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26-year-olds face challenges as they fall off parents’ health insurance

82b7f_171101124208-obamacare-enrollment-open-video-card-1024x576 26-year-olds face challenges as they fall off parents' health insurance

Marguerite Moniot felt frustrated and flummoxed. Despite the many hours she had spent in front of the computer this year reading consumer reviews of health insurance plans offered on the individual market in Virginia, she still did not know what plan was right for her.

Moniot was preparing to buy an insurance policy of her own, knowing she would age out of her parents’ plan when she turned 26 in October. She asked her parents for help and advice. But they, too, ran into trouble trying to decipher which policy would work best for their daughter. The family had relied on her father’s employer-sponsored plan through his work as an architect for years, so no one had spent much time sifting through policies.

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“Honestly, my parents were just as confused as I was,” said Moniot, a restaurant server in Roanoke.

In defeat, just before Thanksgiving, she went with her mother to meet a certified health insurance navigator and bought a policy that allowed her to keep her current doctors.

82b7f_171101124208-obamacare-enrollment-open-video-card-1024x576 26-year-olds face challenges as they fall off parents' health insurance
Marguerite Moniot spent hours researching her insurance options.

A new crop of young people like Moniot are falling off their parents’ insurance plans when they turn 26 — the age when the Affordable Care Act stipulates that children must leave family policies.

They were then expected to be able to shop relatively easily for their own insurance on Obamacare marketplaces. But with Trump administration revisions to the law and congressional bills injecting uncertainty into state insurance markets, that task of buying insurance for the first time this year is anything but simple.

The shortened sign-up period runs from Nov. 1 through Dec. 15. That window is half as long as last year’s, hampering those who wait until the last minute to obtain insurance.

Related: Consumers who froze credit reports could hit hurdles with Obamacare enrollment

Reminders and help are scarcer than before: The federal government cut marketing and outreach funds by $90 million, and federal funding to groups providing in-person assistance was whacked by 40%.

“I think it’s definitely going to be difficult. There’s just additional barriers with [less] in-person help, just fewer resources going around,” said Erin Hemlin, director of training and consumer education for Young Invincibles, an advocacy group for young adults.

Emily Curran, a research fellow at Georgetown University’s Health Policy Institute, said those actions combined with the Trump administration’s vigorous criticism of the health law could further handicap the uphill battle to entice young people to enroll.

“There’s already a barrier where young adults are having difficulty understanding what the value of insurance is,” she said. “Coming out … and saying prices are going up, choice is going down and this law is a mess doesn’t really get at the young adult population.”

Before the Affordable Care Act, young adults had the highest uninsured rate of any age group.

The ACA made coverage more affordable and accessible. It allowed states to expand Medicaid to cover single, childless adults. Tax credits to help pay for premiums made plans on the individual market more affordable for people whose incomes fell between 100% and 400% of the federal poverty level, or between $12,060 and $48,240 for an individual in 2018. And young adults were allowed to stay on their parents’ plan until their 26th birthday.

In all, the uninsured rate dropped to roughly 15% among 19- to 34-year-olds in 2016.

Still, young adults have not joined the individual market in the numbers as expected. About a quarter of marketplace customers in 2016 were ages 18 to 34, according to the Department of Health and Human Services. But that age group makes up about 40% of the exchanges’ potential market, according to researchers and federal officials.

Related: California is outspending the U.S. government to market Obamacare

If the Trump administration’s moves dampen enrollment, insurers could face additional challenges in attracting healthy adults to balance those with illnesses, who drive up costs.

“When you’re relatively healthy, it’s not something that you’re thinking about,” said Sandy Ahn, associate research professor at Georgetown University’s Health Policy Institute.

82b7f_171101124208-obamacare-enrollment-open-video-card-1024x576 26-year-olds face challenges as they fall off parents' health insurance
“If you don’t have insurance, you don’t have anything,” says Dominique Ridley, who turned 26 in early December.

But illness does not recognize age. Dominique Ridley, who turned 26 on Dec. 6, knows this all too well.

Ridley has asthma. She always carries an inhaler and sees a doctor when she feels her chest tighten. The student at Radford University in Virginia relies on her mother’s employer-sponsored plan for coverage.

Ridley started peppering her parents with questions about health insurance as soon as she started seeing ads for this year’s open enrollment.

“I don’t want to just go out there and apply for health insurance, and it be all kinds of wrong and I can’t afford it,” she said.

Her parents didn’t have the answers, but her mother linked up Ridley with a friend that runs a marketing company tailored to promoting the Affordable Care Act. Ridley then connected with a broker who signed her up for a silver plan that will cost her less than $4 per month, after receiving a premium subsidy of more than $500 a month.

“If you don’t have health insurance, you don’t have anything,” Ridley said.

The Obama administration relied in part on partnerships to attract young enrollees to sign up. Last year, it collaborated with national organizations like Planned Parenthood Federation of America and Young Invincibles on a social media campaign called #HealthyAdulting. Emails, according to Joshua Peck, former chief marketing officer for healthcare.gov, were particularly effective for recruitment.

The Centers for Medicare Medicaid Services, which oversees the marketplaces, said it will focus this year’s resources on “digital media, email and text messages.”

Related: Obamacare enrollment could fall millions short for 2018

Hemlin said the government has not asked Young Invincibles to assist in marketing. Her group will use its own resources to pay for targeted ads on social media to reach the target demographic, she said.

“But obviously we can’t make up for $90 million in advertising” that’s been cut, said Hemlin.

82b7f_171101124208-obamacare-enrollment-open-video-card-1024x576 26-year-olds face challenges as they fall off parents' health insurance
James Rowley says he may not need it now, but he knows insurance is “important.”

James Rowley, a 26-year-old entrepreneur from Fairfax, Virginia, is among those who signed up without help. He started his own company two years ago while covered under his father’s health plan. When he turned 26, he signed up for health insurance on his own through a special enrollment period this year. After general enrollment opened this fall, he once again picked a plan.

“I might not 100% need it now, but there will come a time where health insurance is important,” said Rowley.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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82b7f_171101124208-obamacare-enrollment-open-video-card-1024x576 26-year-olds face challenges as they fall off parents' health insurance

Health Insurance Challenges for Young People Off Obamacare | Time

Marguerite Moniot felt frustrated and flummoxed, despite the many hours she spent in front of the computer this year reading consumer reviews of health insurance plans offered on the individual market in Virginia. Moniot was preparing to buy a policy of her own, knowing she would age out of her parent’s plan when she turned 26 in October.

She asked her parents for help and advice. But they, too, ran into trouble trying to decipher which policy would work best for their daughter. The family had relied on her father’s employer-sponsored plan through his work as an architect for years, so no one had spent much time sifting through policies.

“Honestly, my parents were just as confused as I was,” said Moniot, a restaurant server in Roanoke.

In defeat, just before Thanksgiving, she went with her mother to meet a certified health insurance navigator, buying a policy that allowed her to keep her current doctors.

A new crop of young people like Moniot are falling off their parents’ insurance plans when they turn 26 — the age when the Affordable Care Act stipulates that children must leave family policies.

They were then expected to be able to shop relatively easily for their own insurance on Obamacare marketplaces. But with Trump administration revisions to the law and congressional bills injecting uncertainty into state insurance markets, that task of buying insurance for the first time this year is anything but simple.

The shortened sign-up period, which started Nov. 1, runs through Dec. 15. That window is half as long as last year’s, hampering those who wait until the last minute to obtain insurance.

Reminders and help are scarcer than before: The federal government cut marketing and outreach funds by $90 million, and federal funding to groups providing in-person assistance was whacked by 40 percent.

“I think it’s definitely going to be difficult. There’s just additional barriers with [less] in-person help, just fewer resources going around,” said Erin Hemlin, director of training and consumer education for Young Invincibles, an advocacy group for young adults.

Emily Curran, a research fellow at Georgetown University’s Health Policy Institute, said those actions combined with the Trump administration’s vigorous criticism of the health law could further handicap the uphill battle to entice young people to enroll. As of Nov. 25, nearly 2.8 million people had enrolled through the federal marketplace, according to the Centers for Medicare Medicaid Services. The data were not sorted by age.

“There’s already a barrier where young adults are having difficulty understanding what the value of insurance is,” she said. “Coming out … and saying prices are going up, choice is going down and this law is a mess doesn’t really get at the young adult population.”

Trouble attracting young ddults

Before the Affordable Care Act, young adults had the highest uninsured rate of any age group.

The ACA made coverage more affordable and accessible. It allowed states to expand Medicaid to cover single, childless adults. Tax credits to help pay for premiums made plans on the individual market more affordable for people whose incomes fell between 100 and 400 percent of the federal poverty level (between $12,060 and $48,240 for an individual). And young adults were allowed to stay on their parents’ plan until their 26th birthday.

In all, the uninsured rate dropped to roughly 15 percent among 19- to 34-year-olds in 2016. Still, young adults have not joined the individual market in the numbers as expected. About a quarter of marketplace customers in 2016 were ages 18-34, according to the Department of Health and Human Services. But that age group makes up about 40 percent of the exchanges’ potential market, according to researchers and federal officials.

If the Trump administration’s moves dampen enrollment, insurers could face additional challenges in attracting healthy adults to balance those with illnesses, who drive up costs.

“When you’re relatively healthy, it’s not something that you’re thinking about,” said Sandy Ahn, associate research professor at Georgetown University’s Health Policy Institute.

But illness does not recognize age. Dominique Ridley, who turns 26 on Dec. 6, knows this all too well.

Ridley has asthma. She always carries an inhaler and sees a doctor when she feels her chest tighten. The student at Radford University in Virginia relies on her mother’s employer-sponsored plan for coverage.

Ridley started peppering her parents with questions about health insurance as soon as she started seeing ads for this year’s open enrollment.

“I don’t want to just go out there and apply for health insurance, and it be all kinds of wrong and I can’t afford it,” she said.

Her parents didn’t have the answers, but her mother linked up Ridley with a friend that runs a marketing company tailored to promoting the Affordable Care Act. Ridley then connected with a broker who signed her up for a silver plan that will cost her less than $4 per month, after receiving a premium subsidy of more than $500 a month.

“If you don’t have health insurance, you don’t have anything,” Ridley said.

A digital campaign

The Obama administration relied in part on partnerships to attract young enrollees to sign up. Last year, it collaborated with national organizations like Planned Parenthood Federation of America and Young Invincibles on a social media campaign called #HealthyAdulting. Emails, according to Joshua Peck, former chief marketing officer for healthcare.gov, were particularly effective for recruitment.

The Centers for Medicare Medicaid Services, which oversees the marketplaces, said it will focus this year’s resources on “digital media, email and text messages.”

Hemlin said the government has not asked Young Invincibles to assist in marketing. Her group will use its own resources to pay for targeted ads on social media to reach the target demographic, she said.

“But obviously we can’t make up for $90 million in advertising” that’s been cut, said Hemlin.

One factor that might compensate is that 20-somethings are facile at shopping online, said Jill Hanken, director of Enroll! Virginia, a statewide navigator program.

“Our job is to make sure they understand to look at provider networks and drug formularies if they have health concerns. But they’re able to do the mechanics of enrollment on their own very often.”

James Rowley, a 26-year-old entrepreneur from Fairfax, Va., is among those who signed up without help. He started his own company two years ago while covered under his father’s health plan. When he turned 26, he signed up for health insurance on his own through a special enrollment period this year. When general enrollment opened, he once again picked a plan.

“I might not 100 percent need it now, but there will come a time where health insurance is important,” said Rowley.

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Carmen Heredia Rodriguez is a Kaiser Health News reporter.

Growth of internet has brought new global challenges: Sushma Swaraj

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Enterprises must address Internet of Identities challenges

As November ends, everyone and their brother/sister will be writing about their IT and security predictions for 2018. Here’s a no-brainer from me — we’ll see massive proliferation of Internet of Things (IoT) devices on the network next year. Some of these will be general-purpose devices, such as IP cameras, smart thermostats, smart electric meters, etc., but many others will be industry-specific sensors, actuators, and data collectors. 

Managing the deployment, operations, and security of all these devices will be quite challenging. Someone must figure out network access controls, connectivity, segmentation, baseline behavior, network performance implications, etc.

This is where identity comes into play. Each device should have its own identity and attributes that govern connectivity, policy, and trust. My sagacious colleague, Mark Bowker, calls this trend the Internet of Identities. With Mark’s help, I introduced the concept of the Internet of Identities in this blog post, and further elaborated on the massive changes the Internet of Identities will bring in this one

The Internet of Identities is coming fast, but ESG research indicates that many organizations are not prepared for the onslaught because:

Global Health Challenges Offer Social Entrepreneurs Opportunity

You can download an audio podcast here or subscribe via iTunes.

“We have grown far too tolerant of businesses not acting in alignment with the public good,” said Derek Fetzer, director of Johnson and Johnson’s CaringCrowd crowdfunding site for global health. “ Shouldn’t all business, all entrepreneurship be for the public good?

“The spirit of social entrepreneurs is crucial in solving global health challenges, and has been a driving force in uncovering innovative solutions to tackle the ever-changing global health landscape,” Carol Pandak, PolioPlus director for Rotary International, said. (I am a member of Rotary and once wrote an article for the Rotarian Magazine.)

Pandak noted that global health issues hold a unique space on the plant. “It could be easy to diagnose many global health challenges as problems of individual regions and nations.” After all, it has been decades since anyone in the Americas got polio.

She pointed out that the United Nations’ Sustainable Development Goal number 3 targets healthy lives and well-being for all. “When it comes to global health, there really is no issue from which any group, any nation is immune.” Even with only 15 cases reported so far in 2017, polio is just a plane ride away.

To get a better perspective on global health opportunities for social entrepreneurs, I invited 12 experts and practitioners to join me for a roundtable discussion. You can watch the entire 90-minute discussion in the video player above. Pandak participated only in writing. In a wide-ranging discussion, we covered challenges and opportunities in global health along with specific examples and some key lessons learned.

Credit: Engineering World Health

Leslie Calman, Engineering World Health

Leslie Calman, CEO of Engineering World Health, extended Pandak’s idea. “The answer must be broadly systemic, not singular: a combination of broad public health measures; an educated and paid healthcare workforce including doctors, nurses and technicians; support from governments and NGOs for public hospitals and clinics that serve low-income people; [and] the education of women and girls.”

Entrepreneurs have many roles to play in global health, said Deepak Kapur, the Chairman, India National PolioPlus Committee. He highlights needs assessment, monitoring, cutting red-tape for rapid response to emergent needs, special perspectives of business and industry and piloting new programs.

Global Health Challenges Offer Social Entrepreneurs Opportunity

You can download an audio podcast here or subscribe via iTunes.

“We have grown far too tolerant of businesses not acting in alignment with the public good,” said Derek Fetzer, director of Johnson and Johnson’s CaringCrowd crowdfunding site for global health. “ Shouldn’t all business, all entrepreneurship be for the public good?

“The spirit of social entrepreneurs is crucial in solving global health challenges, and has been a driving force in uncovering innovative solutions to tackle the ever-changing global health landscape,” Carol Pandak, PolioPlus director for Rotary International, said. (I am a member of Rotary and once wrote an article for the Rotarian Magazine.)

Pandak noted that global health issues hold a unique space on the plant. “It could be easy to diagnose many global health challenges as problems of individual regions and nations.” After all, it has been decades since anyone in the Americas got polio.

She pointed out that the United Nations’ Sustainable Development Goal number 3 targets healthy lives and well-being for all. “When it comes to global health, there really is no issue from which any group, any nation is immune.” Even with only 15 cases reported so far in 2017, polio is just a plane ride away.

To get a better perspective on global health opportunities for social entrepreneurs, I invited 12 experts and practitioners to join me for a roundtable discussion. You can watch the entire 90-minute discussion in the video player above. Pandak participated only in writing. In a wide-ranging discussion, we covered challenges and opportunities in global health along with specific examples and some key lessons learned.

Credit: Engineering World Health

Leslie Calman, Engineering World Health

Leslie Calman, CEO of Engineering World Health, extended Pandak’s idea. “The answer must be broadly systemic, not singular: a combination of broad public health measures; an educated and paid healthcare workforce including doctors, nurses and technicians; support from governments and NGOs for public hospitals and clinics that serve low-income people; [and] the education of women and girls.”

Entrepreneurs have many roles to play in global health, said Deepak Kapur, the Chairman, India National PolioPlus Committee. He highlights needs assessment, monitoring, cutting red-tape for rapid response to emergent needs, special perspectives of business and industry and piloting new programs.

Regulating Internet Content: Challenges and Opportunities

Terrorist groups, like everyone else today, rely on the internet. Al-Qaeda in Iraq made its name disseminating hostage beheading videos. Omar Hammami became a Twitter star for the Somali jihadist group al-Shabaab. The Islamic State put all this on steroids, producing and disseminating thousands of videos in Arabic, English, French, Russian and other languages to reach Muslims around the world.

Much of this content is propaganda, meant to inspire new recruits, demonstrate to funders that their money is being well spent, and shore up morale among existing followers. Social media also is a way to involve part-time supporters who can modify Islamic State images or generate their own content and disseminate it. Such propaganda also is used by face-to-face recruiters who reinforce their in-person sessions with video or teaching distributed through the internet.

Some of the content is clever and compelling. The Islamic State, for example, put up numerous images of how good life is under its rule, with pictures of swimming pools, happy children, and Nutella. Many jihadists posted pictures of themselves with cats (the adorable feline mujahids often held guns). Many of their most famous images, however, involved beheadings of hostages, including several Americans, or the burning alive of a Jordanian pilot in a cage—videos that are visceral and stomach-churning.

Less publicly, but often more importantly, terrorists often use the internet for operations. Over the years, they’ve used an array of technologies to plan attacks or help move money or people from place to place. New recruits are often directed by email or via supposedly secure applications. The Islamic State posts instructions on “How to Survive in the West” for all to see. And they have strategy debates, with key works such as the “Management of Savagery” readily available for anyone who wants to download it. We’ve also seen individual terrorists post their words and intended deeds on Facebook or otherwise advertise their commitment to violence to their “friends” or “followers.”

Preventing terrorists from recruiting and planning operations via the internet is difficult for several reasons. One is that the internet encompasses many things, from email and websites to apps and social media—-and terrorists use them all. Whether it’s Gmail and YouTube or Telegram and WhatsApp, stopping specific content from flowing across all internet platforms can be technically difficult or impossible. Indeed, monitoring new content and communications is highly resource-intensive at best, requiring thousands of human hours to comb through the nooks and crannies of different virtual sites or sort what various algorithms have generated.

Legal concerns often loom large. The line between embracing violence and engaging ina political debate can be tricky. The infamous “Nuremberg Trials” website involved an anti-abortion group that posted the names and addresses of abortion doctors and had links to other sites that endorsed violence. Because the website itself did not openly call for violence, a fiercely contested court case pitting Planned Parenthood against the ACLU ensued. In the end, the host of the website simply denied the group its services—solving this particular case but not the issue in general. Similarly, earlier this year Cloudflare dumped the Daily Stormer because of its objectionable content and fears that Cloudflare’s brand would be tainted. With this decision went Cloudflare’s claims to “remain neutral” in free speech disputes. Large legal questions remain: How does incitement work in this context? Should these actions be covered under the material support statutes? To what extent is a particular instance political speech? And those are just a few.

It might be tempting to simply have a high bar and not fret about all these possibilities—terrorists are terrorists, after all. But a high bar can easily interfere with legitimate users in the name of counterterrorism. Facebook, for example, took down the iconic and disturbing image of a naked Vietnamese girl fleeing after a napalm attack on the grounds that images of naked girls are, well, child pornography. (After an outcry, Facebook restored the image.) Likewise, a high bar on encryption might prevent terrorists from communicating securely with one another, but it could also prevent human rights dissidents from doing the same.

Making this more complex, different countries have vastly different rules. The United States is a free-speech outlier—most European states are far more restrictive, let alone dictatorships like China or Saudi Arabia. Germany, for example, prohibits pro-Nazi propaganda. However, without the United States entering the arena with a feasible alternative, these more restrictive states proceed unchallenged. Earlier this month, Britain’s home secretary announced a proposed expansion to the statute that criminalizes possessing or collecting information for terrorist purposes. Previously, the law covered only information that was downloaded or printed; the proposal would include information that was repeatedly streamed or viewed online. In an increasingly restrictive environment, the United States may find value in opening the debate and proposing alternative solutions.

Although terrorists’ exploitation of the internet is a net negative, intelligence agencies may also want some terrorist use of the internet. Terrorists’ tweets, Facebook posts and communications can be monitored, and often, security services discover unknown threats or find compelling evidence that can be used to disrupt terrorist attacks. When an Islamic State cell in Australia plotted a major bombing this summer, the attack was thwarted only because an intelligence agency intercepted communications between the cell and their handler inside Syria.

Not surprisingly, technology companies are being thrust into the limelight. Part of this is because the terrorists are using their platforms to foster their violent agendas. But part of it is also because the policy world has not engaged this issue directly. Different legal regimes in different countries, regulations written for an older technological era, and tricky issues balancing free speech and the risk of violence all make it easier to demand that internet companies act on their own rather than governments take responsibility.

To solve the problem, we need action—ideally, coordinated action—at multiple levels. Technology companies are already experimenting with artificial intelligence and other tools to identify hateful content and at times block it. Many have dumped Islamic State, neo-Nazi, or other accounts, using their own terms of service as justification even when the law does not require them to do so. To date, these takedowns have been effective: Islamic State supporters created fewer new Twitter accounts after the platform began suspending them en masse, while white nationalist supporters on Reddit made far fewer extremist comments (or left the site altogether) after the company shut down its most hateful subreddits.

Yet self-regulation by the technology sector, however welcome, is not in itself a viable long-term solution. Both Twitter and Reddit, for example, cracked down on extremist content only after a massive public outcry—and in the case of the Islamic State, only after the group had already used the platform to attract thousands of new supporters, many of whom either traveled to Syria or carried out attacks in their own countries.

Any effort should begin at home and in Europe, but it shouldn’t end there. The United States will also need to negotiate with China, Russia and other less friendly powers. These negotiations will require a delicate balancing act: They will need to restrict our enemies from fomenting extremist speech but without so normalizing free speech restrictions that autocrats across the globe feel more empowered to suppress pro-democracy voices at home. If the United States demanded that terrorist-related content be banned, many countries would quickly brand any domestic opponents as “terrorists.” These governments would label not only the Islamic State and al-Qaeda as terrorists, but also Uighurs in China, the Muslim Brotherhood in Egypt and whoever is criticizing Vladimir Putin on a given day. Finally, if negotiations fail or simply are not possible—as is often the case in states experiencing civil war—direct action may be necessary in severe cases. In rare cases, this may require arresting or targeting the propagandist if the propaganda poses an immediate threat to national security, or knocking their sites offline even in their home countries.

Fortunately, Lawfare has long debated the intersection of technology and extremism, such as when Seamus Hughes questioned how frequently radicalization happened exclusively online. Most of the commentary to date has focused on narrow legal issues. For example, Matthew Weybrecht cited Humanitarian Law Project and Brandenburg to argue that self-radicalization may lead to another carve-out in free speech jurisprudence, while Elinor Fry summarized the famous Dutch Context prosecution, noting how the Netherlands’ incitement requirement differs from Brandenburg. Meanwhile, Paul Rosenzweig wondered if an ISIS-related copyright act modeled after the Digital Millennium Copyright Act could compel providers to take down some ISIS-supporting content. Yet the most sustained commentary on the issue comes from Zoe Bedell and Benjamin Wittes. In a threepart series, the two considered whether Twitter was violating the material support statutes by allowing designated Foreign Terrorist Organizations to have accounts. They note that perhaps the prudential judgments of the FBI and Department of Justice most protect Twitter, and that these judgments push prosecutors to steer as far away from the First Amendment line as possible when prosecuting material support cases. Likewise, in another set of articles, Bedell and Wittes questioned Twitter’s civil liability for violating material support statutes; they found a civil claim would be difficult because establishing both mens rea and proximate causation would be a stretch. In a follow-up piece, Bedell and Wittes looked at Section 230 of the Communications Decency Act and determined that the section would not protect Twitter or a similar service provider if the plaintiff did not rely on the contents of the tweets as evidence; however, it would be nearly impossible to do so.

Over the coming months, we will be building on Lawfare’s longstanding debates over technology and terrorism. In particular, we will be looking at policy proposals and technical ideas that might reduce the internet space available to terrorists. Our focus will be on assessing the impact and practicality of many proposals, and we’d welcome input on this as well as on the legal ramifications of what we propose.

We suspect some steps will be straightforward and others near-impossible. But a concerted effort on all fronts can restrict the virtual space in which terrorists operate while ensuring that civil liberties and business interests also are protected.

Foxconn profits tumble on iPhone X supply chain challenges

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Trump Health Agency Challenges Consensus on Reducing Costs …

In September, the department released an outline of a “new direction” for the Center for Medicare and Medicaid Innovation, set up by the Affordable Care Act to test models aimed at improving medical care and reducing costs. While the Obama administration had pushed large, mandatory experiments to test new models of pay, the Trump administration wants to encourage smaller, voluntary programs — and has asked the doctors to help design them.

“Clearly a great big foot has been put on the brake,” said Donald Crane, the chief executive of CAPG, a group of doctors and hospital administrators that, unlike many in the profession, has pushed to tie physician pay to quality measures rather than the old model of fee for service.

Mr. Crane was referring specifically to the scaling back of the cardiac and joint replacement programs by Tom Price, an orthopedic surgeon and Republican former congressman chosen by Mr. Trump as secretary of health and human services. Mr. Price, who resigned in September over his use of expensive private jets, had accused the Obama administration of trying to “commandeer clinical decision-making” by forcing doctors to participate in experiments that test new ways of paying for care. Mr. Trump is said to be close to appointing a successor — possibly Alex Azar, a former pharmaceutical company executive who worked in the Department of Health and Human Services under President George W. Bush — and doctors’ groups will be watching carefully to see if the agency continues in the same direction.

Already, other administration officials have signaled support for protecting doctors and giving them more say. The agency’s Centers for Medicare and Medicaid Services, led by Seema Verma, has suggested it will accept more recommendations than it did in the past from a committee of doctors formed by the American Medical Association on how much Medicare should pay for services and procedures — essentially letting doctors set their own pay.

Ms. Verma’s agency also issued the call for changing the direction of the innovation center. The formal “request for information” proposed, among other potential changes, allowing doctors and hospitals to contract directly with Medicare patients. This would allow doctors and other providers to propose their own prices, moving toward a long-held Republican goal of so-called premium pricing.

Research has shown that the traditional model of paying doctors, known as “fee for service,” often results in unnecessary or inappropriate care. The federal government has been slowly moving away from it since 1983, when Medicare changed some of its payments to hospitals.

But the changes now pushed by H.H.S. are a renunciation of the Obama administration in particular. It had sought to shift 30 percent of fee-for-service Medicare payments to alternative payments based on quality or value by 2016 — a goal it achieved — and 50 percent by 2018. To do so, it required doctors and hospitals in many regions of the country to adopt those new payment models.

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Canceling mandatory bundled payments for cardiac and orthopedic procedures was a pet project for Mr. Price, who had fought against what he saw as unnecessary government intervention since his days as a surgeon in the suburbs north of Atlanta.

Mr. Price defended the old model in front of thousands of doctors and medical administrators gathered in June for the annual meeting of CAPG, the group pushing for new payment models, arguing that the health care system in the United States — “the finest,” he said, in the world — had developed around it.

“So we ought to recognize,” he told the group, that “fee for service may not be the end of the world.”

Photo

2dec2_00DOCTORS2-master675 Trump Health Agency Challenges Consensus on Reducing Costs ...

Seema Verma, left, the head of the Centers for Medicare and Medicaid Services, was a partner in efforts by Tom Price, right, to slow changes in the way doctors are paid.

Credit
Eric Thayer/Getty Images

Many in the health care field criticized some of the rules issued by the Obama administration as overly prescriptive and welcomed the department’s effort to review them.

“Many experiments that the Obama administration launched were overly micromanaged,” said Grace-Marie Turner, an opponent of the health law and president of the Galen Institute, a research center that advocates free-market health policies. “Innovation has to percolate up from the bottom. The Obama administration tried to drive it from the top.”

Even with Mr. Price’s departure, the department still has numerous people who have advocated strongly for doctors and industry in the past. They include senior staff members who have worked representing medical device makers, pharmaceutical and hospital supply companies, the nursing home industry and physician specialty groups. The acting secretary of health and human services, Eric Hargan, is a former lawyer for the law and lobbying firm Greenberg Traurig who served as a deputy secretary at the agency during Mr. Bush’s tenure.

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Miranda Franco, senior policy adviser at the law firm Holland Knight, has closely tracked the changes. She said it appeared the administration was using the innovation center to further its priorities of “more provider-friendly approaches, more voluntary models.”

Ms. Verma, the administrator of the centers, seemed to confirm that when she wrote in a Wall Street Journal op-ed: “Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements.”

Last month, Ms. Verma also announced a plan to re-examine and streamline all the ways the federal government has been measuring the quality of the care doctors provide, saying in a speech, “We want to move to a system that pays for value and quality — but how we define value and quality today is a problem.” The goal, she said, was to relieve doctors of excessive regulatory burdens and make sure payment policies are “guided by those on the front lines serving patients.”

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Gail Wilensky, the administrator of the Centers for Medicare and Medicaid in the first Bush administration, said she heard many complaints from doctors who felt that during the Obama presidency the agency was not listening to any of their ideas for how to move toward payment based on quality rather than quantity.

“It’s hard for me to believe that physicians will do any better than they would have done, having Tom Price there,” Ms. Wilensky said. “From their point of view, this was about as good as it was going to get.”

But Tim Gronniger, a deputy chief of staff at the centers during the Obama administration, argued that there was little demand from hospitals or physicians to cancel the bundled payments, or to delay the merit-based payments.

In fact, many doctors are still subject to the rules of the merit-based system, which passed with bipartisan support in Congress in 2015. And other value-based programs are continuing.

“They’ve confused people,” said Mr. Gronniger, now a senior vice president at Caravan Health, which helps health care providers shift to value-based payment models. “The risk that H.H.S. and Tom Price created is that some physicians incorrectly read the press release or hear from their colleagues that Medicare is canceling value-based purchasing and think all of that’s over.”

“Physicians and hospitals need to be engaged in this work,” he added, “and exempting them doesn’t do them any favors.”

Although little has changed since Mr. Price’s departure, there are signs that the agency is still trying to figure out the best way to proceed, said Michael Chernew, an economist at Harvard Medical School who supports moving away from fee for service.

Mr. Chernew said he was “cautiously hopeful” about H.H.S. continuing to promote alternative payment models, pointing out that Medicare rates under fee for service will remain flat over the next decade anyway under the payment law that Congress passed in 2015.

“My general sense, and I’ve met with them, is that they genuinely want to try to have a better set of payment models,” Mr. Chernew said of Ms. Verma and those working for her at the Centers for Medicare and Medicaid Services. “They don’t just want to try to blow everything up.”

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He added, “If you take all the politics out of it, the right thing for them to do is move ahead.”


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Increase In Uptake of Computer Science Challenges Universities

The current surge in undergraduate enrollments in Computer Science courses and degree programs is straining resources at many U.S. colleges and universities according to the National Academies of Sciences, Engineering, and Medicine.

The newly published report, Assessing and Responding to the Growth of Computer Science Undergraduate Enrollments, provides ample evidence of a trend that we have repeatedly commented on – that of the marked increase in the number of US university and college undergraduates opting for computer science.

Its headline finding is that the number of bachelor’s degrees awarded nationally in computer and information science has increased by 74 percent since 2009, compared to a 16 percent increase in bachelor’s degrees produced overall. Moreover, as this chart based on data from the CRA Taulbee Survey indicates, the statistics suggest that the number of students attaining computer science bachelor’s degrees is likely to continue to rise for at least the next several years.

Interest in the CS courses has also grown dramatically among non-majors:

One interesting point in this chart is that the number of non-majors in courses intended for CS majors is increasing at a rate equal to or higher that that for majors. The report states:

Between 2010 and 2015, introductory CS course enrollment increased by an average of 158 percent for majors and 169 percent for non-majors; enrollment in the mid-level course increased by 148 percent for majors and 248 percent for non-majors; enrollment in the upper-level course increased by135 percent for majors and 144 percent for non-majors.

In our previous reports noting Students Flocking to Computer Science, we have seen the increase in the popularity of CS degrees as being a positive, commenting, for example:

The fact that the number of Computer Science concentrators at Harvard has increased each year for the past five years, from 86 in 2008 to 153 in 2013 shows that the message that gaining a CS degree is good for your employment prospects is being taken notice of.

As we reported earlier this month with reference to US Bureau of Labor Statistics, possession of CS degree is acknowledged to open the way to well-paid jobs in industry and while this is good for students, and has led to more of them choosing to study it, it is a problem for educational institutions.

According to the report:

The most common challenges cited by departments include increased faculty workload; too few faculty, instructors, or teaching assistants; greater need for academic undergraduate advisers and administrative support; and increased need for classroom, lab, and office space. In recent years over half of new Ph.D.s in computer science have taken jobs in industry, posing challenges to finding faculty.


Data indicate that from 2006 to 2015, the average increase in tenure-track computer science faculty at research institutions was only about one-tenth of the increase in the number of computer science majors.

 


 

 

The report sets out a range of alternative strategies for addressing the problem, one of which is to:

“seriously consider increasing the number of academic-rank teaching faculty.”

Among the option discussed is that of limiting the number of students allowed to study Computer Science. With regard to this the National Academies’ Press Release states:

While some institutions may view imposing limits on enrollment in computer science programs and courses as desirable or inevitable, they should carefully consider the consequences before doing so, the report says. Such limits may cut students off from their true passion, and they may introduce an environment of real or perceived competition among students who desire to enter a program, which could discourage participation among underrepresented groups.

So here’s the situation.

Over the past 5 years or more we’ve seen successive initiatives to promote Computer Science as a topic to be included throughout the school curriculum and also be promoted outside the classroom. Starting from modest beginnings with CS Education Week, the idea snowballed when Code.org’s Hour of Code was promoted not only by tech industry leaders such as Bill Gates and Mark Zuckerberg but also by role models from the worlds of sport and entertainment and was enthusiastically endorsed by then-President Barak Obama. In his final State of the Union Address in January 2016 Obama introduced his “Computer Science for All” initiative, which included $4 billion in funding for states and $100 million directly for districts to increase access to K-12 computer science education by training teachers and expanding access to instructional materials.

Since then we’ve seen CS become an official STEM subject and the launch of  K-12 Computer Science Framework drawn up by Code.org together with the ACM and other partners in collaboration with states and districts and the expansion of and encouragement of participation in AP Computer Science. On theme common to all these initiatives is to encourage participation of “underrepresented groups“, namely girls and Hispanic/Latino, African-American and American Indian/ Alaska Native students.

While it revealed that the longstanding under-representation of women and some minority groups among computer science bachelor’s degree recipients had not improved significantly as of 2015, the last year for which national data are available, the report found some evidence that representation may be improving among students currently majoring in or interested in majoring in computer science and stressed the importance of supporting diversity and

should leverage the growing interest as an opportunity to recruit and retain more women and underrepresented minorities into the field.

The report makes recommendations for attracting and retaining sufficient faculty including:

Increasing the number and enhancing the role of academic-rank teaching faculty should be give serious consideration.

Another approach could be interpreted as a move to emulate MOOCs, which have had a significant impact in widening access to computer science not just in the US but globally. The recommendation is:

Institutions should pursue innovative strategies for using technology to deliver high-quality instruction at scale to large numbers of students.

It goes on to suggest that the National Science Foundation, which last year awarded grants to look at the impact of pre-college CS computing could support research on how best to use technology in teaching large classes. There already is a lot of evidence for the effectiveness of MOOCs and MOOCs are already in a position to bolster on-campus Computer Science. Take, for example, the edX MOOC Introduction to Computer Science and Programming Using Python from MIT. It can now count as 3 credit hours towards a degree courtesy of edX partner Charter Oak State College, Connecticut’s public online college, and transferable to other educational establishments. Expanding such transferable credit schemes could take pressure off institutions that didn’t have the resources to teach Computer Science and still offer it to non-majors while those with the best CS courses could share their expertise more widely.

 

More Information

Colleges and Universities Should Take Action to Address Surge of Enrollments in Computer Science

Assessing and Responding to the Growth of Computer Science Undergraduate Enrollments (2017)

K-12 Computer Science Framework

 

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Trump Health Agency Challenges Consensus on Reducing Costs

In September, the department released an outline of a “new direction” for the Center for Medicare and Medicaid Innovation, set up by the Affordable Care Act to test models aimed at improving medical care and reducing costs. While the Obama administration had pushed large, mandatory experiments to test new models of pay, the Trump administration wants to encourage smaller, voluntary programs — and has asked the doctors to help design them.

“Clearly a great big foot has been put on the brake,” said Donald Crane, the chief executive of CAPG, a group of doctors and hospital administrators that, unlike many in the profession, has pushed to tie physician pay to quality measures rather than the old model of fee for service.

Mr. Crane was referring specifically to the scaling back of the cardiac and joint replacement programs by Tom Price, an orthopedic surgeon and Republican former congressman chosen by Mr. Trump as secretary of health and human services. Mr. Price, who resigned in September over his use of expensive private jets, had accused the Obama administration of trying to “commandeer clinical decision-making” by forcing doctors to participate in experiments that test new ways of paying for care. Mr. Trump is said to be close to appointing a successor — possibly Alex Azar, a former pharmaceutical company executive who worked in the Department of Health and Human Services under President George W. Bush — and doctors’ groups will be watching carefully to see if the agency continues in the same direction.

Already, other administration officials have signaled support for protecting doctors and giving them more say. The agency’s Centers for Medicare and Medicaid Services, led by Seema Verma, has suggested it will accept more recommendations than it did in the past from a committee of doctors formed by the American Medical Association on how much Medicare should pay for services and procedures — essentially letting doctors set their own pay.

Ms. Verma’s agency also issued the call for changing the direction of the innovation center. The formal “request for information” proposed, among other potential changes, allowing doctors and hospitals to contract directly with Medicare patients. This would allow doctors and other providers to propose their own prices, moving toward a long-held Republican goal of so-called premium pricing.

Research has shown that the traditional model of paying doctors, known as “fee for service,” often results in unnecessary or inappropriate care. The federal government has been slowly moving away from it since 1983, when Medicare changed some of its payments to hospitals.

But the changes now pushed by H.H.S. are a renunciation of the Obama administration in particular. It had sought to shift 30 percent of fee-for-service Medicare payments to alternative payments based on quality or value by 2016 — a goal it achieved — and 50 percent by 2018. To do so, it required doctors and hospitals in many regions of the country to adopt those new payment models.

Advertisement

Continue reading the main story

Canceling mandatory bundled payments for cardiac and orthopedic procedures was a pet project for Mr. Price, who had fought against what he saw as unnecessary government intervention since his days as a surgeon in the suburbs north of Atlanta.

Mr. Price defended the old model in front of thousands of doctors and medical administrators gathered in June for the annual meeting of CAPG, the group pushing for new payment models, arguing that the health care system in the United States — “the finest,” he said, in the world — had developed around it.

“So we ought to recognize,” he told the group, that “fee for service may not be the end of the world.”

Photo

7af1e_00DOCTORS2-master675 Trump Health Agency Challenges Consensus on Reducing Costs

Seema Verma, left, the head of the Centers for Medicare and Medicaid Services, was a partner in efforts by Tom Price, right, to slow changes in the way doctors are paid.

Credit
Eric Thayer/Getty Images

Many in the health care field criticized some of the rules issued by the Obama administration as overly prescriptive and welcomed the department’s effort to review them.

“Many experiments that the Obama administration launched were overly micromanaged,” said Grace-Marie Turner, an opponent of the health law and president of the Galen Institute, a research center that advocates free-market health policies. “Innovation has to percolate up from the bottom. The Obama administration tried to drive it from the top.”

Even with Mr. Price’s departure, the department still has numerous people who have advocated strongly for doctors and industry in the past. They include senior staff members who have worked representing medical device makers, pharmaceutical and hospital supply companies, the nursing home industry and physician specialty groups. The acting secretary of health and human services, Eric Hargan, is a former lawyer for the law and lobbying firm Greenberg Traurig who served as a deputy secretary at the agency during Mr. Bush’s tenure.

Newsletter Sign Up

Continue reading the main story

Miranda Franco, senior policy adviser at the law firm Holland Knight, has closely tracked the changes. She said it appeared the administration was using the innovation center to further its priorities of “more provider-friendly approaches, more voluntary models.”

Ms. Verma, the administrator of the centers, seemed to confirm that when she wrote in a Wall Street Journal op-ed: “Providers need the freedom to design and offer new approaches to delivering care. Our goal is to increase flexibility by providing more waivers from current requirements.”

Last month, Ms. Verma also announced a plan to re-examine and streamline all the ways the federal government has been measuring the quality of the care doctors provide, saying in a speech, “We want to move to a system that pays for value and quality — but how we define value and quality today is a problem.” The goal, she said, was to relieve doctors of excessive regulatory burdens and make sure payment policies are “guided by those on the front lines serving patients.”

Advertisement

Continue reading the main story

Gail Wilensky, the administrator of the Centers for Medicare and Medicaid in the first Bush administration, said she heard many complaints from doctors who felt that during the Obama presidency, the agency was not listening to any of their ideas for how to move toward payment based on quality rather than quantity.

“It’s hard for me to believe that physicians will do any better than they would have done, having Tom Price there,” Ms. Wilensky said. “From their point of view, this was about as good as it was going to get.”

But Tim Gronniger, a deputy chief of staff at the centers during the Obama administration, argued that there was little demand from hospitals or physicians to cancel the bundled payments, or to delay the merit-based payments.

In fact, many doctors are still subject to the rules of the merit-based system, which passed with bipartisan support in Congress in 2015. And other value-based programs are continuing.

“They’ve confused people,” said Mr. Gronniger, now a senior vice president at Caravan Health, which helps health care providers shift to value-based payment models. “The risk that H.H.S. and Tom Price created is that some physicians incorrectly read the press release or hear from their colleagues that Medicare is canceling value-based purchasing and think all of that’s over.”

“Physicians and hospitals need to be engaged in this work,” he added, “and exempting them doesn’t do them any favors.”

Although little has changed since Mr. Price’s departure, there are signs that the agency is still trying to figure out the best way to proceed, said Michael Chernew, an economist at Harvard Medical School who supports moving away from fee for service.

Mr. Chernew said he was “cautiously hopeful” about H.H.S. continuing to promote alternative payment models, pointing out that Medicare rates under fee for service will remain flat over the next decade anyway under the payment law that Congress passed in 2015.

“My general sense, and I’ve met with them, is that they genuinely want to try to have a better set of payment models,” Mr. Chernew said of Ms. Verma and those working for her at the Centers for Medicare and Medicaid Services. “They don’t just want to try to blow everything up.”

Advertisement

Continue reading the main story

He added, “If you take all the politics out of it, the right thing for them to do is move ahead.”

Robert Pear contributed reporting.


Continue reading the main story

Baxter sees opportunities, challenges in new role as leader of Mercy Health-Toledo

As Bob Baxter settles into his new role as president and CEO of Mercy Health-Toledo, his first message is clear: While the leadership has changed, the mission has not.  

Mr. Baxter, 49, sees opportunities for the system to grow in providing access to under-served communities, through partnerships with community organizations, and in future construction projects.

He was named president and CEO earlier this month after serving in an interim role since June. He succeeds Dr. Imran Andrabi, who left in June to become president at ThedaCare, a hospital system in northeast Wisconsin. 

WATCH: Bob Baxter sits down with Lauren Lindstrom to talk access to healthcare

Mr. Baxter also will continue as president and CEO for Mercy Health-Lima, a position he has held since 2012. Daily leadership duties in Lima primarily are in the hands of Mercy Health St. Rita’s Medical Center President Dale Gisi.

Mr. Baxter’s dual role makes way for stronger ties between the two regions to better serve patients across northwest Ohio, he said. Some of those ties were already in the works, such as combining the call center for ambulance and life flight services. But he sees opportunities to better connect services such as pediatrics and neuroscience. 

Since making the move official, Mr. Baxter has been meeting leaders inside the system and across the Toledo community. One place he sees an opportunity to be a community leader is in the fight against the area’s opioid epidemic, which has hit urban areas like Toledo and the more rural communities around Lima’s Allen County alike.

He was pleased to learn about Mercy Health’s partnership in the Drug Abuse Response Team through the Lucas County Sheriff’s Office.

“I think that whether you’re in a large or small community, it’s about having the right partners and collaborators at the table,” he said. “The mental health board or social service providers, housing, every community is going to have its own unique challenges.”

Jeff Dempsey, president of Mercy Health St. Vincent Medical Center and Children’s Hospital, said Mr. Baxter’s experience in the Mercy Health system and in northwest Ohio made it easy for him to move to a new role. Mr. Dempsey called Mr. Baxter a “mission-focused leader.”

“He has jumped right aboard, and he has been there to support us,” Mr. Dempsey said. “He has done an amazing job to reach out to medical staff and community leaders right away.”

Mr. Baxter said recent construction projects, including a new emergency and surgical emergency center and a new hospital underway in Perrysburg, are concentrated in areas where officials project growth and increased need for services. 

He alluded to “other opportunities for expanding access” that aren’t to the point of public discussion.

One way to sustain the health of the area and growth in the system is educating and retaining bright young medical professionals, he said. That includes investing in residency programs across the system.

“We want to not only provide a great education for these young men and women to go out and be amazing practitioners, but also we want to find individuals who are interested in serving this community that is expending resources to help them get trained,” he said.

The Lima region received accreditation this month to begin four residency programs, though Mr. Baxter declined to divulge which specialties will be featured until more details are finalized. A new neurology residency will begin in Toledo next year, he said.

But physical expansions must be paired with growth in opportunities for health-care access, particularly for low-income and otherwise disadvantaged patients.

“We’re always going to be a champion of making sure that access to services for the poor and under-served is maintained,” he said. “We feel like we need to have a voice in those conversations, whether that’s on a state level or a national level.”

As the future of the nation’s health-care laws is in a constant state of flux, Mr. Baxter said Mercy Health officals need to be adaptable yet ready to bring their concerns to state and federal lawmakers. Proposed cuts to Medicaid and decreased reimbursements to hospitals from government payers pose two particular challenges.

“We know the environment is changing,” he said. “We also have a chance to be a player, especially on the state level.”

But as changes are abundant, Mr. Baxter said he is intent on continuing the work that began in Toledo more than 163 years ago.

“While we’ve had a leadership change in terms of my role, we’re still serving the same mission,” he said. “Our overall approach to care, to making sure that we provide access to resources, to keeping patients at the center of what we do really hasn’t changed. That momentum continues, that focus continues.”

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.


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Star Wars: Jedi Challenges review — The Force is strong in AR

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Order the Google Pixel 2:
Verizon |
Best Buy | Shop: Black Friday 2017

New computer brings new challenges, great help

For us seniors who didn’t grow up with computers and the latest technologies, it can be a daunting task to deal with all the technological advances.

When I graduated from high school, my first job was with the A.C. Nielsen Company in Green Bay. I was hired to operate a comptometer, which I’m sure is now obsolete.

Nielsen had field reps who went out to stores and inventoried certain products. They would write down the information and that would come back to us. Our job was to compute the sales for various companies. There were no computers.

I did that for a little over a year, before we decided to go out to California. Out there, I worked for General Telephone for a while in the yellow pages department, selling ads as a customer service representative. When the operators went on strike, we had to be information operators. We physically looked up numbers in an assortment of books. Nowadays, I’m sure that’s all done by computer.

Next I worked in customer service for Liberty Mutual Insurance. There were still no computers.

Then I worked in retail sales in my family’s clothing store until it closed. Toward the end of that, computers were just coming into being.

We finally got one for the store to help compute sales and more. By that time, I had worked years without one and it was quite an adjustment.

So, my last computer died a slow and painful death last week, and I had to get a new one.

Justin Brown is a computer whiz and I don’t know what I would do without him. He set up my new machine for me. So I’ve been trying to adjust since last week.

First, I couldn’t find my email.

Then I didn’t have any clue as to how to type out a document. So I am making progress.

A couple of calls for help and it’s finally making some sense. I can now access my email, where I found 250 messages, most of it spam, another word for junk. Well, that took about a half-hour to delete those messages.

Then it came time to write this column and I didn’t have the Open Office program I had before. I had no idea how I was going to write it and get it to the paper.

So, of course, I called Justin and he came to the rescue. I now have a program to write my column and can email it out.

So there might still be hope for this old lady. And a big thanks to Justin for helping me get it all settled.

I was looking up riddles on the internet and found this one: “What turns everything around, but it doesn’t move?

The answer is, “A mirror.”

Have a great week, everyone.

Barb Ludlow is a former Kewaunee County reporter. Email her at bludlow1@charter.net.

Health care enrollment counselors facing stiff challenges

It’s not easy being an advocate for the Affordable Care Act right now.

Health care advocacy groups are making an against-all-odds effort to sign people up despite confusion and hostility fostered by Republicans opposed to President Barack Obama’s signature domestic policy achievement.

The Trump administration has taken numerous steps to undermine the law, and many states are doing little to promote coverage as health insurance open enrollment begins this week. Health care advocates are particularly concerned about people in Republican-led states with hundreds of thousands of uninsured residents, like Florida, Texas and Georgia.

Many of these groups are scrambling to fill in the gaps and combat misinformation, helping people decide which insurance policies are best for them and encouraging them to act quickly during the tight enrollment period of Nov. 1 through Dec. 15.

A coalition of nonprofits in Kansas’ largest county paid $66,000 for a television commercial airing 500 times in the coming weeks and created fliers dispelling myths about the law. They’re being sent home in the backpacks of 20,000 students, and distributed with utility bills to another 8,000 residents. They also hired 12 new enrollment counselors, up from their usual four.

“We knew that we needed to band together,” said Molly Moffett of the Community Health Council of Wyandotte County.

President Donald Trump repeatedly claims that the Affordable Care Act is in a death spiral, and has withdrawn support for it in many ways, fostering turmoil that has prompted many insurers to drop out or raise rates by double digits. The consulting firm Avalere Health predicted that individual plans bought through the health insurance marketplaces will rise an average of 34 percent nationwide.

Now that it’s time to enroll again, his administration has slashed marketing budgets completely in some areas, and shortened the sign-up period from 12 weeks to six. Across the country, Trump cut spending on health care counselors, or navigators, by roughly 40 percent, from $62.5 million to $36.8 million, and reduced advertising from $100 million spent last year to $10 million, according to federal health officials.

Almost every state will feel the spikes at a time when enticing consumers to sign up for coverage has never been harder.

In Florida, where premiums are expected to rise 49 percent, the Epilepsy Foundation of Florida is hosting a handful of house parties during which navigators will assist with sign-ups.

Victor Rodriguez said during a phone-banking session in Miami that he recently began getting insurance through disability, but he’s planning to re-enroll his wife through the federal marketplace.

“I’m concerned that (the law) is going to go away or the premiums are going to be very high and we are going to be priced out,” he said.

In Ohio, the largest state navigator group shuttered its program after losing nearly 88 percent of its funding, dropping from $1.7 million to $486,000. The group helped sign-up about 10,000 residents last year, said Lisa Hamler-Fugitt, executive director Ohio Association of Food Banks.

It was similar in Iowa, where Planned Parenthood of the Heartland in Des Moines dropped out after its funding went from more than $304,000 last year to $45,000.

Shelli Quenga leads South Carolina’s navigator program under the Palmetto Project, which previously served all 46 counties in the state. This year, her group will be in only the most densely populated areas after losing nearly half its funding. Rural areas will feel the brunt.

“You have so much land to cover and not very much money to do it,” said Quenga. “Our state is mostly rural, so that means traveling great distances between small numbers of people, and it’s just not cost-effective to do that when you also only have six weeks.”

Enrollment groups warn the cuts will have real-life consequences when people miss the opportunity to get the right insurance for them.

Health policy experts and insurers also worry the cuts and misinformation could disrupt the market’s delicate balance — meaning more sick people will sign up because they need insurance the most, while those who are younger and healthier (and wait longer to sign up) will stay away.

One group that targets this crowd, Young Invincibles, has beefed up social media efforts around the county and has had a surge of volunteers.

“That lack of awareness and confusion over what’s available has kind of tripled and become so much more difficult this year because of all the repeal efforts in Congress,” said Erin Hemlin, a director with Young Invincibles.

Alaska is one of the few states offering good news for consumers: a drop in premiums. But a 25 percent budget cut meant the Alaska Primary Care Association had to cut its marketing program. A coalition of local groups stepped in to pick up some of the slack.

In Texas, where premiums are rising an average of 23 percent and many counties only have one or two providers, local health officials fear the price spike and lack of competition will turn consumers away.

“When you are sitting with a family of four below 125 percent of the federal poverty level and they look at you in the eye and say, ‘Do I buy food for my kids tonight or do I pay a premium,’ it’s heartbreaking to see,” said Daniel Bouton, a director at the Community Council of Greater Dallas.

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Associated Press writer Ricardo Alonso-Zaldivar in Washington, D.C., contributed to this report.

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Follow Kelli Kennedy at https://twitter.com/kkennedyAP

Health care enrollment counselors facing stiff challenges

It’s not easy being an advocate for the Affordable Care Act right now.

Health care advocacy groups are making an against-all-odds effort to sign people up despite confusion and hostility fostered by Republicans opposed to President Barack Obama’s signature domestic policy achievement.

The Trump administration has taken numerous steps to undermine the law, and many states are doing little to promote coverage as health insurance open enrollment begins this week. Health care advocates are particularly concerned about people in Republican-led states with hundreds of thousands of uninsured residents, like Florida, Texas and Georgia.

Many of these groups are scrambling to fill in the gaps and combat misinformation, helping people decide which insurance policies are best for them and encouraging them to act quickly during the tight enrollment period of Nov. 1 through Dec. 15.

A coalition of nonprofits in Kansas’ largest county paid $66,000 for a television commercial airing 500 times in the coming weeks and created fliers dispelling myths about the law. They’re being sent home in the backpacks of 20,000 students, and distributed with utility bills to another 8,000 residents. They also hired 12 new enrollment counselors, up from their usual four.

“We knew that we needed to band together,” said Molly Moffett of the Community Health Council of Wyandotte County.

President Donald Trump repeatedly claims that the Affordable Care Act is in a death spiral, and has withdrawn support for it in many ways, fostering turmoil that has prompted many insurers to drop out or raise rates by double digits. The consulting firm Avalere Health predicted that individual plans bought through the health insurance marketplaces will rise an average of 34 percent nationwide.

Now that it’s time to enroll again, his administration has slashed marketing budgets completely in some areas, and shortened the sign-up period from 12 weeks to six. Across the country, Trump cut spending on health care counselors, or navigators, by roughly 40 percent, from $62.5 million to $36.8 million, and reduced advertising from $100 million spent last year to $10 million, according to federal health officials.

Almost every state will feel the spikes at a time when enticing consumers to sign up for coverage has never been harder.

In Florida, where premiums are expected to rise 49 percent, the Epilepsy Foundation of Florida is hosting a handful of house parties during which navigators will assist with sign-ups.

Victor Rodriguez said during a phone-banking session in Miami that he recently began getting insurance through disability, but he’s planning to re-enroll his wife through the federal marketplace.

“I’m concerned that (the law) is going to go away or the premiums are going to be very high and we are going to be priced out,” he said.

In Ohio, the largest state navigator group shuttered its program after losing nearly 88 percent of its funding, dropping from $1.7 million to $486,000. The group helped sign-up about 10,000 residents last year, said Lisa Hamler-Fugitt, executive director Ohio Association of Food Banks.

It was similar in Iowa, where Planned Parenthood of the Heartland in Des Moines dropped out after its funding went from more than $304,000 last year to $45,000.

Shelli Quenga leads South Carolina’s navigator program under the Palmetto Project, which previously served all 46 counties in the state. This year, her group will be in only the most densely populated areas after losing nearly half its funding. Rural areas will feel the brunt.

“You have so much land to cover and not very much money to do it,” said Quenga. “Our state is mostly rural, so that means traveling great distances between small numbers of people, and it’s just not cost-effective to do that when you also only have six weeks.”

Enrollment groups warn the cuts will have real-life consequences when people miss the opportunity to get the right insurance for them.

Health policy experts and insurers also worry the cuts and misinformation could disrupt the market’s delicate balance — meaning more sick people will sign up because they need insurance the most, while those who are younger and healthier (and wait longer to sign up) will stay away.

One group that targets this crowd, Young Invincibles, has beefed up social media efforts around the county and has had a surge of volunteers.

“That lack of awareness and confusion over what’s available has kind of tripled and become so much more difficult this year because of all the repeal efforts in Congress,” said Erin Hemlin, a director with Young Invincibles.

Alaska is one of the few states offering good news for consumers: a drop in premiums. But a 25 percent budget cut meant the Alaska Primary Care Association had to cut its marketing program. A coalition of local groups stepped in to pick up some of the slack.

In Texas, where premiums are rising an average of 23 percent and many counties only have one or two providers, local health officials fear the price spike and lack of competition will turn consumers away.

“When you are sitting with a family of four below 125 percent of the federal poverty level and they look at you in the eye and say, ‘Do I buy food for my kids tonight or do I pay a premium,’ it’s heartbreaking to see,” said Daniel Bouton, a director at the Community Council of Greater Dallas.

——

Associated Press writer Ricardo Alonso-Zaldivar in Washington, D.C., contributed to this report.

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Follow Kelli Kennedy at https://twitter.com/kkennedyAP

Knowles: Local health care providers expect challenges enrolling residents in ACA

Open enrollment for Affordable Care Act plans is set to start Nov. 1, but some are worried about challenges that might prevent consumers from signing up.

Earlier this year, President Donald Trump’s administration cut the federal marketing budget for open enrollment by 90 percent, according to news reports. State officials said Illinois is providing $1 million for marketing this year compared with $5 million from the federal government last year.

Federal officials also reduced the open enrollment period from 12 weeks to six. So, this year, it will end Dec. 15 for coverage beginning Jan. 1, 2018.

“Marketing and outreach is going to be our No. 1 challenge,” said Maria Borrayo, manager of health care plans and patient access at Aunt’s Martha Health Wellness, which assists south suburban residents.

Computer programmer with disabilities explains challenges of …

NEW ORLEANS —  Step inside Stuart Simon’s office and you’ll hear a lot of typing.  It sounds like he’s going a thousand miles per a minute.  And as soon as he’s done with one project…

“There are other big projects on the whiteboard you see behind me,” Simon said.

All of it is very technical. Write the wrong code and that could mean big problems.  That’s already hard enough, but there’s something else.

“I do have mild cerebral palsy in addition in addition to autism spectrum disorder,” Simon said.

But what Simon wants you to know is there are many more people who have disabilities like him.  And they are all capable of high level work. 

“I’m living the dream of being a working, talking example of what successful advocacy can get you and where it can get you,” Simon said.

The problem he says is employers overlook people with disabilities, but his boss says his skills are indispensable.

“He does things that we wouldn’t be able to do,” Susan Killam said.

Killam helps lead the center where Simon works. The Center’s focus is to help people with disabilities from early childhood to adulthood.

“But a lot of the service models are, take care of the patient, should people with disabilities work?” Killam explained.

Killams says many employers still maintain an old way of thinking.

“Just like all of us go to work for an income and if we’re lucky we get to do work that we like to do,” Killam said.

Simon wants the system to change so more people like him can learn advanced skills.

“Their typical jobs are for example stacking in grocery stores,” Simon said.

And that’s why he’s speaking out to raise awareness.

“Right now as I sit here, I see myself as another person just working.”

© 2017 WWL-TV

Computer programmer with disabilities explains challenges of finding employment

NEW ORLEANS —  Step inside Stuart Simon’s office and you’ll hear a lot of typing.  It sounds like he’s going a thousand miles per a minute.  And as soon as he’s done with one project…

“There are other big projects on the whiteboard you see behind me,” Simon said.

All of it is very technical. Write the wrong code and that could mean big problems.  That’s already hard enough, but there’s something else.

“I do have mild cerebral palsy in addition in addition to autism spectrum disorder,” Simon said.

But what Simon wants you to know is there are many more people who have disabilities like him.  And they are all capable of high level work. 

“I’m living the dream of being a working, talking example of what successful advocacy can get you and where it can get you,” Simon said.

The problem he says is employers overlook people with disabilities, but his boss says his skills are indispensable.

“He does things that we wouldn’t be able to do,” Susan Killam said.

Killam helps lead the center where Simon works. The Center’s focus is to help people with disabilities from early childhood to adulthood.

“But a lot of the service models are, take care of the patient, should people with disabilities work?” Killam explained.

Killams says many employers still maintain an old way of thinking.

“Just like all of us go to work for an income and if we’re lucky we get to do work that we like to do,” Killam said.

Simon wants the system to change so more people like him can learn advanced skills.

“Their typical jobs are for example stacking in grocery stores,” Simon said.

And that’s why he’s speaking out to raise awareness.

“Right now as I sit here, I see myself as another person just working.”

© 2017 WWL-TV




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