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Native Americans Feel Invisible In US Health Care System

ae7a2_anna-1_custom-73636c1fa0bd1433d776b36c08e997644a21d607-s1100-c15 Native Americans Feel Invisible In US Health Care System

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana, had hernia surgery a couple of years ago. The Indian Health Service picked up a part of the tab for the surgery but denied coverage for follow-up appointments.

Mike Albans for NPR


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Mike Albans for NPR

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana, had hernia surgery a couple of years ago. The Indian Health Service picked up a part of the tab for the surgery but denied coverage for follow-up appointments.

Mike Albans for NPR

The life expectancy of Native Americans in some states is 20 years shorter than the national average.

There are many reasons why.

Among them, health programs for American Indians are chronically underfunded by Congress. And, about a quarter of Native Americans reported experiencing discrimination when going to a doctor or health clinic, according to findings of a poll by NPR, the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health.

Margaret Moss, a member of the Hidatsa tribe, has worked as a nurse for the Indian Health Service and in other systems. She now teaches nursing at the University of Buffalo.

She says she has seen racism toward Native Americans in health care facilities where she’s worked, and as a mom trying to get proper care for her son.

Once, when she was on a health policy fellowship with a U.S. Senate committee, Moss’ son had a broken arm improperly set at a non-IHS health facility in Washington, D.C.

She asked the physician about options to correct it, but he told her it was fine, she said. “Even when I, as an educated person using the right words was saying what needed to happen, [he] didn’t want to do anything for us even though we had a [health insurance] card.”

ae7a2_anna-1_custom-73636c1fa0bd1433d776b36c08e997644a21d607-s1100-c15 Native Americans Feel Invisible In US Health Care System

Moss then reluctantly pulled out a business card with the Senate logo, she recalled, and was instantly transformed in the doctor’s eyes from “this American Indian woman with my obviously minority son” to someone he could not afford to dismiss.

“It wasn’t until the person … felt they could get in trouble for this … then the person did something,” said Moss. “I felt like it was racism. Not everybody has a card they can just whip out.”

She says she feels discrimination is more overt, “in areas where American Indians are known about,” like the Dakotas and parts of the American Southwest, but also exists in places without big tribal populations.

In the NPR poll, Native Americans who live in areas where they are in the majority reported experiencing prejudice at rates far higher than in areas where they constituted a minority.

In places where there are few American Indians, Moss says, “people don’t expect to see American Indians; they think they are from days gone by, and so you are misidentified. And that’s another form of discrimination.”

Health care systems outside the Indian Health Service generally see very few Native American patients, because it’s so hard for American Indians to access care in the private sector. A lot of that has to do with high poverty and uninsured rates among American Indians, who also often live in rural areas with few health care providers.

“The strikes against people trying to get care are huge: geographic, transportation, monetary,” Moss says.

A persistent myth inside and outside Indian Country is that Native Americans get free health care from the federal government.

“I hear that all the time,” says Moss, sighing.

ae7a2_anna-1_custom-73636c1fa0bd1433d776b36c08e997644a21d607-s1100-c15 Native Americans Feel Invisible In US Health Care System

Sorrell started exercising and going on walks after her experience with hernia surgery.

Mike Albans for NPR


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Mike Albans for NPR

Sorrell started exercising and going on walks after her experience with hernia surgery.

Mike Albans for NPR

The federal government promised to take care of Native Americans’ health when it signed the treaties in which tribes gave up almost all of their land.

“Unfortunately, they have not kept up their end of the bargain,” Moss says.

Congress has long failed to allocate enough money to meet Native American health needs. In 2016 it set the Indian Health Service budget at $4.8 billion. Spread across the US population of 3.7 million American Indians and Alaska Natives, that’s $1,297 per person. That compares to $6,973 per inmate in the federal prison system.

Moss says the IHS can be less an aid to people than another bureaucratic barrier. “It is highly complicated,” Moss says, “even if you took out the racism, perceived or real.”

The IHS isn’t insurance. It’s more like the Veterans Administration, running clinics and hospitals where its members can get care. But the IHS is far smaller than the VA.

Federal funding is also supposed to pay for care in the private sector that IHS hospitals can’t provide. But, quoting a sardonic joke familiar to many in Indian Country, Moss says it’s well known that “you’d better get sick by June, because there won’t be any more money, or it’s life and limb only, those are the things that would be authorized.”

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana experienced that firsthand. The IHS picked up part of the tab for her hernia surgery at a hospital outside of the IHS a couple of years ago, but when it was time to schedule follow-up appointments, Sorrell was out of luck.

“It got denied. My follow-up got denied,” Sorrell says. “[The hospital] didn’t even ask if I was willing to pay,” she says, and that felt like discrimination. “They would assume that other non-Indians would pay for it themselves, why do we as Indian people not get to make those decisions ourselves?” Sorrell asks.

She felt like she was falling through a crack in the health care system at a particularly poignant time.

ae7a2_anna-1_custom-73636c1fa0bd1433d776b36c08e997644a21d607-s1100-c15 Native Americans Feel Invisible In US Health Care System

Anna and her husband, Gene Sorrell, outside their home in Evaro, Mont. Anna eventually received follow-up care for her surgery, but the process took years.

Mike Albans for NPR


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Mike Albans for NPR

Anna and her husband, Gene Sorrell, outside their home in Evaro, Mont. Anna eventually received follow-up care for her surgery, but the process took years.

Mike Albans for NPR

“I was 57 years old. My mom died at 57,” Sorrell says. In Montana, the life expectancy for Native American women is 62, that’s 20 years less than for non-Native American women. The life expectancy for Native American men in Montana is 56.

With help from her tribe, Sorrell eventually got her follow-up care, but her journey from diagnosis to actually getting surgery took years, and the University of Buffalo’s Margaret Moss says a lot of Native Americans just give up.

“That is the idea out there in Indian Country … , ‘I’m not even going to try, because it’s not going to happen.’ Or they hear so many stories of people who did try, and it didn’t happen,” Moss says.

That means a lot of American Indians simply put up with what she calls, “tolerated illness.

“They say they’re fine, but they’re not,” Moss says, and their health problems often progress until it’s too late for treatment to help.

Anna Whiting Sorrell, a health care administrator for her tribes, says she is optimistic that the Affordable Care Act will make a big difference for Native Americans. It gives lower-income people access to affordable insurance coverage outside the IHS. Many Natives Americans who weren’t eligible for Medicaid before the ACA now are, too.

Moss is more skeptical that the ACA will make a big difference, in part because of entrenched institutional discrimination toward Native Americans in healthcare.

“Until attitudes change,” Moss says, “we’re still going to be in a sad situation.”

Our ongoing series “You, Me and Them: Experiencing Discrimination in America” is based in part on a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. We have previously released results for African-Americans, Latinos, Asian-Americans, whites and women.

You can follow Montana Public Radio’s Eric Whitney on Twitter: @MTPRND

What would our health care system look like if doctors spoke the same language as engineers?

Physician-engineer Roderic Pettigrew will be the first CEO of Texas AM’s new Engineering Health initiative. – Sam Craft, courtesy of Texas AM Health Science Center

Medical school students today are trained to diagnose complicated diseases, but they are rarely trained to engineer the solutions themselves. To change that, soon Texas AM University will start training doctors and nurses to also be engineers.

Half a century ago, a few physicians in Canada wanted to see if they could use electrical pulses to regulate a human heartbeat. They had the medical knowledge, but they needed an engineer. Only problem was, engineers and doctors didn’t exactly hang out, according to the man who helped invent the pacemaker half a century ago.

“In those days there wasn’t much rapport between engineering and medicine, and I think that was one of the real problems in our research,” electrical engineer Jack Hopps recalled in a 1984 interview with the Canadian Broadcasting Corporation. “The medical people didn’t know the potential of engineering to a system and we knew nothing at all about the medical problems.”

In the decades since, the silos separating engineering from medicine have started to break down. You can see the collaboration at startups like Dallas-based MedNoxa. Engineer Eric Frey shows off his product — which wouldn’t exist without cross-discipline partnerships.

Our technology [is] is a bandage that generates oxygen from the chemical decomposition of hydrogen peroxide,” Frey said. A chemical reaction between the layers of the bandage creates a concentrated oxygen gas which Frey said helps a wound heal. MedNoxa is seeking FDA clearance to sell the bandages by prescription and over the counter.

After Frey came up with the idea, he needed to put together a team — people who speak the language of medicine as well as people who speak the languages of engineering and design. But what if doctors or engineers were bilingual, so to speak, from the start?

That’s the idea behind a new program at Texas AM called EnHealth.

“EnHealth is a new initiative, the first in the country in fact, that will integrate engineering into all colleges that are part of the health care enterprise,” Roderic Pettrigrew said. Pettigrew, a doctor and engineer, is leading the effort. Texas AM recruited him from the National Institutes of Health in Maryland where he served as the founding director of the National Institute of Biomedical Imaging and Bioengineering.

Pettigrew said the EnHealth program is different from existing university based collaborations because it integrates the curriculum into all health-related degree programs — from medicine and nursing to dentistry and public health. He believes it will help students think about better ways to diagnose, treat and prevent disease while they’re in school.

“And from this sort of engineering-based mindset — a mindset that we call ‘physicianeers’ — should emerge a group of students who are better equipped and more effective and efficient in problem solving,” he said.

That also means that students in the school of medicine would graduate with both an MD and a masters in engineering in four years. Giving doctors the tools to think like engineers would be valuable, Frey said.

“I think the more cross-training you have, the better it enables all that collaboration you need,” Frey said.  

Just a handful of students are part of the pilot program at Texas AM now, with plans for several dozen to be part of the first class in July 2019.

A computer system needing less time and memory to simulate mechanical systems

Simulating the functioning of a mechanism requires programming languages which are used to calculate the dynamic equations of mechanics. One of the main limitations of this programming is the excessive run time the computer needs to generate these equations, even for simple problems. In this research they developed a set of techniques and algorithms that can be used with any formulation and with any type of coordinates and whose results are practically the same as those obtained with the best of the formulations.

Besides achieving optimum quality in the code generated, the main advantage of these techniques is that the equations obtained are optimized. “Since they are optimum, the computer takes less time to ‘digest’ them in order to subsequently work with them, and, therefore, the door is opened up for using computers with less computing power,” said Plaza.

Another of the contributions of the research has been to eliminate the trigonometric simplification process to generate optimum symbolic equations. “The equations of mechanical systems are, in general, capable of being simplified,” explained the researcher. “This simplification helps to reduce the size of the equations, but carrying this out involves extensive computing time. The technique proposed obtains the trigonometrically simplified equations directly without having to carry out this specification explicitly, which enables a piece of optimum code that is faster and with fewer memory resources to be generated.”

Various applications

The engineer had the chance to put his proposal into practice in a collaboration project between the Applied Mechanical and Computational Engineering research group-IMAC of the NUP/UPNA, which he belongs to, and a company in the railway sector. A part of this project was to design the computational model of a locomotive to be used in various virtual experiments. “As it is a highly complex model, the computer took a long time to create it: about two and a half hours. That was partly because the model was developed using general purpose commercial software for symbolic calculations. As it was general and did not focus on mechanical models, it did not carry out the operations in the best way possible,” he pointed out.

After applying the set of techniques and algorithms proposed in the research, the time to generate the equations was cut to ten minutes and the number of mathematical operations needed for the computer to “digest” this model was 0.3% with respect to the number of operations that it would need if it were generated by a piece of general software. What is more, it was not necessary to resort to general purpose commercial software, the use of which is restricted to those who purchase a licence.

This technique for obtaining equations can be applied to a whole range of mechanical systems. “Right now, for example, we are working on the model of a wind turbine. In the same way, we have produced models for cars, robots and vehicle suspensions in addition to other models we use for our research and even for teaching purposes,” he said.

###

Troubled driver’s license computer system is on track to launch next month, Kansas department says

A driver’s license computer program rife with delays and complications is on track for launch in early 2018, a spokeswoman for the Kansas Department of Revenue said Thursday.

Rachel Whitten said the second phase of KDOR’s computer system replacement should go live Jan. 2 and replace the second part of a 30-year old system used to issue driver’s licenses, identification cards and commercial licenses and process motor vehicle titles and registrations.

The project should have replaced the old systems in two phases in 2011 and 2012, but the first portion replacing the title and registration system launched 10 months late in May 2012 and spurred long lines at county treasurers’ offices.

The second phase of the system, which will issue licenses, still isn’t online nearly six years after its initial targeted launch date of January 2012, but it should go live next month.

“It’s looking like it’s ready to go live on that date,” Whitten said.

Auditors placed the project on caution status in July and October reports because of changes to the scope of the project and missed deadlines by the project’s contractor, MorphoTrust.

The Kansas Legislative Division of Post Audit will release another review of the program next week.

The office has been monitoring the program because of its challenges.

Whitten said there were no apparent issues at this time that might delay the rollout.

“With any project there’s challenges that are presented and you work on those challenges, and (Revenue Secretary Sam Williams) has been very involved in this project — overseeing and making sure the people working on the project have the resources they need and the support to ensure the success of the project,” Whitten said.

Whitten said Department of Motor Vehicles employees who will be dealing with the new system are undergoing training. She said Williams has said the system won’t go live if something goes wrong and it won’t be “successful.”

“Whether it’s two days or two weeks, it will only go live when it is ready,” Whitten said.

Some legislators and auditors expressed concern over the rollout earlier this year. Rep. Blake Carpenter, a Derby Republican and member of a joint committee on information technology, said he wasn’t concerned at this time after Williams appeared before the committee in September.

“Basically, the committee wanted to make sure the rollout wasn’t a cluster,” Carpenter said.

Troubled driver’s license computer system is on track to launch next …

A driver’s license computer program rife with delays and complications is on track for launch in early 2018, a spokeswoman for the Kansas Department of Revenue said Thursday.

Rachel Whitten said the second phase of KDOR’s computer system replacement should go live Jan. 2 and replace the second part of a 30-year old system used to issue driver’s licenses, identification cards and commercial licenses and process motor vehicle titles and registrations.

The project should have replaced the old systems in two phases in 2011 and 2012, but the first portion replacing the title and registration system launched 10 months late in May 2012 and spurred long lines at county treasurers’ offices.

The second phase of the system, which will issue licenses, still isn’t online nearly six years after its initial targeted launch date of January 2012, but it should go live next month.

“It’s looking like it’s ready to go live on that date,” Whitten said.

Auditors placed the project on caution status in July and October reports because of changes to the scope of the project and missed deadlines by the project’s contractor, MorphoTrust.

The Kansas Legislative Division of Post Audit will release another review of the program next week.

The office has been monitoring the program because of its challenges.

Whitten said there were no apparent issues at this time that might delay the rollout.

“With any project there’s challenges that are presented and you work on those challenges, and (Revenue Secretary Sam Williams) has been very involved in this project — overseeing and making sure the people working on the project have the resources they need and the support to ensure the success of the project,” Whitten said.

Whitten said Department of Motor Vehicles employees who will be dealing with the new system are undergoing training. She said Williams has said the system won’t go live if something goes wrong and it won’t be “successful.”

“Whether it’s two days or two weeks, it will only go live when it is ready,” Whitten said.

Some legislators and auditors expressed concern over the rollout earlier this year. Rep. Blake Carpenter, a Derby Republican and member of a joint committee on information technology, said he wasn’t concerned at this time after Williams appeared before the committee in September.

“Basically, the committee wanted to make sure the rollout wasn’t a cluster,” Carpenter said.

Troubled driver’s license computer system is on track to launch next month, department says

A driver’s license computer program rife with delays and complications is on track for launch in early 2018, a spokeswoman for the Kansas Department of Revenue said Thursday.

Rachel Whitten said the second phase of KDOR’s computer system replacement should go live Jan. 2 and replace the second part of a 30-year old system used to issue driver’s licenses, identification cards and commercial licenses and process motor vehicle titles and registrations.

The project should have replaced the old systems in two phases in 2011 and 2012, but the first portion replacing title and registration system launched 10 months late in May 2012 and spurred long lines at county treasurers’ offices. The second phase of the system, which will issue licenses, still isn’t online nearly six years after its initial targeted launch date, January 2012, but it should go live next month.

“It’s looking like it’s ready to go live on that date,” Whitten said.

Auditors placed the project on caution status in July and October reports because of changes to the scope of the project and missed deadlines by the project’s contractor, MorphoTrust. The Kansas Legislative Division of Post Audit will release another review of the program next week. The office has been monitoring the program because of its challenges.

Whitten said there were no apparent issues at this time that might delay the roll out.

“With any project there’s challenges that are presented and you work on those challenges, and [Revenue Secretary Sam Williams] has been very involved in this project — overseeing and making sure the people working on the project have the resources they need and the support to ensure the success of the project,” Whitten said.

Whitten said Department of Motor Vehicles employees who will be dealing with the new system are undergoing training. She said Williams has said the system will not go live if something goes wrong and it won’t be “successful.”

“Whether it’s two days or two weeks, it will only go live when it is ready,” Whitten said.

Some legislators and auditors expressed concern over the roll out earlier this year. Rep. Blake Carpenter, a Derby Republican and member of a joint committee on information technology, said he wasn’t concerned at this time after Revenue Secretary Sam Williams appeared before the committee in September.

“Basically, the committee wanted to make sure the roll-out wasn’t a cluster,” Carpenter said.

UN health agency launches first global monitoring system for dementia

7 December 2017 – The United Nations health agency on Thursday launched the first global monitoring system for dementia, which is expected to affect 152 million people worldwide by 2050 – triple the current 50 million – amid the aging of the global population.

Dementia includes Alzheimer’s disease and other types of memory loss and cognitive disabilities.

“Nearly 10 million people develop dementia each year, six million of them in low- and middle-income countries,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), in a news release.

“The suffering that results is enormous. This is an alarm call: we must pay greater attention to this growing challenge and ensure that all people living with dementia, wherever they live, get the care that they need,” he added.

The Global Dementia Observatory, a web-based platform, launched by WHO, can track progress on the provision of services for people with dementia and for those who care for them, both within countries and globally.

It will also monitor the presence of national policy and plans, risk reduction measures and infrastructure for providing care and treatment.

“This is the first global monitoring system for dementia that includes such a comprehensive range of data,” said Tarun Dua of WHO’s Department of Mental Health and Substance Abuse. “The system will not only enable us to track progress, but just as importantly, to identify areas where future efforts are most needed.”

64632_12-07-infographic_dementia-01 UN health agency launches first global monitoring system for dementia

64632_12-07-infographic_dementia-01 UN health agency launches first global monitoring system for dementia

WHO says the annual global cost of dementia is estimated at $818 billion, equivalent to more than one per cent of global gross domestic product. The total cost includes direct medical costs, social care and loss of income of caregivers.

By 2030, the cost is expected to more than double, to $2 trillion, a cost that could undermine social and economic development and overwhelm health and social services, including long-term care systems.

To date, WHO has collected data from 21 countries. By the end of 2018, it is expected that 50 countries will be contributing data.

Of the countries reporting data so far, 81 per cent have carried out a dementia awareness or risk reduction campaign, 71 per cent have a plan for dementia, 71 per cent provide support and training for caregivers and 66 per cent have a dementia-friendly initiative.

All of these activities are recommended by WHO in the Global action plan on the public health response to dementia 2017-2025.

The Plan provides a comprehensive blueprint for action that can be taken by policy-makers, health- and social-care providers, civil society organizations and people with dementia and their caregivers.

How to use System Restore on Windows 10

d3cd3_windows-10-system-restore How to use System Restore on Windows 10

System Restore on Windows 10 allows you to send your PC back in time to undo changes that may be causing problems, and here’s how to use it.

Sometimes something just goes wrong. An install screwed up everything, or you were tinkering and stuff isn’t working right anymore. Of course, you performed a full backup first, but Windows 10 also includes System Restore so you can easily revert system changes without losing your files.

System Restore works by detecting system changes, such as in system files and settings, Registry, applications, and drivers, and saving a working state as a “restore point.” If as a result of a misconfiguration your device experiences any issues, you can then use a restore point to undo the changes to fix problems that may be causing your PC to stop responding or affecting performance.

By default, System Restore is disabled on Windows 10, but when enabled and configured correctly, it can automatically create checkpoints, but you can create restore points manually before making any system changes.

In this Windows 10 guide, we’ll walk you through the steps to configure and use System Restore to undo changes that may be harming your device.

  • How to enable System Restore
  • How to create a System Restore point
  • How to undo changes with System Restore

How to enable System Restore

On Windows 10, System Restore is turned off by default, but you can use the following steps to enable it:

  1. Open Start.
  2. Search for Create a restore point, and click the result System Properties.
  3. Under “Protection Settings,” select the main system drive, and click the Configure button.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  4. Select the Turn on system protection option.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10Quick Tip: You can also use the slider to set the amount of storage you want System Restore to use, which by default is only one percent.

  5. Click Apply.
  6. Click OK.

Once you’ve completed the steps, a new restore point will be created automatically when an important system change occur, such as before an installation of a Windows 10 update.

If you need to delete checkpoints, within the same page, you can click the Delete button to remove them all, which is a handy option, when creating a new restore point manually, and there isn’t any more available space.

It’s worth noting that you can enable System Restore only on supported drives. It’s not a feature that you can turn on per device. In the case that you have multiple drives, it may not be possible to configure them.

How to create a System Restore point

Although a new restore point will be created automatically during a significant change happens, there will be times where you may want to manually create a restore point before modifying anything that might cause problems if you don’t do it correctly.

  1. Open Start.
  2. Search for Create a restore point, and click the result System Properties.
  3. Under “Protection Settings,” select the main system drive, and click the Create button.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  4. Enter a description to identify the restore point.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  5. Click Create.

After completing the steps, if something wrong happens while modifying the Registry, installing a new app or a driver, you can use the steps outlined below to use the restore point to undo the changes.

How to undo changes with System Restore

In the case you come across any issues, before reinstalling Windows 10, you roll back changes using a restore point to get up and running again.

  1. Open Start.
  2. Search for Create a restore point, and click the result System Properties.
  3. Click the System Restore button.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  4. Click Next.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  5. Select the most recent known working restore point that will help you to fix the current problem.
  6. Click the Scan for affected programs button to see the applications that will be removed if they’re installed after the restore point was created.
  7. Click Close.
  8. Click Next.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  9. Click Finish.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

Once you’ve completed the steps, your device will go back in time to a previous state where everything was working correctly.

Using a restore point when your device won’t boot

The previous steps went over how to use a restore point when you still have access to the desktop. However, there will be times when you may need to use System Restore because a system change is preventing your device from starting.

If you unable to start your computer, it’s possible to use the system advanced options to access System Restore, which you can do with these steps:

  1. Try to start your PC three times to trigger automatic repair on Windows 10.
  2. Click on Advanced Startup.
  3. Click on Troubleshoot.
  4. Click on Advanced options.
  5. Click on System Restore.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  6. Click Next.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  7. Select the most recent known working restore point that will help you to fix the current problem.
  8. Click the Scan for affected programs button to see the applications that will be removed if they’re installed after the restore point was created.
  9. Click Close.
  10. Click Next.

    d3cd3_windows-10-system-restore How to use System Restore on Windows 10

  11. Click Finish.

If you can’t get to the automatic repair environment, you can boot your device using a bootable media, click Next, click the Repair your computer button, and then follow the above instructions.

Wrapping things up

While we’re focusing this guide on Windows 10, System Restore has been around for years, and you can use the same instructions on Windows 8.1 and Windows 7.

Also, remember that this feature isn’t replacement for a full backup or to reset your device to factory defaults. If your computer encounters a hardware problem, you won’t be able to use this feature to recover, and it’s likely that you may lose your files.

More Windows 10 resources

For more helpful articles, coverage, and answers to common questions about Windows 10, visit the following resources:

18470 Henry Ford Health System patients’ data hacked

 

  • Personal health records breached in early October
  • Not clear if information used for inappropriate purposes
  • Investigation of how it happened continues

 18470 Henry Ford Health System patients' data hacked

 18470 Henry Ford Health System patients' data hacked

More than 18,000 Henry Ford Health System patients’ personal health information was viewed or stolen in early October by an unknown person or entity who hacked the Detroit-based health system’s electronic health records.

 

HFHS officials said it is not clear whether the 18,470 patient files have been used for inappropriate purposes.

“We are very sorry this happened. We take very seriously any misuse of patient information, and we are continuing our own internal investigation to determine how this happened and to ensure no other patients are impacted,” Henry Ford said in a statement.

Henry Ford said it first learned of the incident Oct. 3 after someone gained access to or stole the email credentials of a group of employees. The employee credentials are name- and password-protected by encryption. The email accounts had patient health information.

Like other health organizations, Henry Ford providers share encrypted email messages to ensure patient care is seamless, the statement said.

Over the past several years, hospitals and health insurers in Michigan and other states have been subject to loss of patient data through hacking or stolen laptops. For example, Detroit Medical Center in July warned 1,529 patients of a systemwide breach of protected health information.

In 2010, Henry Ford experienced a patient data breach when a laptop containing personal health information was stolen from an unlocked office.

Federal law requires health care organizations to notify patients within 60 days of a data breach.

Henry Ford said patient information viewed or taken may have included their name, date of birth, medical record number, provider’s name, date of service, department’s name, location, medical condition and health insurer. Social Security numbers or credit card information were not compromised, HFHS said.

“To reduce future risk of this happening again, we are strengthening our security protections for employees, all of whom will be educated about this measure in the coming weeks,” the statement said.

“In addition, we are expediting our initiatives around email retention and multi-factor authentication, which will decrease future risks to our patients and employees.”

Henry Ford said patients can request new medical record numbers.

Slow computer system prompts closure of DMV offices | Idaho Press … – Idaho Press

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Crack computer systems and pull information from any system… with White Hacker Bundle

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With a payment of literally anything, you’ll secure your first course — Ethical Hacking for Beginners. You’ll start by learning the terms, tools, and techniques that all young IT pros learned to find and exploit threats and vulnerabilities in any network system.

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Your coursework will also give you the background to successfully infiltrate network systems (Cyber Security Volume II: Network Security), test systems for vulnerabilities (Learn Website Hacking and Penetration Testing From Scratch) and even introduce you to Kali Linux, one of the most powerful penetration testing tools around (Ethical Hacking Using Kali Linux From A to Z).

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NXP launches new version of the Linux operating system customised for industrial operations

NXP has launches what it describes as a “community-based industrial Linux distribution for Industry 4.0”.

Open Industrial Linux, or OpenIL, provides immediate access to industrial time-sensitive networking technology, says NXP.

NXP Semiconductors is best known for making computing chips but also has a big business in connectivity solutions, which is what Industry 4.0 is about – connecting machines to the internet. 

NXP says its Linux-based OpenIL is specially designed for factory automation and original equipment manufacturers.

By breaking down the barriers of real-time computing and networking in a standard, community-based distribution, OpenIL helps these OEMs usher in the Industry 4.0 era, says NXP.

 

The OpenIL distribution includes TSN support, per-stream policing, time-aware shaping of network traffic, and 801.1AS time synchronization.

TSN Ethernet is integrated in the Layerscape LS1028A industrial applications processor announced by NXP in March 2017.

Dan Mandell, senior industry analyst at VDC Research Group, says: “NXP has taken a leadership role with the OpenIL distro in focusing Linux designers specifically on industrial automation opportunities, while simultaneously leveraging its Layerscape system-on-chip capabilities to enable Industry 4.0 smart manufacturing systems. It should prove a powerful combination.”

Factory managers and industrial-equipment makers are turning to Linux for its operational stability, security, and cost of ownership.

For similar reasons, they are turning to Ethernet to replace vendor-specific networking protocols.

Richard House, software vice president at NXP Semiconductors, says: “OpenIL combines security, TSN, edge computing, and Industry 4.0 into a single Linux distribution.

“OEMs can focus on their value-added technologies to create the next generation of smart manufacturing solutions while utilizing proven hardware and software platforms.”

Originated by NXP, OpenIL’s baseline capabilities include IT infrastructure software such as networking stacks, web servers – which NXP says is useful for configuration management, scripting tools, and system utilities commonly part of Linux distros.

OpenIL facilitates OEMs adding software from the rich Linux ecosystem using an optional instantiation of the popular Ubuntu user-space filesystem layout, says NXP.

Other notable OpenIL distribution features include:

  • Xenomai real-time extensions to Unix, easing porting from a real-time operating system like VxWorks or pSOS
  • Extensible Markup Language and NetConf-based network configuration utilities for TSN
  • Generalized precision time protocol with the linuxptp daemon
  • Drivers for the Ethernet Interfaces and the NXP SJA1105T TSN switch
  • Support for edge computing services

Mecklenburg County offices hit by county-wide computer system outage

Mecklenburg County is experiencing a county-wide computer system outage, impacting business at most county offices.

“This will affect email, printing and other county applications, including the ability to conduct business at most county offices,” according to a release.

People planning on going to a county office are advised to contact the office beforehand.

All county-wide ITS systems will be shut down until further notice, the county announced. The outage if affecting email, printing and other services at county offices.

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County courts announced they were affected by the outage, as the disruption interfered with jury service.

Each department is activating plans to continue operating during the outage, the county said. There is no indication of when the issue will be resolved.

LaVendrick Smith: 704-358-5101; @LaVendrickS

NXP launches new version of the Linux operating system …

NXP has launches what it describes as a “community-based industrial Linux distribution for Industry 4.0”.

Open Industrial Linux, or OpenIL, provides immediate access to industrial time-sensitive networking technology, says NXP.

NXP Semiconductors is best known for making computing chips but also has a big business in connectivity solutions, which is what Industry 4.0 is about – connecting machines to the internet. 

NXP says its Linux-based OpenIL is specially designed for factory automation and original equipment manufacturers.

By breaking down the barriers of real-time computing and networking in a standard, community-based distribution, OpenIL helps these OEMs usher in the Industry 4.0 era, says NXP.

 

The OpenIL distribution includes TSN support, per-stream policing, time-aware shaping of network traffic, and 801.1AS time synchronization.

TSN Ethernet is integrated in the Layerscape LS1028A industrial applications processor announced by NXP in March 2017.

Dan Mandell, senior industry analyst at VDC Research Group, says: “NXP has taken a leadership role with the OpenIL distro in focusing Linux designers specifically on industrial automation opportunities, while simultaneously leveraging its Layerscape system-on-chip capabilities to enable Industry 4.0 smart manufacturing systems. It should prove a powerful combination.”

Factory managers and industrial-equipment makers are turning to Linux for its operational stability, security, and cost of ownership.

For similar reasons, they are turning to Ethernet to replace vendor-specific networking protocols.

Richard House, software vice president at NXP Semiconductors, says: “OpenIL combines security, TSN, edge computing, and Industry 4.0 into a single Linux distribution.

“OEMs can focus on their value-added technologies to create the next generation of smart manufacturing solutions while utilizing proven hardware and software platforms.”

Originated by NXP, OpenIL’s baseline capabilities include IT infrastructure software such as networking stacks, web servers – which NXP says is useful for configuration management, scripting tools, and system utilities commonly part of Linux distros.

OpenIL facilitates OEMs adding software from the rich Linux ecosystem using an optional instantiation of the popular Ubuntu user-space filesystem layout, says NXP.

Other notable OpenIL distribution features include:

  • Xenomai real-time extensions to Unix, easing porting from a real-time operating system like VxWorks or pSOS
  • Extensible Markup Language and NetConf-based network configuration utilities for TSN
  • Generalized precision time protocol with the linuxptp daemon
  • Drivers for the Ethernet Interfaces and the NXP SJA1105T TSN switch
  • Support for edge computing services

How to create automatic System Restore points daily on Windows 10

d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

Use this hidden option to make sure there is always an up-to-date restore point to roll back changes in case of system issues on Windows 10.

On Windows 10, System Restore is a feature that automatically checks for system changes on your device and saves a system state as a “restore point.” In the future, if a problem occurs due to a change you made, or after a driver or software update, you can go back to a previous working state using the information from a restore point without causing data loss.

When the feature is enabled supported apps and Windows 10 can create restore points during significant changes happen, and you can even trigger them manually. However, if you accidentally make a change without creating a restore point and there isn’t a recent checkpoint created, you may not be able to revert back. Furthermore, if there is only an old restore point, you may end up undoing other system changes.

If you want to make sure there is always a fresh restore point available, it’s possible to enable a Windows Defender Antivirus hidden option to automatically create checkpoints every day before its daily scanning.

In this Windows 10 guide, we’ll walk you through the steps to make sure a System Restore point is created automatically on the daily basis.

  • How to enable System Restore on Windows 10
  • How to enable automatic System Restore points using Group Policy
  • How to enable automatic System Restore points using Registry

How to enable System Restore on Windows 10

By default System Restore isn’t enabled on Windows 10, but you can use these steps to enable the feature:

  1. Open Start.
  2. Search for Create System Restore and click the result to open System Protection.
  3. Under “Protection Settings,” if your device system drive has “Protection” set to Off, click the Configure button.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  4. Select the Turn on system protection option.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  5. Click Apply.
  6. Click OK.

After enabling System Protection, you can use the steps below to make sure restore points are created daily.

How to enable automatic System Restore points using Group Policy

If you’re running Windows 10 Pro, you can modify the Group Policy settings to create restore points every day automatically.

  1. Use the Windows key + R keyboard shortcut to open the Run command.
  2. Type gpedit.msc and click OK to open the Local Group Policy Editor.
  3. Browse the following path:

    Computer Configuration Administrative Templates Windows Components Windows Defender Scan

  4. On the right side, double-click the Create a system restore point policy.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  5. Select the Enabled option.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  6. Click Apply.
  7. Click OK.

Once you’ve completed the steps, your computer will save a new restore point prior to every daily malware scan.

In case that you change your mind, you can always revert the changes following the same instructions, but on step No. 5, make sure to select the Not Configured option.

How to enable automatic System Restore points using Registry

If you’re running Windows 10 Home, you won’t have access to Group Policy, but you can change the same settings by editing the Registry.

Warning: This is a friendly reminder that editing the Registry is risky, and it can cause irreversible damage to your installation if you don’t do it correctly. It’s recommended to make a full backup of your PC before proceeding.

  1. Use the Windows key + R keyboard shortcut to open the Run command.
  2. Type regedit, and click OK to open the Registry.
  3. Browse the following path:

    HKEY_LOCAL_MACHINESOFTWAREPoliciesMicrosoftWindows Defender

    Quick Tip: On the Windows 10 Creators Update and later, you can copy and paste the path into the new Registry’s address bar to quickly jump to the key destination.

  4. Right-click on the Windows Defender (folder) key, select New, and click on Key.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  5. Name the key Scan and press Enter.
  6. Right-click on the right side, select New, and click on DWORD (32-bit) Value.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  7. Name the key DisableRestorePoint and press Enter.
  8. Double-click the newly created DWORD and make sure its value is 0.

    d8013_daily-system-restore-point-windows10 How to create automatic System Restore points daily on Windows 10

  9. Click OK.

After completing the steps, a checkpoint will be created every day, which you can use to undo changes that might have harmed your device.

If you want to revert the changes, simply follow the same instructions, but on step No. 5, right-click the Scan (folder) key and click Delete to remove the entries.

More Windows 10 resources

For more helpful articles, coverage, and answers to common questions about Windows 10, visit the following resources:

Microsoft’s Windows 10 S is now a viable operating system, but does that matter?

Microsoft’s Windows S which debuted with the Surface Laptop has been the subject of some debate for its short existence. To briefly recap, Windows 10 S is a variant of Windows 10 S which has been streamlined and optimized for security and speed, the trade-off being a few limitations of varying importance. Microsoft won’t let you install software from anywhere but the Microsoft Store, and hides the registry editor and command line tools so you can’t really dive deep into your PC. Yet, despite all those limitations, a case could be made that Windows 10 S could evolve into something that goes beyond functional, but is actually desirable to use.

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

To begin with the negatives first, Windows 10 S is still nearly mythical. This isn’t saying anything good or bad about the OS, just that it barely seems to exist at the moment. Microsoft shipped the OS with the Surface Laptop for the first time — though it was with an easy upgrade to Windows 10 Pro. Microsoft also announced a number of devices, yet more devices featuring Windows 10 S have yet to come out. I would expect by now, a Windows 10 S version of the Acer Swift 3, a popular and powerful mid-range PC for the price. Or perhaps a Windows 10 S powered HP Stream 14, a cute little laptop with a streamlined OS for students at University, College and secondary school levels who only need to type up word documents and perform rudimentary research on their PCs would be useful. Yet, I haven’t seen any of this. The first wave of Windows 10 S PCs have released, are predictably US only with the exception of the Surface Laptop. Few more have come to light.

Perhaps Microsoft is waiting for some sign from its OEMs, perhaps they just need more apps, but from where I’m sitting Windows 10 S seems to have gotten up with a whimper. That’s however, neither here nor there regarding the viability of the system.

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

The largest concern potential users have with Windows 10 right now, as it stands, is apps. PCs stand and fall by the apps they have, and unlike ChromeOS (which itself has now resorted to using Android apps), Windows was never built on a platform of running apps from the web. As Microsoft found out with the hard way Windows 8 RT, people expect their Windows-powered PC to run familiar apps.
To their credit, the Microsoft Store has grown such that you’ll be able to find many apps that you want. Microsoft’s Office Suite has been made available for Windows 10 S users in the past year, Evernote and Spotify have come to the Microsoft Store as well. Apple is promising to bring iTunes to the Windows Store, so you can get your Apple Music fix from there soon. There are tons of other good to great apps available in the Microsoft Store that the prospect of living on a PC with just Microsoft Store sourced apps no longer makes me reflexively shudder.
That is, with the exception of browsers. Microsoft will not be allowing alternative browsers like Firefox or Edge into the Windows Store unless they effectively become Edge skins. As that’s most certainly not going to happen, users on the Windows 10 S are stuck with Edge (and a handful of other browsers not worth mentioning).

When I last wrote about Edge in this context, I didn’t give it many compliments, saying:

Like most desktop users, much of my computer usage involves using the internet. In essence, a powerful browser with extension support for things like Adblock Plus (for a few sites with out of control ads), Grammarly for helping with writing, and while a bunch of other extensions I’m currently trying out to streamline my online workflow.
When it comes to extensions, Edge only has a few. There’s support for the Adblock Plus which has whitelist support and send to OneNote and EverNote for quickly taking notes and clipping pages, as well as Amazon Assistant for streamlining online shopping. When you step out of that limited circle though just like the Windows Store, there’s barely anything else. There aren’t any Google extensions (shocker), nor are there any that change your new tab page to maximize productivity. Pocket on Chrome integrates with the New Tab page to show me stories that I’m generally interested in saving and reading later on Pocket’s iPhone app, and there are extensions to quickly show you the weather as well.
Most painfully, however, Edge has issues with performance for me. I won’t attempt to generalize my experience to every single person who uses Edge, but my experience with using Edge for any sustained period of time leads to frustration, lost work, and freezing. This is consistent whether I use my PC on Insider builds, freshly reset or otherwise.”

My thoughts on Edge, were, regardless, negative. Now, with the Windows 10 Fall Creators Update and several cumulative updates behind us, I have had a change of opinion — as one does when the facts of the matter change.

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

 Microsoft's Windows 10 S is now a viable operating system, but does that matter?

Edge has developed to include more extensions. and a key one for me — Grammarly — now joins the fold. That’s not all, Edge is, in fact, more stable. I haven’t experienced an Edge crash since updating to the Fall Creators Update, and that’s a big deal for me. I’ve surfed the web looking at user and reviewer reports and takes on Edge, and the same story is there, Edge has gotten better since the Fall Creators Update. Microsoft is also slowly tackling missing features like pinnable web-apps. You can now pin sites to your taskbar as if they were real apps. They will open in Edge UI of course, but those baby steps point to real work taking place on Edge.

Windows 10 S still faces software problems when it comes to driver installation, there will be some niche device somewhere that needs a manual driver installation, and you’ll either need to be incredibly creative, do without or pony up to Microsoft to unlock the full capabilities of your device.

That is ultimately the Windows 10 S problem at its core. It is secure, and the apps within it are useful, but it doesn’t offer much over similarly priced Windows PCs with Windows 10 Home and Pro, and it isn’t meaningfully different in the sense that it would make sense to limit your PC. If Microsoft did more work on this so that you could eke our far more battery life, or managed to streamline the driver installation process, then Windows 10 S would be just about there.
To be clear, I get the sense that an average user can use Windows 10 S right now and not skip a beat. However, I can’t see a reason for going out of your way to do so.

LA Sheriff’s antiquated computer system makes data collection a nightmare

It’s hard to ignore the security that surrounds the Los Angeles County Sheriff’s Department’s communications center. It sits atop a hill in Monterey Park behind a tall fence and inside a building with thick concrete walls and no windows.

Inside, dispatchers don headsets and deploy deputies from the 10,000-strong force across the nearly 5,000 square miles that comprise L.A. County. It’s impressive until someone shows you the technological guts of the operation. 

The room is mostly silent expect for the humming of the fans that keep it cool – and a nearly constant clicking sound.

“Those are mechanical switches that are activated with each one of those radio calls,” said Dean Gialamas, director of the sheriff’s technology and support division.

The analog dispatch system is the most glaring example of the technological problems facing the largest sheriff’s agency in the country. Spare parts for the dispatch system aren’t even manufactured anymore – the department has to make them. 

Not only are the department’s thousands of computers antiquated, but they’re not interconnected, said Gialamas.

“When you look at our IT systems across our department, we have so many different systems,” he said.

“All of our staff has become very creative … they come up with their own systems,” added Gialamas.

Some records on use of force aren’t even in electronic form – they’re on paper, he said.

95a29_180094-full LA Sheriff's antiquated computer system makes data collection a nightmare
One of the sheriff’s department’s antiquated computers.

Frank Stoltze/KPCC

When he became the department’s top official three years ago, Sheriff Jim McDonnell had a to-do list of reforms that included reducing violence in the jails and providing more humane treatment for mentally ill people who end up in jail.  But to achieve measurable results, he needs good data. And McDonnell acknowledges that he’s not getting it.

“You potentially have 100 different systems capturing crime data information, risk management information and other information,” he said.

Serious flaws in the sheriff’s data systems first came to light this summer, when county Inspector General Max Huntsman found the department was tracking jail violence using incompatible types of software.

In some cases, multiple incidents were counted as one – a serious problem for a department with a history of deputy-on-inmate violence.

McDonnell concedes that for a long time department leaders spent money on what they saw as more important things: more deputies, more patrol cars and new station houses.

“To be very candid, [modernizing the computer systems] has not been a priority for many years,” McDonnell said.

Gialamas said the department is making progress.

Its office of technology planning is adding 22 people and the L.A. County Board of Supervisors has approved funding for two big projects: $25 million to computerize the ancient dispatch system and $35 million to modernize the digital jail management system.

But Gialamas acknowledges there’s a lot more to do – the department needs to set up systems to store and manage crime and personnel data – and it needs to get all of the sheriff’s various computer networks talking to each other.

Far behind the LAPD

The region’s other large law enforcement agency, the LAPD, was forced to embrace big data in 2000 when it reached a settlement with the federal Department of Justice.

As part of reforms aimed at reducing racialized policing and excessive use of force, the LAPD had to start documenting all car stops, including the race of the driver. It also created a computerized system to track performance evaluations, complaints and other data on officers, said attorney Gerry Chaleff, a former police commissioner who oversaw the reforms at the LAPD.

“It gave us a better sense of … which employees might have risk management issues,” he said. “It allowed us to see trends with … officer-involved shootings and other uses of force.”

The tracking system is now a model for the country.

“It put the department on the road to the fact that we had to collect data, we had to analyze data and we had to be transparent about it,” said Chaleff, who now advises police departments around the country on consent decrees.  

The sheriff’s department was never really put on that road – although it’s now collecting new data under a similar reform agreement with the federal justice department designed to improve mental health care inside jails.

Watchdog groups are frustrated that when it comes to big data, the sheriff’s department is so far behind the LAPD.

“If McDonnell is serious about changing the department, he’d invest in technology,” said Michelle Infante of the Coalition to End Sheriff’s Violence.

“They put out the statistics they want people to know and what they don’t want you to know they don’t put out,” she said. “The department is not being clear, it’s not being honest.”

McDonnell says while the department struggles with technology, it never lies about the data it has.

Kim McGill of the Youth Justice coalition says the department’s computer troubles can lead to bad policies.

“If we have no data or bad data, then we’re really legislating and policing by emotion,” McGill said. “And emotion unfortunately is often driven by race, class, gender and age.”

The sheriff’s civilian oversight commission also has expressed concerns about data, saying to increase public trust, the sheriff should release more data, and in a timely fashion.

J.P. Harris, a former sheriff’s lieutenant who sits on the civilian panel, agrees that the department needs to upgrade its information technology so it can get a better handle on its data.

“If you don’t measure it, you’re not going to know what’s going on,” he said at a recent meeting.

Senate’s huge tax bill would have potent ripple effects for health-care system

The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health-care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time.

The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’s nonpartisan budget analysts.

Yet downstream effects of the bill that have drawn less attention could potentially damage the health care and well-being of far more people.

The Senate plan would increase the federal deficit starting in the current fiscal year and — unless lawmakers intervene — would unleash a budgetary sequence of events cutting billions of dollars from Medicare and public health services. The reductions would flow from a “pay as you go” law that basically requires offsets to increases in federal spending.

At the same time, the frenzied negotiations to line up support for the huge legislation within the Senate’s slender majority improved the prospects for temporarily reviving payments to ACA insurers that President Trump ended this fall. In becoming the last GOP senator to announce support for the tax bill, Sen. Susan Collins (Maine) said late Friday afternoon that Senate Majority Leader Mitch McConnell (R-Ky.) had “committed to support” two separate measures by the end of the year.

One is a bipartisan plan that would restore for two years “cost-sharing reduction” payments to cover the expense of discounts that the ACA compels insurers to give lower-income customers on deductibles and other out-of-pocket costs. Trump cut off the monthly payments as of October, erroneously terming them “bailouts” to the insurance industry. The plan, forged by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), also would expand consumers’ ability to buy inexpensive “catastrophic” health plans through ACA marketplaces and make it easier for states to secure federal permission to carry out the law’s basic ideas in different ways.

An attempt to pass the plan faltered in the Senate earlier in the fall, but Collins said Friday that McConnell was now willing to support its passage, along with a newer plan that would give states two years of money for various “reinsurance” funds intended to help insurers blunt premium increases. Neither measure has been considered by the House.

Now that both chambers of Congress have passed versions of the biggest rewrite of tax law in decades, the differences must be negotiated. The House bill would not end penalties for Americans who fail to carry insurance, but Republicans there have been sympathetic to the idea, which was part of legislation that the House adopted this year to dismantle much of the ACA.

The likelihood of big reductions in other forms of health-care spending, triggered by the pay-as-you-go law — also known as paygo — to deter deficit increases, is less certain.

In the hours before the Senate’s final vote on the tax overhaul package, McConnell and House Speaker Paul D. Ryan (R-Wis.) sought to tamp down fears of such cuts, issuing a joint statement in which they accused Democrats of “misleading claims” and promised to “work to ensure these spending cuts are prevented.”

The bill itself does not avert them, however. Separate action would be required later and — unlike the parliamentary maneuvers used to adopt the tax plan with only GOP votes — would require support from some Democrats. Republican leaders predict that Democrats would cooperate rather than bear blame for harming health-care funding.

The leaders’ joint statement has its skeptics. “We are aware they say they will waive the paygo, but we have little comfort that they can do this,” said Georges S. Benjamin, executive director of the American Public Health Association. “Why did they not write the bill to address this in the first place?”

The cuts, if they happen, would decrease federal spending on Medicare by 4 percent — amounting to about $25 billion next year, the Congressional Budget Office forecast. Because paygo rules do not allow Medicare benefits to be touched, the funding loss would be spread among payments to doctors, hospitals and others that provide care to the program’s 56 million older and disabled Americans.

Those rules focus only on the mandatory spending within the federal budget and would leave untouched some health-care programs that provide help to low-income Americans, such as Medicaid and the Children’s Health Insurance Program. But it could eliminate nearly $1 billion a year for a Prevention and Public Health Fund, created under the ACA, that now represents 12 percent of the Centers for Disease Control and Prevention’s budget.

If that fund disappears, “people are going to be sicker,” Benjamin warned, with fewer low-income Americans likely to get tested for breast or colon cancer, and public health workers less able to control outbreaks of contagious infections.

Even if the paygo cuts are averted, advocates for vulnerable groups of Americans fear that the sheer magnitude of the bill’s deficit increase — $1.5 trillion in the coming decade — would give conservatives in Congress reason to shrink social safety programs that they have long hoped to target.

“That is ultimately the most troubling part,” said David Certner, legislative counsel for AARP. “We create these large deficits, and that will put pressure for cuts to Medicare, Medicaid. . . . Everything will be on the table.”

Senate’s tax bill would have major ripple effects on health care system

The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time.

The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’s nonpartisan budget analysts.

Yet downstream effects of the bill that have drawn less attention could potentially damage the health care and well-being of far more people. The Senate plan would increase the federal deficit starting in the current fiscal year and – unless lawmakers intervene – would unleash a budgetary sequence of events cutting billions of dollars from Medicare and public health services. The reductions would flow from a “pay as you go” law that basically requires offsets to increases in federal spending.

At the same time, the frenzied negotiations to line up support for the massive legislation within the Senate’s slender majority improved the prospects for temporarily reviving payments to ACA insurers that President Donald Trump ended this fall. In becoming the last GOP senator to announce support for the tax bill, Sen. Susan Collins of Maine said late Friday afternoon that Majority Leader Mitch McConnell, R-Ky., had “committed to support” two separate measures by the end of the year.




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