Emma Walton had an easy pregnancy. She didn’t feel as much movement as the books had led her to expect, and the fetus regularly passed ultrasounds and nonstress tests.

After many hours of labor at a local community hospital in northwest Pennsylvania, the baby appeared distressed and needed to be delivered by emergency cesarean section. “They pulled him out and there was no sound,” Emma says. “You usually expect to hear a screaming baby and there was just nothing. Dead silence.”

Baby Conrad was intubated and taken by ambulance 60 miles to a neonatal intensive care unit (NICU) in Erie. Emma’s husband, Scott, traveled with him while Emma recovered from surgery. Conrad had been born with dangerously low muscle tone — “floppy,” doctors say — and couldn’t breathe on his own or swallow. After a few days, when doctors still couldn’t determine the cause of his symptoms, they referred him to the nationally acclaimed Children’s Hospital of Pittsburgh.

The hospital, which opened its $625 million clinical and research campus in 2009, is one of a growing number of sumptuous new children’s hospitals that combine state-of-the-art medical care with playrooms, whimsical decor, and extensive support services.

After genetic testing and a muscle biopsy, Conrad received a diagnosis of myotubular myopathy, a rare genetic disorder in which muscle cells do not form properly. It’s a life-threatening condition, but by the end of six weeks in the NICU, Conrad could breathe without a ventilator, though his saliva still had to be suctioned regularly to prevent him from aspirating. He received a surgical procedure so that he could be fed through a tube into his abdomen.

“A lot of the basic research out there was pretty grim,” Emma says. “It was a lot to take in all at once."

Before bringing him home, Conrad’s parents had to know how to suction him and how to use a pulse oximeter. They learned how to vacate air bubbles from syringes and how to administer his medications. They began to master the physics of enteral tube feeds. Even cuddling Conrad, whose body Emma describes as “very much like a rag doll,” required preparation and vigilance.

The Waltons brought Conrad home in May 2013, when he was 2 months old. A nurse stayed with them the first night. As Emma recalls, "We got up the next morning, and we were, like, 'OK, we've got this baby to take care of.'"

 

*Bring In The Preemies*

In August 1963, three months before her husband was assassinated, Jackie Kennedy gave birth to a baby boy. Patrick Bouvier Kennedy was born five and a half weeks premature and weighed 4 pounds 10 ounces. He had lung disease, which is common among premature babies. Patrick was rushed from Cape Cod to Boston Children’s Hospital, where he died at 39 hours old.

Baby Patrick’s death helped to catalyze the then nascent field of neonatology, which has made miraculous strides over the past 50 years. A baby born in Patrick’s condition today has almost a 100% survival rate. Indeed, babies born weeks earlier than Patrick, weighing less than 2 pounds, routinely survive without serious complications. The breakthroughs are so impressive that one such baby, a child named Emalyn, occupied the cover of Time magazine last week, a tiny testament to the wonders of modern medicine.

But what Time failed to note is that the babies and their families are not the only beneficiaries of this progress. It turns out these infinitely vulnerable patients have become cash cows for the hospitals treating them. Indeed, for many hospitals, a steady flow of such patients is critical to the bottom line. The reason is simple: Insurance reimbursements are usually higher for inpatients and for procedure- and technology-intensive medicine. Premature babies check both boxes; from a revenue perspective, they are ideal hospital patients.

Children’s hospitals, which provide a disproportionate amount of care to poor kids on public insurance, can be especially dependent on their NICUs. According to Farzan Bharucha, a consultant with Kurt Salmon, it is “not uncommon for the NICU today to represent 50% or more of a children’s hospital’s total clinical revenue base.” That helps to explain why they routinely dedicate a quarter or more of their beds to NICU care — and bank on keeping them filled. Without these patients, many children’s hospitals would likely have to curtail other vital services or perhaps even close.

There is certainly no shortage of such patients. With nearly 500,000 babies born before 37 weeks of pregnancy annually in the U.S., the preterm birth rate is the highest in the industrialized world, with nearly 1 in 8 babies born early. And, tragically, the rate of prematurity in this country has risen by 30% since 1981.

Premature birth is the leading cause of infant mortality, and preterm babies remain at greater risk for a host of ongoing health problems, from developmental delays to severe disabilities like cerebral palsy and blindness.

Prematurity is a financial burden as well. According to the March of Dimes, babies born before 32 weeks have an average hospital bill of $280,000, about 56 times as much as a healthy full-term baby. A great deal of that money goes toward NICU care. The March of Dimes says prematurity costs U.S. employers more than $12 billion a year in excess health costs.

Those numbers are increasingly having real economic repercussions. In February, AOL CEO Tim Armstrong made headlines when he announced that the company would have to reduce employee benefits on account of two “distressed babies” that cost AOL about $1 million each. Amid the ensuing controversy, he restored the benefits. But the financial tug-of-war won’t go away anytime soon.

If hospitals want to stay in business, they have little choice but to conform to a payment regime that privileges providing certain kinds of care to certain kinds of patients. But when it comes to caring for the most fragile children, these systematic biases can devastate patients and their families.

 

*The NICU Calculus*

U.S. hospitals have become very good at saving preemies; babies born at 27 weeks now survive about 90% of the time. But a system that emphasized prevention over treatment would likely result in better general pediatric health and save billions. 

Spending in the NICU is “a terrible anomaly and it heavily distorts our healthcare system in bizarre and unfortunate ways,” says Dr. Craig Jackson, medical director of neonatology at Seattle Children’s Hospital. “Instead of caring for 500-gram (1.1 pound), 23-week-gestation babies and spending $200,000 on them, we could be spending that money on preventative care, obesity, or pick your favorite topic, and you'll save hundredfold more lives.”

That said, he recognizes that it’s a critical revenue engine. “Our neonatology program is responsible for subsidizing those noninterventional pediatricians that we desperately need and count on,” Jackson says. The proceeds are “used to spread around and make everybody whole as best I can.”

Some experts say there's not enough emphasis on prevention. No one cause triggers prematurity, but it has been correlated to factors including poverty, race (blacks are more likely to be born premature than whites), inadequate time between pregnancies, stress, and smoking or drinking during pregnancy. Still, the March of Dimes believes a number of inexpensive interventions, including smoking-cessation programs and progesterone treatments could have promising results. A 2012 study in the American Journal of Obstetrics and Gynecology found that a model known as centering pregnancy — in which groups of women meet throughout their pregnancy for checkups, education, and mutual support — reduced prematurity and increased birth weights. It showed especially strong results for black women.
 

But as Dr. Peter Smith, a developmental and behavioral pediatrician at the University of Chicago, puts it, “Right now, there is no incentive for the University of Chicago Medical Center, or whatever [hospital] you want to pick, to send people out into the community to actually prevent prematurity.” Indeed, quite the opposite.

One might expect health-insurance companies, which often wind up footing the bill for preterm births, to push for reform. In interviews, several major insurers I spoke with touted their maternal-health efforts, but they declined to comment on their results. It’s simply not a big priority. “Pediatric care is seen as a rounding error,” compared to the costs of adult care, Smith says.

 

*The Crisis In Follow-Up Care*

It can be discomfiting to view saving lives in stark financial terms, but the economics are instructive. Adult hospitals make their real money by seeing a steady stream of patients in need of lucrative surgeries as well as treatment for heart disease and various cancers.

Childhood disease is far more rare, and treating it is nowhere near as predictable a business model. Preemies and other babies with complex medical needs at birth are the closest thing children’s hospitals have to the sort of steady patient flow adult medicine relies on.

Dr. Usha Raj, physician in chief of the children’s hospital at the University of Illinois, Chicago, told me that neonatology is the hospital’s only subspecialty that approaches breaking even.

Between 1997 and 2012 the number of births in the U.S. rose less than 2%, but the NICU bed count expanded by about 60%, according to the American Hospital Association. The growth in beds is owed in part to medical advances that have enabled doctors to save preemies born earlier and treat infants with certain serious conditions. It’s now “fairly common” to resuscitate babies born at 22 weeks, Dr. Jackson of Seattle Children’s says, although fewer than a quarter of babies born that premature survive.

Overall, about two-thirds of babies born before 27 weeks have some kind of disability at age 3. The earlier a baby is born, the more likely they are to require interventions like surgery and dialysis. As impressive as NICU care has become, the babies who do pull through and leave the hospital aren’t necessarily out of the woods healthwise. Many will have immense medical needs for years. Medically complex babies like Conrad, who suffer from incurable conditions, are permanently on the brink of life-threatening emergencies and accumulate exorbitant medical bills. *
*

Unfortunately, the kinds of care NICU “graduates” need tend to be far less profitable to hospitals and doctors and are therefore harder to obtain. After babies leave the NICU, parents can also struggle to obtain coverage for medical equipment, home care, and even prescription drugs.

“Within the hospital world, whenever there’s a tradeoff that’s necessary, the tradeoff is made in favor of the kinds of services that are more profitable because that’s how we’ve organized our healthcare system,” says Dr. John Lantos, a pediatrician and bioethicist at Children’s Mercy Hospital in Kansas City.

Lantos explored this situation in a 2010 essay for the journal Health Affairs about an unspecified medical center where he used to work. (He spent many years at the University of Chicago.) Management wanted to build a new children’s hospital with an expanded NICU, and Lantos lobbied for a NICU follow-up clinic.

The article details a series of bureaucratic scuffles resulting in a new hospital with an expanded NICU but “without a NICU follow-up clinic or any other outpatient clinics.” Lantos writes that the amount of money in question to fund the clinic approximated the cost of keeping a baby in the NICU for a week.

Jackson describes what this dynamic means for kids with severe intellectual disabilities: “There are really no procedures on which to bill if you're a neurodevelopmental specialist,” he says. “And the children tend to take up enormous amounts of clinic time because they're often behaviorally disordered.

“They often need a lot of other specialists like psychologists, audiologists, speech therapists, and orthopedists to manage their tight heel cords,” he adds. “It just goes on and on and on. We tend to lose buckets of money on those kinds of services, and yet are morally obligated, really, to provide them, because those are the most needy children there are. We've actually participated in contributing to the number of [them] through our NICUs.”

From a pure dollars-and-cents perspective, he points out, the system creates an incentive for children’s hospitals to avoid these patients.   

"If you were an unscrupulous medical director or CEO of a hospital, what you might do is say, 'Let's get into the business of doing level three [advanced] NICU care because it's so profitable, but we're going to leave the neurodevelopmental stuff to the children's hospital across town.' Maybe you wouldn't even be unscrupulous. You're just an economically driven person who's responsive to your board. That's exactly what you would do, and that is exactly what is happening in every metropolitan center in the United States."

Smith puts it more bluntly. “We spend literally hundreds of thousands of dollars on this child,” he says. “They leave the hospital and no one cares anymore.”

 

*Caring For Conrad*

A few weeks after bringing Conrad home, the Waltons had 64 hours of home nursing a week, slightly more than half of what the doctor had requested.

At constant risk of aspirating, he needed monitoring at all hours. So when Emma went back to her demanding job in behavioral health, Scott, who was out of work for much of the summer, looked after him during the day. The Waltons had nurses for overnight shifts and two four-hour daytime blocks a week for Scott to look for a job.

“This began several months of partial denials and appeals and many hours of phone calls and advocacy on my part” to secure more paid nursing for Conrad, Emma later wrote in an email. In addition to her job and looking after Conrad, she had to haggle with the private insurer, the nursing agency, and the Medicaid plan.

Taking Conrad in the car required two adults, one to drive and one to watch him. It turned routine diaper runs into scheduled activities.

“It’s incredibly difficult when you have these very fragile kids, to turn your living room into an ICU,” says Dr. Renee Turchi, a Philadelphia pediatrician who works with special-needs children but doesn’t know Conrad. “Having someone you can trust to leave with your child and know your child is going to be OK makes all the difference in the world for some of these families to stay intact.”

“In their partial denial of nursing hours,” Emma wrote, the Medicaid program “indicated that skilled nursing was not needed because a trained caregiver or parent was available to care for Conrad ... I was often asked who else was trained on Conrad's care and was strongly encouraged to train someone,” such as a relative, who would watch him free.

The Waltons’ private insurer couldn’t comment on Conrad’s case but said its plans generally limit home nursing to 16 hours a week.

In August, the Waltons had an appeal hearing to discuss the amount of nursing they needed. The appeal was rejected. Immediately after, Conrad got sick and had to be helicoptered to Pittsburgh. Tests came back positive for both bacterial and viral pneumonia, and the Waltons decided to let the doctors give Conrad a tracheostomy and put him on a ventilator full-time.

A tiny silver lining: Going on the ventilator made him eligible for more nursing.

 

*A Booming Industry*

The Children’s Hospital of Pittsburgh, which has repeatedly saved Conrad’s life, is a world-class facility. After an impressed economist named Martin Gaynor took a tour, he remarked to Kaiser Health News, “It’s a very awkward question to ask, but at some point one wonders, just how nice does this have to be?”

The U.S. is seeing a children’s-hospital arms race. In 2010, Salesforce.com CEO Marc Benioff and his wife, Lynne, announced a $100 million gift toward the construction of a new UCSF Benioff Children’s Hospital in San Francisco, due to open next year. This April, the couple announced another $100 million gift, and the Oakland Children’s hospital has been renamed for them as well.

Children’s hospitals have also been christened in honor of gifts from Michael Dell (Austin) and embattled hedge-fund billionaire Steven A. Cohen (Long Island, New York). But as a monument to healing children, the $840 million 23-story Ann and Robert H. Lurie Children’s Hospital of Chicago, which opened in 2012, is probably unsurpassed.  

For parents with sick children, these hospitals are the answer to their prayers. Many of the top facilities also offer amenities that wouldn’t seem out of place in a celebrity rehab clinic in Malibu, as well as kid-thrilling touches, like dressing the window washers as Batman and Captain America.

Pittsburgh offers dog therapy, music therapy, and a teen lounge. Patients who need imaging “embark on a safari adventure for Nuclear Medicine, relax at ‘Cozy Camp’ for PET scans, take a trip to outer space for MRI scans, explore the ocean for CT scans, and discover the beach for Radiation Oncology.” Lurie has a full-size fire-truck cab, which weighs almost 2 tons, with lights kids can activate, a steering wheel that turns, and a wheelchair-accessible space in the back. (The horn is mercifully silent.)

But while these temples to healing sick children have donors’ names plastered on every available space, it’s often the NICUs that keep their doors open.

  

*‘No Warning, No Explanation’*

Late in the summer, inspired by the care Conrad had received, Conrad’s father, Scott, began taking classes with an eye toward a nursing career. Between his classes and Emma’s work they had to leave Conrad alone at the hospital in Pittsburgh several nights a week.

“There were lots of questions about where was God in all of this," Emma says. “And why wasn't he answering our prayers, but I really thought we had worked through a lot of that stuff and were very hopeful again."

On a Sunday in late September, Emma later wrote, Scott went to their church to use the internet to do some of his classwork:

“I was kind of distracted with Conrad when he left and only half paid attention when he kissed me goodbye. A couple of hours later he texted me to ask how our ‘Man of Steel’ was doing. I said that he was kind of fussy with teething. Scott told me to give him some Tylenol. Those were the last words that I ever got from my husband. In the wee hours of the morning on September 30, Scott shot himself in the forehead. There was no warning, no explanation. Just a blood-spattered sheet of notebook paper that read ‘I love you Emma and Conrad.’”

Emma asked for two weeks of round-the-clock nursing; she got three days. Not even enough to last until the funeral. It wasn’t for another several months, after she had switched insurance again, that Emma obtained the services she and Conrad needed.

* * *

Since his father died, Conrad has won some hard-fought victories. He survived flu season without having to be hospitalized, for one. “He can smile. He knows me,” Emma wrote in an email. “He is a very content baby and has a happy disposition.”

But in March, after returning from what for him is a routine checkup, the nurse noticed his oxygen levels dropping. He turned blue and Emma pulled over and called 911. An ambulance brought him back to Pittsburgh. A “large plug of mucus and blood” was blocking his airway. After it was suctioned out, he returned to the pediatric intensive care unit (PICU).

On a subsequent hospital visit he received a diagnosis of hydrocephalus, an accumulation of fluid in the brain and had to have surgery. Emma described it as a kind of breakthrough in that it may have relieved some of his discomfort.

Not long after, she said he seemed to be making progress. “Hoping we can stay out of the PICU for a good long while now!”

 

Alex Halperin is a freelance reporter living in Brooklyn. You can follow him on Twitter @alexhalperin.

*Read more of Business Insider's long-form features »*

Join the conversation about this story » Reported by Business Insider 10 hours ago.

WASHINGTON -- As President Barack Obama took to the podium on April 17 to announce that eight million people had signed up for private health coverage through the Affordable Care Act, a sense of finality hit the White House briefing room.

Six and a half months had passed since the start of Obamacare's implementation. A technological crisis had produced a political one. And the experience that followed had been both emotionally draining and professionally vexing. That it ended with the administration exceeding expectations made it seem like the ideal time to stop and take a breath -- and perhaps even celebrate. A few days later, the White House's health care team did just that over drinks and snacks.

But for others inside the administration, the end of the open enrollment period in mid-April provided no break at all. If anything, the race to get Americans health care coverage had just begun.

"Outreach is never over," said Marlon Marshall, the deputy director of the White House office of Public Engagement. "We've always continued."

In practical terms, Marshall, 34, is the White House official most responsible for convincing people without health insurance that coverage under Obamacare is right for them. And between now and mid-November, when open enrollment is set to begin again, there are many more people he is hoping to reach.

Special enrollment remains ongoing and, as with other elements of the health care law, many of those eligible for coverage don't understand all the details. Medicaid and the Children’s Health Insurance Program (CHIP) remain available to everyone eligible throughout the year. But people can also enroll if they've had a "qualifying life event" -- meaning they've gotten married or divorced, had a baby, adopted a child, placed a child up for adoption, moved residences, gained citizenship, left incarceration, graduated from college or lost their health coverage. In most cases, once such an event occurs, a person has a 60-day window to get coverage.

Targeting these individuals is critical for Obamacare's success. And so, as the political world's interest in the law begins to fade from its obsessive-compulsive heights, Marshall remains unflinchingly attentive.

"This is an educational process," he said. "This is a big decision. People want a chance to research their options, have a conversation, talk to their families about it. Why would we just start that process in November, and say, 'Now we're open again, check everything out?' We have all summer to actually get out there and reach out to people and let them know about their options."

The Congressional Budget Office originally estimated that 8 million people would sign up for private insurance plans via the exchanges during the calendar year of 2014, a goal the administration has already hit. But if you want a formal accounting of how many people sign up for insurance during the special enrollment period alone, good luck. Monthly enrollment numbers won't be made available between now and November. Asked why, Marshall would only say that there isn't enough incoming information about who is signing up for plans -- an odd explanation for a self-professed data-driven White House.

But it's widely acknowledged that many people will see their insurance needs change during the special enrollment period, especially given the still-soft economy.

"People's connection to health insurance changes throughout the year, always has, always will," said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. "People are constantly getting detached from or reconnected to health insurance throughout the year."

An analysis in Health Affairs magazine that ran at the end of November noted that "as many people will become newly eligible for Marketplace coverage over the course of 2014 as are currently eligible." In Minnesota, for example, officials say that they have averaged 1,100 new enrollees every day during the special enrollment period -- the same numbers the state saw during open enrollment.

The White House and allied outside groups haven't taken their foot off the gas. The Centers for Medicare and Medicaid Services has launched Connecting Kids to Coverage, a national campaign that aims to boost enrollment in Medicaid and CHIP. A CMS official told The Huffington Post that "a spring wave of targeted outreach" began in May and will continue through August. Currently, CMS is spending $375,000 on digital outreach efforts for the campaign.

That's a small amount of the roughly $14 million outreach budget CMS has. And it doesn't even touch enrollment in private coverage. And so administration officials are using other means to sell Obamacare more broadly. At commencement addresses, for example, they have been keen to mention that graduation counts as a qualifying life event. They've also worked closely with student body presidents to spread the word to graduating students.

New rules have also been instituted to make people in the workforce aware of health care options. One of the changes that will do the most to facilitate coverage, Marshall argued, is that companies will soon have to mention the availability of Obamacare on notices given to workers about COBRA eligibility. Reports already indicate that this change is having an effect.

On the communications front, various efforts have been made to emphasize the availability of financial assistance for people whose income puts them less than 400 percent above the poverty line. This remains one of the least understood elements of the law, Marshall explained, and consequently, the perception that health care is unaffordable is one of the biggest impediments to convincing people to enroll.

The White House has also become convinced that an increase in radio appearances will help sell Obamacare. During open enrollment, administration officials would do interviews with local programs or syndicated shows, often hitting a market 10 to 12 times and advertising enrollment forums. Going forward, Marshall stressed, the medium would continue to be used heavily.

But old tricks need to be updated if you want to reach new audiences. And with a limited ad budget, the White House is looking for "earned media" opportunities too, like the president's appearance on "Between Two Ferns," an online comedy series hosted by Zach Galifianakis. Obama promoted the health care law during the interview, which sparked a wave of press coverage.

"We've got to think of new, creative ways to help get the word out," Marshall added. "From here, we can help do what we can to create earned media. The more we can do up here to help raise awareness, it helps their work on the ground, and vice versa."

To coordinate the on-the-ground component, the administration has been participating in biweekly meetings with health care reform groups. One of them, Enroll America, currently has more than 230 staffers across the country, which is just slightly below the 250 it employed at the end of open enrollment. The group has maintained a robust volunteer presence as well. For a Weekend of Action planned for the end of June, the group has registered more than 1,000 volunteer shifts and scheduled just under 400 events. They had averaged the same number of events during weekends in March with about twice as many volunteers.

There are two reasons Enroll America hasn't wound down more during the special enrollment period, said the group's president, Anne Filipic: to avoid having to train new officials when the next open enrollment period starts, and because it sees ample opportunity to run up the number of insured people in the meantime.

The group is currently operating programs across the country targeting people going through qualifying life events. In Maricopa, Arizona, it is working with probation officers to reach those being released from prison. In western North Carolina, representatives are going to maternity wards in local hospitals, handing out fliers to new mothers. In southern Texas, they are a presence at naturalization ceremonies. And at community colleges nationwide, they have been hosting enrollment fairs.

"We recognized the important role of trusted messengers. People start the process really skeptical… and the way to overcome that is to get someone they trust to talk to them about it," Filipic said. "Probably the most important thing we did is to not sit in D.C. and tell local organizers what was best in their communities."

Perhaps the best reason for continuing outreach efforts during special enrollment period, Filipic argued, is that doing so lays the groundwork for when open enrollment starts again. The predominant lesson learned over this past half-year was that selling insurance is a slog. If you want to close the deal, often it requires a profound amount of education and multiple conversations. So why not start months in advance?

"It's not like we can just have someone do one event and leave, and that's the thing," Marshall said. "We just have to be repetitive." Reported by Huffington Post 10 hours ago.

OLDWICK, N.J.--(BUSINESS WIRE)--U.S. health insurance stocks followed up a fantastic year in 2013 by increasing an additional 3.5% through the first quarter of 2014, according to a new report from A.M. Best. This special report, titled “U.S. Health Insurer Stocks Carry Momentum through First Quarter of 2014,” states that the health index population stocks maintained the strong gains experienced in 2013, when prices rose 41.3% year over year, despite the volatility experienced thus far in 2014. Reported by Business Wire 9 hours ago.

The American Institutes for Research (AIR) will send experts in health care, health practice and health policy to the AcademyHealth Annual Research Meeting (ARM), being held June 8-10, 2014, at the San Diego Convention Center in San Diego, CA. AIR staff will give presentations on a wide range of health issues, such as how Health Insurance Marketplaces can successfully attract and retain consumers; measuring long term care preferences; and developing an innovative intervention to increase the use of maternity care quality information by consumers.

Washington, D.C. (PRWEB) June 03, 2014

The American Institutes for Research (AIR) will send experts in health care, health practice and health policy to the AcademyHealth Annual Research Meeting (ARM), being held June 8-10, 2014, at the San Diego Convention Center in San Diego, CA. AIR staff will give presentations on a wide range of health issues, such as how Health Insurance Marketplaces can successfully attract and retain consumers; measuring long term care preferences; and developing an innovative intervention to increase the use of maternity care quality information by consumers.

AcademyHealth’s ARM convenes a broad community of health services research professionals seeking to improve health care and promotes interactions across health services research and policy. For the past 30 years, ARM has provided a forum for over 2,400 health services researchers to discuss health policy implications, share research methods and network with other professionals from around the world.

Presentations by AIR health experts include:

Sunday, June 8, 2014·     Developing an Innovative Intervention to Increase the Use of Maternity Care Quality Information by Consumers

Poster Session: A
Time: 2:30 PM - 4:00 PM
AIR Presenter: Kirsten Firminger

Monday June 9, 2014

·     Developing CAHPS for Cancer Care Prototype Survey: Progress and Next Steps

Session Title: Listen: Refinements and New Applications of Patient Experience Measures
Time: 8:00 AM – 9:30 AM
AIR Presenter: Christian T. Evensen

·     Adapting the CAHPS® Child Medicaid Survey for Use in the Health Insurance Marketplaces: Methodological Challenges and Opportunities

Poster Session: B
Time: 9:45 AM - 11:15 AM
AIR Presenter: Coretta Mallery

·     Consumer Understanding of the Health Insurance Marketplaces: Insight into How Marketplaces Can Successfully Attract and Retain Consumers

Poster Session: B
Time: 9:45 AM - 11:15 AM
AIR Presenter: HarmoniJoie Noel

·     Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance

Poster Session: B
Time: 9:45 AM - 11:15 AM
AIR Presenter: Christopher Pugliese

·     Sampling and Analysis Issues Related to the CMS Consumer Experience Surveys for Health Insurance Marketplaces and Qualified Health Plans

Poster Session: B
Time: 9:45 AM - 11:15 AM
AIR Presenter: Christian T. Evensen

Tuesday, June 10

·     Measuring Long Term Care Preferences

Poster Session: C
Time: 7:30 AM - 9:00 AM
AIR Presenter: Jing Guo

·     Supporting Safety Net Providers’ Measurement of Population Health, Patient Experience, and Costs

Poster Session: C
Time: 7:30 AM - 9:00 AM
AIR Presenter: Grace Wang

·     Evaluation of a Public-Private Partnership: Sacramento County’s Respite Partnership Collaborative Innovation Project

Poster Session: C
Time: 7:30 AM - 9:00 AM
AIR Presenter: Grace Wang

·     Consumers’ Early Care Experiences Using Health Insurance Marketplace Qualified Health Plans: Preliminary Findings from California

Late-Breaking Abstract Session: The ACA and Early Performance
Time: 10:45 AM – 12:15 PM
AIR Presenter: Brandy Farrar

For more information about the conference, visit the AcademyHealth website.

About AIR
Established in 1946, with headquarters in Washington, D.C., the American Institutes for Research (AIR) is a nonpartisan, not-for-profit organization that conducts behavioral and social science research and delivers technical assistance both domestically and internationally in the areas of health, education and workforce productivity. For more information, visit http://www.air.org. Reported by PRWeb 9 hours ago.

NDB now offers industry leading HIPAA security audits and assessment services for Covered Entities (CE) and Business Associates (BA) located in Southern California. From San Diego to Los Angeles – and beyond – organizations can now look to the healthcare experts at NDB for all their HIPAA compliance needs.

Los Angeles, CA (PRWEB) June 03, 2014

NDB now offers industry leading HIPAA security audits and assessment services for Covered Entities (CE) and Business Associates (BA) located in Southern California. From San Diego to Los Angeles – and beyond – organizations can now look to the healthcare experts at NDB for all their HIPAA compliance needs. With the passing of the Final Omnibus Ruling in January, 2013, the Health Insurance Portability and Accountability Act now has serious regulatory compliance teeth, those that come with stiff penalties and costly fines. Now’s the time for Southern California businesses to get serious when it comes to ensuring the safety and security of Protected Health Information (PHI), and the proven and trusted HIPAA security specialists at NDB are ready and willing to help.

NDB, with years of regulatory compliance and HIPAA specific expertise, can help put in place all necessary information security and operational specific policies, procedures and processes as mandated by the Health Insurance Portability and Accountability Act. More specifically, NDB can assist in implementing necessary controls and drafting all mandated policy documents for the HIPAA Security Rule and Privacy Rule provisions.

The HPAA security audits and assessment services for Southern California businesses offered by NDB include a comprehensive HIPAA Policy Packet, along with essential security awareness training documentation, forms, checklists, and more. Trust the experts at NDB for HIPAA compliance by calling NDB’s healthcare and cyber security expert Charles Denyer today at 1-800-277-5415, ext. 705, or via email at cdenyer(at)ndbcpa(dot)com. Reported by PRWeb 7 hours ago.

I saw “Obvious Child,” the Jenny Slate-starring comedy written and directed by Gillian Robespierre, at Sundance in January. It hit all the right notes, but the main takeaway — no doubt influenced by the capsule reviews and clicky headlines — was that it was an abortion-themed comedy. It was convenient and put an entire movie in a nice little box, and when A24 bought the film, it created the internet-friendly prospect of a new wave of buzzword headlines upon its summer release.

But I watched the movie again last week, and something struck me: I realized it's less about abortion than it is a movie about a person — a stand-up comic played by Slate — unraveling when she loses her job, gets dumped, and yes, finds out she's pregnant after a one-night stand (with Jake Lacy). With the support of her best friends (Gaby Hoffman and Gabe Liedman), she decides to have an abortion very early on, and the film never wavers from that inevitable end.

So really, the bulk of the movie isn't about the decision, but, as Slate herself told TheWrap, “always about the journey of the individual.”

*Also read: *Sundance: A24 Acquires Jenny Slate Comedy ‘Obvious Child’

Abortion, Robespierre said, “is the easiest thing that journalists have seemed to glom on to.” Which is a shame, she said, because, “we don't necessarily think it's the easiest thing and best way to describe our movie.”

Of course, they're not complaining (especially not with the word “Abortion” at the top of their poster), because mostly, they just want people writing about the film. And thus, the following is Slate and Robespierre's conversation with TheWrap about “Obvious Child.”

*So why did you make that initial short film? I know it was four or five years ago now.*

*Robespierre:* Yeah, it was in 2009. Again we wanted to show the struggle of a funny and sweet and realistic female main character who was both sort of going through post-breakup, navigating those really raw and awful feelings, and we also wanted to depict an abortion in a different way. So we just took those two ideas and slammed them together and Jenny was in it, which was amazing, and Donna was not a stand-up yet, and she was a lot younger, we were all a lot younger. Donna was just a different person, we were different people. And then when it grew into the feature, we were able to explore and expand on her self-sabotaging ways.

*I think the late 20's breakdown is different than the early 20's breakdown.*

*Robespierre:* We put a lot more pressure on ourselves. “Why don't I have it figure out yet? I felt like I was supposed to be completely settled.” And that's not the case. They all lied to us. We love not being in our 20's anymore. It was fun, it was slightly destructive, a lot of good stories came out of it, but I'm really — not that we're fully formed and I don't know that anyone will ever die fully formed — but I think there's something that happens when you turn 30.

*Slate:* You're released from that secret adolescence that no one told you about. I really feel much better now that I'm in my 30's.

*Also read: *NYC's Rooftop Summer Film Festival Lineup Includes Kristen Wiig, Anna Kendrick, Jenny Slate Films

*Robespierre:* I still feel like there's a part of me that's still adolescent.

*Slate:* Well, me too.

*Robespierre:* I'm always going to want ice cream cake.

*Slate:* That's the good part, that's childhood! The shitty turmoil where you're not exactly sure if your self is big or small or a wild animal or a boring sheet of paper, you're just not sure where you fall. You have hints, and when you get a certain taste of yourself, you almost get heartsick to be who you want to be, but you're not there yet and you just don't have everything available to you. You're just waiting to grow.

*Robespierre:* And yet you still have to pay rent and figure out health insurance and seem normal and not rely on things that you didn't think you're supposed to still be relying on, like your parents, emotionally and financially.

Story continues below the trailer*I turned 28 last week and saw the movie “Neighbors,” and it made me nervous because I was siding with the older people.*

*Slate:* I side with Zac Efron's bare chest. His pecs. Whatever studio it was, I was there for a meeting, and there was a big poster of him without his shirt on, and I literally, before someone was like, “Do you like that poster?” just stood in front of that poster going, “What the fuck?” and just staring at his bare chest for so long. Beautiful physique, that gentleman. He looks pretty great, so congrats to him.

*How often, during this press tour and since Sundance, have you gotten asked about women directors and women in comedy?*

*Slate:* It's not the most prevalent.

*Robespierre:* Mostly during our Q&As, when we're in the theater, they have questions about what they just watched. They have questions about what rings true to them, not about women in comedy or me being a female director. Just real questions about how did you get this movie made? How did you make the performances so natural? It's really just filmmaking questions and story questions.

But those questions come from journalists, and I worked at the Directors’ Guild of America for seven years and I sat through a lot of board meetings falling asleep — they pump so much AC in that room so we were all awake somehow at seven in the morning — and the numbers are bad for women directors, for TV shows and feature films.

But I listened to those numbers and I sat in those meetings, but I just didn't let them affect me. We didn't ask for permission to tell this story, and I didn't use anything but what I had in my brain to tell this story. We were trying to be honest and authentic and that's it. That was our only motive.

*Also read: *Anna Kendrick, Orlando Bloom, Jenny Slate, Mike Birbiglia Join Joe Swanberg's New Film (Exclusive)

*Do you think all the conversation on the internet — which rarely involve studio executives commenting — actually translates to changes?*

*Robespierre:* Yeah, I don't know. I think audiences just want a change and a shift in tone, and I think television and movies are making that shift, and we're just excited to be part of it, and a part of a world where these other creators are telling stories they want to tell them.

*Slate:* When Donna, in “Obvious Child,” is in the abortion clinic, and everything is clinical and sterile, I think it's touching for her and I think that it's overwhelming for her, because she's the most human thing that is there while she's lying on that table. And I think that's why she cries a little bit. Have you ever just felt yourself so much that you just cry out of the joy and pain of being an individual with a lot of options? It's that. That sticks out for her. She's the only self in the room, and she's protected and safe by doing something new and pretty scary. It's straightforward, the camera is right on her. No music. It's spare.

*Robespierre:* The emotion isn't spare, you can see a lot in Jenny's performance behind her eyes, just little sparks that she gives, so I think that's where all the feeling comes from. We're just alone with her in that moment.

*Did you shoot the movie in order? Was that one of the last things you shot?*

*Robespierre:* Not in order, but Planned Parenthood was one of the last days we shot. It was one of the most perfect days we had. I feel like the crew and cast and everyone really got together that day and figured it out. Not that the first day is terrible, but the first day is scary because you're getting to know each other, it's the first day of camp, nobody knows each other's names yet and you're embarrassed.

*Slate: *Our dressing rooms were exam rooms. Jake had his own exam room. We had luckily gotten to know each other well enough at that point and I think that really helped the waiting room scene. We had each made a mix for the car, we had an hour drive or so. It felt like we were in the height of camp. Everyone knew how to do their job.

*Was it a difficult day to shoot? A relief? What was it like to be there?*

*Robespierre:* It was great to be there. And useful. We shot the scene in the short in an orthopedic doctors’ office, and the scene was really good in the short, but I think being at a Planned Parenthood, I think you don't need to be a method actor to do acting but I think that it was a combination of us really all being in sync that day, and Jake and Jenny really knowing what they wanted to do with that scene.

*Slate:* I thought a lot about it.

*There is a debate in the movie over whether she should tell Jake about the pregnancy, and that is a conversation that carries over after the movie. And the way she does it, with stand-up, was interesting.*

*Slate:* I think it's individual to each person, and the way that Donna does it is so specific to her that, you know, you could never say that the film is wagging its finger and saying, “This is how you should do it if you're a cool person.” It is specific to Donna. It is so one woman's story, but what we're calling attention to is that there is a process that involves many, many different choices and moving pieces. And this is three different individuals, a man and a woman and another woman tossing them around. And they all have their own opinion and would all do different things.

The post Why Jenny Slate's ‘Obvious Child’ Is Way More Than Just an Abortion Movie appeared first on TheWrap.

*Related stories from TheWrap:*

'Obvious Child's' Gillian Robespierre to Direct Divorce Comedy for OddLot

Sundance Competition Lineup Features Films Starring Kristen Stewart, Aaron Paul, Anne Hathaway Reported by The Wrap 7 hours ago.

Philadelphia, Pa., Jun 3, 2014 / 03:07 pm (CNA/EWTN News).- The Archdiocese of Philadelphia and its affiliated entities filed a lawsuit June 2 challenging federal mandates that require employers to provide or to help provide contraceptive services through their health insurance.

The federal rules force the entities “to violate their religious convictions by either directly supplying, or cooperating in the process to supply, contraceptive services that gravely conflict with Catholic belief,” the archdiocese said Tuesday.

“The court filing disputes the Government's power to order Catholic entities to offer or cooperate in such services.”

The archdiocese and its charitable agencies have filed suit against the Department of Health and Human Services, the Department of Labor, the Department of the Treasury, and their secretaries.

The lawsuit seeks to block enforcement of the 2010 Affordable Care Act’s mandatory contraceptive coverage for employers. The lawsuit says the mandates violate the Religious Freedom Restoration Act and the First Amendment to the U.S. Constitution.

The Department of Health and Human Services mandate requires most U.S. employers to provide insurance coverage for sterilization and contraception, including some drugs that can cause abortions. Many Catholic organizations do not qualify for the narrow exemption from the mandate, despite their religious and moral objections to providing the coverage.

The HHS department mandated the coverage as “preventive care.” Some religious exemptions have been offered, but many Catholic organizations have found them inadequate.

The dioceses of Pittsburgh and Erie secured a temporary injunction against the mandate in November 2013.

The mandate has resulted in over 97 legal cases representing over 300 plaintiffs, the Beckett Fund for Religious Liberty says.

The plaintiffs include many non-Catholic individuals and organizations and both for-profit businesses and non-profit organizations.

The Supreme Court will rule in two cases before the end of June concerning the application of the mandate to for-profit businesses. The cases, involving Hobby Lobby and Conestoga Wood Specialties, focused on statutory protections for religious freedom. Reported by CNA 6 hours ago.

Mississippi Republicans are choosing a Senate nominee today, a special time when people in the only state with the Confederate stars and bars in its flag talk about a "fresh start." Ted Cruz compared efforts to cap campaign contributions to the oppression in "Fahrenheit 451," reminding us of our favorite allegorical novel about expanded background checks for gun buyers, "Animal Farm." And Politico's parent company plans to expand to Belgium. There's definitely a metaphor in the fact that Politico is expanding to a place where people like to dip things in mayonnaise -- we'll let you know when we iron it out. This is HUFFPOST HILL for Tuesday, June 3rd, 2014:

*GOP FINDS SCANDAL THAT'S A MIX OF WILLIE HORTON AND BENGHAZI, ABSOLUTELY OVER THE MOON* - If the party could put two pickle slices on Bergdahl, place him in a bun and sell him to loyal heterosexuals at Chick-fil-A, it totally would. Amanda Terkel and Sam Stein: "As soon as President Barack Obama told the nation Saturday evening that America's only prisoner of war in Afghanistan had been rescued, Republican lawmakers and pundits began criticizing the administration on how it handled the release of Sgt. Bowe Bergdahl. Many lawmakers have been upset that Obama did not give Congress 30 days notice, as required by law. Others are upset that five Taliban detainees who were being held at Guantanamo Bay were released in return, with some conservatives even accusing the administration of negotiating with terrorists. (The government of Qatar actually negotiated the deal.) There are also now questions about Bergdahl himself, and whether he initially deserted his post...*But prior to Bergdahl's release, Republican lawmakers were some of the sergeant's biggest advocates, and repeatedly pressed the administration to do something -- in fact, everything within its power -- to get him returned to the United States.* A May 22 press release from Ayotte's office read, 'As part of ongoing efforts to urge the Department of Defense to do all it can to find Sergeant Bowe Bergdahl and bring him home safely, Senator Ayotte worked successfully to include a provision in the bill that presses Pakistan to fully cooperate in the search for SGT Bergdahl.'" [HuffPost]

John McCain on this same basic deal in February: "I would be inclined to support such a thing depending on a lot of the details."

*CALLS FOR BERGDAHL HEARING GROW* - We can only assume the reason we haven't heard from Peter King on the prisoner exchange is that news of the swap literally made his head explode. Mike McAuliff and Sabrina Siddiqui: "Leading congressional Republicans sharply criticized the Obama administration on Tuesday for not consulting with Congress over the release of Sgt. Bowe Bergdahl in exchange for five Taliban detainees held at Guantanamo. 'The administration has invited serious questions into how this exchange went down and the calculations the White House and relevant agencies made in moving forward without consulting Congress despite assurances it would re-engage with members on both sides of the aisle,' House Speaker John Boehner (R-Ohio) said in a statement. Sen. Saxby Chambliss (R-Ga.), the top Republican on the Senate Intelligence Committee, also slammed the White House and President Barack Obama, saying he was not consulted or informed at all. 'I haven't had a conversation with the White House on this issue in a year and a half, and if that's keeping us in the loop, this administration is more arrogant than I thought they were,' Chambliss told reporters on Capitol Hill, accompanied by Senate Minority Leader Mitch McConnell (R-Ky.), who also said he didn't hear about the deal until the morning it was announced. Chambliss and McConnell said they wanted hearings on the prisoner swap, and Chambliss demanded that the White House declassify the files of the five detainees." [HuffPost]

*DAILY DELANEY DOWNER* - Local government does bidding of businesses, causes hardship for Ohio poor people: "A decision by the state to stagger the dates that food stamps are provided is causing hardships for recipients, according to Jack Frech, executive director of the Athens County Department of Job and Family Services. Until April, Athens County provided food stamps — actually uploaded onto a card similar to a debit card — during the first five days of the month. Now the distribution is spread over a 20-day period. County Commissioner Charlie Adkins raised the issue with Frech at Tuesday’s commissioners’ meeting, saying he’s heard from people for whom it’s caused problems. '*This has been a real hardship for folks*,' Frech told the commissioners, causing transportation problems and gaps in benefits. *Frech said the change was made by the state at the request of the Ohio Grocers Association because having all recipients come to stores at the beginning of each month caused inventory and staffing problems*." [AthensOhioToday.com]

Does somebody keep forwarding you this newsletter? Get your own copy. It's free! Sign up here. Send tips/stories/photos/events/fundraisers/job movement/juicy miscellanea to huffposthill@huffingtonpost.com. Follow us on Twitter - @HuffPostHill

*THAD COCHRAN REALLY DOESN'T DESERVE TO WIN TODAY* - Dude just needs to make like all old rich white Mississippi bros and find the nearest porch to spend the rest of his days in a seersucker suit. Atlantic: "Defeating Cochran, who has been in Washington for 41 years, has emerged as the top priority of the right wing of the Republican Party this year, and it's not hard to see why. Mild-mannered to the point of self-effacement, Cochran seems to have as much fighting spirit as a guppy. He told the Washington Post last week that he would have preferred to retire—'I thought I'd served long enough'—but 'people were saying, what are we going to do without you?' In that interview and others, he has often seemed confused. Asked about the national debt, he wandered off on a tangent about free trade...I followed Cochran from the square to a local diner, Jean's Restaurant, where patrons swiveled away from plastic plates of boiled okra and corn fritters to shake his hand. On the wall were two framed photographs of Chris McDaniel. The restaurant's owner, Diane Trammell, told me McDaniel had visited twice and stayed for an hour each time. 'I don't recall the last time I seen Thad,' she said. She'd always voted for Cochran in the past, but now she wasn't sure. Cochran didn't pose for any pictures during his brief sweep. *As he made his way toward the exit, Cochran held out his hand to me. I had met and interviewed him less than half an hour before. 'Hello, how are you doing?' he said with a kindly smile. 'I'm Thad Cochran.'"* [Atlantic]

*WHITE HOUSE DEFENDS BERGDAHL'S SERVICE* - And they haven't even unveiled the player to be named later, so let's all hold our judgement for now. The Hill: "The White House on Tuesday defended National Security Adviser Susan Rice's assertion that Sgt. Bowe Bergdahl served 'with honor and distinction,' amid questions about whether the recently returned soldier deserted his unit. *'Sgt. Bergdahl put on the uniform of the United States voluntarily and went to war for the United States voluntarily,' White House press secretary Jay Carney told CNN on Tuesday*. 'That takes honor and is a mark of distinction,' he added. Rice has come under fire for the comment, made during an interview with ABC News on Sunday, following new reports that suggest the Pentagon concluded in 2010 that Bergdahl intentionally walked away from his fellow soldiers. The New York Times reported on Tuesday that he left a note in his tent saying he was disillusioned with the U.S. Army and did not support the mission in Afghanistan. Deputy national security adviser Tony Blinken said 'we need to give Sgt. Bergdahl an opportunity to tell his story and tell us what happened' when asked about Rice's comments during an interview Tuesday with MSNBC...The administration officials also insisted that the U.S. obligation to rescue Bergdahl existed whether he had deserted or not. 'We do not allow members of the military being held by the enemy to sit and rot,' Carney said." [The Hill]

*The chairman of the Joint Chiefs weighed in on the deal*: "U.S. Joint Chiefs Chairman Gen. Martin Dempsey responded to some of the criticism about the rescue of Sgt. Bowe Bergdahl, writing on Facebook Tuesday that it was 'likely the last, best opportunity to free him.'... In an interview with the Associated Press, Dempsey added that the Army may pursue an investigation that could lead to desertion charges against Bergdahl." [HuffPost]

*MEET SYLVIA MATHEWS BURWELL, THE (LIKELY) NEXT HHS SECRETARY* - Laura Bassett and Jeff Young: "As President Barack Obama's nominee to lead the Department of Health and Human Services, she could soon be responsible for overseeing a massive and complex bureaucracy still reeling from Obamacare's botched implementation, with many challenges ahead...A mother of two young children and a native of Hinton, West Virginia, Burwell appears to be up to the task. She worked on President Bill Clinton's economic team, held major leadership positions across the public and private sectors, and earned the approval of both Republicans and Democrats in Congress along the way. Her résumé rivals that of any Washington power player. *After working in the Clinton White House, the Harvard graduate became deputy director to then-Office of Management and Budget Director Jack Lew, and after that was chief of staff to Treasury Secretary Robert Rubin. She went on to run global development for the Bill and Melinda Gates Foundation and took over the Walmart Foundation before returning to Washington to oversee OMB*....Key components of HealthCare.gov, the web portal for enrollment in more than 30 states, have yet to be built, and others still require overhauling. Burwell also would be at the center of the next big fight about the cost of health insurance, as prices for exchange plans trickle out over the coming months against a backdrop of the congressional elections, amplifying the attention this still-unpopular program will get." [HuffPost]

*Eric Cantor has the same relationship with immigration reform as Mitch McConnell does with Obamacare*: "House Majority Leader Eric Cantor (R-Va.) has, in recent weeks, highlighted his efforts to block comprehensive immigration reform as he looks to fend off a June 10 primary election challenge. But on Monday, a new mailer touting his tough stance on immigration cited a report that at least one of Cantor's staffers on Capitol Hill has disputed. The mailer plays up Cantor's role in blocking the passage of the Senate's comprehensive immigration reform bill, which his campaign refers to as the 'Obama-Reid plan to give illegal aliens amnesty.' As evidence, it cites an Associated Press article last month about immigration activists 'increasingly focusing their ire at one person: Eric Cantor, the House majority leader.' But Rory Cooper, a spokesman for Cantor's congressional office, previously had taken issue with the same report and implied over Twitter that it was planted by Democratic staffers to make his boss look bad." [HuffPost's Sabrina Siddiqui]

*TED CRUZ EQUATES CAMPAIGN FINANCE REFORM TO 'FARENHEIT 451'* - Because if there's one thing that evokes an anti-intellectual dystopia where robotic dogs troll the streets in search of banned books and old women self-immolate in protest, it's initiatives aimed at curbing contributions to American Crossroads. Mike McAuliff and Paul Blumenthal: "Texas Sen. Ted Cruz (R) criticized the push for a constitutional amendment on regulating campaign cash Tuesday, deriding 'Fahrenheit 451 Democrats' and contending the liberals these days want to ban books and movies*. Democrats are seeking an amendment to override recent Supreme Court decisions that removed certain limits on campaign contributions. An amendment sponsored by Sen. Tom Udall (D-N.M.) would restore some of Congress' power to regulate federal political spending*. But in a debate on the measure before the Senate Judiciary Committee, Cruz slammed the move as an assault on the First Amendment and an about-face by Democrats who used to oppose such ideas. 'This constitutional amendment would change the scope of the First Amendment,' said Cruz, pointing to past opposition to similar measures by liberal stalwarts like the late Sen. Ted Kennedy (D-Mass.) and former Sen. Russ Feingold (D-Wis.), who helped write the last campaign finance law." [HuffPost]

*BECAUSE YOU'VE READ THIS FAR* - Here is history's most baller pomeranian .

*POLITICO'S PARENT COMPANY EXPANDING TO BRUSSELS BECAUSE SURE WHY NOT* - BuzzFeed: "*The parent company of the Washington, D.C. politics website and newspaper Politico is on the verge of expansion to Europe, two sources familiar with the plans said, launching a news organization in Brussels on the same model it recently exported to New York*. The planned move would mark an ambitious step for Allbritton Communications, which publishes Politico and Capital New York, and has been selling the local television stations that were long the center of its business in favor of digital and print initiatives led by Politico co-founder Jim VandeHei, who is now CEO and president of the two publications. Politico’s model — high-velocity reporting; newsletters consumed by lobbyists and other insiders with money to spend; and a lucrative print business driven by the high value of influence in Washington — is in some ways a natural fit for Brussels, home to the European Parliament and European Commission. It will also depend on advertisers’ willingness to spend money to influence officials who often report, ultimately, to decision-makers in London, Paris, Berlin, and other national capitals." [BuzzFeed]

*COMFORT FOOD*

- Falling into open cellar doors is one of our gravest New York City fears, right after "homeless man sitting on your lap on B train." [http://nym.ag/TaB5up]

- If you're rich and in the U.K. you can pay a company to train you in the ways of debonair spies like James Bond and then have said company stage an attack on your estate. [http://bit.ly/1mOzovf]

- A fat cat transposed onto famous works of art. [http://bit.ly/1ueGdel]

- Conan O'Brien starred in a 1980s training video for musical instrument merchants. [http://huff.to/1nLslca]

- College Humor presents the hottest new diet and workout fad: Genetics. [http://bit.ly/1l3hSVK]

- Cats experience addiction, too. [http://bit.ly/1mOCyPR]

- A supercut of people flipping tables in movies -- solid performances by Jesus. [http://bit.ly/1mOFQ5G]

- The "Wet Hot American Summer" edition of hangman. [http://vult.re/1ueJBpH]

*TWITTERAMA*

@jimgeraghty: Do we have any drones over Qatar? Asking for a friend.

@mckaycoppins: I'm old enough to remember when nobody I knew made "I'm old enough to remember" jokes. It was awesome.

@LOLGOP: Even if Bergdahl had done something awful like approving torture or invading the wrong country, we still had an obligation to get him back.

*Got something to add? Send tips/quotes/stories/photos/events/fundraisers/job movement/juicy miscellanea to Eliot Nelson (eliot@huffingtonpost.com), Ryan Grim (ryan@huffingtonpost.com) or Arthur Delaney (arthur@huffingtonpost.com). Follow us on Twitter @HuffPostHill (twitter.com/HuffPostHill). Sign up here: http://huff.to/an2k2e* Reported by Huffington Post 6 hours ago.

*Click here to watch the TEDTalk that inspired this post.*

Glance at one of Liu Bolin's works of art and you might just miss him. Standing camouflaged among backdrops of imperial palaces, newsstands and Communist Party slogans, Liu disappears into whichever scene he chooses to present. But once you spot him, it's hard to focus on anything else.

As a foreigner visiting China in the late 1990s, I only had a chance to glance at the country. Amazed by a nation in obvious growth mode, I was blind to the contradictions that growth posed to society. It wasn't until I later lived as an expat in Beijing and Shanghai that I was able to sift through the noise, and begin to see the hidden injustices and resulting confusion that Liu's art encapsulates.

In 2004, I was working in Shanghai for a US-invested company which operates international standard hospitals across China. This was only a few years after the period Liu references when discussing his "Xia Gang" work. As China transitioned from a planned economy to a market economy, the government dismantled its "Iron Rice Bowl" system which provided cradle-to-grave security. Not only did 21 million people lose their jobs, but they also frequently lost their housing, pension and medical benefits. Patients without health insurance would now need to pay in advance before seeing a doctor - even in emergency cases.

A friend in the medical equipment business was visiting a local Shanghai hospital when a Chinese patient arrived. He had suffered a heart attack and needed emergency surgery. Later, a surgeon emerged from the operating room to discuss the patient's condition with his family. His arteries were blocked in several areas and he would need three stents to have a decent chance of surviving. But the patient lacked health insurance, and his family could only afford the cost of one stent. My friend looked on as the doctor reviewed with the family members the pros and cons of placing the single stent in one spot versus another, and then solicited their immediate decision.

Liu's "Chinese Noodles" and "Plasticizer" speak to the ongoing food safety concerns in China, and highlight the dangers that a 'growth at all costs' system can pose to a country's citizens and consumers. At our hospital, the majority of patients were expats or wealthy Chinese, since foreign-invested hospitals could not participate in the local insurance system. A number of expats adopted Chinese babies, and we often performed the required health exams. Over time we developed a relationship with an orphanage in rural Henan province, providing pro bono surgeries to children with congenital defects and donating infant formula from the US. But despite the formula donations, children at the orphanage were still malnourished and underdeveloped. Upon further investigation, we learned that the children had not received the formula because the orphanage managers had been stealing it to sell on the black market. The managers then cut corners and fed the children local formula that was watered down, stunting their growth, and in some cases, preventing their adoption.

It was Liu's first work, portraying the forced demolishment of his art camp which I found most captivating. Buildings throughout China regularly find themselves spray-painted with the foreboding "chai" or "demolish" character. In some cases the government wants to destroy structures where activities considered 'subversive' occur. In others, local developers or officials profit when homes are razed to build more lucrative developments on the land. And in yet others, old buildings must come down to support the country's modernization and urbanization. But in each case, migrant workers from China's poorest provinces are most often performing the actual labor. Today, an estimated 260 million migrant workers provide China with the cheap labor it needs to build thriving cities. But because of the country's hukou system, which ties public benefits to the place of household registration, China's migrants cannot access education, pension or medical services in their adopted cities.

On our Shanghai hospital's opening day, a group of migrant workers showed up in the Emergency Room. Their colleague had slipped on construction scaffolding and fallen four stories to the ground. They brought him to a couple of local hospitals, but were refused admittance. Without a Shanghai hukou, or resident permit, this worker from Anhui province was not entitled to receive local medical benefits. His family lived back in Anhui, and his colleagues did not have funds to cover the treatment. The workers learned about our hospital and rushed over, thinking that an international hospital might not turn them away. But it was too late. Their colleague was dead on arrival.

For me, Liu's artwork gives face to the migrant worker from Anhui, the cardiac patient in Shanghai and the orphans in Henan - those who have struggled with the contradictions in Chinese society and have remained invisible during China's development process. But these circumstances are not unique to China. As Liu remarks, "any culture has its irreconcilable contradictions." Often we are just too wrapped up in our own societies to see them. Sometimes it takes fading into the background as a quiet observer to bring these contradictions into sharp focus.

We want to know what you think. Join the discussion by posting a comment below or tweeting #TEDWeekends. Interested in blogging for a future edition of TED Weekends? Email us at tedweekends@huffingtonpost.com. Reported by Huffington Post 6 hours ago.

Riverdale Urgent Care informs community on staying healthy during travel season.

Bronx, NY (PRWEB) June 03, 2014

Summer is approaching and it’s time to make the most of it. Whether planning a family vacation, a romantic getaway, or just some time to catch up with friends, Riverdale Urgent Care wants every trip to be a healthy one. Here are some tips to keep in mind during the most popular travel season.

The first thing to remember is to pack a first aid kit. Bandages and Neosporin are good for cuts; for larger injuries, bring tape and gauze. Hydrocortisone cream provides relief for conditions like poison ivy and stinging nettles. Benadryl helps fight allergic reactions and could also be used as a sleep aid. Pack extra prescription meds in case of getting stranded. And don’t forget the sunscreen! For adequate protection, put on a fresh coat every two hours and apply a healthy amount.

Next, travelers should be sure to check their health insurance. Not all medical insurance covers travel abroad. Don’t let a medical emergency add thousands of dollars to travel expenses. Consult with an insurer before leaving, and consider buying a supplemental policy. There are a number of travel medical insurance products that are reasonably priced.

Traveling on a crowded plane can leave travelers exposed to infection from passing germs. While onboard, drink plenty of water, use saline nasal spray and avoid touching the face. If possible, sit at the front of the plane, which tends to have the best ventilation. Finally, pack an alcohol-based hand sanitizer or antibacterial wipes to clean hands, tray tables and armrests.

Don’t let the bedbugs bite! Put clothes into sealable bags, and when arriving at the destination, do a scan for the small bugs, or their blood, on the mattress and furniture. Keep suitcases off the floor and avoid putting clothes on furniture or inside the dresser drawers. Once travelers return home, they should put clothes in the laundry and vacuum their suitcase.

Last but not least, visit Riverdale Urgent Care to discuss travel plans and CDC recommended vaccines for trips. Common vaccines offered include those for yellow fever, tetanus, hepatitis A, hepatitis B and typhoid. Riverdale Urgent Care can administer most commonly used vaccines, including those required for international travel, as well as prescriptions for commonly needed medication like anti-malaria. Please schedule a visit in advance, as some vaccines need to be administered at least two weeks before date of travel.

About the company:
Riverdale Urgent Care is conveniently located at 5665 Riverdale Ave. in the Riverdale section of the Bronx, NY. At Riverdale Urgent Care, each staff member brings in-depth understanding, extensive experience and skills. In addition to treating life’s everyday minor injuries, they offer drug testing, blood testing, vaccines, on site x-ray, EKG, stitches and rapid in house testing for flu, strep throat and mono. They can also perform physicals for DOT commercial drivers, camp, school and employment.

The Riverdale Urgent Care clinic is open 7 days a week - evenings, weekends and holidays, when most doctors’ offices are closed. Appointments are never required - just walk in. The clinic is open 8 a.m. – 8 p.m. Monday – Friday and 8 a.m. – 3 p.m. on weekends. Call (347) 913-4242 today for more information. Reported by PRWeb 5 hours ago.

Moda Health, which grabbed the lion's share of the individual health insurance market in Oregon with its low rates this year, wants to hike premiums for individuals next year. Moda is requesting a 12.1 percent average rate hike.The actual increases will vary between 10.6 percent and 13.7 percent, depending on the plan, said spokesman Jonathan Nicholas. Will the request make Moda less attractive to consumers during the next open enrollment in November? Moda doesn't think so. "We were not surprised… Reported by bizjournals 4 hours ago.

Reporting from Japan for this NY1 series on Japanese nutrition and healthcare, Health Reporter Erin Billups filed the fourth installment on how Japan's much older healthcare system is working for its citizens Reported by NY1 15 minutes ago.

Opponents of the Affordable Care Act (ACA) have tried, unsuccessfully, to derail the historic law. They sought to have the law declared unconstitutional but lost in the Supreme Court. They voted approximately 50 times in the House of Representatives to repeal it, to no avail. And they shut down the government for 16 days in a quixotic attempt to defund it.

And now comes the latest, and most far-fetched, attempt to upend the ACA: Opponents of the law have filed four lawsuits designed to stop families from obtaining the very thing that allows them to afford their health insurance premiums: tax credit subsidies.

If the law's opponents ultimately prevail in this litigation, millions of individuals and families who are currently receiving tax credit subsidies would lose them, and the overwhelming majority would lose their ability to afford health insurance as a result.

The suits challenge a Treasury Department ACA regulation that enables middle- and moderate-income families to receive these tax credit subsidies regardless of which state they live in. But, according to ACA opponents, these tax credit subsidies should be eliminated in the 34 states where the federal government (instead of the state) is running the health insurance marketplaces.

Why? Opponents argue that Congress intended to induce states to run the marketplaces by making the tax credits available only in states that chose to run the marketplaces directly. This argument, conjured up months after the ACA's passage, is clearly contrary to congressional intent.

All five of the committee chairmen who crafted the ACA -- Sens. Baucus and Harkin, as well as Reps. Waxman, Levin, and Miller -- filed court papers indicating that the ACA opponents are trying to flout congressional intent. They said that the opponents' "assertion is inconsistent with the text and history of the statute, and with its fundamental purpose -- to make health insurance affordable for all Americans, wherever they reside."

The opponents' assertion also makes no sense. Why would Congress wish to withhold federal tax credit subsidies in the very marketplaces that are operated by the federal government? That would make the federal government's investment in a marketplace essentially pointless because few uninsured people could afford health insurance.

If Congress had truly intended to induce states to run their own marketplaces by withholding tax credit subsidies from those that did not, it would have clearly and unmistakably communicated that message. Tellingly, in all of the floor debates, committee reports, or other statements there is no evidence that Congress had such intent.

In fact, states were unaware that their decision to have the federal government run their marketplace could hamper their residents' ability to obtain the subsidies that residents in state-run marketplaces would receive. States often made their decisions based on political considerations (such as a governor's or state legislators' views about the ACA) and/or practical factors (such as the fiscal and administrative impacts of running a marketplace).

As a case in point, Virginia, which decided to allow the federal government to run its marketplace, even filed a friend-of-the-court brief indicating it had no inkling that its decision would deprive residents of the subsidies. "There was no suggestion when the ACA was adopted that premium tax credits would be unavailable in states with federally-facilitated [marketplaces]," the state said.

To date, two federal district court judges -- one a Clinton appointee and the other a Reagan appointee -- found that the plaintiffs' claims lacked merit and dismissed the lawsuits. Those decisions are now on appeal, and two other federal district court cases will also move forward. Since judges are not immune to political considerations, we must take these suits seriously.

If these lawsuits succeed, it would cause enormous pain for huge numbers of families across the country, and it would violate Congress' intent when it passed this historic law.

Ronald F. Pollack, a former law school dean, is Executive Director of Families USA, the national organization for healthcare consumers. Reported by Huffington Post 48 minutes ago.

— A huge new paperwork headache for the government could also be jeopardizing coverage for some of the millions of people who just got health insurance under President Barack Obama's law. Reported by detnews.com 15 minutes ago.

SPRINGFIELD, Mass.--(BUSINESS WIRE)--Health New England (HNE), a nonprofit health insurance carrier based in Western Massachusetts, will expand its service network to include all of Worcester County as of July 1, 2014. Reported by Business Wire 14 hours ago.

In trading on Thursday, textiles shares were relative laggards, up on the day by about 0.1%.  Helping drag down the group were shares of PVH Corporation (PVH), down about 6.4% and shares of American Apparel (APP) down about 3.9% on the day. Reported by Forbes.com 12 hours ago.

NDB now offers industry leading HIPAA security audits and assessment services for Covered Entities (CE) and Business Associates (BA) located in Orange County California. Southern California health care organizations can now look to the security experts at NDB for all their HIPAA compliance needs.

Irvine, CA (PRWEB) June 05, 2014

NDB now offers industry leading HIPAA security audits and assessment services for Covered Entities (CE) and Business Associates (BA) located in Orange County California. Southern California health care organizations can now look to the security experts at NDB for all their HIPAA compliance needs. With the passing of the Final Omnibus Ruling in January, 2013, the Health Insurance Portability and Accountability Act now has serious regulatory compliance teeth, those that come with large penalties and costly fines. Now’s the time for Orange County businesses to get serious when it comes to ensuring the safety and security of Protected Health Information (PHI), and the proven and trusted HIPAA security specialists at NDB are ready and willing to help.

NDB, with years of regulatory compliance and HIPAA specific expertise, can help put in place all necessary information security and operational specific policies, procedures and processes as mandated by the Health Insurance Portability and Accountability Act. More specifically, NDB can assist in implementing necessary controls and drafting all mandated policy documents for the HIPAA Security Rule and Privacy Rule provisions.

The HPAA security audits and assessment services for Orange County businesses offered exclusively by NDB include an in-depth HIPAA Policy Packet, along with essential security awareness training documentation, forms, checklists, and more.

Trust the experts at NDB for Orange County HIPAA compliance by calling NDB’s healthcare and cyber security expert Charles Denyer today at 1-800-277-5415, ext. 705, or via email at cdenyer(at)ndbcpa(dot)com. Reported by PRWeb 13 hours ago.

Friday, the Labor Department is expected to report the economy added 213,000 jobs in May. This is in line with the pace so far this year and stronger than in 2013, and the Federal Reserve is likely to follow through with plans to raise interest rates.

The labor market remains slack; however, recent consumer price reports indicate inflation is picking up. The Fed will phase out purchases of Treasury and mortgage-backed securities by the end of this year, and feel considerable pressure to raise short-term interest rates in 2015.

These moves will push up rates for mortgage, auto, and other consumer loans. However, upward pressure on interest rates should not be enough to derail the bull market for U.S. stocks.

The unemployment rate likely will remain close to its current 6.3 percent. Well below the 10 percent recession peak, it largely reflects a lower adult participation rate. Were the same percentage of adults working or looking for work today as before the financial crisis, the unemployment rate would be 10.4 percent.

Baby boomer retirements are not driving down adult participation—32 percent are in the labor force today, as compared to 23 percent 15 years ago. Rising life expectancies, the loss of benefits-defined pensions, and the disappointing performance of most individual investment accounts are all motivating more elderly to work.

Rather, decent employment opportunities for prime working age adults have not kept pace with population growth. The percentage of Americans ages 25 to 54 that have a job is down to 77 percent from 82 percent 15 years ago, despite a larger share of women in paid employment.

Shrinking opportunities, especially in manufacturing and the building trades, have hit men hard. One out of six between the ages of 25 and 54 is without a job, and many of them have few prospects for finding desirable employment.

Nineteen million Americans over 25 are working part-time. More elderly in the workforce supplementing retirement savings, and the structure of government benefits and regulations contribute to this phenomenon. For example, ObamaCare and the Earned Income Tax Credit (EITC) encourage low wage employees to work part-time to avoid losing benefits, and some employers are limiting workers to less than 30 hours per week to avoid tougher health insurance coverage mandates.

The loss of manufacturing and construction jobs and growth in part-time employment reflects a broader shift in the economy to low wage jobs and lower household incomes.

Although the economy has restored all the jobs lost during the financial crisis, businesses in industries paying average wages in the bottom third of all employers have added 1.9 million jobs, about the same number as jobs lost in the top two-thirds. Consequently, since 2007, annual inflation-adjusted median household incomes are down about $5,000.

The root cause of poor jobs creation and falling real incomes is slow economic growth that has bedeviled both the Bush and Obama administrations. Whereas during the Reagan-Clinton era GDP growth averaged 3.4 percent, since 2000 the pace has slowed to 1.7 percent.

After GDP contracted one percent in the first quarter, forecasters’ growth expect it to rise at a 3three percent rate the balance of this year. However growth in the range of 4 to 5 percent would be needed to provide the 350,000 jobs required each month to bring unemployment down to pre-financial crisis levels over 3 years.

Holding back growth are the trade deficits with China and Japan and on oil, which sap demand for domestically produced goods. Those gaps stem from trade agreements that have exposed U.S. manufacturers to less-expensive imports without opening comparable opportunities abroad for more competitive U.S. enterprises, and the U.S. policy of not developing most of its off-shore oil and gas resources. Altering those policies to cut the trade deficit in half could easily add another one percentage point to growth.

Additionally, new business regulations—such as Dodd-Frank and the above mentioned disincentives to work full-time and hire imposed by ObamaCare—higher taxes on entrepreneurs, and now new regulations to reduce carbon-emissions raise business costs, slow investment, and reduce growth.

Balancing growth with other social and environmental goals is always difficult. However, the choices voters and politicians have implemented in this century are profoundly suppressing the number of jobs the economy creates and wage levels.

Additional stimulus from the Fed can’t overcome those constraints and create jobs, and inflation heating up will require it to raise interest rates by mid-2015.

Peter Morici is an economist and business professor at the University of Maryland, national columnist and five-time winner of the MarketWatch best forecaster award. He tweets @pmorici1 Reported by Breitbart 11 hours ago.

By raising its minimum wage to $15, Seattle is leading a long-overdue movement toward a living wage. Most minimum wage workers aren't teenagers these days. They're major breadwinners who need a higher minimum wage in order to keep their families out of poverty.Across America, the ranks of the working poor are growing. While low-paying industries such as retail and food preparation accounted for 22 percent of the jobs lost in the Great Recession, they've generated 44 percent of the jobs added since then, according to a recent report from the National Employment Law Project. Last February, the Congressional Budget Officeestimated that raising the national minimum wage from $7.25 to $10.10 would lift 900,000 people out of poverty.Seattle estimates almost a fourth of its workers now earn below $15 an hour. That translates into about $31,000 a year for a full-time worker. In a high-cost city like Seattle, that's barely enough to support a family.The gains from a higher minimum wage extend beyond those who receive it. More money in the pockets of low-wage workers means more sales, especially in the locales they live in -- which in turn creates faster growth and more jobs. A major reason the current economic recovery is anemic is that so many Americans lack the purchasing power to get the economy moving again.With a higher minimum wage, moreover, we'd all end up paying less for Medicaid, food stamps and other assistance the working poor now need in order to have a minimally decent standard of living.Some worry about job losses accompanying a higher minimum wage. I wouldn't advise any place to raise its minimum wage immediately from the current federal minimum of $7.25 an hour to $15. That would be too big a leap all at once. Employers -- especially small ones -- need time to adapt.But this isn't what Seattle is doing. It's raising its minimum from $9.32 (Washington State's current statewide minimum) to $15 incrementally over several years. Large employers (with over 500 workers) that don't offer employer-sponsored health insurance have three years to comply; those that offer health insurance have four; smaller employers, up to seven. (That may be too long a phase-in.)My guess is Seattle's businesses will adapt without any net loss of employment. Seattle's employers will also have more employees to choose from -- as the $15 minimum attracts into the labor force some people who otherwise haven't been interested. That means they'll end up with workers who are highly reliable and likely to stay longer, resulting in real savings.Research by Michael Reich (no relation) and Arindrajit Dube confirms these results. They examined employment in several hundred pairs of adjacent counties lying on opposite sides of state borders, each with different minimum wages, and found no statistically significant increase in unemployment in the higher-minimum counties, even after four years. (Other researchers who found contrary results failed to control for counties where unemployment was already growing before the minimum wage was increased.) They also found that employee turnover was lower where the minimum was higher.

Not every city or state can meet the bar Seattle has just set. But many can -- and should.
ROBERT B. REICH's film "Inequality for All" is now available on DVD and blu-ray, and on Netflix. Watch the trailer below: Reported by Huffington Post 11 hours ago.

According to data released yesterday by the federal government , due to the Affordable Care Act, 6 million more Americans now have insurance through Medicaid. That's a victory for the law and for the Obama administration, and it's also a victory for our national soul, despite the fact that we still have some distance to go before we reach the goal of universal coverage. I want to elaborate on something I discussed this morning at the Washington Post with regard to these and other numbers: The conservative nightmare of a nation of moochers suckling at government's teat for health insurance has, to a substantial degree, come true.

As you might expect, I have a chart. But first, let's go over a few numbers. With these six million new members, enrollment in Medicaid and CHIP (the Children's Health Insurance Program) is now at 64 million. Add in the 52 million seniors on Medicare and the 9 million veterans in the Veterans Health Administration, and 125 million Americans, or 39 percent of the total population, get their health insurance from the government.

I had a little trouble finding historical enrollment data for veterans, but here's how Medicare and Medicaid have grown over the last three decades (data come from here, here, and here):

In 1985, 21 percent of the American population was enrolled in one of these two programs. By 2000 it was 26 percent, after the Great Recession (which made a lot of people newly eligible for Medicaid) it jumped to 33 percent, and according to projections, by 2020 it'll be 43 percent.

If you harbor the hope that one day we might be able to assemble a single-payer health insurance system, that number makes it seem not so out of reach. Not that going to there from where we are now would by any means be easy, but you could envision some kind of reform that combines Medicare and Medicaid into a single program. Throw in the possibility for people and businesses to buy into that program (a public option, if you will), and it could expand even further.

A chart like that one no doubt fills many conservatives with despair, even if most American still get their health insurance through private companies. As the Republicans' repeated failed attempts to privatize Medicare show, it's almost impossible to get people to go along with a change in their health coverage if they're pleased with what they have. That's why one of progressives' primary health care tasks in coming years should be to make sure Medicaid works as well as it possibly can. Imagine if it was as beloved among its recipients as Medicare is now. Republicans would find their efforts to devolve and slash and undermine it equally fruitless. They might even give up trying. Reported by The American Prospect 11 hours ago.