Cartoon- Decision Making Today
Category Archives: Uncategorized
Cartoon – Head of Decisive Action
Harvey pounded the nation’s chemical epicenter. What’s in the foul-smelling floodwater left behind?
http://www.latimes.com/nation/nationnow/la-na-houston-chemical-plant-20170831-story.html
The pounding rains of Hurricane Harvey washed over the conduits, cooling towers, ethylene crackers and other esoteric equipment of the nation’s largest complex of chemical plants and petroleum refineries, leaving behind small lakes of brown, foul-smelling water whose contents are a mystery.
Broken tanks, factory fires and ruptured pipes are thought to have released a cocktail of toxic chemicals into the waters. Explosions that released thick black smoke were reported at the Arkema Inc. chemical plant, where floods knocked out the electricity, leaving the facility outside Houston without refrigeration needed to protect volatile chemicals.
Meanwhile, emissions into the air have soared as the petrochemical industry shut down and then started up chemical operations, a cycle that causes an uptick in releases.
The potential health problems were magnified by overflowing sewers, inoperative treatment plants and the residues of animal waste, including carcasses.
Nobody is sure how much long-term health impact, if any, will result from the tidal wave of toxins and bacteria that swept through the nation’s fourth largest city.
Exhaustive investigations by the Environmental Protection Agency and the National Academy of Engineering after Hurricane Katrina, in which floodwaters languished in New Orleans for about six weeks, showed that toxic concentrations and the resulting exposures were too low to cause significant long-term health problems.
That festering flood caused a stench for weeks that left soldiers gagging for air as they flew helicopters 2,000 feet over the city. The Army Corps of Engineers had to pump the water out of New Orleans, much of which lies below sea level.
A report by the National Academy of Engineering in March 2006 said the floodwaters contained elevated levels of contaminants. The inorganic compounds were below drinking-water standards, while arsenic levels, attributed in part to lawn fertilizer, were above those standards.
The EPA took 1,800 samples of residue and soil from across the New Orleans area after Hurricanes Katrina and Rita and found that generally “the sediments left behind by the flooding from the hurricanes are not expected to cause adverse health impacts to individuals returning to New Orleans.”
The situation is far different in Houston, where the floodwaters are receding much faster.
But because Houston is far more industrialized, Harvey could have a much larger potential for leaving a toxic trail.
Without question, air emissions rose significantly during and after the storm, said Elena Craft, a toxicologist and senior scientist at the Texas branch of the Environmental Defense Fund.
The industry shutdown and startup cycle released 2 million pounds of pollutants, equal to 40% of all the emissions from 2016, Craft said, based on reports the industry made to the Texas Commission on Environmental Quality.
“In a few days, we have had months of exposure,” Craft said.
Marathon Oil, for example, reported to the state that heavy rain had pounded the roof of a storage tank so hard that it tilted, exposing gasoline to the air.
The emissions reports also included such carcinogens and suspected carcinogens as benzene and butadiene.
Craft said that sewage treatment plants in Beaumont went off line. A pipe carrying anhydrous hydrogen chloride was compromised in La Porte. Harris County’s 26 federal Superfund toxic waste sites may have been affected, including one that contains dioxins from a former paper mill along the San Jacinto River.
The fire at the Arkema chemical plant in Crosby released organic hydrogen peroxide, which officials said is an irritant but not toxic.
Tommy Newsom, who lives about 7 miles from the plant, said he felt fine but wondered what other chemicals might be involved. “Who knows how much of what they’re telling us is true?” he said.
“I think the wind’s in my favor,” said Newsom, a 60-year-old port worker, pointing to Texas state and U.S. flags at the entrance to his housing development.
Jennifer Sass, a senior scientist with the Natural Resources Defense Council’s health program, said the situation in Houston is a perfect breeding ground for hepatitis and tetanus.
“The flood is so large and slow-moving and the area is packed with dirty industries that are poorly regulated. Because the oil and gas industries down here are not as safe, we are concerned those toxins and chemicals are leaking,” she said.
Texas regulators urged caution. “Floodwaters may contain many hazards, including infectious organisms, intestinal bacteria, and other disease agents,” the Texas Commission on Environmental Quality said in a statement. “Precautions should be taken by anyone involved in cleanup activities or any others who may be exposed to floodwaters.”
The American Chemistry Council said its members are in constant communication with state and federal regulators about the status of their operations.
“Hurricane Harvey has presented extreme and unique challenges for the city of Houston and the surrounding areas in southeast Texas and Louisiana, warranting an unprecedented response effort, including that by local industry,” the trade group said in a statement.
Bipartisan group of governors calls on Congress to shore up elements of Affordable Care Act
A bipartisan group of governors is trying to jump-start efforts to strengthen private insurance under the Affordable Care Act, urging Congress to take prompt steps to stabilize marketplaces created by law while giving states more freedom from its rules.
In a blueprint issued Thursday, the eight governors ask House and Senate leaders of both parties to take several steps to reverse the rising rates and dwindling choices facing many of the 10 million Americans who buy health plans on their own through ACA marketplaces.
Specifically, the state leaders say Congress should devote money for at least two years toward “cost-sharing subsidies” that the 2010 health-care law promises to pay ACA insurers to offset deductibles and other out-of-pocket expenses for lower-income customers. The House sued the Obama administration over the subsidies’ legality, and President Trump has repeatedly suggested that he might halt the payments — sending tremors through insurance companies in the marketplaces.
Five days before the House and Senate return to Washington, the governors also recommend preserving “for now” the ACA’s requirement that most Americans carry health insurance. Though this rule is unpopular, they concluded that it is “for the time being … perhaps the most important incentive for healthy people to enroll in coverage.”
The proposal also calls for a federal fund, to be available for two years, to buffer insurers from high-cost customers, and for the government to foster competition in ACA marketplaces by encouraging insurers to move into counties with only one company. Those that do would have the law’s insurer taxes waived on health plans sold in those locations.
Led by Ohio Gov. John Kasich (R) and Colorado Gov. John Hickenlooper (D), the blueprint essentially fleshes out the contours of four principals that many of the same governors recommended to Senate leaders in June. It focuses on the insurance market for individuals and families that buy coverage on their own — a fraction of the country’s consumers with private insurance but a perennially shaky part of the industry that the ACA was designed to strengthen.
Greg Moody, a longtime health-care aide to Kasich, said the blueprint is also an acknowledgment of the failure this year of Republicans who control Congress to deliver on their years-long goal of replacing the ACA. “We’ve recently seen how difficult that is,” Moody said.
The blueprint envisions a quick federal boost to shore up the marketplace for the coming year, while deferring to states longer term to experiment with potential changes in insurance subsidies, for instance, or different forms of penalties for consumers who drop coverage.
The proposal was released Thursday so that it would attract attention before two days of hearings scheduled next week by the Senate’s health committee, which will explore bipartisan ideas for improving the law and its marketplaces.
The other governors who signed on are Brian Sandoval (R-Nev.), Tom Wolf (D-Pa.), Bill Walker (I-Alaska), Terry McAuliffe (D-Va.), John Bel Edwards (D-La.) and Steve Bullock (D-Mont.).
Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs
Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs
Hurricane Harvey and its torrential aftermath disrupted everything on the Texas and Louisiana coasts — including health care. Patients can expect months of chaos, as their providers scramble just to get back to work and sort out medical records. In addition, the storm may end up killing, injuring and sickening many more people, as toxins such as mold and chemical explosions take their toll.
Even so, Harvey could have been worse, says a panel of experienced health care journalists on the latest Kaiser Health News “What the Health?” podcast. That’s because the medical infrastructure, unlike in many previous national disasters, held up relatively well. Hospitals planned for flooding, to the point that underground tunnels connecting one to another could be sealed off with “submarine doors” to keep the water from invading every facility.
Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times also discuss what impact the relief effort in Washington could have on an already jampacked September agenda. The pressing need for money to rebuild in Texas and Louisiana could complicate and delay other important congressional decisions, including deliberations on stabilizing or changing the Affordable Care Act.
Also this week: an interview with KHN Editor-in-Chief Elisabeth Rosenthal, author of “An American Sickness,” about why medical care costs so much.
Cartoon – This makes me sick
Despite jitters, some health insurers start to prosper
http://www.tampabay.com/news/business/1-inch-1-inch-of-body-type-1-inch-1-inch-of/2335280
It has not been a market for the faint of heart.
Supporters of the Affordable Care Act achieved a major victory this past week when, thanks to cajoling and arm-twisting by state regulators, the last “bare” county in the United States — in rural Ohio — found an insurer willing to sell health coverage through the law’s marketplace there. So despite earlier indications that insurance companies would stop offering coverage under the law in large parts of the country, insurers have now agreed to sell policies everywhere.
But a moment of truth still looms for the industry in the coming weeks under the law known as Obamacare. Companies must set their final plans and premiums by late September, even as the Trump administration continues to threaten to cut off billions of dollars in government subsidies promised by the legislation. Insurers are also awaiting Senate hearings set to start Sept. 6 for a hint of what steps, if any, lawmakers may take to stabilize the market.
With congressional Republicans’ yearslong quest to dismantle the Affordable Care Act dead for now, the fate of the landmark law depends in large part on the health of the insurance marketplaces and the ability of insurers to make a viable business out of selling coverage to individuals. When the law passed seven years ago, insurers saw a potential bonanza: tens of millions of brand-new paying customers, many backed by generous government subsidies and required by the new law to have health coverage. Now, about four years after the law’s marketplaces opened for business, most of the industry’s biggest players have pulled out.
Yet the continuing churn among insurers and the anxiety pervading the industry have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper.
“Outside of the noise,” the surviving companies “are seeing a path forward in this marketplace,” said Deep Banerjee, an analyst with Standard & Poor’s who has examined the financial results of more than two dozen Blue Cross insurers.
“It is still a new market,” he added, “and everyone is adjusting to it.”
The healthier business outlook has been achieved at a big cost to consumers. To stanch their losses, many companies raised their prices substantially for this year while narrowing their networks of providers to hold down costs.
In some cases, companies will seek even higher rates for 2018; the lone insurer left in Iowa is asking for a nearly 60 percent increase, on average.
Among the insurers now making money in the individual market and expanding is Centene, a for-profit company. Some of the Blue Cross insurers, including Health Care Service Corp., which operates plans in multiple states, including Texas and Illinois, and Independence Blue Cross, which has 300,000 customers in Pennsylvania and New Jersey, began to turn a profit in the market this year.
Oscar Health, a venture capital-backed insurance startup, lost roughly $200 million last year but, sensing a more promising future, plans to enter three more states and expand in California and Texas.
Centene made use of its experience, including setting up networks of hospitals and doctors that care for Medicaid patients, to sell coverage. The company now insures about 1.1 million people in the individual market.
“For 2018, we intend to grow this profitable segment of our business,” Michael Neidorff, the company’s chief executive, told investors last month.
Court Strikes Down Overtime Pay Rule
The Department of Labor rule that would have compelled employers to pay overtime to millions of more workers has been struck down by a federal court in Texas.
Agreeing with business groups and the 21 states that had challenged the Obama administration rule, District Judge Amos Mazzant said the pay level in the changed rules was set too high.
What the Labor Department had done was to nearly double the minimum pay — from $455 to $913 a week — for determining what workers were exempt from overtime and what workers were entitled to it.
“This significant increase would essentially make an employee’s duties, functions, or tasks irrelevant if the employee’s salary falls below the new minimum salary level,” Mazzant said in his ruling.
While that was also true of the old salary threshold, the states and business groups that challenged the DOL argued the new pay level was set so high that it would sweep in millions of workers performing managerial, administrative and professional work.
Under the Fair Labor Standards Act, workers regardless of how much they earn must be paid overtime, except if they fall under certain exemptions, which largely define them as managers and white collar workers. But over the years, the DOL has adopted a financial test setting a minimum pay as a way to simplify the classification.
Thus, those making less than $455 a week are automatically to be paid overtime. And under the duties test, even workers earning more than the $455 a week are entitled to overtime unless they are “bona fide executive, administrative, professional (or) outside sales employees.” Some types of computer jobs also are included.
The revised salary threshold was to have gone into effect December 1 last year. But just weeks before the deadline, Judge Mazzant issued an injunction which left the old pay level — first adopted in 2004 — in place. The Labor Department appealed the injunction, then reversed course after the Trump administration took office. That left the injunction in place and freed the district court to rule on the merits.
In his ruling, Mazzant said the DOL can use a salary test, but only in conjunction with a duties test.
Carolinas HealthCare, UNC Health Care reveal intent to merge
Health systems say they are entering negotiations to combine clinical, medical education and research units.
HHS cuts ACA advertising budget by 90%
The Department of Health and Human Services announced today it’s slashing the advertising and promotional budget for the Affordable Care Act for next year. It’s planning to spend $10 million to promote the law in the open enrollment period that starts in November — compared to the $100 million the Obama administration spent last year.
Why they’re doing it: On a conference call with reporters, HHS officials argued that last year’s promotional spending — which was doubled from the year before — was ineffective because signups for new customers actually went down. They also said the $10 million budget is more in line with what Medicare Advantage and Medicare Part D spend to promote their open enrollments.
Why it matters: The Trump administration is making cost-effectiveness a major theme this year, but it’s sure to be accused of undermining ACA enrollment, given all of the Trump administration’s battles to repeal the law — and given that it also cancelled advertising for the final days of last year’s open enrollment.
One more thing: HHS is also planning to cut spending on “navigators,” who are supposed to help people enroll, by tying their funding to their effectiveness in reaching their enrollment goals last year.
HENRY KOTULA 