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'Privatization' Is Not 'Privacy'

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*Author's note:* I had the privilege on April 4 of delivering the following remarks as part of a panel on "Creating the Politics of Privacy," a session of the capstone conference for Ohio State's 2013-14 series of campus-wide programs on the distinction between public and private.

America's cultural turn in recent decades toward a glorification of the private and a denigration of the public has coexisted with what quite obviously is a deterioration in privacy. As individuals, we have dramatically less capacity than in earlier decades to control information about even the most personal aspects of our lives. This is not just historical coincidence. The cultural turn to the "private" has actually hurt privacy.

What I mean by a cultural turn is that, for the last 35-ish years, U.S. law and politics have moved away from the public-regarding orientation of the New Deal and its programmatic outgrowths and toward the individualist orientation of Reaganite small-government conservatism. We can see these moves in a variety of ways that implicate the private/public distinction. For example, we know that public institutions, such as schools, simultaneously create both public value and private value. They help both to benefit society through an educated citizenry and to prepare individuals for economic self-sufficiency. Yet our public policy toward schools has increasingly emphasized only their private value as providing persuasive reasons for their support.

Likewise, private action simultaneously has both private and public impacts. What I do as an individual both serves my personal needs and gratifications and imposes externalities on others. Not all externalities are positive. Yet courts and politicians have increasingly resisted treating negative externalities as a sufficient justification for regulation. Supreme Court decisions limiting Congress' powers to keep guns away from schools or to provide federal remedies for domestic violence are perfect examples. The court's 2012 decision that Congress lacked power under the Commerce Clause to compel the private purchase of health insurance was based on legal arguments that earlier courts would have rejected out of hand.

To understand how these developments have hurt privacy, it is helpful to note that both legal and ordinary discourse commonly use the concept of a private/public distinction to mean quite different things. When we talk about the private/public distinction, we sometimes mean to refer to what might better be called the privacy/publicity distinction. This is a distinction often seen in terms of categories of information. Some information, personal information, we are entitled to keep confidential, or at least closely under our control. Other information about us is public. Third parties -- indeed, society at large -- are entitled to know and to disseminate such information.

The private/public distinction is often used, however, to mean something analytically different. It refers to a distinction in the legitimate locus of power that might best be called the private/governmental distinction. That is, there are activities in which we engage in which society presumes that everyone is entitled to govern their own behavior. People generally regard raising families or running businesses as paradigm examples. To various degrees, our behavior in these domains may be constrained by law, but the default position is individual autonomy. There are even aspects of our autonomy -- choice of religion, for example -- that the Constitution forbids government to constrain. "Private," as conceived by the private/governmental distinction, has no necessary connection to secrecy or intimacy. When we say a shopping center is private property, we refer to its governance, not its confidentiality.

Governmental action, of course, is distinctly different from private action. Only persons chosen through constitutionally approved processes are entitled to wield government power. That power is subject to constitutional limits. Its exercise is subject to mandatory norms of equality and due process. Notably, the Supreme Court in the mid-20th century increasingly identified a variety of private acts so entwined with government as to become "state action" also subject to mandatory constitutional norms. The paradigm case would be private ownership of a so-called "company town." The Court has now significantly retreated from that position, with the consequence that large swaths of what had once been viewed as inherently governmental functions are increasingly turned over to private hands, with far less public accountability. Private prisons are the perfect example.

So how has the cultural turn favoring the private in the private/governmental distinction weakened the cause of privacy in the privacy/publicity distinction?

First, vast quantities of information we instinctively put on the privacy side of the privacy/publicity distinction are now in the hands of third parties who enjoy their own presumption of autonomy under the private/governmental distinction. That is, if a firm operating a social network or selling merchandise online possesses information about me, they are entitled -- unless forbidden by law -- to use that information as they see fit. This includes highly personal information, such as information about the books and movies I like, the identities of friends and family members, the history of my pharmaceutical purchases, and the like. What I experience as a compromise of privacy is, to the firm, an exercise of its liberty.

Second, Facebook's or Google's or any other firm's entitlement to use my data as it chooses is legitimated by the fetish we have made of personal choice as justifying the firm's freedom to use my data in whatever manner I have supposedly agreed to. I have chosen, that is, to click "I agree" when presented with a chance to read the firm's terms and conditions of service. It is well known, of course, that hardly anyone reads or is familiar with the terms and conditions for which they click "agreement." Most people understand that in refusing to volunteer our data as these firms require, we would be excluding ourselves from major forums within the public sphere. We would estrange ourselves from information flows that are invaluable to our participation in society. We would deny ourselves services all but essential to the effective transaction of daily life. If the government insisted on access to personal data as a precondition for speaking in a so-called public forum, such exclusion would be subject to First Amendment challenge. But because of the private/governmental distinction, the First Amendment extends the liberty of private firms to regulate their own public forums; it does not restrict corporate prerogative in our favor.

These two points strongly suggest that reemphasizing the importance of the public or the governmental in our conceptions of the private/public divide might be helpful in protecting privacy because such a cultural move would legitimate regulating data-holding private firms in order to mitigate the negative externalities of their data uses. We could shift the locus of power regarding "terms and conditions" of data use away from unaccountable private actors and toward relatively more accountable government actors.

But that's only part of the problem. The most obvious material factor facilitating the breakdown of personal privacy has been the evolution of new technologies of surveillance. Surveillance has turned out to be a more pervasive government activity than most people understood prior to the Edward Snowden leaks. Might a cultural turn back toward the public side of the private/public distinction not exacerbate that problem? Aren't we better off, for example, when the government proposes -- as the president now has done -- that information potentially relevant to national security investigations be held by private firms, rather than by government agencies, and searchable only through court order? How could a cultural turn back to the governmental side of the private/public distinction possibly help that problem?

As I have already noted, the government is subject to limitations that private companies are not. So long as the NSA is gathering and storing information, it is subject to constitutional limitations and to judicial and congressional oversight. Nothing equivalent applies to private firms holding personal data. NYU law professor Kathy Strandburg has recently urged with some cogency that the NSA's collection of bulk communications metadata violates our First Amendment freedom of association. Whether or not that argument prevails, no such argument can hold for telecom companies because they are not subject to the First Amendment.

But I wish also to offer a more speculative but perhaps deeper point. The cultural turn toward the private has reinforced our tendency, even as citizens, to evaluate the impacts of government data practices mostly in terms of our individual welfare. If I am not breaking the law, the saying goes, why worry? But the most powerful arguments for personal privacy may not be the arguments based on individual welfare but rather on the threat to democracy posed when we conduct our lives under constant surveillance. My colleague Amna Akbar has written powerfully about how the surveillance of Muslim communities in the United States has led to the impoverishment of political and religious discourse in those communities:
Muslims know they are being watched. Muslims feel pressure to signal loyalty to American identity over their Muslim identity or else risk signaling terrorist propensity. Muslims are afraid of being too Muslim and therefore labeled anti-American, extremist, radical. Instead of speaking up, many Muslims have shut up.
We would be foolish, I think, to doubt that a regime of pervasive surveillance will eventually have a desiccating impact on our political life even more widespread than this.

If I am right, then a reenergized recognition of the importance of government in our lives could help ameliorate government policies that diminish personal privacy because that recognition would motivate us as citizens to regard privacy as a public, not just private, good. We would care more deeply about the quality of government because we would take more seriously the possibility of government as a positive force. Our public-regarding assessment of privacy challenges would weigh more heavily surveillance's democratic, not just individual, impacts. For this reason, as well as because of my anxiety about largely unregulated private governance over my personal information, I believe that "privatization," as both a cultural and institutional phenomenon, hurts the cause of privacy. Perhaps surprisingly, a cultural and institutional recommitment to the collective good might help it. Reported by Huffington Post 6 hours ago.

Is the Nonprofit Mental Health Industry Misleading Congress?

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Congress is being misled by the nonprofit mental health industry, which argues that ordinary life events like bad grades, being unemployed, having an unhappy marriage, and this year's cause célèbre, bullying, are the mental illnesses worthy of congressional funding. They ignore the homeless and psychotic who can't get treatment, sleep on the streets, forage dumpsters for food, and scream at voices that only they can hear.

Prior to the 1960s the U.S. mental health budget was primarily spent on providing treatment to people with serious mental illnesses. Today, at the behest of the mental health industry, we've largely abandoned the most seriously mentally ill and use the budget for everyone else. In 1955 there were half a million public psychiatric beds for the seriously ill. Today there are less than 50,000. Because of the shortage, about 200,000 mentally ill are homeless, and according to a recent report by the Treatment Advocacy Center and National Sheriff's Association, 10 times as many mentally ill persons are incarcerated as hospitalized.

The community-based mental health industry is not serving the same populations as those who would be served by hospitals. Community programs only accept voluntary patients and generally choose the higher-functioning. Instead of providing services to treat the seriously ill, many community programs focus on creating stigma campaigns. Michael Biasotti, the immediate past president of the New York State Association of Chiefs of Police, recently told Congress that this shunning of the seriously mentally ill is forcing police to pick up the slack:
We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. ... [M]ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.
Money is not the problem; mission creep is. Mental health spending totaled $100 billion in 2003, representing 6.2 percent of all health care spending. By 2014 it is expected to double to $204 billion. The elephant in the room is getting treatment to the most seriously ill. Instead of treatment, the nonprofit mental health industry argues for Congress to fund public education. This is based on the mistaken assumptions that the reason that people do not get care is that they are so asymptomatic that the public needs special training to identify them, and that once they're identified, treatment will be available. Neither assumption is true for the seriously ill. As Creigh Deeds learned, families can -- and do -- beg for treatment for loved ones already identified as being ill. And yet they still can't get it.

If Congress wants to improve care, save money, and reduce violence, it should stop funding groups working to improve people's mental health and use the savings to treat people with serious mental illness. Replace mission creep with mission control.

That's the idea behind H.R. 3717, the Helping Families in Mental Health Crisis Act. Introduced this past December by Rep. Tim Murphy (R-Pa.), with the support of 74 other representatives from both parties, the legislation would:
· *Get treatment to people who are too sick to accept voluntary treatment.* H.R. 3717 requires states to have an assisted outpatient treatment (AOT) program in order to access federal mental health block grants. AOT is limited to the most seriously ill who have a past history of violence, incarceration, or needless hospitalizations caused by going off treatment. It allows courts, after extensive due process, to order them to stay in mandated and monitored treatment as a condition of living in the community, and equally importantly, to order community programs to provide the care rather than turn them away. New York's AOT program (also known as "Kendra's Law") reduced homelessness, arrest, and incarceration in excess of 75-percent each and cut costs in half by reducing the use of more expensive incarceration and hospitalization. The Department of Justice certified AOT as an "effective crime prevention program."
· *Free parents of the seriously mentally ill from HIPAA handcuffs.* Parents need information about the diagnosis, treatments and pending appointments of their children in order to facilitate care. But the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA) prevent parents from receiving it. School authorities identified Jared Loughner as being mentally ill and potentially dangerous before he shot Gabrielle Giffords, but HIPAA and FERPA laws kept his family in the dark. H.R. 3717 writes exceptions into the law so that that won't happen again.
· *Require the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Mental Health Services (CMHS) to focus on serious mental illness.* The Wall Street Journal editorial "The Definition of Insanity" outlined the massive problems at SAMHSA. H.R. 3717 requires all SAMHSA grants to be evidence-based and reviewed by persons with clinical experience in mental health treatment, and it prohibits SAMHSA from making grants not authorized by Congress. These reforms are needed because SAMHSA and CMHS fail to focus on serious mental illness, fund programs that lack independent evidence of effectiveness, and award taxpayer money to organizations that lobby against treatment for the most seriously ill. For example, in spite of the fact that getting the correct diagnosis is key to getting the right medication, SAMHSA distributes millions to "peer" groups that believe "psychiatric labeling is a pseudoscientific practice of limited value in helping people recover."
· *Create an Assistant Secretary for Mental Health and Substance Abuse Disorders.* More than anything, this individual is needed to end mission creep, reduce duplication, coordinate piecemeal federal agencies, and stop the federal funding of non-evidenced-based programs.
· *Preserve psychiatric hospital beds.* H.R. 3717 rejects the mental health industry shibboleth that everyone can survive safely in the community by preserving a few inpatient psychiatric beds for those who can't.
· *Increase the role of the criminal justice system in setting mental health policies.* Many of the policies espoused by the nonprofit mental health industry, like closing hospitals and making civil commitment more difficult, increase the incarceration of people with serious mental illness. H.R. 3717 gives criminal justice powerful representation on federal advisory boards so that they can prevent these policies from being adopted.
· *Refocus the Protection and Advocacy for Individuals With Mental Illness (PAIMI) Program.* Started with the noble purpose of providing representation to persons with serious mental illness who were being abused, PAIMI has morphed into a political advocacy machine that ignores the psychotic and assumes that all persons with mental illness are well enough to "self-direct" their own care. Joe Bruce told Congress that PAIMI lawyers "freed" his son William from involuntary hospital care over the objections of his mom and dad. William then killed his mom. H.R. 3717 returns PAIMI to its original focus of helping people who need help, and it prohibits PAIMI groups from using federal funds to lobby for other agendas.
· *Empower NIMH.* Under Dr. Thomas Insel, the National Institute of Mental Health has forsaken mission creep and now focuses on serious mental illness. H.R. 3717 turns over certain funds that were misspent by SAMHSA to NIMH, so that they can find cures for serious mental illness.
There is a crisis. Solving it requires getting treatment to people with untreated serious mental illness, not all others. Throwing money at mental health as Congress has done will not help those with serious mental illness. Passing H.R. 3717 is the best chance Congress has at addressing the real problem.

This is an updated version of a post that originally appeared in the Ripon Forum, published by the Ripon Society. It is reprinted with their permission.

DJ Jaffe is Executive Director of Mental Illness Policy Org., a nonpartisan, science-based think tank focused on serious mental illness (not mental health). Reported by Huffington Post 6 hours ago.

Colorado's private health insurance enrollment stands at 124,000

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Final figures for Colorado's open-enrollment in private health insurance under the Affordable Care Act stands at about 124,000, state exchange officials announced Monday. Reported by Denver Post 18 hours ago.

Zane Benefits Publishes New Information on How to Cancel Group Health Insurance

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What Your Business Needs to Know

Park City, UT (PRWEB) April 14, 2014

Today, Zane Benefits, the #1 Online Health Benefits Solution, published new information on how to cancel group health insurance.

According to Zane Benefits’ website, for businesses to thrive in today’s economy, finding and retaining the best employees is top priority. In the past, group health insurance was the best way to offer competitive health benefits. However, continual increases in healthcare costs have adversely impacted U.S. businesses’ ability to provide traditional health benefits.

Zane Benefits’ website says smaller businesses have been particularly challenged and are canceling group plans because they have become too expensive. Other businesses are canceling group plans simply because employees can purchase better and less expensive coverage on the new individual health insurance market.

But this doesn’t mean businesses are canceling health benefits altogether. Instead, businesses need new ways to offer employees the same or better benefits at an affordable cost. According to Zane Benefits, the solution is "pure” defined contribution health benefits.

Click here to read the full article.

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About Zane Benefits
Zane Benefits, the #1 Online Health Benefits Solution, was founded in 2006 to revolutionize the way employers provide employee health benefits in America. We empower employees to take control over their own healthcare, while helping employers recruit and retain the best talent. Our online solutions allow small and medium-sized businesses to successfully transition to a health benefits program that creates happier employees, reduces costs and frees up more time to serve their customers. For more information about ZaneHealth, visit http://www.zanebenefits.com. Reported by PRWeb 18 hours ago.

Obamacare To Cost Less In 2014 Than Initially Estimated: CBO

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CBO also estimates that 12 million more non-elderly people will have health insurance in 2014 than if Obamacare had not become law. Reported by IBTimes 18 hours ago.

McCurry Divinely Inspired, Says Hillary Won't Run

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*Mike McCurry Knows Politics*.

He learned at the knee of the Master, Bill Clinton, as his press secretary in the early 1990s. Last week, he told a rapt audience at a private dinner at the National Press Club he did not believe Hillary Clinton has made a decision to run for President. He also is in the minority. Maybe after graduating from Divinity School, McCurry knows something from a higher authority?

"I am (the guy) in the last 5 percent that doesn't think she will," he said to gasps. "She is having such a great time working with her daughter (and with the Clinton family initiative) and with the President. They have always worked better when they have concentric circles. It works for them."

He then commented on this quixotic and dynamic duo: "Who are we to judges?" No casting stones?

"If my theory is correct, then Gov. Martin O'Malley (MD) is attractive as is Sen. Mark Warner (D-VA). Andrew Cuomo is formidable," he mused. "Hickenloooper in Colorado is a pretty interesting guy. My first candidate ever (for whom McCurry campaigned) in 1976 was Jerry Brown." But he feels the country is not ready to elect and older guy, like Brown. McCurry, like so many commentators, he knows the U.S. is leaning further left and progressive. But Brown?

McCurry speaks from experience in politics and knowledge of the Clinton dynasty. He also remembered another Cuomo thought to be a front runner way back in 1992, Mario.

"In 1992 when President Clinton (ran) we were waiting for Mario. It was Hamlet on the Hudson," McCurry recalled. "There was a waiting jet for him to file in New Hampshire in October, 1991 and he didn't take that plane. Do we want to wait until the end of 2015? We probably will have wait" to know yet "that becomes a little untenable."

"Mrs. Clinton ought to get in early and be decisive and not let others build a head of steam," said quoting a guy at Brookings he worked with -- "that is a plausible strategy."

"I have tried to figure it out and there is not a wink and a nod going on -- nobody is certain she is running and this (campaign) is not developing an infrastructure. They have brought in great people who have brought along various parts (of a campaign apparatus). It will be a great machine for whoever we end-up nominating.

McCurry predicts: "Lots of people will jump in if she is not going to run. At some point does she let other people do their own thing. I don't know the answer. I think there is something in the chemistry that says you either gotta do it. Or you don't."

Interesting. Hillary Clinton has such a commanding lead for a non-candidate it is hard to imagine -- especially based on what we know about the Clinton Dynasty and her preparation on a global stage and knowledge of international affairs, she would let that voter equity pass by.

I last saw Hillary Clinton speak at HIMSS, the health insurance industry's information systems show. Last week, someone threw a shoe at her at the scrap metal recyclers conference in Vegas. She is clearly building a war chest with speaking fees.

McCurry's own narrative is fairly well-known. He worked for Daniel P. Moynihan, in the early days. He now works with Public Strategies. He reminded the Press Club veteran public affairs folks, including me, of his resume in wistful terms:

"I was at State in 1993-94 during Somalia and black hawk down. In 1995 it was the Gingrich era and that inexorable dance.1996 we had the re-election campaign. 1997 was l'affaire Monique"

"Democrats are fractured," he said, and moving toward "a more populist strain. What does that do to the political environment," he wondered. "We are all communicators and how we talk about things matter."

His main advice to the PR and government relations folks, including the President of Edelman PR Rob Rehg (my old boss when I was VP of Technology there) and the former doyenne of Powell Tate Kathy Gest (my fellow Northwestern Medill School of Journalism alum), is "you need very supportive bosses who will give you what you need to do your job." He felt he had that great mentor in President Clinton.

Today, McCurry is an alchemist trying to return the chemistry of civility and patriotism to Capitol Hill. He said: "Church should be more engaged. How do you make them more civil" to each other. "Get people to build relationships with each other. Elected leaders don't know each other (today) and are not socializing.

In thinking about the great era of Moynihan, he remembered that "Congress worked more effectively back then. They used to go to dinner and the spouses knew each other. There is no more fraternization. They would not demonize each other if they had kids going to school with each other."

That doesn't happen -- he says, in part because "Congress has to flee to go back to campaign. But even in town they are shaking down folks for money. Let's declare two days a month to be campaign or fundraising free zones. Nobody will sanction (fundraising) on those days."

God Bless America.

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Mike Smith worked for Edelman's Washington practice reporting to Rehg and Mike Deaver in the late 1990s. He served on the Clinton Transition Team in 1992-93 in Communications. Reported by Huffington Post 18 hours ago.

Rep. Blackburn: Obamacare Destroyed Health Insurance Industry

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The federal government spent billions of dollars and eviscerated the nation's health insurance industry to accommodate perhaps 3 million people who did not have insurance, Rep. Marsha Blackburn said. Reported by Newsmax 18 hours ago.

10 Tips For Surviving Life After College

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10 Tips For Surviving Life After College Leaving college can be tricky for many students, as they take jobs in the "real world" far away from the comforts and security of campus life.

Oftentimes, the best advice comes from those who have already been through this shift. In response to a recent thread asking "College graduates of Reddit, how did you make the transition from college to the 'real world'?," reddit users offered tips on personal finance, health, and the workplace.

*Here are some of the best tips we found:*

*Build a routine.*

"The best thing to do is gain a routine — don't waste your time. I go to the gym 3 times a week and it helps me stay on course and was the first stepping stone in getting my life organized."— Mardini

*Don't worry if you don't land your dream job.*

"Even if it's not your dream job, get one. Nothing scares employers quite like a gap in work history."— Loughla

*Take advantage of the resources around you.*

"Aside from the social/living aspect of moving to a new city, you should not forget how many resources will be available in your office; when you're starting your new job, there is no shame in asking your HR person for some help in finding an internet connection, tax forms, health insurance, or anything else. They're there to help, and they'll know a lot of what you need to know when moving to a new city."— mexicono

*Be careful with your money.*

"You've been living on $10k/ year for 4 years. Continue to do this, pay off your debt ASAP save a stack and continue to save. Do not live beyond your means, or you will quickly become dependent on your job."— teaching-man

*Become a local.*

"The most important thing for me was to make it as normal as possible while still living it up. I wanted to know how to get from my apartment to the grocery store without GPS, but I also wanted to go exploring and eat at restaurants that I'd never seen or heard of before. It's also important to know where doctor's offices, pharmacies, Targets/Wal Marts and gas stations are located in reference to where you live."— I_just_want_salsa

*Make healthy choices.*

"The only thing I slightly increased spending on is better quality food, because I can afford it and it's good for you."— QuestionAxer

*Make sure you're active.*

"Exercise feels amazing after sitting at a desk all day."— EMJ0913*Learn to navigate your new city.*

"When you move to a new city, take every opportunity to explore it. Go downtown, go to the parks, go to the museums, go to the bars. Learn how the city is laid out, and learn how to get around."— fooliam

*Take your job seriously.*

"The principal rules I've found are be good, show up on time, be nice. Pick two and you'll do fine most places."— TWmanyparagraphs

*Realize you're not at college anymore.*

"One important thing I did not anticipate is that my free time is now precious. In college I had so much time to work out, cook, do laundry, read, bike, etc. I didn't realize that doing laundry would be something I would ever have to plan out. Now, I see that I was extremely lucky and that the rest of the world operates on a much higher frequency."— TSLAGUY

*FOLLOW US! Check Out BI Colleges On Facebook*

Join the conversation about this story » Reported by Business Insider 17 hours ago.

AGC of California Selects The Contractors Plan as Health Insurance Partner for AGC of CA Members

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AGC of California Selects The Contractors Plan as Health Insurance Partner for AGC of CA Members AUSTIN, Texas & SACRAMENTO, Calif.--(BUSINESS WIRE)--The Associated General Contractors of California (AGC of CA) and its Affinity Partner Fringe Benefit Group today announced that the AGC of CA has selected Fringe Benefit Group’s product, The Contractors Plan, as a health insurance solution to offer to AGC of CA members. For more than 30 years, The Contractors Plan has helped companies bidding and performing on work subject to the Davis-Bacon Act, state prevailing wage laws, and living and res Reported by Business Wire 18 hours ago.

Golden Opportunity from the Golden State

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Enrollment of more than 7 million Americans in health insurance isn't the only recent milestone for the Affordable Care Act. Beginning this month, following sustained legal pressure, the state of California will conduct what may be the largest voter-registration mailing in U.S. history. It will reach more than 4 million eligible voters in the state who sought coverage under the landmark law.

The mailing is a hard-won investment in democracy and a healthy step for California. But imagine if recipients toss it in the trash. The mailing will only realize its main purpose if community leaders throughout the state call attention to its arrival and give voice to the spirit that made it happen. The message? Open the letter. Get registered. Take the opportunity to become a voter and urge everyone else in your household to register.

This month the Supreme Court's ruling in the McCutcheon case removed overall limits on donors' campaign contributions per two-year election cycle. It threatens to make elections and the policy process even more a rich man's game.

Against this backdrop, the mailing is evidence that toeholds still exist in the law for demanding that government invite the 99 percent into the democratic process. If reinforced with other alerts, this outreach in their preferred language to millions of predominantly low to moderate income Californians who sought insurance under the ACA, including new citizens, students, seniors, and people with disabilities, could alter the calculus of state elections and change the game. That goes for the Golden State and some other states that might follow California's lead.

The massive mailing stems from a settlement by the state with voting-rights groups, including the ACLU. They had insisted that California's well-coordinated effort to offer health insurance to legal residents through the health marketplace established by the landmark 2010 federal law qualified as a public benefit. That in turn triggered the requirement to offer voter registration under the 1993 National Voter Registration Act, or "motor voter" law, signed by President Clinton after being vetoed by his predecessor, George Bush Sr. The law earned its nickname for placing voter-registration forms at driver's license counters in state motor vehicles agencies.

California is home to more than 24 million adults who are eligible to vote, but 6.5 million of this total, or about 27 percent, are not registered. That figure comes from the year-end 2013 report by Secretary of State Debra Bowen, who signed the settlement agreement with voting-rights advocates that commits the state to remedying its past failure to register voters through its Covered California campaign with the current mega-mailing. It's possible that up to half of its recipients, or 2 million people, may not be registered to vote. If just twenty percent of this segment, or 400,000 Californians, actually use the form to register, it could push total state voter registration over the 18 million mark.

That simply underscores the need for the mailing to succeed, and for a larger public information push by civic leaders and local service providers to urge Californians to use the form and sound a drumbeat for registration. The form is also available free online in 10 languages.

The mega-mailing dramatizes the opportunity for voter sign-ups in places where the registration gap is widest and for civic forces to mount a sustained drive. In San Bernardino County, for instance, just 67 percent of eligible voters are registered, compared with 73 percent statewide. In Riverside, registration is even lower, at 63 percent. These two counties have the lowest registration levels of any large counties in the state. Taken together, they are home to nearly 1 million eligible voters who aren't registered. And over the past decade they have led the state in total population growth, showing today the future of its electorate.

California's outreach to those who inquired about insurance enrollment sets a precedent. It is the only one of the 16 states operating its own healthcare marketplace to act on its obligation to provide voter registration. States such as Nevada and Hawaii can and should follow suit. U.S. Census estimates from 2013 indicate their registration levels trail California's.

There is a thrill to registering new voters, teen or elderly, immigrant or native-born, that connects to the deepest themes of our democracy. But rulings like Citizens United from 2010 and McCutcheon this month that guarantee industries and billionaires seats at the front table in the forum we call the democratic process, with a strong hand on the microphone, the ballot box, and the gavel of governance, risk dulling the civic impulse. Wealthy interests' dominance of elections and policy-making corrupts our system and can warp desire to engage into cynicism and apathy. Still, in America, every vote is equal. And power goes to those who participate.

It took cajoling for California to take a healthy step forward to help more people register to vote. It will take a chorus of community voices, now and in the weeks to come, to maximize the grassroots response and maintain the momentum. Reported by Huffington Post 17 hours ago.

Boston councilors pitch gender identity health insurance coverage

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Boston councilors pitch gender identity health insurance coverage [caption id="attachment_126350" align="alignnone" width="614"]
A gay pride flag flies outside of Boston City Hall. Credit: Michael Naughton/Metro file photo[/caption] A pair of Boston city councilors have pitched an order that would forbid the city to contract with any health insurance company that discriminates against gender identity or expression. [related tag=”boston” limit=5] The proposal, submitted for consideration ahead of Wednesday's City Council meeting, was filed by councilors Michelle Wu and Ayanna Pressley. (The entire proposed ordinance can be read below). The councilors stated in the proposed ordinance that mental health services, hormones and surgery should not be excluded from coverage when medically necessary for people diagnosed with Gender Dysphoria. "For many people diagnosed with GD, pursing transition-related care is the only safe and effective medical treatment option. This may include mental health services, hormones, surgery, and other services. Therefore, it should not be excluded from coverage when it is medically necessary," Wu and Pressley wrote in the proposal. The councilors also said in the ordinance that covering gender transition-related surgeries improves the health of transgender people and may save money in the long run. They cited Seattle, San Francisco and Washington, D.C. as cities that provide coverage for transition-related care for city employees. Also, the councilors said Portland, Ore., experienced a 0.08 percent increase in costs after removing exclusions on coverage of transition-related care for city employees.

  Follow Michael Naughton on Twitter @metrobosmike.

The post Boston councilors pitch gender identity health insurance coverage appeared first on Metro.us. Reported by metronews 17 hours ago.

Pan-American Life Insurance Group taps former AIG exec to grow insurance offerings

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Pan-American Life Insurance Group is gearing up to expand its accident and health insurance offerings in the U.S. and Latin America in an effort build on growth that helped more than double earnings last year. The New Orleans-based insurance company has tapped a former AIG executive to lead the effort. Reported by nola.com 17 hours ago.

If We Build It, Will They Come? Drug Treatment and the Affordable Care Act

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With the passage of the Affordable Care Act, Congress has provided us with a historic opportunity to reduce the demand for illegal drugs. The law requires health insurance companies, Medicaid and Medicare, to cover treatment for substance abuse disorders. It will make drug treatment more available than ever before. The U.S. government estimates that illicit drug use costs more than $193 billion annually in crime, health care and loss of income. More effective treatment will likely save money as well as lives. The question is, will greater availability of drug treatment bring more problematic drug users into treatment? If we build it, will they come?President Obama's Office of National Drug Control Policy (ONDCP) estimates there are 23.1 million drug users in need of treatment; historically, only 10 percent of them ever access these services. Health insurance will eliminate one of the barriers. Others remain. For most addicts drug treatment is identified with the criminal justice system and viewed as a punishment. Admission of a drug or alcohol problem can also be humiliating and stigmatizing. It puts people at risk of being discriminated against in employment, housing, and health care. Moreover, the help being offered, whether voluntary or coerced, is a one-size-fits-all treatment. It requires abstinence prior to entering a program and abstinence while in the program. For the treatment to be considered successful, lifelong abstinence post-treatment is also necessary. The majority of drug users are unable to overcome these barriers. Only the most desperate or those coerced by the criminal justice system show up in our public programs.There is also evidence that insurance by itself is not likely to change this. When Massachusetts enacted universal health care and increased appropriations for drug treatment by $60 million, enrollment in treatment services remained flat. Clearly, the overwhelming majority of those in need of drug treatment do not want the help we have been offering.Bringing unengaged substance abusers into treatment will require us to think differently about addiction, its treatment and how one overcomes or recovers from it. We need to enlarge our all or nothing abstinence approach and give those in need a choice in the kind of recovery available. Rather than demand they cease all substance use prior to treatment, we can create programs that are willing meet addicts where they're at and work with them while they are still using drugs. Programs like this were developed at the height of the AIDS epidemic when it was urgent we engage addicts even if they were unwilling to get off drugs. We offered them sterile syringes, HIV/AIDS education and, in some programs, coping and stress reduction skills to help them self-manage their many chronic health and mental health conditions.I helped create a program like this 25 years ago at the height of the AIDS epidemic before effective medications for HIV/AIDS existed. At that time, tens of thousands of injecting drug users were showing up in our emergency rooms and hospitals infected and dying from AIDS. It was urgent we find ways to engage and help them. Aware of their reluctance to go into existing drug treatment programs, we created an approach that looked like a three credit college course. It consisted of twenty-four classes that met three times a week over an eight-week span. It was our hope that seeing a clearly defined beginning, middle and end, a prospective participant would be more willing to commit. Abstinence was not a condition for participation in the program. We wanted our instructors to have a similar backgrounds and life experience as our students. We strove to create a respectful, non-judgmental environment that would be welcoming to all and conducive to learning. We held our first class in a church basement on Manhattan's lower eastside with seven participants who voluntarily showed up.Twenty-five years later, this program called ARRIVE, continues to play a significant role in our fight against AIDS and drug abuse. We just completed our 128^th eight-week cycle of classes and there are more than 10,200 graduates. All attended voluntarily. This program put many on the path to recovery from addiction.Taking advantage of the opportunity presented to us by the Affordable Care Act will require a willingness to learn this lesson and to create many programs based on the same principles as ARRIVE. As our drug laws become more moderate, treatment services must attract participants rather than rely on coercion by the criminal justice system. We need to treat addiction as a chronic condition. Treatment services must include self-management skills to prevent existing chronic conditions from deteriorating. We must engage and work with people whether they want to stop using drugs or not. We need to recognize that lifelong sobriety is not the only way to overcome addiction and that successful recovery can include responsible use of some substances. If we make these changes, and create programs that make good sense to addicts they are likely to make constructive use of them and take full advantage of the Affordable Care Act.Howard Josepher is president and chief executive of Exponents, an organization dedicated to improving the quality of life of people affected by drug addiction. Having overcome his own addiction to heroin many years ago, he has been a long-term advocate for drug law reform. Reported by Huffington Post 15 hours ago.

CBO: Deficits to drift lower on lower health costs

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The biggest factor is $165 billion less in spending on health insurance subsidies for policies sold through exchanges created under Obamacare. Medicare spending will also dip slightly, mostly because of lower-than-expected prescription drug costs. Reported by SeattlePI.com 15 hours ago.

Report projects health law's subsidies will cost $1 trillion over 10 years, instead of $1.2 trillion

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The Affordable Care Act's health insurance subsidies will cost a little less than previously thought, according to a new... Reported by Deseret News 14 hours ago.

MNsure extension deadline for private insurance buyers April 22

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MNsure has told about 8,200 people who couldn't get health insurance by the end of last month that they might now face a sign-up deadline of April 22. Reported by TwinCities.com 14 hours ago.

CBO Projects Lower Premiums in Health-Insurance Exchanges

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Health-insurance premiums for plans sold in the Affordable Care Act's exchanges will be lower than previously expected for the next few years, according to a report by the Congressional Budget Office. Reported by Wall Street Journal 11 hours ago.

Health Insurance: Obamacare Costs Lower Than Expected

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One of the largest criticisms of the Affordable Care Act (ACA, also known as “Obamacare“) is that the program is simply too expensive. Lawmakers opposed to the ACA have continually called the program an expensive waste and even shut down … Reported by WebProNews 11 hours ago.

Student Loan Borrowers' Costs To Jump As Education Department Reaps Huge Profit

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The U.S. Department of Education is forecast to generate $127 billion in profit over the next decade from lending to college students and their families, according to the Congressional Budget Office.

Beginning in the 2015-16 academic year, students and their families are forecast to pay more to borrow from the department than they did prior to last summer’s new student loan law, which set student loan interest rates based on the U.S. government's costs to borrow. The higher costs for borrowers would arrive at least a year sooner than previously predicted.

James Kvaal, a top White House official, last year dismissed the possibility that student borrowers would pay higher costs under the new law. The Consumer Protection Financial Bureau on Monday warned borrowers about a "jump" in rates.

The projection, made public Monday by the nonpartisan budget scorekeepers, provides the federal government’s best estimate of how much the government's student loan program will cost taxpayers. That the program is predicted to generate an average annual profit of about $12 billion through 2024 is likely to fuel calls for the Obama administration and Congress to take additional steps to reduce borrowers’ debt burdens, which the Education Department pegs at an average of more than $26,000.

The program produces a profit because the interest rate paid by borrowers exceeds the federal government’s cost to fund those loans and administer the program. The figure also accounts for loan defaults and borrowers’ use of flexible repayment plans that tie monthly payments to their incomes.

The congressionally mandated accounting method that determines the profit figure has been criticized by some experts, including the Congressional Budget Office. The Education Department in the past has disputed the use of the word “profit.”

Education Secretary Arne Duncan has used the profit to help his department reduce its cost to taxpayers to the lowest level since 2001, budget documents show. As Washington focuses on reducing federal expenditures, some experts and student groups said they fear the Education Department may be too reliant on student loan revenues to advocate for debt relief.

“This is a profit-making machine for the Education Department,” said Chris Hicks, who leads the Debt-Free Future campaign for Jobs With Justice, a Washington-based nonprofit group. “The student loan program isn’t about helping students or borrowers -- it’s about making profits for the federal government.”

Education Department representatives did not respond to a request for comment.

Amid an era of falling inflation-adjusted incomes for college graduates and increasing student debt burdens -- total student debt has doubled since 2007, according to the Federal Reserve -- a group of federal regulators, policymakers and student loan experts worry that the nation’s economy will be restrained for years as monthly student loan payments take an increasing bite out of borrowers’ paychecks.

Researchers have found that student loan borrowers are less likely to start small businesses, save for retirement, take out a home mortgage or buy a car. A group of bank chief executives that advise the Fed also have warned about negative repercussions on the nation’s banking system from growing student debt loads.

Hicks said younger borrowers face daunting circumstances. If forced to choose, he said he reckons that borrowers would most likely default on their federal student loans rather than give up their credit cards or forgo health insurance. “I really wonder whether the Education Department is thinking of the consequences of potentially setting up a generation of borrowers to fail,” he said.

To prevent economic ruin, a loose coalition of groups led by the Center for American Progress has been advocating for a federal plan that would enable borrowers with high-rate student loans to refinance into cheaper debt.

Refinancing plans have either been endorsed or formally introduced by lawmakers, including Sens. Sherrod Brown (D-Ohio), Kirsten Gillibrand (D-N.Y.), and Elizabeth Warren (D-Mass.).

Some White House officials are said to support a student loan refinancing scheme, proponents said, but President Barack Obama has not yet publicly endorsed it.

The Education Department, on the other hand, has told some refinancing supporters that a plan to enable borrowers to refinance expensive debt into loans carrying lower interest rates could cost as much as $100 billion over a 10-year period in foregone federal revenue. The department also has warned that a refinancing plan likely would force it to reduce the number of Pell Grants given to college students from low-income households.

Supporters have taken the rough estimate and Pell Grant warning as an indication that the department does not want to allow borrowers to refinance.

Jason Delisle, director of the federal education budget project at the New America Foundation, said CBO figures show that the Pell Grant program will need more money to continue at present levels beginning in 2017. Assuming that Congress does not want to reduce the amount of Pell Grants available to low-income students, the program would need an additional $38.1 billion from 2017 through 2024, Delisle estimated.

Refinancing supporters argue that student loan profit should be used to offset the loss of future federal revenues that would result from allowing borrowers to refinance expensive student loan debts. Student loan profits are used to fund the federal government generally, rather than specific programs, James Runcie, Office of Federal Student Aid chief operating officer, told a Senate panel last month.

But the CBO estimates have been wrong before, underscoring the danger of basing policy on fleeting budget estimates from Washington’s main arbiter on the cost of federal programs.

For example, in August, when Congress was poised to pass the student loan law that set future interest rates, the budget office forecast that federal student loans would generate a $184.7 billion profit through 2023 -- more than the new estimate. Last year, the budget office estimated that the Pell Grant shortfall would be more than $47 billion, Delisle said. The budget office regularly revises its estimates, taking into account recent economic activity and other data.

Still, the Education Department’s estimated profits show a federal student loan program that is charging borrowers way too much, according to Hicks. Beginning in 2015, the average undergraduate borrower will pay 5.72 percent to borrow from the federal government, the budget office estimates. Graduate borrowers are forecast to pay at least 7.27 percent, while parents will pay 8.27 percent.

All three rates are higher than what borrowers paid in the 2012-13 academic year -- the last year before Congress changed the law. The Education Department could help borrowers deal with higher rates by pushing its loan servicers to offer distressed borrowers flexible repayment plans that base monthly payment amounts on incomes.

Despite White House pressure, the number of borrowers in income-driven repayment plans remains low.

“The public needs to be concerned about a government agency acting like a bank,” Hicks said. “The Education Department has a profit motive.” Reported by Huffington Post 11 hours ago.

Obamacare cost forecast is reduced 7% by U.S. fiscal watchdog

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Lower-than-expected health insurance premiums will save the federal government $104 billion in subsidies over the next decade, the Congressional Budget Office says. Reported by L.A. Times 9 hours ago.
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