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Archive for July, 2014

The United States of America?

There is no doubt that we are a country divided. I have blogged for three years about the fact that Americans are seeking compromise from our leaders. We want solutions from Congress. No one ever expected the Supreme Court to be the place where laws get negotiated. But that is where we are today. Who needs Judge Judy when we have Judges Alito and Ginsburg? (Note to Boomers: Remember the days when no one knew the names of Supreme Court Justices because they rose above it all?)  I don’t know if it is the advent of a 24 hour news cycle or our culture’s increasing fascination with celebrities but now the Supreme Court Justices are household names and you can guess the way a ruling is going to go based on gender.

It isn’t just a Blue versus Red divide troubling this country right now. It’s some fundamentalist Christians in the Republican Party versus everyone else. It’s Male versus Female. Wait, am I leaving anyone out? Because that would be un-American. At least it would have been un-American, not too long ago. Remember those days, when we could expect to have our voices represented in the Capitol, when honoring and working out our differences is what made us uniquely American?

I had lunch the other day with someone who has spent a lot of blood, sweat and maybe even tears, lobbying on behalf of Planned Parenthood. We talked about the fact that she is Hindu and believes that life begins at first breath. It really gave me pause. Honestly, it never occurred to me that in this evolving mosaic of nationalities and religion that our country is becoming, a voice like this had been eclipsed so completely. It was just another sign that the religious diversity this country was founded on has been moved to the back burner by a party that voted out Eric Cantor and doesn’t have a voice like my friend’s to speak of.

The news right now is that Obamacare is surely heading back to the Supreme Court. Yesterday, two different courts offered two diametrically opposed rulings on whether the Feds could offer tax credits for subsidies used to purchase health insurance in states that have refused to set up exchanges. I’m all for states’ rights but let’s acknowledge that the rulings could kick us back to Square One. We will once again be a country where some people have access to insurance and others don’t. In this case, it looks like those in Blue states will get it and those in Red states won’t. The question today is can we break the cycle of partisanship and craft compromise going forward as nation? Or should we just agree to disagree and each back into our own corners … or states? Is someone who can’t afford insurance and can’t get a subsidy going to have to move to a state where they can?

If the Republicans have been waiting to use opposition to Obamacare as a rallying cry to reclaim Washington, they need to be aware that Americans are getting tired of all the Sturm und Drang or High Court High Drama. There is movement on both sides towards universal access, empowering small businesses to pool together to increase their purchasing power and even talk of Medicaid expansion among some Republicans. So, why didn’t these issues get legislated in the four years since the Supreme Court ruled Obamacare is legal? Why is it up to the Supreme Court to pick through the legislation piecemeal and decide what the law will eventually look like? It isn’t. I am concerned, even a little disgusted, at all the money and time tied up in the fight when both sides seemed to have acknowledged the time for health care reform has arrived. It actually arrived four years ago.



Missouri and the Obamacare Rulings

Differing Court Rulings On Obamacare Mean One Thing: Nothing Changes For Now


On Tuesday, two federal appeals courts issued conflicting decisions that could have major ramifications for the future of the Affordable Care Act.

The controversy hinges on whether people in the 36 states that opted NOT to set up their own health insurance exchanges can qualify for subsidies (really, tax credits) on their health insurance premiums. Missouri and Illinois are among those 36 that don’t have state-run exchanges.
Will people from Missouri and Illinois who bought health insurance on the federal exchange lose their subsidies?
Credit (via Flickr/Jennifer Boriss)
The St. Louis Post-Dispatch reported that “85 percent of Missourians and 77 percent of Illinoisans who bought a plan on the exchange received some level of financial assistance for those plans.”

But the bottom line is that no one in Missouri or Illinois who bought insurance through the federal marketplace is going to lose their subsidies any time soon.

Here’s a little more background on what happened and what it means.

For the first time, a court ruled that that only people in states that set up their own health insurance exchanges can get subsidies. That decision came from a three-judge panel of the U.S. Court of Appeals for the District of Columbia.

As NPR’s Nina Totenberg explained, the decision was based on a “glitch” in the law that applies to the 36 states that don’t have their own health-care exchanges:

The problem — the glitch, as it were — is in one subsection of the Affordable Care Act. It says that subsidies can be paid to low-income insurance buyers, but mentions only exchanges “established by the states” — not those run by the federal government.

Two hours later, a federal appeals court in Richmond, Virginia reached the opposite conclusion to that of the D.C. court.

The Obama administration plans to ask the full D.C. court of appeals to review the case, while opponents of the Affordable Care Act who lost in Virginia plan to appeal to the U.S. Supreme Court.

Totenberg pointed out that ordinarily, when two circuit courts come to opposite conclusions, the situation is ripe for the Supreme Court to take it up. However, “if the D.C. Circuit undertakes a review by the full court — and most expect it will — the decision that was issued Tuesday by the three-judge panel will be voided immediately.”

Kaiser Health News’ Julie Rovner explained that the Obama administration is confident the D.C. Circuit decision will be overturned. Rovner quotes White House spokesman Josh Earnest:

“You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace,”

Jonathan Adler, the Case Western Reserve University law professor who helped craft the case that went before the Washington court, disagrees.

“The heart of the decision today is a reaffirmation of the principle that the law is what Congress enacts, not what Congress wanted to enact or what some, with the benefit of hindsight, wish Congress had done differently,” he said.

An article by Sarah Kliff on looked at the different rationale of the two courts. Kliff writes that both courts looked at the vague language in the ACA — the “glitch” — and came to different conclusions.

“The fact is that the legislative record provides little indication one way or the other of congressional intent,” Judge Thomas Griffith writes, going on to say the only appropriate course of action is to rely on the “statutory text” (that’s Section 1401), which omits any mention of the federal marketplace.

The Fourth Circuit, which came to the opposite conclusion, found that the intent was unclear — and in the case of ambiguity, defers to how a federal agency interprets the statute.”

As a side note, Kliff also wrote an article several months ago in the Washington Post that predicted that American territories would play a huge role in decisions related to Obamacare. It seems that when Congress had to decide how people in the territories would be treated under ACA, it made the rules different in Guam. The people in Guam are denied subsidies.

In a follow-up post today, Kliff explained that one of the judges in the D.C. court opinion used this exception to prove his case.

The argument here is that, if the Obama administration created (and defended) a law that was a disaster for the territories — one that denied tax credits in the territories, while requiring everybody to get coverage — why would it be unthinkable to have a similar situation in the states?

The New York Times wrote that that the plaintiffs who brought the case before the D.C. court are primarily disgruntled over the requirement to buy insurance, even though subsidies reduce the cost. One of the plaintiffs, David Klemencic, told the Times: “If I have to start paying out for health insurance, it will put me out of business. As Americans, we should be able to make our own decisions in matters like this.”

But no matter how the issue plays out in the courts, nothing is likely to be decided until sometime next year, at the earliest.

And in the meantime, your subsidies are safe.


Blue v. Red Obamacare? / NYT

Two Americas on Health Care, and Danger of Further Division
JULY 23, 2014 Margot Sanger-Katz

For decades, the United States has had a fragmented health policy. States called the shots on major elements of how health care and health insurance were financed and regulated. The result: a hodgepodge of coverage and a wide variance in health.

The Affordable Care Act was designed to help standardize important parts of that system, by imposing some common rules across the entire country and by providing federal financing to help residents in all states afford insurance coverage. But a series of court rulings on the law could make the differences among the states bigger than ever.

The law was designed to pump federal dollars into poorer states, where lots of residents were uninsured. Many tended to be Republican-leaning. But the court rulings, if upheld, could leave only the richer, Democratic states with the federal dollars and broad insurance coverage. States that opted out of optional portions of the law could see little improvement in coverage and even economic damage.

“It will be essentially health reform for blue states,” said John Holahan, a health policy fellow at the Urban Institute, a research group.

Source: Urban Institute’s Health Reform Monitoring Survey

On Tuesday, the United States Court of Appeals for the District of Columbia Circuit ruled that the law didn’t allow the federal government to offer financial assistance to people buying insurance in states not running their own insurance marketplaces. That ruling is a long way from final — a second federal court, considering the same issue, ruled to leave the subsidies untouched. If the Washington court’s logic was endorsed by the Supreme Court, it could mean that millions of residents in 36 states would lose access to insurance through the A.C.A.

But even if the current cases fizzle, as some legal analysts expect, there is an existing red-state-blue-state fissure in insurance expansion under the Affordable Care Act.

Two years ago, the Supreme Court ruled that another key provision of the law, one that expanded the Medicaid insurance program to all low-income Americans around the country, would be optional for states. Now that the expansion is underway, existing disparities in rates of insurance have widened among the states. About half the states decided not to expand Medicaid. Recent surveys show that those states that did expand it have significantly reduced their uninsured population. An Urban Institute survey found that the uninsurance rate among adults under 65 had declined by 6.1 percentage points in states that expanded, compared with only 1.7 percentage points in those that didn’t.

With the Medicaid decision and the D.C. Circuit decision, “it really turns what was a national reform plan into a state-by-state reform,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a health care research group. “It gives enormous power to states to decide whether major pieces of the Affordable Care Act go forward.”

There are 24 states that have not expanded Medicaid and that don’t have state insurance exchanges. Fifteen states with state exchanges have expanded Medicaid. The remaining states are participating in one Obamacare program, but not the other.

Continue reading the main storyContinue reading the main storyContinue reading the main story
The Medicaid expansion applied to families earning less than 135 percent of the federal poverty level, or about $16,000 a year for a single person. The insurance subsidies at the heart of the recent case apply to middle-income people who earn more — up to 400 percent of the federal poverty level. The vast majority of people who bought Obamacare health insurance this year qualified for some level of subsidy, including an average of 87 percent of the people who signed up in the 36 states without their own marketplaces, according to an analysis from the health care industry consultants at Avalere Health.

Estimates from Kaiser suggest that most of the five million people who got subsidies in those states this year earned between twice and triple the poverty level, meaning they tend to be working families without access to employer coverage. These people probably could not easily afford the full price of an insurance policy. The Avalere analysis found that tax credits for the people who have already signed up for marketplace health plans paid for more than three-quarters of the cost of their premiums, on average.

Of course, many more people are expected to sign up for health insurance in the years ahead if the law proceeds unmodified. Kaiser estimates a total of nearly 13 million people who are legally eligible for subsidized insurance in the 36 states.

The elimination of subsidies would leave a group of states where residents “would remain without many of the benefits of the Affordable Care Act,” said Elizabeth Carpenter, a director at Avalere who wrote the report.

The loss of the subsidies could set in motion a cascade of consequences for those states. Obamacare requires people to obtain insurance if they can afford it, and fewer people will be subject to that requirement if the subsidies disappear. Taking away both the encouragement of subsidies and the penalties for remaining uninsured will most likely mean that only the sickest and most motivated people will keep buying insurance in those marketplaces. That, in turn, could drive up the cost of insurance and prompt insurers to stop selling their products there, making access to insurance even more difficult.

And the loss of insurance subsidies may also spell trouble for health care providers and the communities they serve. The Affordable Care Act paid for its generous subsidies in part by reducing payments it makes to hospitals. Hospitals took the deal because they calculated that all the new customers with insurance would help make up for the losses. The reduction in insured customers could mean big hits to those hospitals, many of which are major employers in their communities. The states in this category include some of the poorest in the nation.



Spicy Marinated Tomatoes

From Cooking Light:


4 cups halved red, yellow, or orange cherry tomatoes
1/3 cup thinly sliced green onions (about 4)
4 garlic cloves, minced
1 jalapeño pepper, thinly sliced
1/3 cup white balsamic vinegar
1 tablespoon light brown sugar
1 tablespoon extravirgin olive oil
2 teaspoons minced peeled fresh ginger
1 teaspoon ground cumin
1/2 teaspoon salt
1/2 teaspoon freshly ground black pepper

Combine first 4 ingredients in a large bowl. Combine vinegar and remaining ingredients in a small bowl; stir until blended. Pour vinegar mixture over tomato mixture, tossing to coat. Chill 1 hour.
MyRecipes is working with Let’s Move!, the Partnership for a Healthier America, and USDA’s MyPlate to give anyone looking for healthier options access to a trove of recipes that will help them create healthy, tasty plates. For more information about creating a healthy plate, visit

Joanne Weir, Cooking Light
JUNE 2006

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Teen Solo World Flight

County Executive Candidates Fight for Women’s Vote


The nasty contest for St. Louis County executive got even nastier today when incumbent Democrat Charlie Dooley launched a new TV ad that attacks rival Steve Stenger for a client he represented 14 years ago as a court-ordered attorney in a prostitution case.

“Steve Stenger represented a prostitution kingpin who sold women into slavery, some as young as 13,” the ad declares. “Stenger blamed the victims, saying it was ‘a lifestyle they chose.’ Why would we choose Stenger?”
County Executive Charlie Dooley launched a negative TV ad against County Councilman Steve Stenger, assuming him of defending a prostitution kingpin.
Credit Wikipedia
Dooley’s spokeswoman Linda Goldstein said the ad illustrates that Stenger “doesn’t support women.”

“I’m very worried that if Steve Stenger got elected, he would have this attitude toward women,’’ said Goldstein at a news conference at Dooley’s campaign headquarters. Dooley did not attend because of a scheduling conflict, his staff said.

Stenger replied that the ad is “character assassination’’ and misrepresents his role in the court case. Stenger said the ad also takes his comments in court “out of context.”

“I think this ad rises to the level of defamation,’’ Stenger said, adding that it cannot be compared with his own ads that attack Dooley’s administration and record.

“I believe Mr. Dooley feels he’s losing this election and he’s taking a wild swing with this ad,” said Stenger at a news conference in his law office.

Stenger also took note of Dooley’s absence at his own campaign news conference. “Mr. Dooley did not have the courage to go forward to speak for himself about his despicable ad,” Stenger said.

Like the Dooley camp, Stenger appeared to be aiming his comments at women voters. He was joined by former U.S. Sen. Jean Carnahan, who lives in Clayton. She chastised the Dooley campaign for launching such an attack and defended Stenger’s record on women’s issues.
Charlie Dooley
Credit Jason Rosenbaum, St. Louis Public Radio
Stenger and Dooley have both been endorsed by the St. Louis political arm of Planned Parenthood, and Dooley’s spokeswoman made clear their side is disturbed by the dual support.

“We were astonished,’’ Goldstein said.

Goldstein said that Dooley had a stronger record opposing sex trafficking. Stenger disagreed, citing his own actions against such activities.

In any case, Goldstein said that Dooley’s ad was, in part, to counter Stenger’s attack ads – especially one that features women who accuse the Dooley administration of turning them away from domestic-violence services.

“Stenger is grandstanding, he is pandering to the female vote,’’ Goldstein said. (One of Dooley’s earliest ads, which featured the voice of his daughter, appears to be directed particularly to women because of its emphasis on health care and access to mammograms.)

Stenger’s campaign said Dooley’s attack ad also appeared aimed at women, who are expected to cast a majority of the votes in the Aug. 5 Democratic primary.

The 2000 prostitution case

Regarding the prostitution court case, Stenger said he was among a number of area lawyers assigned by the court to represent the defendants because they couldn’t afford their own lawyers.
Steve Stenger
Credit Jason Rosenbaum, St. Louis Public Radio (file photo)
“I was ordered by a court to represent an individual named Monroe Evans. He was an individual that participated in an international pimping ring,” Stenger said. “The individual that I represented was an individual who was very unsavory. A person that I would no way condone any of his activities, in any way shape or form.”

Jake Zimmerman, a former state legislator who now is St. Louis County’s elected assessor, was another lawyer assigned to the defense, said Stenger. Zimmerman has endorsed Dooley.

Goldstein said that Zimmerman’s participation was different because he had not been publicly quoted making the comments that Stenger made on behalf of his client.

Zimmerman replied in a statement, “I played a minor role in writing an appellate brief for one of the defendants, well after trial. Like Steve, my law firm was appointed by the court and had no choice about whether to take the case.” But Zimmerman said that he disagreed with some of Stenger’s apparent comments during the trial.

TAGS: Charlie Dooley Steve Stenger
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Outside Consultants to Review Sexual Assault Practice

Outside Consultant Will Review UM Sexual Assault Policies


The University of Missouri system announced Wednesday it is hiring an outside consultant to review the school’s policies and materials concerning sexual assault and mental health services.

The move is the latest action in response to the highly publicized case of Sasha Menu Courey, a student at the Columbia campus who committed suicide in 2011. After her death, information emerged that she had said she was sexually assaulted more than a year before, possibly by one or more members of the Mizzou football team.

University President Tim Wolfe, who last week issued an executive order strengthening the system’s Title IX reporting procedures, said that the hiring of the National Center for Higher Education Risk Management would provide important third-party assessment of the procedures and policies on the university’s four campuses.

Tim Wolfe
Credit University of Missouri website
Wolfe said in a statement that the center’s “credible, independent analysis of our current resources will help us to improve in the way we serve people on our four campuses in terms of sexual assault prevention, reporting and education, and mental-health service delivery.”

The university said the center currently represents 35 college and universities as outside counsel and provides consulting services to more than 3,000 clients. Its president and CEO, Brett A. Sokolow, said he hoped to help the university system and its campuses “become exemplars not just of compliance, but of excellence, in the face of this challenge.”

He added: “Every college and university in the country is facing challenges with prevention and response to campus sexual violence.”

A university spokesman said the center’s work would begin immediately and it is scheduled to submit a written report on May 5. It will be paid $40,000, with the funds coming from the system’s budget as part of a commitment Wolfe has made to improve safety on campus.

Police in Columbia are continuing an investigation into Courey’s case.

Law firm’s report

Besides the hiring of the consultant and the executive order, Wolfe also directed the university’s campuses to review resources available in sexual assault cases. And the Board of Curators hired the St. Louis law firm of Dowd Bennett to look into the university’s handling of the Courey case.

Its report, presented to the university’s Board of Curators last week, found that the school “did not have policies in place for its employees addressing how university employees should handle information of a possible sexual assault upon a university student and what procedures should be followed by the university to investigate and ensure compliance with Title IX once the university receives notice of such allegations.”

The report, based on interviews conducted by the firm, said that the language of Title IX and its corresponding regulations do not deal directly with sexual assault. In its investigation of the handling of the case, the law firm said, “because of the uniqueness of these particular facts, and because of the lack of specificity, clarity and precision within the actual statute and regulations as would be applied to these facts, it would be fairly easy to craft reasonable arguments that the university’s actions did not ‘violate the law.’ However, we do not believe such legal debate is worthwhile for the purposes of advising the board.”

The report concluded:

‘Therefore, while we do not conclude that the university ‘violated the law,’ we do conclude with certainty that the university, as set out above, acted inconsistently with the Department of Education’s guidance about the requirements of Title IX and did not act in accordance with what would be expected of a university with a robust Title IX compliance program.”

Reaction to the report has come from a variety of sources.

On, a website dedicated to Courey, a statement posted this week by her “family and friends” were “pleased with the results of the independent investigation.”

The site noted that “Wolfe contacted Sasha’s parents personally, to offer his deepest sympathy and confirmed that they will be taking action to strengthen the university’s policies to ensure students are safe on campus. We are hoping the transformation in their support system will make a difference and become a model for other universities.”

The posting also said that the findings of the investigation could be put to positive use.

“Our daughter Sasha went through a perfect storm of unfortunate events that led to her suicide. Although we cannot change the past, we hope that the lessons learned from the investigation will lead to positive changes for future athletes and students. We hope to see a transformation of the processes that colleges and universities have in place to deal with students struggling with mental health issues and sexual assaults, whether they are athletes or not. This will never bring Sasha back, but we are hoping the changes will prevent another situation like this from occurring again…..

“To transform this tragedy into a message of hope, our efforts today continue to be on mental health awareness. Whether a rape victim, someone born with a disorder, or just going through a tough time, one in four will need mental health support at some point in their life. It is time that support is available when it is needed, without having to languish on a waiting list.”

Also responding to the report this week was Mizzou Chancellor R. Bowen Loftin, who became head of the campus earlier this year and was not in Columbia at the time of the events involving Courey.

“I accept the findings,” Loftin said in a statement, “and acknowledge that we have a responsibility as a university to ensure that we are stronger in the future.”
R. Bowen Loftin
Credit University of Missouri-Columbia website
He noted that Athletic Director Mike Alden has created a panel to look into how his department handles “student incidents and concerns.” The task force includes an independent prosecutor, the Mizzou campus sexual assault coordinator and the associate dean of the law school.

Loftin added:

“Not unlike our peer institutions around the country, we must continue to examine our policies as they relate to alcohol and our enforcement of those policies. Missouri is not immune to the damaging consequences when alcohol and our young people mix.”

On a personal note, Loftin said, “I am the chancellor, but I am also a professor, a husband, a father of two and a grandfather of three. I take my responsibilities in all of my roles with the utmost seriousness, and I am committed to ensuring that we are a stronger community moving forward. We owe it to Sasha, her family and to all those entrusted to us.”

U.S. Sen. Claire McCaskill, D-Mo., noting that she is a former sex crimes prosecutor, announced what she called an “unprecedented congressional survey” of 350 colleges and universities to learn how sexual assaults are reported and handled on their campuses.

“This survey will give us an unprecedented look into exactly how our colleges and universities act — or sometimes, fail to act — to protect students, and bring perpetrators to justice,” she said in a statement.
Claire McCaskill
Credit (UPI file photo)
“Just like the challenges we grappled with in confronting sexual assaults in our military, we need to ensure we have a firm grasp on the policies in place, and the reality on the ground, to inform any specific solutions. This survey is an important part of that effort.”

A draft of the survey includes questions about how many investigations of sexual harassment and sexual assault schools have conducted in the past four years. It also seeks information on whether students know how to file a Title IX complaint and whether schools try to determine the climate on campus regarding issues involving sexual assault.

Other questions ask about staff and faculty training in the area of sexual assault, reporting procedures and statistics for cases such as the use of “date rape” drugs.

McCaskill will be at Saint Louis University Thursday to take part in a training session on campus-based sexual assault policies and Title IX training.

TAGS: education University of Missouri Tim Wolfe Sasha Menu Courey sexual assault

A Teachable Moment

Folks, this is a teachable moment!

This is the moment Planned Parenthood has been waiting for. The answer to the inexplicable sacrifice Title X funds get every time a race starts to narrow and a moderate needs to appease the far right.

I am wondering if Gloria Borga of CNN is right and whether it will wind up that Congress steps in to provide supplemental coverage.

In an ideal world, the government wouldn’t be involved in sex ed, abortion services or birth control, at all. But our world is less than ideal, especially if you are a poor woman who doesn’t have a job or health insurance or who works for a small, privately held company whose bosses don’t cover it, because of their religious beliefs.

What perfect timing for Planned Parenthood to say, “If it is unfair to add a contraception mandate to a mandate a lot of family owned business already didn’t like (Obamacare), then someone needs to recognize how unfairly Title X has been treated all these years.”

I’ve been blogging for a few years in hopes of opening up new ways of thinking around the Republicans and politics in general. A swing voter or an Independent Republican, I’ve advocated just going purple and electing the best people, regardless of whether they identify blue or red.

Last weekend, I was one of three people in a car heading to a Republican political event in Columbia, Missouri . Two of us were scrambling to help the driver with directions by looking them up on our phones. We both had the same address but my Mapquest was telling me to turn left; his app was telling him to turn right. I laughed because that pretty much summed up the conversation we had been having on the car ride down about the direction of the Republican Party.

But now, the Supreme Court, which used to be above party politics, represents not only that intractable ideological divide between the Republican and Democratic parties but also the gender divide. OMG. Yes, I know that OMG is a bad pun. But, maybe it’s time for the justices, once charged with rising above the political rancor, to cast off the black robes and just wear the red and/or blue.

The male justices were right that you can’t violate religious freedom. And the female justices were right that many women will need access to the contraceptive methods at the heart of the case, sometimes for reasons other than birth control.

In an ideal world, no one gets their rights infringed on. But no one knows better that life is less than ideal than Planned Parenthood. They’ve always been there to fill the gaps in contraception. To fill the gaps in education. To fill the gaps in income and access. To fill the gaps between what people wish would happen and what did.