Money in State Politics. But outside groups spent at least as much (and gave a rare half-million-dollar contribution directly to Hill in early October).

When a federal judge struck down Montana’s limits on giving directly to candidates in early October, the RGA sent $600,000 to the Montana Republican Party, which gave $500,000 to Hill the next day.

The previous limit on party giving to gubernatorial candidates was $22,600. Four days later, a federal appeals judge reinstated those limits, but not before Hill got the donation, which accounted for a quarter of his fundraising.

Meanwhile, Steve Bullock, who defended the state’s campaign finance laws as attorney general after a shadowy nonprofit sued the state over spending and contribution limits as well as disclosure requirements, benefited from outside spending by the D.C.-based Democratic Governors Association.

The DGA-funded JET PAC spent at least $1.7 million on ads, about the same amount that candidate Bullock raised. One of the ads featured current Gov. Brian Schweitzer endorsing Bullock for the job.

Nail-biter in Washington state

The RGA has made its mark on three states where it sought to take governors’ mansions inhabited by Democrats.

In Washington, Democrat Jay Inslee and Republican Rob McKenna were essentially tied late Tuesday — the governors associations played a large role right up until voting day. The race had yet to be called by this writing.

McKenna edged out Inslee in fundraising, but got an even larger boost from the RGA, which outspent its Democratic counterpart by $2 million, according to the Washington Secretary of State.

In the two weeks before the election, the RGA plastered the state with $1.3 million in ads calling Inslee a “D.C. congressman” who is “part of the problem.” The late ad spending was four times as much as a DGA-funded group, called Our Washington, could muster before Nov. 6.

In New Hampshire, Democrat Maggie Hassan crushed Republican Ovide Lamontagne on Tuesday, despite a major effort by the RGA-funded Live Free PAC. The RGA spent nearly $8 million on ads — a quarter of it since Oct. 18 — attacking her tax policies.

The DGA-funded New Hampshire Freedom Fund spent about $3 million on ads against Lamontagne, according to the state’s election division.

GOP wins big in North Carolina

The RGA’s major pickup on Election Day was in North Carolina. The state’s ban on corporate and union outside spending was nullified after the 2010 high court decision.

Republican Pat McCrory’s race with Democrat Lt. Gov. Walter Dalton was never close. Dalton suffered from attacks tying him to the unpopular tenure of current Gov. Bev Perdue, who chose not to run for re-election.

McCrory, the former mayor of Charlotte, trounced Dalton on the fundraising front, and also benefitted from a 2-to-1 edge from outside spending on his behalf — according to the North Carolina-based Institute for Southern Studies.

The RGA used corporate treasury money to kick off an early ad campaign against Dalton, tying him to Perdue’s unpopular record. Since May, it raised $5 million, compared to the DGA-funded group North Carolina Citizens for Progress’ $2.6 million.

In states with unlimited contribution limits to candidates, the governors associations made direct donations.

In Missouri, incumbent Democrat Jay Nixon held a solid fundraising advantage and a solid lead in the polls against Republican Dave Spence — which carried through to a 12-point Tuesday victory.

The RGA tried to keep Spence alive with $1.25 million in donations in October alone, and could have given more.

State supreme court results

Since Citizens United, last-minute outside spending has played a major role in state supreme court races. In 2010, about 43 percent of spending on TV ads in judicial races came the week before Election Day, according to the Brennan Center for Justice at New York University Law School.

This year, North Carolina’s incumbent conservative judge Paul Newby squeaked by in a heated contest with Sam Ervin IV that saw heavy outside spending.

Both judges participated in the state’s public financing program, which capped spending after awarding each candidate $240,000.

Outside groups not encumbered by limits, poured money into the race on behalf of Newby. Two groups used corporate and out-of-state funds to run nearly a half-million dollars’ worth of ads in the final week alone, including a $50,000 outlay for an ad called “Noise” on Nov. 5, sponsored by the North Carolina Judicial Coalition.

The other pro-Newby group, North Carolina Justice for All, ran an ad on Nov. 1 that asked “can we trust Sam Ervin?”

Justices retained

Three Florida justices easily won bids to keep their jobs Tuesday, and an Iowa justice hung onto his seat on the bench. The races were subjected to massive outside spending on ads and even dueling bus tours.

Eighteen states require appointed Supreme Court justices to periodically face voters in “merit retention elections.” If a majority votes against a judge, the governor appoints new justices from a list of names submitted by a nonpartisan nominating commission.

Florida justices R. Fred Lewis, Barbara Pariente and Peggy Quince will remain on the bench after roughly 67 percent of voters chose to retain them despite a wave of ads paid for by two tea party organizations.

Restore Justice and the Koch-funded Americans for Prosperity targeted the justices mainly for their involvement in a 2010 Supreme Court ruling that invalidated a ballot initiative challenging President Barack Obama’s health-care law.

The three justices, who collectively raised more than $1.3 million, received substantial support from Defend Justice from Politics, an outside group which spent roughly $1.5 million on a campaign dedicated to retaining the justices.

Nearly 54 percent of Iowans voted to retain Justice David Wiggins, who survived Republican attacks for his part in a 2009 Supreme Court vote that affirmed same-sex marriage. Two years ago, three of Wiggins’ former colleagues were ousted thanks to a similar campaign waged by conservatives upset with the ruling.

Conservative groups, joined by former GOP presidential candidate Rick Santorum, collectively spent roughly $450,000 on their “No Wiggins” campaign, which included television ads and a statewide bus tour.

Legislators in South Carolina have taken initial steps toward what could be the first major overhaul of the state’s ethics rules in twenty years. As the Free Times reported this morning, government watchdog groups rattled off their wish lists at a hearing held last week by a panel of state House Democrats. South Carolina earned an overall grade of F for corruption risk from the State Integrity Investigation earlier this year, and fallout from that report — along with a series of recent ethics scandals — appears to have built political consensus on the need for reforms, said John Crangle of South Carolina Common Cause.

Among the changes called for at the hearing: more robust financial disclosure requirements, new rules on PACs and the creation of a more independent ethics oversight body. State leaders have formed four separate panels to help shape a reform package, one convened by each party in the state House, one by the majority Republicans in the Senate and one at the direction of GOP Gov. Nikki Haley.

The House Republican panel will hold its first hearing Thursday morning. Crangle said it’s too early to say whether the legislature will take recommendations from the panels and adopt substantive changes in the 2013 legislative session.

Read more at the Free Times.

Marijuana legalization, gay marriage and a state version of the DREAM Act are this year’s ballot initiative winners. But those who gave the largest sums to state referenda poured tens of millions of dollars into their cause — and lost.

Molly Munger was the largest individual donor to a state ballot initiative, giving about $44 million to support a proposal to raise revenue for schools and early childhood education in California, according to the California Secretary of State.

Seventy-two percent of California voters rejected Proposal 38, which was backed by the Pasadena civil rights attorney.

Munger’s father is Charlie Munger, the billionaire vice chairman of Warren Buffett’s Berkshire Hathaway investment firm. She co-founded the Advancement Project with her husband Steven English (who chipped in $3.3 million for Prop 38). In 2000, the group won a billion-dollar lawsuit over inequitable school-construction practices in California.

Munger’s millions equal 5 percent of all federal Head Start money California received in 2009 for its early childhood education programs. A $44 million gift to Los Angeles’ Head Start agency would equal a fifth of the federal grant the city received last year.

Munger outspent her brother, Stanford physicist Charles Munger Jr., a Republican activist who shelled out $23 million on ballot proposals. Munger Jr. opposed Democratic Gov. Jerry Brown’s initiative that sought to raise revenue for schools by upping the sales tax and levies on the state’s wealthy residents.

The measure passed with 53 percent of the vote.

Munger Jr. also supported an effort to restrict unions from using members’ dues payments to fund political activities. It was rejected by 56 percent of voters.

In Michigan, the owner of North America’s busiest international crossing spent nearly $32 million to hinder construction of a second, government-funded bridge across the Detroit River, according to the Michigan Campaign Finance Network.

Billionaire Manuel Moroun’s DIBC Holdings Inc., which owns the Ambassador Bridge connecting Detroit and Windsor, Canada, was the sole funder of referendum Number 6 called “Let the People Decide.” When Michiganders went to the polls, 60 percent favored the new bridge.

Another subsidiary of Moroun’s financial empire, Liberty Bell Agency, Inc., spent $3.5 million to support a tea party-backed initiative that would have required a two-thirds vote in the Legislature to raise any taxes. Seventy percent of voters rejected the proposal.

Moroun and the Mungers spent roughly $100 million on state ballot initiatives. The total tops the combined output of the two top donors to federal super PACs for the 2012 election, casino magnate Sheldon Adelson and Texas billionaire Harold Simmons, who gave nearly $81 million through Oct. 17.

In Michigan, a ballot initiative to put collective bargaining rights in the state constitution drew $22 million from unions around the country. Roughly half came from the Detroit-based United Auto Workers, the National Education Association and its state affiliate. Voters rejected the initiative, which garnered $25 million in opposition spending from Chamber of Commerce-affiliated groups in the state.

Adelson and his wife, Simmons and the No. 4 federal super PAC donor, Joe Ricketts, sent $2.6 million combined to Michigan to stop public employee unions’ most aggressive attempt to secure bargaining rights this year.

Unions won on their other major priority, the repeal of the state’s far-reaching emergency manager law. The law allowed Republican Gov. Rick Snyder to appoint a “financial czar” in several cities and school districts to fire elected officials, privatize city services and abolish collective bargaining agreements.

The repeal passed by a 52-to-48 margin.

The ballot effort garnered roughly $2 million in spending, almost entirely from the American Federation of State, County and Municipal Employees union.

In Washington state, a successful effort to expand charter schools garnered $11 million in spending — $4.5 million from Microsoft founders Bill Gates and Paul Allen. Alice Walton, of the Wal-Mart family fortune, sent $1.7 million from Bentonville, Ark., according to the Washington Secretary of State.

Also in Washington, the successful effort to legalize marijuana raised a third of its $6 million from Peter Lewis, the CEO of Progressive Casualty Insurance Co. California-based Dr. Bronner’s Magic Soaps All-One-God-Faith Inc., also chipped in on the campaign.

In June, the company’s CEO, David Bronner, put his money where his mouth is. He locked himself inside a cage full of marijuana plants and parked it outside the White House to protest laws banning hemp production.

While the D.C. Fire Department sawed through the bars to apprehend Bronner, he sat inside preparing his usual breakfast: hemp oil slathered on French bread.

Voters in three states — Maryland, Maine and Washington — approved laws allowing same-sex marriage. In Minnesota, voters rejected a proposed amendment to the constitution to restrict it. The ballot victories mark a shift away from trends in the last few elections. In 2004, 11 states passed constitutional amendments banning same-sex marriage.

Voters in Maryland affirmed a 2011 law modeled on the federal DREAM Act. Fifty-eight percent of voters supported the law, which allows undocumented immigrants to pay in-state tuition for college, provided they attend a Maryland high school and offer evidence that they or their families have paid taxes.

Chris Young contributed to this report.

If Karl Rove was an NFL coach and not a political strategist, he would probably be looking for a new job about now.

Organizations co-founded by the GOP’s most effective fundraiser spent more than $175 million only to see President Barack Obama win a second term and Democrats actually gain seats in the U.S. Senate.

According to a Center for Public Integrity review of spending records, Rove’s super PAC, American Crossroads, went 3-10 during the 2012 election cycle, while Crossroads GPS, its nonprofit counterpart, went 7-17. The two groups, which were both active in a handful of contests, had a combined 9-21 record.

When asked by Fox News host Chris Wallace on Election Night if his groups’ spending was “worth it,” Rove was unapologetic: "Look, if groups like Crossroads were not active, this race would have been over a long time ago.”

Meanwhile, Jonathan Collegio, the spokesman for the two Crossroads organizations, has maintained that “sub-optimal candidate quality” contributed to Republican losses in the Senate and that his groups will be a “permanent entity on the center-right.”

“By leveling the financial playing field, conservative super PACs kept this race close and winnable all the way until the end,” Collegio told the Center for Public Integrity. “Our contributors are of course disappointed with the results, but satisfied with the impact we had.”

Democratic super PACs fared far better, especially Majority PAC, launched by former aides to Senate Majority Leader Harry Reid, D-Nev. The organization had a 14-3 record.

House Majority PAC, a group focused on aiding House Democrats, also appears to have backed more winners than losers. Thirty-four of its preferred candidates won while 31 lost. Democrats are leading in five of six undecided contests where the group also invested money.

“If you look back to 2010, there were lots of races where Democrats were overwhelmed by outside money at the last minute,” said House Majority PAC spokesman Andy Stone. “We aimed to reduce the disparity in outside GOP money to outside Democratic money, and we cut it in half from 2010 to 2012.”

Zach Gorin, the spokesman of Majority PAC, stressed that it was important for Democrats to compete in the fundraising arms race against groups like American Crossroads and Americans for Prosperity, which has ties to conservative billionaire brothers Charles and David Koch.

"At the beginning of the cycle, the conventional wisdom was that Democrats would surely lose their majority in the Senate,” Gorin said. “But our growing financial momentum in the lead-up to November ensured that we would not only be able to compete with Karl Rove and the Koch brothers on the air in Democratic seats, but also bring the fight to them in red states, as well."

The Democratic super PACs may have played a role, but they had an easier task than their Republican counterparts. Democratic candidates for Senate, for example, collectively outraised their Republican counterparts by more than $35 million in the seven most hotly contested races. A similar dynamic held true in the presidential contest, where Obama’s campaign outraised his Republican rival Mitt Romney by more than $240 million.

In addition, Republican Senate seats in Missouri and Indiana, which were expected to be Republican pickups, appear to have suffered from “sub-optimal” candidates, in Collegio’s words.

Rep. Todd Akin, the GOP Senate candidate in Missouri, saw his standing in the polls drop after he said women who were victims of “legitimate rape” rarely get pregnant.

Comments about rape also contributed to the defeat of Indiana Republican Richard Mourdock, who, during a late October debate, said that pregnancies resulting from rape shouldn’t be aborted because they were “something that God intended to happen.”

In addition to Indiana, Majority PAC’s 14 “wins” included victories in Montana and North Dakota, states where Obama lost the popular vote to Romney.

Super PACs and nonprofits, which proliferated after the controversial 2010 Supreme Court’s Citizens United ruling, are allowed to accept contributions of unlimited size from individuals, corporations and unions. This money can be used on advertisements, officially called “independent expenditures,” but spending cannot be coordinated with campaigns.

The scorecards of the Democratic Senatorial Campaign Committee and the National Republican Senatorial Committee mirrored those of their aligned super PAC and nonprofit allies, even though they face limits on fundraising.

Party committees can only accept limited contributions from individuals and PACs, and while some of their spending can be coordinated, they also operate arms devoted strictly to independent expenditures.

The NRSC’s independent spending supported nine GOP Senate candidates, seven of whom lost on Election Night. Eleven of 13 candidates the DSCC made independent expenditures on behalf of won.

The Democratic Congressional Campaign Committee and National Republican Congressional Committee had more mixed results.

The GOP managed to retain control of the U.S. House of Representatives though its advantage appears to have dropped by a handful of seats. As of press time, the Associated Press had still not called nine races.

“The money was not decisive in a lot of races,” said Kyle Kondik, an analyst at the Center for Politics at the University of Virginia. “Candidates matter too.”

Despite the Crossroads organizations not having “a very good record to point to,” Kondik says that Rove “still does have a lot of cachet on the right.”

Conservative attorney Dan Backer, too, predicts Rove is here to stay.

“Karl Rove is not retiring anytime soon,” Backer said.

Andrea Fuller contributed to this report.

Super PACs and nonprofits unleashed by the Citizens United Supreme Court decision have spent more than $840 million on the 2012 election, with the overwhelming majority favoring Republicans, particularly GOP presidential nominee Mitt Romney.

An estimated $577 million, or roughly 69 percent, was spent by conservative groups, compared with $237 million spent by liberal groups, or about 28 percent, with the remainder expended by other organizations.

Of all outside spending in the 2012 election, more than $450 million was dedicated to the presidential election with more than $350 million spent helping Romney and about $100 million spent to help President Barack Obama.

The spending helped close the gap on Obama’s considerable fundraising advantage over Romney. As Election Day approaches, Romney and Obama are neck-and-neck in national polls.

The totals are from a joint analysis of Federal Election Commission data by the Center for Responsive Politics and the Center for Public Integrity. The Centers' analysis covers the period from Jan. 1, 2011 through Oct. 28, 2012, and does not include independent spending by the political party committees.

The final tally will be higher as spending continues to accelerate before Election Day.

Obama's campaign raised more than $632 million in the 2012 election, 62 percent more than Romney's $389 million. Even when including money raised by the Democratic and Republican National Committees, Obama still has an edge of more than $166 million: $924 million for the president’s re-election team versus $758 million for Romney and the GOP.

The president’s campaign committee was bankrolled to a great degree by money from grassroots supporters, while Romney relied more heavily on larger donors. Individuals who gave $200 or less accounted for 34 percent of Obama’s war chest. Meanwhile, such small-dollar donors were responsible for only 18 percent of the Romney campaign’s haul.

The deluge of outside spending was made possible by the 2010 Citizens United decision and a lower court ruling that allowed individuals, labor unions and corporations to give money to outside spending groups — mostly nonprofits and super PACs — to buy advertising attacking or supporting candidates.

Super PACs were generally backed by super donors. Billionaire casino magnate Sheldon Adelson and his family, for example, gave $54 million to Republican super PACs as of mid-October, far more than any other donor this election cycle.

Nonprofit “social welfare” groups and trade associations can raise just as much money, but are not required to report their donors. The lack of transparency sparked legislation to require disclosure, but it was defeated.

Nonprofits were responsible for more than $245 million, or about 30 percent, of the $840 million in total outside spending. That’s about $100 million more than they spent in 2010.

Spending surge helps Romney

During the week of Sept. 30, about $16.5 million was spent by outside groups benefiting Romney, mostly on ads attacking Obama. Three weeks later, the seven-day total jumped to more than $55 million, according to FEC filings.

Outside spending benefiting Obama over the same period never exceeded $14 million, records show.

The GOP candidate, facing the Obama fundraising juggernaut, needed the help of outside groups to keep pace.

The Obama campaign aired nearly three times as many ads as the Romney campaign between late April and late October, according to a recent study by the Wesleyan Media Project.

Wesleyan found that the 460,500 ads aired by the Obama campaign in the presidential election was more than the Romney campaign, the RNC and seven other Republican-aligned outside spending groups combined — including the top GOP super PACs Restore Our Future and American Crossroads and conservative nonprofits Crossroads GPS and Americans for Prosperity.

Super PACs in the 2012 election raised about $660 million.

Restore Our Future alone accounted for about $1 out of every $5 of all super PAC donations received. The pro-Romney group raised more than $130 million, much of which was spent decimating Romney’s rivals during the GOP primaries.

The Obama-backing Priorities USA Action, by contrast, raised $64 million.

In 2010, during their first year of existence, all super PACs combined raised just $85 million.

The top 149 individual super PAC donors — each of whom has contributed at least $500,000 — are responsible for $290 million of funds raised.

And 858 individuals who contributed at least $50,000 to super PACs accounted for nearly 60 percent of all money the groups collected in the 2012 election. The median household income in 2011, by way of comparison, was $50,054, according to the U.S. Census Bureau.

Donations from large, publicly traded corporations have been relatively rare, but in the waning weeks of the campaign, oil and gas giant Chevron wrote a $2.5 million check to the Congressional Leadership Fund, a super PAC backing Republican candidates that is closely associated with House Speaker John Boehner, R-Ohio.

The emergence of super PACs has been heralded by some, such as Republican lawyer Brad Smith, the former chairman of the Federal Election Commission who co-founded the conservative Center for Competitive Politics.

“[Super PACs] have helped to level the playing field between Romney and Obama, whereas otherwise Obama’s spending advantage would have been substantial,” said Smith. “And in some cases they have raised issues that concern voters that the candidates have chosen to avoid.”

Others disagree.

“When elected officials rely on the most-wealthy of wealthy Americans, it means the voices of everyday people lose out,” said Nick Nyhart, president of the advocacy group Public Campaign, which favors publicly financed elections.

Unlike traditional political action committees, super PACs have no contribution limits and the funds they raise can't be directly donated to candidates. Instead, the money they raise has primarily been used to fund attack ads.

Prior to Citizens United, groups that wanted to expressly advocate for or against a candidate were limited to receiving no more than $5,000 per donor per calendar year.

Donations shrouded in secrecy

As important as super PACs were in the 2012 election, the loosening of political spending rules for non-disclosing, nonprofit organizations was also a key development following the Citizens United decision.

GOP-aligned nonprofits have outspent their Democratic counterparts by a ratio of more than 8 to 1.

Notably, this figure represents a conservative tally of nonprofits’ political spending.

Federal law requires spending to be reported only if a group's advertisements encourage viewers to vote for or against a candidate, or if they mention a candidate shortly before a political convention or election.

Justice Anthony Kennedy, the author of the Court's Citizens United 5-4 opinion, made a point of saying that disclosure was a key part of the court’s rationale. Disclosure would allow citizens to monitor the new political activity.

"This transparency enables the electorate to make informed decisions and give proper weight to different speakers and messages," he wrote.

But the tax-exempt groups — some of which clearly exist for no other reason than to elect favored candidates — are spared by Internal Revenue Service and FEC rules from having to publicly reveal their donors.

Crossroads GPS, co-founded by GOP strategist Karl Rove, claims in press releases to have spent more than $120 million since January 2011, of which only $57 million has been reported to the FEC. At least $12 million has been spent attacking Obama, according to FEC records.

Voters watching its ads have no idea where the money is coming from. Nor do they know who is funding the work of liberal organizations doing the same thing, albeit with a lot less money.

Patriot Majority has reported spending $6.5 million on ads, more than half of which has opposed Rep. Dean Heller, the Republican who is running for U.S. Senate in Nevada.

Not all secret money is coming from nonprofits. Throughout the election season, mystery corporations have popped up, spending huge sums.

Specialty Group Inc. of Knoxville, Tenn., wrote seven checks totaling $5.2 million to pro-tea party super PAC FreedomWorks for America in early October. The corporation was created on Sept. 26. The name and address listed on incorporation records are those of a Knoxville, Tenn., area attorney. His published phone line has been disconnected.

The source of the funds, as of this writing, is unknown.

Meanwhile, more than $10 million in funds given to super PACs, which disclose donors regularly, have come from nonprofits, showing that even the groups required to be transparent about their funding sources can still shield the names of donors.

Going negative

The explosion in outside spending has coarsened the political debate, flooding the airwaves in Ohio, Florida, Virginia and other battleground states with negative, often inaccurate ads.

Roughly 80 percent of all spending by both conservative groups and liberal groups has been negative, FEC records indicate.

Fully 100 percent of the nearly $57 million Priorities USA Action reported spending has been on negative ads.

The group, which coined the slogan “If Mitt Romney wins, the middle class loses,” linked Romney to the death of a woman who lost her battle with cancer.

Another of the super PAC’s most memorable ads featured a worker describing how building the stage on which officials announced the plant’s closure, after it was bought by Bain Capital, was like building his “own coffin” and made him “sick.”

Eighty-eight percent of Restore Our Future's spending went toward negative ads, as did 95 percent of American Crossroads' expenditures.

Many of these ads have criticized Obama’s handling of the economy, arguing that the country “can’t afford” four more years of Obama’s policies. One spot features a small-business owner saying, “We can’t create more jobs until Obama loses his.”

Others ads have featured disillusioned Obama supporters from 2008 expressing disappointment with the president.

The winners in the post-Citizens United campaign finance regime won’t be known for certain until after Election Day. But Ciara Torres-Spelliscy, an assistant professor of law at Stetson University's law school who previously worked as an attorney with the Brennan Center for Justice, said it won’t be the voters.

“I fear that we have lost elections on a human scale with post-Citizens United spending by super PACs” and non-disclosing groups, she said. “The losers here are voters who get carpet bombed with political ads full of half-truths and distortions.”

Researchers Robert Maguire of the Center for Responsive Politics and Alexandra Duszak of the Center for Public Integrity contributed to this report. Graphic design by Paul Williams of the Center for Public Integrity.

This story is a collaboration between the Center for Public Integrity and the Center for Responsive Politics. For up-to-date news on outside spending in the 2012 election, follow our Source2012 Tumblr and the hashtag #Source2012 on Twitter.

Health insurers invested a lot of what you paid them in premiums in an effort to get more of their friends elected to Congress. As the Center for Public Integrity reported last month, the political action committees of the 11 largest health insurers and their biggest trade group—America’s Health Insurance Plans (AHIP)—gave $10.2 million to federal politicians between January 2007 and August 2012. Most of that money went to Republicans who pledged to repeal or gut the Affordable Care Act.

The return on that investment was not so good. But that doesn’t mean insurers have come to accept that Obamacare must be implemented as Congress intended. On the contrary, even more of your premium dollars are about to be spent on a propaganda campaign to get the law changed to protect profits.

Even as insurers were helping to bankroll their friends’ campaigns, they were  publicly expressing support for the reform law. AHIP president Karen Ignagni said in April 2010, a month after the president signed the Affordable Care Act,  that her group was “strongly committed” to its “successful implementation.”

What she really meant is that insurers were committed to the parts of the law they like—such as one that requires us to buy coverage from them—but not so much to the ones that might negatively impact their bottom lines. Like those that will end the abusive practices that have enabled them to pad those bottom lines.

When Ignagni and insurance company executives speak, it is important to parse their words to understand what they are really saying. That’s just as true now as it was in 2010.

Here’s what Ignagni said after it was clear that her industry’s campaign investments had not paid off last Tuesday:

“Health plans are committed to working with policymakers to make coverage more affordable, promote choice and competition, and maintain a strong safety net for our nation's most vulnerable populations. As the health care reform law is implemented, policymakers must prioritize affordability for consumers and employers. Several provisions in the law, such as the new premium tax, minimum coverage requirements, and age rating restrictions, need to be addressed to keep coverage as affordable as possible and ensure broad participation in the system.”

Take it from me, a 20-year veteran of the insurance industry: that line about commitment to a strong safety net for “our nation’s most vulnerable populations” is as insincere as the 2010 statement about being “strongly committed” to implementing reform. If industry leaders really cared a whit about the most vulnerable, millions of us would not be uninsured because of common industry practices — practices like refusing to sell coverage to those with pre-existing conditions and charging women and older people such high premiums that many have no option but to remain uninsured.

It takes a boatload of gall for an industry spokesperson to talk about affordability three times in three sentences as part of a statement so laden with obscure meaning that it will require multiple columns to decipher. So stay tuned.  For today, though, let’s focus on what Ignagni meant by talking about age rating restrictions.

One of the most important consumer protections in Obamacare prohibits insurers from charging older people more than three times as much as younger people.  Insurance company lobbyists have persuaded many state lawmakers to allow them to charge older folks five times as much as younger folks, and some states have no restrictions at all. As a result, many Americans in their 40s, 50s and early 60s can’t possibly afford coverage.

Insurers have no problem with that. As we age, we have greater need for medical care, and insurers would rather not have to pay for it. They much prefer to sell skimpy policies with relatively low premiums to young people who are less likely to get sick. 

Ignagni’s group lobbied hard for a 5-1 old/young ratio during the reform debate—and even harder against the more restrictive ratio of 2-1 that Mitt Romney helped enact when he was governor of Massachusetts. So the 3-1 ratio in Obamacare was a compromise. 

But even a 2-1 ratio can pose a real hardship for many people. A 2009 Boston Globe analysis revealed that an average policy in Massachusetts cost 32-year-olds $190.27 a month. The same policy cost 62-year-olds $376.96. Had the ratio been 5-1, it would have cost them almost $1,000 a month. 

That’s just fine with Ignagni and her crowd, which will be spending an enormous amount of your money to make you believe that young people will be priced out of the market unless lawmakers change the age rating restriction. Insurers are brilliant when it comes to that sort of misdirection. Don’t fall for it. And don’t let your President and members of Congress fall for it either.

President Obama and Congress now have just over seven weeks to reach an agreement on the federal budget that would avert a round of automatic tax hikes and spending cuts in defense and social programs that members of both parties have depicted as draconian.

Jan. 1 is the deadline set by the so-called “sequestration” law of 2010 that imposes substantial cuts automatically – over a ten-year period – if the government fails to whack away at the federal deficit. Front and center in the punishment will be the Defense Department, which accounts for a fifth of all federal spending and about a half of so-called “discretionary” funds, or those that lawmakers review and approve annually.

Fifty program areas at the Pentagon would collectively take a roughly $500 billion hit, which seems like a lot but would actually be less than ten percent of the $5.8 trillion that the Obama administration wants the Pentagon to spend from 2013 to 2021. Military leaders have complained fiercely, partly because the Obama administration last year chose to halt a planned 16 percent increase in defense spending, keeping the military’s budget essentially level after a decade of steep growth.

Only a few Democrats and Republicans on Capitol Hill have said they want to cut defense programs deeply, but both parties agreed in the legislation to hold the military’s budget hostage to force a deal. The Democrats’ aim, in particular, was to force the Republicans to raise taxes on the wealthy by threatening to kill military programs that the party faithful traditionally cherish. The Republicans supported the deal because it pushed the issue beyond the election – now just concluded – and because they knew that a disagreement would also harm social programs that Democrats cherish.  

Polls have repeatedly shown broad support for cutting the defense budget more deeply than the sequestration law would require, suggesting that many lawmakers are out of touch with popular opinion. In our poll, conducted in April with the Stimson Center and the University of Maryland’s Program for Public Consultation, both Republicans and Democrats favored substantial cuts in spending for the Army, nuclear arms, air power, missile defenses, and many other programs. A more recent survey by the Chicago Council on Global Affairs also showed broad public support, across party lines, for cutting the defense budget.

And the election itself – in which Obama won in California, Virginia, Florida, Massachusetts, Maryland, Connecticut, and Pennsylvania, all states with considerable military spending – suggests that persistent Republican calls this year for much higher defense spending gained little to no traction with voters.

About a year ago, we started focusing our investigative eye on national security, examining the soundness of some large U.S. military programs with the aim of scrutinizing whether U.S. soldiers and taxpayers are getting what they need. In recognition of this week’s Veteran’s Day, it feels appropriate to call attention to some of the key articles in which we tried to do that:

• Senate report says national intelligence fusion centers have been useless
• F-35 deputy sees challenges ahead
• Dissent among Republicans over defense spending
• Lawmakers complain about monopoly space launch deal
• Counter-IED efforts still beset by poor oversight and duplication
• The Army tank that could not be stopped
• Pentagon efforts to straighten out bookkeeping face billion-dollar cost overruns
• GAO: Missile defense initiative faces continuing challenges
• Congress can’t say no to military pay raises
• More fun facts about the F-35 fighter
• Bouncing too much to find the enemy
• Public overwhelmingly supports large defense spending cuts
• Missile defenses hobbled by uncertainties
• New report darkens reputation of Navy ship
• Will the $55 billion bomber program fly?
• Pentagon misreports or ignores long-term weapons costs
• Puncturing the hot air balloons on defense spending

Not every Congressional  Republican is joining the GOP rush to mend fences with Latino voters by  embracing  the pursuit of comprehensive immigration reform.

Rep. Steve King of Iowa, for example — one of Capitol Hill’s  immigration hawks— made it plain after President Obama’s election victory that he doesn’t approve of the chatter from his party’s “establishment” on this issue. “Obama voters chose dependency over Liberty,” King said in a tweet. “Now establishment R's want citizenship for illegals. You can't beat Santa Claus with amnesty.”

King’s attitudes are significant, given that he’s a member of the House Judiciary Committee and vice chairman of its Subcommittee on Immigration Policy and Enforcement.  Judging from an interaction with one of his constituents, Bethany Gonzalez of Denison, Iowa, King believes in maintaining a hard line, even if U.S. citizens say some immigration policies have turned them into collateral damage.

Gonzalez recently spoke to the Center for Public Integrity about her attempts to persuade King to help her with a life-altering immigration problem. Gonzalez was desperate because immigration penalties she had no idea existed had forced her husband out of the U.S. in 2008, and she and their two children faced prolonged emotional and financial hardship.

King told her she had the option of moving to Mexico.

Gonzalez’s dilemma is shared by families described in a recent report by the Center for Public Integrity about punishments that Congress approved in 1996. The mandatory penalties, adopted as a method to deter illegal immigration, must be imposed on undocumented spouses (or other relatives) of U.S. citizens when they apply for legal status based on their relationships. The 1996 law requires U.S. officials to “bar,” or ban these applicants from the U.S. for 10 years, even for life, with waivers to shorten bars available only in limited cases.

Gonzalez, who is not Hispanic, met her undocumented husband, Jimi Gonzalez, a Mexican national, in 2004 and married him in 2006.  Jimi had arrived in Iowa in 1996, and found work in meatpacking and construction.

The couple wanted to set things right, Bethany said. Jimi learned English and always paid taxes. Bethany had two very small sons, one a baby, from a previous marriage. Jimi stepped up and became the main father figure for her older son. An Iowa court, aware that Jimi was undocumented but married to Bethany, named Jimi the legal father of the youngest son.

In 2007 the couple applied for Jimi’s legal permanent residency. And Jimi traveled, as required, to the U.S. consulate in Juarez, Mexico, for his final interview in 2008.  Jimi and Bethany were shocked when a U.S. consular officer told Jimi that because he had been deported once – and then re-entered the country in 2001 – there was no choice but to bar him from the United States for at least 10 years.  Jimi returned to Mexico’s Campeche state to his father’s farm,  where he ekes out a living growing crops and working at a meatpacking plant that pays the equivalent of $90 for six days’ of work. 

Bethany contacted King, requesting that he help her ask authorities to find a different way to punish Jimi — perhaps with a penance that could let him earn a way to return sooner than 2018. She thought since King professed a strong belief in traditional family values that he might understand.

At first, letters show, King told her how to contact the nearest U.S. consulate to Jimi’s hometown in Mexico, and provided information about how to file a complaint about her lawyer, who didn’t fully explain the punishment Jimi would face.

Bethany asked if King couldn’t sponsor a “private bill” in Congress that might help bring Jimi back. On April 27, 2008, King sent her a letter denying her request. He told her he only pursues private bills if laws have not been broken and if “severe hardship is involved. In your case, United States law was broken and your family has the option of being reunited in Mexico.”

King’s office told the Center earlier this year that he wouldn’t discuss a constituent’s private matter. The congressman was re-elected last week by a 53 to 45 percent margin.

Bethany and Jimi remain committed to their marriage, although they can only afford to see each other a few times a year in Mexico, with or without the boys.

The family lost the house they were buying in Denison, and the boys are upset with the U.S. government for not letting their dad return. Bethany and the boys remain in Denison, thankful for family support she gets in her hometown.  But said she continues to suffer substantial financial strain without Jimi. “There have been days when I stood in the store with $3 in my hand trying to figure out what I can buy,” she said. But neither she nor Jimi can imagine uprooting their sons, 9 and 12, and forcing them to live in a small town in Mexico. 

“I pray every day,” Bethany said, “that God and the President will create a miracle for those people who have to live like my family for the past 4 1/2 years.”

Like a growing number of disabled Americans on Medicaid, Keith Foreman, a 57-year-old in Metropolis, Ill., qualified for a personal caregiver to help him with daily activities like dressing, shaving, and preparing meals.

Foreman, who prosecutors say suffers from a spinal injury, hired his girlfriend, Sheila McDonald, for the job. In 2011, McDonald received almost $5,000 from Medicaid for six months of care she provided to Foreman.

These personal care services, which are available in all 50 states, are designed to help the sick, elderly, and disabled remain in their homes — and out of expensive nursing facilities. But Foreman was not living at home. During the days marked on McDonald’s timesheets, Foreman was housed in the Massac County jail in Illinois, serving time for forging a stolen debit card signature at a local liquor store.

Like Foreman and McDonald, who both pleaded guilty to charges of making false statements, unscrupulous beneficiaries and home health workers are increasingly targeting personal care services programs for illegal money-making schemes, according to a new federal report. Investigators say lax requirements for both caregivers and patients, along with poor state and federal oversight, has made the rapidly growing programs a lucrative target for fraud.  And this isn’t the first time they’ve issued such a warning.

Report faults federal oversight of state programs

A Health and Human Services Office of the Inspector General (OIG) report scheduled to be released today faults the Centers for Medicaid and Medicare Services (CMS) for inadequate oversight of personal care services programs, whose costs are shared by states and the federal government, as is the norm for Medicaid.  The report, which brings together six years of OIG investigations and 23 reports on the topic, describes a program hindered by poor claims documentation, insufficient monitoring of claims data for fraud and waste, and a crazy-quilt of varied requirements for personal care workers in different states.

“Historically, CMS has left a lot of the responsibility for overseeing waste, fraud and abuse to the states,” said Christi Grimm, special assistant to the principal deputy inspector general. “As a result, we have 301 different sets of requirements for caregivers across the states.” 

Although some states mandate criminal background checks and licensing for home health workers, Grimm said others lack even the most basic requirements, including age minimums, which has led to cases in which juveniles escape prosecution for fraud and abuse. Worker requirements are set by counties in a number of states, she added, which has led to a hodge-podge of rules that are difficult to enforce, and nearly impossible to monitor.

“We are asking CMS to step up to the plate,” Grimm said, and use its authority to regulate and monitor the state programs.

The report includes six previous OIG recommendations to CMS and state agencies which have gone unimplemented. In a 2008 report that found five states may have paid up to $11 million in error for personal care services during one quarter of 2005, OIG recommended that the CMS work with states to stop payments for personal care when patients were receiving care in institutions, not at home. The agency agreed with the recommendation, but according to the OIG, the work has not been completed.

In addition to asking the agency to address previous recommendations, the report offers four new goals for CMS to improve oversight and monitoring of state plans, including standardizing rules for personal care workers to set minimum age and education levels, and require criminal background checks.

The report, however, seems unlikely to spur the agency to follow the OIG’s specific suggestions..  In a written response, CMS — part of the Department of Health and Human Services — explicitly concurred with only one of  the OIG recommendations: that it should provide states with claims data to help root out cases in which beneficiaries are simultaneously receiving both institutional care and home health services.  In response to the recommendation on establishing federal guidelines for personal care workers, CMS pointed out there is a shortage of care attendants.

 “Personal care services are an important part of keeping people in their homes and out of nursing homes, which lowers costs and improves the quality of life of the patient,” said CMS spokesman Brian Cook. “We are working to protect personal care from fraud and abuse by promoting stronger training programs for workers who provide personal care, working with states on background check programs for these workers, and developing new data methods to analyze claims for potential fraud and abuse."

Grimm called the CMS response to the report unacceptable. “It’s not uncommon for CMS … to identify things on the horizon, or things they hope to do, but not necessarily commit to doing something,” Grimm said, adding that CMS’s efforts so far simply have not worked. “[CMS] has the authority to do what we are asking. It has not done it yet. And it hasn’t committed to doing it after reading our report.”

A wealth of opportunities

According to investigators, most fraud schemes in personal care services involve billing for care that was not provided or was not allowed. Self-directed programs, which allow beneficiaries to hire and manage their helpers, may be particularly vulnerable, but some prosecutions have also involved home health care agencies.

In January, for example, the owner of a Minnesota home health care company outside Minneapolis was sentenced to two years in prison for cheating Medicaid out of more than $650,000 in charges for personal care services. In March, the owner of Families First Home Health Care in Sparta, N.C., pleaded guilty to fraud and money laundering stemming from a scheme in which she billed Medicaid for personal care services she did not perform and split the proceeds with plan members.

“Fraud goes where the money is,” said Barbara Zelner, executive director of the National Association of Medicaid Fraud Units, which represents state law enforcement agencies that investigate Medicaid fraud.  After nursing homes, Zelner said, home health represents one of the larger slices of state Medicaid budgets.

Personal care services programs have grown quickly since a 1999 Supreme Court decision held that unjustified segregation of the disabled is a civil rights violation. The ruling led to increased spending for home health services; in 2011, Medicaid paid more than $12 billion for personal care services, up 35 percent since 2005, according to the OIG. Investigators say program fraud has kept pace. In 2010, state Medicaid fraud units investigated more than 1,000 cases involving personal care services, more than any other type of Medicaid service.

Not everyone agrees with the OIG’s views on personal care services.  In 2011, an OIG review of Medicaid claims for personal care services in New Jersey found that 40 percent should have been denied. Sherl Brand, president of the Home Care Association of New Jersey, which advocates for home health care providers, questions the OIG’s work, saying the agency often draw broad conclusions from examinations of a limited number of claims. “It is almost a bit ridiculous because of the extrapolation they do,” Brand said.

New Jersey home health workers face criminal background checks and certification and licensure requirements, Brand said. Personal care services programs save money, she said, in addition to helping disabled people live better lives. When New Jersey was faced with budget cuts, Brand said the association determined the average weekly cost for personal care services was $242 dollars a week, only slightly higher than the cost of a single day in a nursing home.

But as funding for the programs increase, fraud follows. Kirk Ogrosky, a former top federal health care fraud prosecutor who is now a partner at the Washington law firm Arnold & Porter, said home health has long been a hotbed of fraud, both in Medicaid and in Medicare. The fraud, he said, is not hard to uncover. Ogrosky recalled that after an extensive analysis of Medicare claims, he sent agents out to interview questionable beneficiaries. When the agents knocked on the doors, they often learned the person they were looking for was at work, Ogrosky recalled.  “That’s utterly preposterous,” he said, “since home health requires that you are homebound.”

In other cases, Ogrosky said, agents found that home health care agencies were filing claims for beneficiaries who did not live at the homes indicated on the claims. “One of my favorite stories is about a homeless guy we found,” Ogrosky said. “He didn’t even have a home to be homebound to.”

In its latest issue, the prestigious British medical journal The Lancet warns about the dangers of “profiteering” in the $1 billion international trade on human tissue and the lack of sufficient regulation worldwide – echoing the findings of an International Consortium of Investigative Journalists seriesearlier this year.

The November 10 issue of The Lancet – one of the world’s leading medical journals -- said that “profiteering threatens the altruism of tissue donation” and that doctors and health agencies in many nations have trouble tracing improperly-obtained bones, skin and tissue when problems occur. 

The Lancet article highlighted case studies and major concerns contained in last July’s four-part ICIJ series, including the legal consequences of stolen tissue implanted in hundreds of patients because of convicted body-snatcher Michael Mastromarino, now in a New York prison. 

The Lancet said the for-profit tissue industry “is not as tightly regulated as organ donation worldwide”. Voluntary donors -- and many families who allowed the use of loved ones’ bodies after death -- are not fully aware of the money-making uses of bones, tissue and skin for such things as cosmetic surgery and dental repairs, it said.

“When you introduce money into the process, then you increase the risk to quality and safety,” Imogen Swann, Director of Regulation at the United Kingdom’s Human Tissue Authority told the Lancet. “Donation should be about altruism.”

Read the full story. 

The nation’s largest hospital group has asked federal officials to create new Medicare pay scales for emergency rooms and outpatient clinics and determine if electronic health records are prompting hospitals to overcharge the federal program.

The American Hospital Association, which represents about 5,000 hospitals nationwide, also signaled that it wants to work with law enforcement officials to write Medicare billing standards that keep its members on the right side of the law.

Hospitals want to ensure that they “receive only the payment to which they are entitled,” Rich Umbdenstock, the group’s president, wrote in a letter dated Nov. 12. The letter was sent to Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder.

“Hospitals share the administration’s goal of a health system that offers high-quality, affordable care and work hard to ensure billing is correct the first time,” Umbdenstock wrote.

The industry has come under fire in the wake of the Center for Public Integrity’s “Cracking the Codes” series, which found that thousands of medical professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The investigation suggested that Medicare billing errors and abuses have been worsening as doctors and hospitals switch to electronic health records.

Medicare regulators acknowledge they are struggling to rein in a surge of aggressive — and potentially expensive — billing by doctors and hospitals linked in some cases to the rapid proliferation of electronic medical records and billing software. A variety of federal reports and whistleblower suits also reflect these concerns.

The center’s analysis of Medicare billing data found that between 2001 and 2008, hospitals dramatically increased their Medicare billing for emergency room care, adding more than $1 billion in costs to taxpayers. Use of the top two most expensive billing codes nearly doubled, from 25 percent to 45 percent of all claims, during that time. In many cases, patients were treated for seemingly minor injuries and complaints in the emergency room.

Hospitals argue that some of the possible overbilling lies in the government’s repeated failure to establish strict billing guidelines for hospitals. As a result, hospitals have since 2000 been using a set of codes designed for physician billing —a system open to broad interpretation by hospitals. The letter suggests AHA should work with the Centers for Medicare and Medicaid Services to “establish a set of national hospital…guidelines.”

Although the Obama administration in early 2009 laid plans for spending as much as $30 billion helping doctors and hospitals purchase electronic health records, little effort was spent making sure that the systems billed accurately.

“We recommend that HHS take immediate steps to develop mechanisms to ensure these new technologies are consistent with existing coding conventions,” the hospital association letter said.

The hospital association also called for HHS to develop a code of ethics for software manufacturers and make sure that the systems can’t be used for “unlawful financial gain.”

Federal officials acknowledged in September that some doctors and hospitals may be cheating Medicare by using electronic health records to improperly bill the health plan for more complex and costly services than they actually deliver — a practice known as “upcoding.”

HHS Secretary Sebelius and Attorney General Eric Holder on Sept. 24 warned five hospital and medical groups of their intention to ramp up investigative oversight, including possible criminal prosecutions, of upcoding.

The stimulus-funded plan to help finance the purchase of digital medical records by doctors and hospitals to improve the quality of medical care has enjoyed widespread political support in the past. But it has recently come under fire from Republicans.

Some are concerned primarily about the wisdom of spending billions on the projects, while others have raised questions about the safety of the devices. Critics worry that the software glitches in electronic medical records can contribute to medical errors. 

U.S. Rep. Renee Ellmers, R-N.C, who chairs the Committee on Small Business healthcare and technology subcommittee, expressed concerns about safety in a Nov. 14 letter to HHS Secretary Sebelius. She noted that a year ago the Institute of Medicine had urged HHS to develop a plan to minimize patient safety risks, but that the plan has not yet been provided to Congress.

Fred Humphries does not fit the stereotype of an FBI agent as cool and unemotional. In person, the man who helped initiate the investigation of CIA Director David Petraeus comes across as a passionate and empathetic person.

Until this week, Humphries was best known as the FBI agent who gleaned critical intelligence from an al-Qaida trained bomber in months of interrogations before the World Trade Center attack. Both a federal prosecutor and defense lawyer praised Humphries for the rapport he developed with Ahmed Ressam, the man convicted of a plot to detonate a bomb in the Los Angeles International Airport.

Humphries interrogations are credited with saving lives, most notably in helping authorities defuse the shoe bomb smuggled onto a commercial jet by Richard Reid. But Humphries raised a few eyebrows when he was called by defense lawyers to testify at sentencing that Ressam provided useful information.

Humphries sat down with a reporter from the Center for Public Integrity last year to talk about his personal beliefs opposing the CIA’s enhanced interrogation techniques employed after 9/11. Humphries described torture as both immoral and ineffective.

In the interview, Humphries said brutal techniques only lead to bad information. While he stressed that he does not condone Ressam’s actions, he said the key to getting cooperation was to try to put himself in Ressam’s shoes.

“As an agent, it’s not my position to judge,” he said. “I’m just there to find facts.”

Humphries’s empathy may have worked against him in the Petraeus investigation. Humphries and his wife became friends with Jill Kelley, a socialite who along with her husband hosted events for top military brass in Tampa. Kelley went to Humphries last May when she received suspicious anonymous emails.

The New York Times reports that the emails raised concerns within the FBI that someone might be stalking senior US officials.

Initial stories reported that Humphries had previously sent a shirtless photo to Kelley. But the Seattle Times reports today that Humphries sent the same photo as a joke to dozens of friends in 2010, including a Seattle Times reporter and Humphries’s former boss at the FBI. The Seattle Times reported that the snapshot shows Humphries, muscular and bare-chested, between two equally buff target dummies on a shooting range.

Humphries also sent friends an email after attending a party with Petraeus, in which he described him and another general as “great leaders,” the Seattle Times reported.

It’s not clear if Humphries realized that the investigation might lead to Petraeus’s resignation or raise questions about numerous flirtatious emails between Kelley and Gen. John Allen, top commander in Afghanistan. Other agents in Tampa reportedly kept Humphries out of the investigation because of his intense interest in it. Left out of the loop, Humphries reportedly feared that the case was being blocked politically. So late last month he went to Congressman Dave Reichert, R-Wa., a former sheriff in Seattle where Humphries had been stationed. News that Humphries went to members of Congress got back to the FBI director.

Within days, the FBI briefed James Clapper, Director of National Intelligence, about its probe. He persuaded Petraeus to resign.

A new report on solitary confinement of minors includes harrowing descriptions of the psychological and physical impact ‘solitary’ has on young people, as well as surprising revelations about why some authorities resort to isolating juveniles.

In “Growing Up Locked Down,” the groups Human Rights Watch and the American Civil Liberties Union report that a substantial number of detained juveniles minors are placed in solitary confinement as punishment, or as part of their rehabilitation plans – or even for their own protection. Some custodians, researchers found, say they put juveniles who are in adult lockups into solitary confinement as a way to protect them from attacks by adult inmates.

Some minors interviewed said they were segregated in juvenile facilities for the same reason – to protect them from threats – and let out only for a couple of hours a day.

Released in October, the report is based on research and interviews conducted in local and state detention facilities in Florida, Colorado, Michigan, New York and Pennsylvania. Investigators also corresponded with confined minors in 14 other states.

“Because young people are still developing, traumatic experiences like solitary confinement may have a profound effect on their chance to rehabilitate and grow,” researchers said. Minors described experiencing hallucinations, cutting themselves with staples or razors and attempting suicide multiple times. Some said they were denied contact with loved ones while in ‘solitary,’ which increased their depression.

The report also says that a Pennsylvania prison official told researchers that many minors in solitary confinement are prescribed sleeping aids and other medications to help them “cope and reduce anxiety.”

A growing number of psychiatrists, juvenile-justice experts and custodians with direct control over juveniles are turning away from using solitary confinement for young people. The report cites various experts who recommend that segregation of youths to be as brief as possible and that custodians use of proven alternatives to control behavior.

“Prison and jail officials sometimes say it is necessary to separate an inmate, or groups of inmates, from others to ensure the security of staff and inmates in the general population,” according to the report. “When this happens, some state prison officials said that they have to use solitary confinement, as they are not equipped to manage individual or small groups of prisoners in any other way. But several prison officials often told Human Rights Watch that they would like to have the ability to manage youth differently.”

In July, the Center for Public Integrity published a report on how California prison guards and probation officers defeated  a state bill that would have required mental-health evaluations of minors every four hours if they are put into solitary confinement. The proposal would have applied to minors in state lockup as well as to those in local facilities, where most detained juveniles in California now reside. The guards, who are big campaign donors in California, and probation officers argued that the proposal was vague, would interfere with guards’ decisions and would cost counties money they didn’t have to hire more staff.

Other states have adopted standards in recent years restricting the use of solitary to control minors in detention, the Center report explained. In June, the U.S. Senate held the first-ever federal hearing on solitary confinement. Speakers described the adverse impact the practice had on inmates who were later released, and how the use of long-term segregation spread among state and federal facilities.

Disruption.

Get ready to hear that word many times in the coming weeks, especially if you hang out inside the Washington beltway.

“Disruption” will be the new buzzword in an upcoming advertising campaign aimed at scaring us. The campaign is selling the idea  that millions of Americans will face higher premiums and possibly be forced into health plans with skimpier benefits — , i.e., disrupted — if Congress doesn’t repeal a provision of the Affordable Care Act (ACA) that raises money to pay for expanding coverage for the uninsured.  

The greed of the health insurance industry knows no bounds. Insurance companies will get billions of dollars in new revenue every year as a result of the health act’s requirement that, starting in 2014, we will have to buy coverage from private insurers if we’re not eligible for Medicare or Medicaid.

The Congressional Budget Office estimates that 32 million uninsured Americans will finally get coverage as a result of the law. While many will be newly eligible for the Medicaid program, millions of others will get subsidies from the federal government to help them buy private insurance. So insurance companies will get new premium revenue not only from individuals and families but also from the government.

To help finance this expanded coverage, the ACA includes a premium fee on insurers and their business customers that provide the highest level of coverage (like the so-called Cadillac plans). The fee, which is estimated to raise $87 billion over ten years, will go into effect simultaneously with the individual mandate.  

Even though insurers will get a huge infusion of cash from us and the government over that period, they are claiming it’s not fair for them have to foot any of the bill. They insist they’ll have  no choice but to pass the fee — which they call a tax — on to their policyholders. In other words, they’re not happy enough with the cake the government is giving them. They want to eat every crumb of it, too.

There will be little evidence, of course, that insurance firms are  behind this campaign. To obscure their involvement, insurers have enlisted the support of the same allies they have called upon in the past to front for them — including the National Federation of Independent Business, the U.S. Chamber of Commerce and the National Association of Manufacturers.

I know this from working with those same groups in another insurance-industry funded front group — the Health Benefits Coalition — that employed the same tactics a decade ago when insurers were trying to kill the Patients’ Bill of Rights. That coalition succeeded by convincing lawmakers that giving patients more rights, especially allowing them to sue insurers for refusing to pay for needed care, would cause premiums to skyrocket.

Like the Health Benefits Coalition, which was operated out of the offices of a Washington PR firm, the Stop The HIT (health insurance tax) Coalition, is warning of dire consequences, including, yes, skyrocketing premiums, if the fee is not abolished. This time they’ve thrown in the term “disruption” for good measure — and because it undoubtedly tested well in focus groups.

Here’s what Heidi Margulis, senior vice president for public affairs at Humana and a former colleague of mine, was quoted as telling Wall Street financial analysts at the company’s investor conference last week:

“I’ve been involved in politics for years and disruption is a really bad word. I think you’ll hear more on the airwaves during this period of time, the lame duck, about the impact of the premium tax.”

Karen Ignagni, president of America’s Health Insurance Plans, also seems to believe that disruption is a really scary word. Here’s what she said on Bloomberg TV’s “Capitol Gains” earlier this month:

“When we look at health reform we look at it through the prism of affordability and disruption. It means making sure that care is affordable a year from now and making sure that employers who are providing coverage and individuals who are buying are not disrupted.”

Margulis went on to tell the analysts that the industry anti-“disruption” campaign would be led by Stop The HIT because insurance companies “are not the best purveyors of that message, perhaps.”

Like the HBC and many other front groups, the Stop The HIT Coalition operates out of a public affairs shop on K Street. The coalition’s phone number is also the number for JDA Frontline, a firm formed by Republican political operatives. It is also the DC number for the office of Republican political strategist Ed Gillespie. The coalition’s media contact, Molly Pacela, is also director of public affairs at JDA and former media relations director at the Republican National Committee.

Don’t let these people scare you. Their real agenda is to prevent any disruption in profits.

The nation’s enforcer of election laws was largely paralyzed during the 2012 election, despite a Supreme Court ruling that left several key money-in-politics issues open to interpretation.

With five of six Federal Election Commission members working on expired terms (one since 2007), President Barack Obama had an opportunity to remake the agency with members more inclined to enforce campaign finance rules, say reformers.

But that hasn’t happened.

The situation hasn’t done much for the agency’s reputation.

“The Federal Election Commission is itself a campaign-finance scandal,” said longtime FEC critic and campaign finance reformer Fred Wertheimer, founder and president of Democracy 21.

“None of the players in the political arena had any reason to believe that the campaign finance laws would be enforced,” Wertheimer said. “The White House needs to address it or else must bear responsibility for this campaign-finance scandal continuing.”

As both Obama and GOP rival Mitt Romney raised hundreds of millions of dollars for their campaigns, long-time allies of each man launched supposedly independent super PACs that served as attack dogs during the long slog of the election.

Former White House aides Bill Burton and Sean Sweeney created the pro-Obama super PAC Priorities USA Action, while former Romney campaign advisers Carl Forti, Charles Spies and Larry McCarthy created the Restore Our Future super PAC to boost the former Massachusetts governor’s candidacy.

Both groups raised tens of millions of dollars, often from donors who also gave the legal maximum to the campaign committee of their preferred presidential candidate. Top campaign officials even appeared at fundraising events for the super PACs, including Romney himself.

Meanwhile groups that didn’t disclose their donors — such as Crossroads GPS, which was co-founded by GOP strategist Karl Rove — reported spending at least $425 million on political ads, according to the Center for Responsive Politics.

The activities of these new spending groups prompted numerous complaints by reform groups, alleging that FEC rules and existing laws banning coordination between campaigns and candidates — as well as those requiring disclosure of donors to outside spending groups — were being violated.

Many organizations have also sought “advisory opinions” from the FEC, seeking guidance on the contours of the new campaign finance landscape. The commission, which consists of three Republicans and three Democrats, has repeatedly deadlocked along partisan lines.

Despite a ban on outside spending groups coordinating with candidates, the commission tied 3-3 on whether the Republican super PAC American Crossroads could feature political candidates in ads with messages that were “thematically similar” to candidates’ campaign materials.

Nor could it reach consensus on whether using the phrases “the White House” or “the administration” in negative ads ahead of Election Day referred to a “clearly identified candidate for federal office,” which would have required the American Future Fund, a conservative nonprofit, to disclose information about its donors.

The three Republican members supported the conservative groups’ positions in both cases.

“If you had an FEC that was at least half-way sentient, they would have promulgated regulations that made clear the kind of coordination and links that would not be permitted,” said Meredith McGehee, policy director at the Campaign Legal Center. ”You could have had an FEC that would have stopped this ‘my super PAC’ phenomenon.”

Likewise, Melanie Sloan, the executive director of Citizens for Responsibility and Ethics in Washington (CREW), agrees that a functioning FEC would have led to “more enforcement of the rules” and “more disclosure of some of the donors behind the negative ads” during the 2012 elections.

Only one commissioner, Republican Chairwoman Caroline Hunter, is working on an unexpired term — though it will end April 30.

The term of Democrat Ellen Weintraub, the commission’s vice chair, expired more than five years ago, in April of 2007.

“Every day I go in and check to see if my key still works,” said Weintraub. “They can replace me at any time. I used to get nervous about it, but now it’s become a fact of my life.”

The terms of Democrat Steven Walther and Republican Don McGahn both expired in April of 2009, while the terms of Democrat Cynthia Bauerly and Republican Matthew Petersen expired in April of 2011.

The law allows the commissioners to retain their seats until replacements are nominated by the president and confirmed by the Senate.

Since taking office in 2009, Obama has nominated just one individual for a seat on the FEC — labor lawyer John J. Sullivan, who, in 2010, told the Center for Public Integrity that the nomination process was “broken” after his lingered for more than 15 months, prompting him to withdraw from consideration.

Conservative lawyer Steve Hoersting doesn’t see the nomination of new commissioners as a top priority for the White House.

“With Benghazi to answer for, treaties to consider and spending cuts to champion, I don't think appointing new commissioners will be an early priority for the Obama administration, nor should it be,” he said.

Many campaign finance reformer advocates, though, are cautiously optimistic.

“Obviously, he has less to worry about from political opponents now that he’s been re-elected,” said Sloan of CREW. “I think there’s going to be [bipartisan] agreement that new FEC commissioners are warranted.”

For now, the White House isn’t saying.

The president “intends to nominate well-qualified candidates” to the FEC, according to spokesman Eric Schultz. But when pressed for specifics on timing, Schultz said he was “not going to publically speculate on future personnel decisions.”

In the aftermath of the Nov. 6 elections, words like “fickle” and “schizophrenic” are being bandied about to describe the Wisconsin electorate.

How else can anyone explain a group of voters who simultaneously picked Democrats Barack Obama for president and Tammy Baldwin for U.S. Senate while preserving a 5-3 Republican edge in its congressional delegation and giving the GOP a commanding majority in both houses of the state Legislature?

But the vote tallies in Wisconsin’s congressional and state legislative races were not nearly as lopsided as the parties’ resulting share of seats, according to a Wisconsin Center for Investigative Journalism analysis. The breakdown between Republican and Democratic votes was close even in the races for Congress and state Legislature, where the GOP scored substantial wins.

Some election observers say these results, which ensure that Republican Gov. Scott Walker will have strong GOP majorities heading into the next legislative session, owe largely to redistricting — the redrawing of voting district boundaries based on the U.S. Census.

“The outcome of this year's U.S. House as well as state Senate and state Assembly elections testify to the power of redistricting,” said Mike McCabe, executive director of the Wisconsin Democracy Campaign, a nonpartisan clean-government advocacy group.

For instance, Republicans received 49 percent of the 2.9 million votes cast in Wisconsin’s congressional races, but won five out of eight, or 62.5 percent, of the seats, according to the Center’s analysis. The Center analyzed unofficial 2012 results reported by the Milwaukee Journal Sentinel and official 2010 results from the state Government Accountability Board.

The vote breakdown in the state’s congressional races was comparable to that for president and U.S. Senate, where the Democratic standard-bearers won 53 percent and 51 percent, respectively.

Wisconsin’s experience is not unique.

Geoffrey Stone, a law professor at the University of Chicago, recently wrote in a Huffington Post blog that Republicans won 55 percent of all House seats nationally while capturing less than half of the total vote. Stone said the GOP “won control of a substantial majority of state governments” in 2010, then “used that power to redraw congressional district lines in such a way as to maximize the Republican outcome in the 2012 House election.”

In Wisconsin, redistricting based on the 2010 Census was done largely in secret by the Republicans who controlled the state Legislature. Democrats accused the GOP of using this opportunity to cement its electoral advantage, which in itself is not illegal.

In March, a panel of three federal judges upheld most of the state’s redistricting process, including the congressional component. The panel did strike down the redrawing of two Assembly districts, saying it diluted the power of Hispanic voters.

“There is no question — none — that the recent redistricting effort distorted the vote,” said Ken Mayer, a professor of political science at the University of Wisconsin-Madison. “Nobody takes seriously the notion that the legislative plan for congressional districts wasn’t politically motivated.”

McCabe said the lines were “drawn in a way that squeezes most Democratic voters into a few districts and widely disperses their voting power across the rest of the districts.” That left GOP candidates “with a pronounced electoral advantage in congressional and legislative races.”

But Rep. Robin Vos, R-Rochester, the new Assembly speaker, didn’t agree that redistricting played a significant role in his party’s fortunes. He said there have always been districts that due to high turnout and other factors lean to one side and that the GOP simply did a better job of getting out the vote.

“Every district is on its own,” Vos said. “There are competitive seats in every part of the state. And I think that at the end of the day, voters made a choice to pick the best individual candidate.”

In the 2010 contested Assembly races, the GOP got a slightly larger proportion of seats than votes. In 2012, that pattern was even more pronounced.

This year, Republicans won 56 of the 76 contested Assembly seats in the Nov. 6 election. That’s 74 percent of the seats — which they won with just 52 percent of the 2.2 million votes.

The Democratic Party of Wisconsin furnished the Center with data showing that if uncontested races were included in the analysis, Democrats actually received 200,000 more Assembly votes than Republicans. Most uncontested races were in Democratic districts.

The GOP’s new 60-39 majority in the Assembly is nearly the same as it was heading into the election: 59-39, with one independent.

In the state Senate, Republicans won six of 11 contested races, including two seats that had been held by Democrats. The Republicans now have a 17-15 advantage in the state Senate, which will likely increase to 18-15 after a December special election in an overwhelmingly Republican district.

But the Democrats actually outpolled the GOP in these contested state Senate elections, winning 50.5 percent of the 941,000 votes cast.

Cal Potter, a former Democratic state lawmaker who now serves on the board of Common Cause in Wisconsin, a nonpartisan watchdog group, noted that the redistricting after the 1990 and 2000 Census was done by the courts, because the Legislature and governor were split and could not agree on a plan. This time around, he said, the GOP ran the show and was able to maximize its electoral advantages.

The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the UW-Madison School of Journalism and Mass Communication. This story was a produced in collaboration with Wisconsin Public Television.

All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

WINDSOR, Ontario — When some women walk onto a factory floor, punch their time card at a food processing facility, or start their shift at the foundry, they are literally dying to go to work, union members and health care advocates say.

A study that showed women working in those industries have a higher risk for breast cancer raised calls for protection of those workers.

And after the study’s principal researchers presented the results of their work to about 40 people here Monday, the reaction was anger, rather than fear.

“We have to say enough is enough,” said Terry Weymouth, a skills co-ordinator with the Canadian Auto Workers. “We are not dying because we need jobs.

“It’s time we stand up and say this is not right,” she said. “We should be mad. One in nine women are diagnosed with breast cancer.”

The six-year study, published Monday in the journal Environmental Health, examined the occupational histories of 1,006 women in Essex and Kent counties who had breast cancer, and another 1,146 who did not.

The researchers, who came from Canada, the U.S., and the U.K., took into account factors like smoking, weight, alcohol use and other lifestyle and reproductive factors. The women in the study worked in auto parts plants, casinos, food canning factories, on farms, and in metalworking plants.

The researchers found that women who work in the automotive plastics industry were almost five times as likely to develop breast cancer, prior to menopause, as women in a control group.

Lead researcher James Brophy called the work “a local study that has far-reaching implications.”

Margaret Keith, another of the principal researchers, said the issue of women’s health in industry is “a no-go area,” and said that more work needs to be done to ensure parity with their male counterparts.

The story has prompted concern that the rights of women in some industries are taken less seriously than their male counterparts

Advocates for women working in auto parts plants say this study will have an impact far beyond the science it presents: it will break the silence on an issue that has long been the subject of uneasy whispers.

“There’s the fear of losing your job or the fear of retribution from your employer if issues are raised,” said Sari Sairanen, national health and safety director for the CAW, which represents about 4,000 workers in parts plants, some of which make plastics.

About 91,000 Canadians work in the plastics trade, according to Industry Canada and — with a 37 per cent female workforce — it has the highest proportion of women of any other manufacturing sector.

Sandra Palmaro, the CEO of the Ontario wing of the Ontario Breast Cancer Foundation — a funder of the study — was in Windsor for the presentation and said the next step is for the research community to accept, and endorse, the findings.

The Ontario Ministry of Labour has 430 inspectors who conduct health and safety inspection blitzes and provides an annual update of exposure limits that restrict the amount and duration of a worker’s exposure to approximately 725 chemical and biological agents.

A ministry spokesperson said companies are obliged to do their own monitoring of toxic chemical levels to ensure the levels fall within safety standards.

In some cases, the ministry conducts its own testing to ensure compliance.

But even minuscule amounts of endocrine-disrupting chemicals can be worrisome, said Andrew Watterson, director of the Centre for Public Health and Population Health Research at the University of Stirling in Scotland.

“This research is raising big questions both about what the [workplace] standards are and even about what happens if conditions are very good, with low-level exposures,” he said.

Bob DeMatteo, health and safety director at the Ontario Public Service Employees Union for 30 years, questions whether ministry oversight protects workers from toxic chemicals that can wreak havoc even at low levels in the body.

“You can’t control it with a threshold,” he said. “You have to regulate it like asbestos — either substitute it or completely control and contain it.”

There is also deep dissatisfaction with workplace regulation in the United States where regulation takes place at the federal level.

Adam Finkel, former director of health standards programs for the U.S. Occupational Safety and Health Administration, said the vast majority of exposure limits enforced by the agency in American workplaces are based on scientific data from the 1960s or earlier, even though an estimated 150 workers die each day of work-related diseases.

“It’s a terrible record, and I’m getting more pessimistic as the years go by,” said Finkel, who runs the Penn Program on Regulation, a research center at the University of Pennsylvania Law School.

Limits for chemicals used in plastics are typically designed to address cancer and acute symptoms, not the sort of hormonal damage that can occur when women of childbearing age receive low-level exposures.

In its statement, OSHA acknowledged, “Many of our current Permissible Exposure Limits are out of date and inadequately protective, and we do not have limits for many other chemicals. OSHA is currently examining ways to strengthen our efforts related to workplace chemical exposures, as well as ways to respond to the identification of new, emerging hazards.”

In both Ontario and the U.S., there are no occupational exposure limits for BPA — the controversial chemical banned by Health Canada for use in baby bottles in 2010. The chemical is seen to have a negligible risk for adults.

A Statistics Canada survey two years ago found that 91 per cent of Canadians had the substance in their bodies.