Breve explicación sobre lo que esta sucediendo en el volcán Poás
Breve explicación sobre lo que esta sucediendo en el volcán Poás
When Tami Haught was diagnosed with HIV, she was one day shy of her 25th birthday. The diagnosis did not come as a shock since doctors had determined her fiancé was dying of AIDS several weeks earlier.
In the two decades since, Haught, 48, has turned to expensive prescription drugs to keep the deadly infection in check. In 2005, she began receiving help purchasing her medications through the AIDS Drug Assistance Program (ADAP), a federally funded network of programs in each state that assist low-income HIV and AIDS patients. Since the Affordable Care Act was implemented, ADAP instead has helped her buy an insurance policy to cover a wide assortment of her health care needs.
Nationally, more than 139,000 clients were served by ADAPs in June 2015, according to the latest report from the National Alliance of State and Territorial AIDS Directors (NASTAD), a coalition of state officials responsible for administering HIV and hepatitis programs. About half of those clients were getting help purchasing insurance through the federal health law’s marketplaces or elsewhere, a switch from the program’s historical role of paying primarily for expensive prescriptions.
Advocates fear Republican plans to overhaul the health law could cause such upheaval in the individual insurance market that the program could not afford to continue the premium assistance and would be forced to turn primarily back to subsidizing medication.
“We are at a pivotal point in HIV where people are talking about the end of the epidemic,” said Ann Lefert, senior director of the prevention and care program and policy at NASTAD. “It’s hard to imagine that, if the health care coverage changes dramatically — it would be hard to get there in the same speed.”
According to the AIDS directors’ report, in June 2015, about 72,000 got help paying for their insurance, including nearly 4,000 who also received assistance to purchase medication. That’s more than twice as many as got insurance help in 2010, when the health law was passed.
Tami Haught, who was infected with HIV 23 years ago, now gets help paying for her insurance through the AIDS Drug Assistance Program. She worries that changes in the health law could cut back that help. (Courtesy of Tami Haught)
To qualify for ADAP assistance, prospective clients must meet standards determined by the state. Individuals must prove their residency and recertify every six months. NASTAD reported more than 70 percent of clients served by ADAP in June 2015 reached viral load suppression, or undetectable levels of HIV in the blood. By comparison, only 3 of 10 people living with HIV in the U.S. reached suppression in 2011, the Centers for Disease Control and Prevention reported.
ADAP is required to choose the most cost-effective way to assist clients. Currently, that option often is financial assistance for purchasing an insurance plan that covers broad health expenses. But before the ACA, when insurance companies could legally exclude customers with preexisting conditions or charge them very high premiums, buying insurance was difficult for HIV patients.
Consequently, the program focused primarily on helping patients buy the pricey drugs they needed. It struggled to meet that demand, however, often using waiting lists to determine which low-income clients could be helped. At its peak, 9,278 individuals waited to access ADAP services, according to NASTAD. The program eventually eliminated the waiting list in 2013.
For many of those low-income patients, it was the only help available, given they weren’t eligible in many states for Medicaid, which generally limited eligibility to children, very-low-income families and people with debilitating conditions.
“Most people had to be disabled in order to get access to Medicaid services, even though the treatments that became available in the 1990s prevented you from being disabled,” said Jeffrey Levi, a health management and policy professor at George Washington University in Washington, D.C.
But the ACA’s provisions — principally, the Medicaid expansion undertaken by 31 states and the District of Columbia; subsidies for low-income people buying plans on the insurance marketplace; and consumer insurance protections —enabled ADAP to spend less on purchasing drugs and use its funds more efficiently to help clients buy coverage. They could use the assistance to pay the portion of premiums not covered by federal tax subsidies and expenses not picked up by their plans, such as deductibles and copayments.
The NASTAD report also found that ADAP paid an average of $1,678 per client for medications in June 2015. In contrast, the program contributed an average $444 to health plans for clients. Some insured clients, however, also received help paying for medication.
While Lefert said she doesn’t anticipate waiting lists returning to ADAP if the health law is partially repealed, other experts worry about how far existing funds can be stretched.
“Now you’re going to have a bunch of people rushing back to the [ADAP] pool with not enough dollars to cover them all,” said Matthew Rose, policy and advocacy manager for the National Minority AIDS Council.
Changes to the health law could interrupt treatment and lead to gaps in care, said Erin Loubier, senior director for health and legal integration and payment innovation at the Whitman-Walker Health clinic in Washington, D.C. And without protections from discrimination based on preexisting conditions, she said, people could shirk screening for fear of losing their jobs or health insurance.
Haught, of Nashua, Iowa, now works as a training coordinator for the SERO Project, an advocacy group fighting against HIV criminalization laws around the nation. Haught said she’s surprised that she’s lived 23 years past her diagnosis, which allowed her to see her son graduate and spend time with her grandson, Chase. Taking her medication is critical.
“I will die if I don’t have access to my medication and treatment, and it’s not pretty,” she said. “I’ve seen it. It’s not an easy death.”
Republican leaders have a lengthy list of talking points about the shortcomings of the health law. Shortly before his inauguration last month, President Donald Trump said that it “is a complete and total disaster. It’s imploding as we sit.” And they can point to a host of issues, including premium increases averaging more than 20 percent this year, a drop in the number of insurers competing on the Affordable Care Act marketplaces and rising consumer discontent with high deductibles and limited doctor networks.
Yet a careful analysis of some of the GOP’s talking points show a much more nuanced situation and suggest that the political fights over the law may have contributed to some of its problems. Here is an annotated guide to four of the most common talking points Republicans have been using.
1. The individual health insurance market is collapsing.
— House Speaker Paul Ryan (R-Wis.), on Meet the Press, Feb. 5, “the law is literally in the middle of a collapse.”
— Senate Majority Leader Mitch McConnell (R-Ky.), on the Senate floor Jan. 9: “Obamacare continues to unravel at every level, leaving Americans to pick up the pieces.”
Republicans are right that the individual market that the Affordable Care Act sought to overhaul is having challenges right now. Many insurance companies left the market at the end of 2016 after losing money, which reduced choices for individuals, and five states have only a single insurer providing coverage in 2017.
But even with these challenges, the health law’s marketplaces, also called exchanges, are providing coverage to more than 10 million Americans. Some analysts say they are far from collapse.
“I have never believed the individual market was in a true death spiral,” said Joe Antos of the conservative American Enterprise Institute. A death spiral is when so many healthy people leave a market that only sick people are left and insurers cannot spread costs.
Insurance markets also vary a lot by state, said John Ayanian, head of the University of Michigan’s Institute for Healthcare Policy and Innovation. “There are a fair number of states where the exchanges are working fairly well, costs are not rising too quickly, and people have a number of choices of health plans,” he said. “There are other states where they have just one choice and prices are going up.”
At the same time, legislation written by Republicans has led to some of the trouble in exchanges. Most directly, Congress limited federal payouts to insurers who encountered higher-than-expected costs in the exchanges. Republicans called the payments “insurance company bailouts,” even though similar federal measures have been used in other markets, such as the Medicare drug plans implemented more than a decade ago.
Still, the result was that the Department of Health and Human Services was able to provide insurers with only 13 percent of the money they were promised under the law in 2015. That shortfall led directly to the implosion of most of the nonprofit co-op health plans, and some private insurers referenced the shortfalls when they pulled out of the marketplaces this year. Yet when House Energy and Commerce Committee Chairman Greg Walden, R-Ore., noted at a Feb. 2 hearing that “only five out of the original 23 insurance co-ops remain. … They tried it, it didn’t work,” he did not mention the loss of the federal payments to cover early losses.
2. Out-of-pocket spending is too high.
— Speaker Ryan, at CNN Town Hall Jan 12: “Deductibles are so high it doesn’t even feel like you’ve got insurance anymore.”
— Senate Majority Leader McConnell (in a CNN op-ed): “It’s raising health care costs by previously unimaginable levels, and it’s hurting the very people it was intended to help.”
Out-of-pocket spending is one of voters’ top concerns when it comes to health care. The January 2017 monthly tracking poll from the Kaiser Family Foundation found 67 percent of those polled said their top health priority is “lowering the amount individuals pay for health care,” followed closely by “lowering the cost of prescription drugs” at 61 percent. (Kaiser Health News is an editorially independent project of the foundation.)
High deductibles — often in the thousands of dollars — have become part of that problem.
People who are most angry about the Affordable Care Act, said Chris Jennings, a health official in the Clinton and Obama administrations, “want deductibles lower and more benefits.”
But Republicans’ most popular proposals for replacing current individual insurance plans — cutting back on required benefits and giving more people access to tax-preferred health savings accounts — would likely increase out-of-pocket spending for those who use health services (although it would be less expensive for people who are healthy all year long).
Letting people buy more bare-bones policies “means insurance doesn’t kick in until people have very significant medical bills,” said Ayanian.
Former Obama administration health official Sherry Glied, on a panel at the National Health Policy Conference in January, asked if having a $10,000 or $20,000 deductible (as some proposals would allow) with perhaps $1,000 in a health savings account “is better than having no coverage at all? Lots of people would go bankrupt at $20,000,” particularly if they don’t have the resources to fund the HSA with their own savings.
3. Medicaid patients can’t find doctors to treat them.
— Sen. Bill Cassidy (R-La.), on the Senate floor Jan. 9: “It is the illusion of coverage without the power of access.”
— Speaker Ryan, from CNN Town Hall Jan. 12: “… so our concern is, that people on Medicaid can’t get a doctor and if you can’t get a doctor, what good is your coverage?”
Studies do suggest that low pay (each state sets its own rates) does decrease physician participation in Medicaid, and finding specialty care can be difficult in some parts of the country. But overall the academic literature shows that Medicaid patients have a far easier time, and are far more likely to obtain health care services than people with no insurance.
Benjamin Sommers of the Harvard School of Public Health, who has studied the issue, said the idea that patients with Medicaid can’t get care comes from looking overall at how many doctors and other providers accept the program’s generally lower payments and higher administrative burdens. “But that’s not the best way to study this. The best question … is when you talk to the people with coverage and ask them if they can get the care they need.”
And he said “study after study” shows that “when people get Medicaid, their access to care improves dramatically,” including greater use of primary care, preventive screening, and care of chronic conditions. “Even with some potential limitations of provider participation, patients are much better off once they get that [Medicaid] coverage,” he said.
4. The ACA has reduced jobs.
— Tom Price, the secretary of Health and Human Services, during a confirmation hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee Jan. 18: “The ACA has decreased the workforce by the equivalent of 2 million FTE’s (full time employees).”
— Senate HELP Committee Chairman Lamar Alexander (R-Tenn.), on the Senate floor Jan. 9: “Across the country … employers have cut jobs to afford Obamacare costs.”
Much of this talking point stems from a report by the Congressional Budget Office in 2014 that projected the nation’s workforce would drop by about 2 million jobs due to the health law, as well as anecdotal reports about employers cutting workers hours to avoid triggering the law’s requirement that they offer health insurance.
But a careful reading of the CBO report notes that the decline they estimate would be due less to employers cutting back, and more to older workers voluntarily opting to work fewer hours — perhaps because of fears of losing their premium subsidies or their Medicaid eligibility — or retiring because they no longer had to work in order to get health insurance.
It is true that some employers cut worker hours below the 30-hour threshold to avoid the employer coverage requirement.
However, the strengthening economy, including in the health care sector, has shrunk the part-time workforce and expanded full-time employment well beyond the numbers reduced by the Affordable Care Act, according to most analysts. In fact, so many jobs have been created in the industry since the ACA became law that it is becoming a problem itself, because having such a vast chunk of the economy devoted to health care makes it harder to reduce health spending.
To celebrate Marquee Moon’s 40th (!) anniversary, Damien Love has posted an extended interview with guitarist Richard Lloyd. Lloyd describes meeting Richard Hell (then Richard Meyers) and Tom Verlaine (then Tom Miller), forming a band, making some singles, Hell leaving to form the Voidoids, and then recording what would slowwwwly turn out to be one of the greatest albums ever.
Tom and I, our guitars meshed together immediately. I had studied a kind of classic rock guitar, where you do whole step bends, half step bends. When I was a teenager, I had a friend who knew Jimi Hendrix, and Jimi gave this guy lessons, who passed them on to me, and I met Hendrix and watched him play, so that’s where I was coming from.
Tom played with a completely different style. He used the classical vibrato. It’s technical to describe, but it’s like on a violin: you move your wrist back and forth, the finger doesn’t move, but the pitch goes up and down. I don’t know where he got it. It was more like a sitar player, but that was Tom’s style, this magnificent classical vibrato. He’d never do whole step bends, always micro-bends. But our two styles just suited each other beautifully. Between the two of us, we had all the different guitar aspects you could want. I was playing much more classical rock, Tom was playing his odd, in-between thing. But if Tom would show me something, I could play it.
The next thing was convincing Richard Hell to play bass. Tom couldn’t do it. Richie said, “I’m not a musician. I can’t do it.” When Tom wasn’t around, I asked him what the problem was. He said, “Listen. Playing with Tom is like going to the dentist. Except you’d rather go to the dentist.”
Like a lot of kids with a lot of cult rock bands, I didn’t hear about Television until I went to college. I really liked Talking Heads, and in the liner notes of their greatest hits comp Sand in the Vaseline, David Byrne says that when their band first got together, they sounded a lot like “early Television.” I was intrigued.
Then VH1 (this being the glory days of VH1) put out a “100 Greatest Albums” special and threw in Marquee Moon at #83. They showed clips of the band and their songs, and people I knew like Sonic Youth and Henry Rollins talking about how beautiful and influential it was.
It didn’t sound like anything else on that list, besides maybe The Velvet Underground & Nico. (At the time, I thought VU was a totally obscure band that I was a genius for discovering and liking.) It still doesn’t. It didn’t sound like the other punk albums, and the only other indie rock album that made the cut was The Replacements’ Let It Be, which has a totally different vibe. It was this little constellation of Gen X diamonds hidden in a list otherwise dominated by aging boomers and young pop-worshippers, with a few undeniable golden age hip-hop albums thrown in to mix it up.
I think I went out and bought Marquee Moon, Van Morrison’s Astral Weeks, Liz Phair’s Exile In Guyville, and Iggy & The Stooges’ Raw Power the next day. Television helped get me to Big Star, The New York Dolls, My Bloody Valentine, and the hundred other record-store guitar bands that made me a sweetly happy, insufferable, twentysomething cliché, now fully prepared to crap all over VH1’s or any other list of 100 Greatest Albums.
But while my pleasure in debating greatest-ever lists has faded, as has my joy in digging through album crates and filesharing sites to find new bands everyone else has already heard of, my love and appreciation for Marquee Moon remains pretty much the same.
Great sound, great songs, great gossipy soap-opera stories — what else could you want?Tags: music
Tags: Elizabeth Sampat lists
The maximum amount of work you can ever possibly do in a relationship is 50%.
When someone says they can’t do something, 75% of the time it means “There are things not worth sacrificing to make this happen.”
Never feel bad for dropping people from your life. Friends, family, whoever.
Don’t rely on a single person for all your emotional needs, even if monogamous. It’s not a poly thing, it’s a diversification of assets.
Brussels sprouts and spinach are delicious, it’s just that your mom couldn’t cook.
Mallory Ortberg’s “what an odd thing to say!” is the world’s best polite response to someone saying something insulting.
You can’t self-control your way out of sadness.
I posted earlier about Atul Gawande’s piece in the New Yorker on the importance of incremental care in medicine. One of the things that the Affordable Care Act1 did was to make it illegal for insurance companies to deny coverage to people with “preexisting conditions”, which makes it difficult for those people to receive the type of incremental care Gawande touts. And who has these preexisting conditions? An estimated 27% of US adults under 65, including Gawande’s own son:
In the next few months, the worry is whether Walker and others like him will be able to have health-care coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.
That’s 52 million people, potentially ineligible for health insurance. And that’s not counting children. Spurred on by Gawande, people have been sharing their preexisting conditions stories on Twitter with the hashtag #the27Percent.
The 27% figure comes from a recent analysis by the Kaiser Family Foundation:
A new Kaiser Family Foundation analysis finds that 52 million adults under 65 — or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable Care Act.
In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%).
36% uninsurable in West Virginia! You’ll note that all 11 of those states voted for Trump in the recent election and in West Virginia, Trump carried the day with 68.7% of the vote, the highest percentage of any state. The states whose people need the ACA’s protection the most voted most heavily against their own interest.
Update: An earlier version of this post unfairly pinned the entire blame for the lack of coverage of those with preexisting conditions on the insurance companies.2 I removed the last paragraph because it was more or less completely wrong. Except for the part where I said we should be pissed at the Republican dickheads in Congress who want to repeal the ACA without replacing it with something better.3 And the part where we should be outraged. And the part where we regulated cars and cigarettes and food to make them safer, forced companies to build products in ways they didn’t want, and saved millions of lives. We can’t make everyone healthier and raise taxes to do it? Pathetic for what is supposedly the world’s most powerful and wealthy nation. (thx @JPVMan + many others)
I hope, for the love of Pete, that everyone reading this site is aware that the Affordable Care Act (the ACA) is Obamacare. Obamacare is the derogatory name the Republicans gave to the ACA that everyone, including Obama himself, ended up using. Which is unfortunate. President Obama and his administration deserve neither all of the credit nor should shoulder all of the blame for the ACA.
I would also like to add that I, as a (very) small business owner, rely on the protections afforded by the ACA to get insurance coverage for me and my family. Something to keep in mind if you otherwise don’t know anyone who would be affected by the ACA’s repeal. (Of course, the cushy insurance policy you get through work might be affected as well, you never know.)↩
At the heart of the ACA is a compromise between the US government and the insurance companies. The insurance companies don’t want to sell people insurance only when people are sick…that would be prohibitively expensive. That’s where the preexisting conditions thing comes in. So, the ACA says, ok, you have to sell insurance to people with preexisting conditions and we’ll make sure that everyone has to buy insurance, whether they’re sick or not. That bargain makes sure more people are covered and gives the insurance companies a larger pool of people to draw premiums from.
You can see why Republicans don’t like it: it forces people to buy something even if they don’t want to and it forces companies to sell things to people they would rather not sell. And as a bonus, people the Republicans don’t give a shit about — women, the poor, people of color — are disproportionately helped by the ACA. So they’ll repeal it and replace it with magic! And the only cost will be an increase in dead Americans.↩
I am all for this, BTW. If Paul Ryan and Donald Trump come up with a plan to give better and cheaper healthcare coverage to everyone in America, let’s do it.↩
ACA Pregnancy Termination, Gender Identity Protections Blocked; Wellness Program Incentives Survive (Updated)
January 3 Update: House Rules And Hawaii Innovation Waiver
ACA-Related House Rules Provisions
Today, January 3, 2017, the 115th Congress convenes for its first session. One of the House of Representatives’ first orders of business will be to adopt its governing rules. As is customary, it will basically adopt the rules that have governed the previous Congress. A number of amendments have been proposed by the Republican leadership, however, several of which are directly relevant to the Affordable Care Act.
One provision, for example, continues the authorization of the House v. Burwell lawsuit in which the House is claiming that the administration is funding the ACA’s cost-sharing reduction payments without an appropriation. Another would stipulate that the ACA’s provision requiring Congress to act on the recommendations of the Independent Payment Advisory Board and limiting the ability of Congress to repeal those provisions do not apply for the 115th Congress.
A number of the rule amendments are directed toward reducing entitlement spending. One provision in particular is aimed directly at the ACA. This provision states that in general it is not in order for the House to consider any bill, joint resolution, amendment, or conference report that the Congressional Budget Office scores as causing a net increase in direct spending in excess of $5 billion during any of the four consecutive 10-year fiscal periods following the current 10-fiscal year window. The amendment further provides, however, that this limitation does not apply to bills repealing or reforming the ACA.
The most recent CBO report on the cost of repealing the ACA estimated that repeal would increase the deficit by about 1 percent of gross domestic product in the 2026 to 2035 period. If Congress, as has been predicted, uses the budget reconciliation process to repeal the individual and employer mandates, the premium tax credit and cost-sharing reduction payments, and the Medicaid expansions, as well as the taxes that the ACA imposed on high-income individuals and health insurers and providers, but leaves the ACA’s Medicare cuts in place, the CBO would likely score the measure as reducing the deficit. A problem may arise, however, if Congress adopts money-saving repeal provisions up front, reducing spending, but then tries later to adopt replacement provisions, increasing spending. Under those circumstances, the rule change may come in very handy.
Hawai’i Innovation Waiver
On December 30, 2016, HHS approved an Affordable Care Act 1332 innovation waiver application for the state of Hawai’i. (fact sheet) Section 1332 allows HHS and the Department of the Treasury to waive certain ACA requirements for states that propose alternative approaches that allow them to provide at least as affordable and comprehensive coverage as that provided by the ACA to at least a comparable number of people without increasing the federal budget deficit.
The Hawai’i waiver will free it from the small employer SHOP provisions of the ACA. The state will be able to use the funds that would have been available for small employer tax credits to help fund grants to small businesses under a state program established under Hawai’i’s preexisting Prepaid Health Care Act. Hawai’i will get $459,199 in 2017 under the waiver and $2.8 million over the 2017 to 2021 period for which the waiver is approved. This is likely to be the only waiver granted by the Obama administration, and possibly the last 1332 waiver ever granted if the ACA is repealed.
Yesterday, January 1, 2017, several Affordable Care Act (ACA) rules were scheduled to go into effect. On December 31, however, a judge granted a preliminary injunction blocking parts of a nondiscrimination rule issued under ACA section 1557. On December 30, another judge refused to block a rule allowing employers to offer significant incentives for employees to disclose medical information in connection with workplace wellness programs.
Judge Blocks Enforcement Of Ban On Discrimination Based On Gender Identity Or Pregnancy Termination
On December 31, 2016, Judge Reed O’Connor of the United States District Court for the Northern District of Texas entered a nationwide injunction in Franciscan Alliance v. Burwell. The order prohibited the Department of Health and Human Services (HHS) from enforcing its nondiscrimination rule promulgated under ACA section 1557 insofar as the rule prohibits discrimination on the basis of gender identity or termination of pregnancy. The remaining provisions of the rule—prohibiting discrimination on the basis of disability, race, color, age, national origin, or sex other than gender identity—will take effect as scheduled, mostly on January 1, 2017.
Section 1557 applies various antidiscrimination laws to entities receiving assistance under, administering, or established by, the ACA. The antidiscrimination provisions incorporated into section 1557 include Title IX of the Education Amendments of 1972, which prohibits discrimination based on sex. In accordance with earlier interpretations of sex discrimination law, the HHS regulations prohibit discrimination based on sexual stereotyping, including discrimination based on gender identity.
This case challenging the rule was filed in August by the Franciscan Alliance (a Catholic hospital system), a Catholic medical group, a Christian medical association, and five states. (Three more states joined in an amended complaint.)
The plaintiffs alleged that the section 1557 regulations forced the plaintiff professionals and facilities to provide gender transition services against their medical judgment and religious beliefs. They also asserted that the regulations prohibited discrimination on the basis of “termination of pregnancy” and failed to provide an exclusion for abortions, thus requiring coverage of abortions. The state plaintiffs alleged that the regulation required them to cover gender transition services and interfered with their “zealous” protection of the physician-patient relationship.
The plaintiffs’ amended complaint, filed in October, alleged that the regulation violated the federal Administrative Procedures Act; constitutional and statutory provisions protecting religious liberty, freedom of expression and association; and the rights of the plaintiff states guaranteed by Constitution’s spending clause and Tenth and Eleventh Amendments.
In September 2016, the American Civil Liberties Union of Texas and the River City Gender Alliance asked the court to allow them to intervene as defendants in the case. Judge O’Connor stayed a ruling on the motion to intervene pending his decision on the motion for a preliminary injunction.
A preliminary injunction is an extraordinary remedy because it grants relief to the plaintiff before the court has an opportunity to fully explore the factual and legal basis of a case. A court can only grant a preliminary injunction if the plaintiff shows a substantial threat of irreparable injury, a substantial likelihood of success on the merits of the case, that the threatened injury to the plaintiff outweighs the threatened harm to the defendant, and that the granting of the injunction is not contrary to the public interest.
The plaintiffs argued that they faced enforcement actions under the rule that would cause them irreparable injury and that the rule misinterpreted the Title IX prohibition against sex discrimination, which, they argued, only prohibits sex discrimination based on a binary understanding of gender. The private plaintiffs also argued that the section 1557 rule did not adequately accommodate their religious beliefs and that the Religious Freedom Restoration Act precluded its application to them.
The Court’s Opinion
Judge O’Connor ruled in favor of the plaintiffs based on statutory grounds and did not reach the plaintiff’s constitutional arguments. He began by disposing of the government’s jurisdictional objections; he found that the rule would require the plaintiffs to change their current policies, refusing to offer or pay for abortions or gender transition surgery, under the threat of enforcement actions, and thus the plaintiffs faced sufficient injury to support standing. The judge also held that the case was ripe for adjudication because the plaintiffs would have to intentionally defy the law, risking serious financial or civil penalties, or forgo conduct that they believed was constitutionally protected. Moreover, the plaintiffs should not, the court concluded, have to defend administrative enforcement actions to defend their rights but could instead directly challenge the regulation.
Plaintiffs’ Likelihood Of Success
Judge O’Connor then turned to the question of the plaintiffs’ likelihood of success on the merits. The government had argued that the court should defer to its interpretation of section 1557 because of the Chevron doctrine, which requires courts to defer to administrative agencies in their interpretation of the law when a statute is ambiguous, an agency is tasked with interpreting the law, and the agency’s interpretation of the law is permissible.
But Chevron deference does not apply if the court finds that a statute is unambiguous, in which case the court must apply the terms of the statute. Judge O’Connor had no trouble finding that section 1557 unambiguously prohibits only biological sex discrimination. The term “sex” as used in Title IX, on which section 1557 is based, “unambiguously refers to the biological and anatomical differences between male and female . . . as determined at . . . birth,” the court wrote. This was the meaning of sex at the time Title IX was adopted, and this was the meaning that Congress meant to incorporate under ACA section 1557. Thus, transgender is not a protected characteristic under the statute, and the implementing rule therefore “exceeds the grounds incorporated by section 1557.”
Judge O’Connor further held that the section 1557 rule was arbitrary, capricious, and contrary to the law under the APA. The rule failed to incorporate Title IX’s exemption for religious entities in situations where the application of Title IX’s prohibitions would be inconsistent with 1) the religious tenets of the organization, or 2) Title IX’s proviso that it should not be construed to require payment for or provision of abortions. HHS had argued that the religious and abortion exemptions were specific to the educational institutions covered by Title IX and should not be incorporated into section 1557, but the court held that section 1557 unambiguously incorporated all provisions of Title IX, including these exemptions.
Judge O’Connor next held that the Religious Freedom Restoration Act prohibited the application of the rule’s provisions on abortion and gender transition to the non-state plaintiffs because the provisions substantially burdened the plaintiff’s exercise of religion and were not the least restrictive means of advancing a protected interest. The section 1557 rule, it should be noted, expressly disavows any application of the rule that would violate RFRA.
Judge O’Connor proceeded to find that the remaining requirements for a preliminary injunction were met: the state plaintiffs were suffering irreparable harm because the rule prevented them from giving paramount consideration to the independent medical judgment of physicians, and the potential harm faced by the plaintiffs outweighed any potential harm to HHS from a delay in enforcing the rule. The decision completely ignores the claims of the interveners, who represented transgender individuals who claimed they would be harmed by a failure to enforce the rule.
Finally, the court entered a nationwide injunction against the enforcement of the rule’s prohibition against discrimination on the basis of gender identity or termination of pregnancy. Judge O’Connor concluded that a nationwide injunction is appropriate in an Administrative Procedure Act challenge and that the plaintiff Christian Medical and Dental Society has members throughout the country.
Some Thoughts On Judge O’Connor’s Opinion
I am not an expert on Title IX, and will leave it to others to comment on Judge O’Connor’s understanding of it, which is at the heart of his opinion. I do, however, find troubling his understanding of the 1557 nondiscrimination rule
He is correct that the rule does not permit insurers or others offering health coverage to “have or implement a categorical coverage exclusion or limitation for all health services related to gender transition;” deny or limit coverage to a transgender individual because those services are ordinarily or exclusively available to individuals different gender from that of the transgender individual at birth; or otherwise discriminate against transgender individuals. Judge O’Connor found this part of the rule to not be supported by Title IX’s definition of sex discrimination as it is incorporated into section 1557 and enjoined it.
But Judge O’Connor is simply wrong in believing that section 1557 requires anyone to pay for or perform abortions. The rule does define sex discrimination to include discrimination on the basis of “termination of pregnancy,” presumably addressing situations where a woman is denied treatment because she had earlier had an abortion, but the preamble is quite clear that the rule is not intended to displace existing federal conscience protection laws (including RFRA), ACA provisions that reject an abortion coverage mandate, or state laws governing abortion.
Moreover, nothing in the section 1557 rule specifically requires practitioners or health care facilities to provide gender transition services.
The rule provides:
A covered entity shall provide individuals equal access to its health programs or activities without discrimination on the basis of sex; and a covered entity shall treat individuals consistent with their gender identity, except that a covered entity may not deny or limit health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that the individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available.
In explaining this provision, the preface states: “For example, a covered entity may not deny, based on an individual’s identification as a transgender male, treatment for ovarian cancer where the treatment is medically indicated,” and, “Nothing in the rule would, for example, require a covered entity to provide a traditional prostate exam to an individual who does not have a prostate, regardless of that individual’s gender identity.”
The rule does not impose on health care professionals an obligation to provide gender transition services, as it does require insurers to cover such services. Indeed, the rule does not require medical professionals to provide care contrary to their medical judgment. The preface explicitly notes that medical reasons may justify distinctions that could otherwise be discriminatory. The rule also specifically provides, “Insofar as the application of any requirement under this part would violate applicable Federal statutory protections for religious freedom and conscience, such application shall not be required.”
Of course, if a practitioner or institution refused care to a transgender individual based on that person’s gender identity, it might be necessary to offer a justification, but that is always true when it is necessary to justify conduct that is otherwise prima facie discriminatory. RFRA does not invalidate all laws that might infringe on anyone’s religious beliefs; it rather requires regulations to accommodate those beliefs.
It is troubling that this litigation has been promoted based on false statements about the requirements of section 1557, which Judge O’Connor has to a certain extent uncritically accepted. A group supporting the litigation claims at its website that the 1557 federal regulation “requires doctors to perform gender transition procedures on children, even if the doctor believes the treatment could harm the child.” This is simply not true. Indeed, in the preface to the rule HHS rejected a suggestion that it declare rules prohibiting coverage of gender transition surgery for persons under age 18 as per se discriminatory.
One of the first legal decisions for the Trump administration will be whether to appeal Judge O’Connor’s ruling. Of course, if the Affordable Care Act is repealed as threatened, the decision may become moot.
Judge Rejects Argument That Wellness Program Incentives Amount To Coercion
The second case, decided on December 30, 2016, involved the Equal Employment Opportunity Commission’s wellness program rule, also scheduled to go into effect yesterday.
The Americans with Disabilities Act (ADA) prohibits employers from requiring employees to submit to medical examinations and from inquiring whether an employee has a disability unless the examination or inquiry is job-related and “consistent with business necessity.” Similarly, the Genetic Information Nondiscrimination Act (GINA) prohibits employers from collecting genetic information (including information on the manifestation of a disease or disorder) regarding employees or employees’ family members. As to both the ACA and GINA, an exception exists for the collection of medical information in connection with an employee health program as long as the employee’s provision of the information is “voluntary.”
Under the Health Insurance Portability and Accountability Act (HIPAA) and, later, the Affordable Care Act (ACA), employers can offer their employees “wellness” programs, which often involve collecting medical information. Under HIPAA, employers could offer employees incentives contingent on participating in some health related program or achieving some health-related goal (or penalties for not participating) up to the 20 percent of the cost of coverage. The ACA increased the amount of rewards or penalties to 30 percent.
Beginning in 2000, however, the Equal Employment Opportunity Commission (EEOC) which enforces the ADA and GINA, took the position that employers could not penalize employees at all for failing to provide health information to wellness programs. In 2010 it took the same position with respect to family medical information under GINA. As more permissive wellness program regulations were issued by HHS, Treasury, and Labor under HIPAA and the ACA, the EEOC waffled some in its position, although in 2014 it took several enforcement actions against employers who penalized employees for not providing health information.
In May of 2016, the EEOC promulgated new regulations aligned more closely with the ACA and HIPAA regulations. The 2016 regulations permitted penalties or incentives of up to 30 percent of the cost of self-only coverage, concluding that penalties and rewards of this magnitude did not render involuntary a wellness program that sought disclosure of ADA-protected information on an employee or GINA-protected medical information on a spouse (but not other family members) as part of a health risk assessment. The regulations were to take effect for plan years beginning on or after January 1, 2017.
In October of 2016, AARP filed a lawsuit on behalf of its members asserting that the EEOC’s new interpretation of “voluntary” is inconsistent with both the ADA and GINA because incentives or penalties of up to 30 percent are, in fact, coercive. Moreover, the AARP claimed, the EEOC’s change of position in its interpretation of “voluntary” in its 2016 rule—from its 2000 ADA guidance and 2010 GINA rule—are inadequately explained and inconsistent with the administrative record. The AARP moved for a preliminary injunction to block the rule from going into effect on January 1, 2017, while the lawsuit remained pending.
The Court’s Opinion
On December 29, 2016, Judge John Bates of the federal district court for the District of Columbia denied AARP’s request for a preliminary injunction. A considerable part of the opinion deals with whether the AARP has standing to bring the lawsuit. Judge Bates ultimately concluded that the AARP is a membership organization (a fact that will come as no surprise to 38 million Americans over age 50) and that at least one of its members (based on affidavits submitted by the AARP) would potentially be injured by the rule.
The court then proceeded to explore whether the requirements for a preliminary injunction were met—threatened irreparable injury, likelihood of success on the merits, the balance of the hardships favoring the petitioner, and the effect of an injunction of the public interest. The judge concluded that information privacy interests are in fact important, but that the threat to these interests in the case was not irreparable. The AARP members could pay higher premiums while the case was pending, and if they prevailed in the end they could recover the money they had paid.
The court also noted that the health information had to be kept in a separate record and could be used only for limited purposes and not for discrimination. Judge Bates was critical of AARP having delayed several months in bringing the lawsuit, suggesting that the threatened injury was not that severe.
Judge Bates next concluded that the EEOC’s interpretation of the term “voluntary” appeared not to be irrational and its change in position in its 2016 rule adequately explained. AARP had not shown, therefore, that it was likely to prevail on the merits. The court also found that the disruption that enjoining the rule would cause to employers and insurers outweighed the potential injury to the plaintiffs.
The court’s judgment may be one of the last involving the Obama administration’s defense of one of its ACA-related rules. It is ironic, therefore, that the case involves a victory for the administration against consumers, rather than against opponents of the ACA.
Today, a white boxtruck conducted a test to verify that the laws of physics do still apply to the 11foot8 bridge. If your truck is too tall it will get stuck. Guaranteed. After they spent a half hour deflating the truck’s tires they finally managed to back the truck out from under the bridge.
The Raleigh News & Observer reports:
The humor publication MAD Magazine has named Gov. Pat McCrory to its annual “20 Dumbest List” because of his support for House Bill 2. The December issue spoofs McCrory as a “stall cop” with an image of the governor in a security officer uniform, a nod to the Paul Blart “Mall Cop” movies. “Keeping North Carolina Bathrooms Safe From Transgender Persons Who Want to Take a Whizz,” the caption says.
The article notes that HB2 has cost the state business and tourism and is difficult to enforce. “It may be up to McCrory himself to travel the state, poking his head into as many restrooms as he can, making sure they’re being used only by those he approves of,” MAD wrote. The Keep N.C. Safe Coalition, one of the primary supporters of HB2, also sought to share some satire about the law Friday, tweeting a cartoon of a dog using a cat’s litter box with the caption “but I identify as a cat.”
— #KeepNCSafe (@KeepNCSafeOrg) December 2, 2016
(Tipped by JMG reader Mike)
FINALLY. Raleigh’s CBS affiliate reports:
North Carolina Governor Pat McCrory has conceded to Attorney General Roy Cooper in the state’s gubernatorial race. McCrory released a video Monday where he congratulated Roy Cooper in his win. “I personally believe that the majority of our citizens have spoken,” McCrory says in the video. “And we now should do everything we can to support the 75th Governor of North Carolina Roy Cooper.” The race was the closest margin in North Carolina history, with Democrat Cooper leading Republican McCrory by 10,250 votes.
The sadz are surely coming!
It’s not just heavy smokers that are setting themselves up for a future of cancer and heart disease. A new study published in JAMA Internal Medicine shows that people who averaged just one cigarette per day still had a 64 percent chance of dying early, compared to nonsmokers.
The Raleigh News & Observer reports:
Gov. Pat McCrory is ready to withdraw his request for a statewide recount if a new hand count of Durham County votes produces the same results as Election Day, his campaign announced Saturday evening.
The governor is asking the N.C. State Board of Elections to hold an expedited hearing on an appeal of the Durham County election board’s denial of a request for a recount there. The state board on Saturday called for a Sunday afternoon meeting by phone to discuss this matter and a federal lawsuit challenging same-day registration ballots.
“If a Durham recount provides the same results as earlier posted, the McCrory Committee will be prepared to withdraw its statewide recount request in the Governors race,” the campaign’s news release says.
McCrory has been trailing Attorney General Roy Cooper by about 7,700 votes as counties around the state finalize their counts with provisional and absentee ballots. McCrory, in order to meet a deadline last week, gave notice that he would request a statewide recount. He is permitted to demand a recount as long as the margin between he and Cooper remains less than 10,000 votes.
Durham has been at the center of allegations of voter improprieties, mostly promulgated by Republican officials and the McCrory campaign, in complaints filed in about half of the counties. The first county election boards to review those complaints, however, have not found significant abuses. In addition to the computer glitches, the eligibility of a number of votes has also been contested, such as accusing voters of being felons, voting in two states or that ballots were cast be dead people.
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A Pumi, one of the new breeds to be unveiled this week. Photo Courtesy Petful | www.petful.com/
Thanksgiving Day is all about tradition, turkey, stuffing, cranberries and dogs. 2016 marks the 15th anniversary of the National Dog Show. Presented by Purina, it airs on NBC on Thanksgiving Day, noon to 2 p.m. (in all time zones) following the Macy's Thanksgiving Day parade.
With over 22 million people watching last year, the National Dog Show is most viewed dog show ever. The show never had an audience less than 17 million. By comparison, on a good night, “The Voice” garners about nine million viewers for NBC.
No word on how many dogs watch, though perennial announcer David Frei touts he’s always been number one among canine viewers. For 27 years, he also announced the famed Westminster Kennel Club Dog Show. And beginning next Easter, he’ll broadcast the Beverly Hills Dog Show.
“I’ve got the greatest job in the world,” he boasts.
The National Dog Show carries is own tradition. The National Dog Show airs on Thanksgiving, but is taped as a part of the Kennel Club of Philadelphia Dog Show, which dates back to 1876. The Philadelphia club predates the American Kennel Club (AKC) which was organized in 1884.
The Kennel Club of Philadelphia hosted its first ‘official’ dog show in 1912, and was elected a member of the AKC in 1913. The Philadelphia cluster of shows has always been a benched dog show; unlike the more common “show and go” format, benched shows require exhibitors to remain in the building for the day. Benched shows allow the public to meet and greet the canines stars. Now almost a lost tradition, only a handful of benched shows remain.
While Frei is considered Mr. Dog Show, his broadcast sidekick, John O’Hurley, is most well known for playing J. Peterman on Seinfeld. He even purchased the company several years back.
Talk about your varied career, O’Hurley has authored books on wide-ranging topics (including dogs), he has broadcast golf on TV; hosted game shows including To Tell the Truth, The Great American Spelling Bee, Family Feud; he starred on Broadway and in the national tour of Chicago; was the first winner of Dancing with the Stars; O’Hurley’s voice can be heard on many cartoons, and was even a guest on the soap opera The Young and the Restless.
O’Hurley says, “Well, I love to do unusual things so I don’t have a unilateral career; I prefer to keep different plates spinning.” He pauses and adds, “But doing the dog show truly has to been a favorite. I love dogs. I hope it shows. Dogs represent the absolute embodiment of innocence. Dogs are God’s reminder that there are angels. Dogs are effusive with their love – and they show it with their eyes.”
Among O’Hurley’s books is “The Perfect Dog.” He says, “I wrote that for my son with a Dr. Seuss style poem describing what the perfect dog would look like. Talk about going full circle, my son – who is now 10 (years old) - reads that very book to young children in schools (to younger children) all over.”
This year’s National Dog Show Presented by Purina will be the debut of three new American Kennel Club breeds:
- American Hairless Terrier: An energetic and fun-loving breed that would like to hunt as their ancestors did, but being hairless – a squeaky toy might be all they should hunt, particularly in the winter. American Hairless Terriers are about 12 to 16-inches.
- Pumi: This is quite the popular and well-known breed, if you happen to live in Hungary. The breed dates to the 17th or 18th Century, likely related to the Rastafarian-look of the Hungarian Puli combined with sheepdogs from France and Germany. In fact, for many years the Puli and Pumi were considered the same breed. A very attentive dog, and quick to alert vocally. Pumi’s, for all their 14 to 17-inches and 18 to 29 lbs. of cuteness, require lots of exercise.
- Sloughi (Arabian Greyhound): A sighthound that originated in Morocco, looks and acts like a cross between a Saluki and Greyhound. This active dog requires a tad more exercise than either of those breeds, but can easily adapt to the city with a daily walk. Currently, Sloughi’s are very rare in the U.S. Sloughi’s are 24 to 28-inches and weigh 66 to 70 lbs.
Last year’s National Dog Show winner was a Skye Terrier named GCH Cragsmoor Good Time Charlie or, as friends just say, Charlie. As for this year, Frei isn’t saying who expects to win, except, “The winner is always that dog sitting on the couch with you while you’re watching the dog show. Your dog is always Best in Show.”
Steve is a certified animal behavior consultant, and the author of several books, including ebooks “Good Cat!” and “Good Dog!” He’s a co-editor of “Decoding Your Dog” (by the American College of Veterinary Behaviorists” which Victoria wrote the foreword. He’s the host of several radio shows, including nationally syndicated Steve Dale’s Pet World, and can be heard on WGN Radio, Chicago. He has a long list of TV credits., from Oprah to Animal Planet shows, including his current appearances on “HouseSmarts TV. He serves on several Boards, including Winn Feline Foundation.
His website/blog: www.stevedalepetworld.com.
We knew this was coming. Via Reuters:
North Carolina Governor Pat McCrory announced on Tuesday he has officially requested a recount of votes from the Nov. 8 election with official results showing him trailing his Democratic challenger, Attorney General Roy Cooper, by one-tenth of a point.
The gubernatorial race in the ninth largest U.S. state remained undecided two weeks after Election Day. Officials with the State Board of Elections were continually updating results as they arrived from the state’s 100 counties. A spokesman for the election board did not immediately respond to a Reuters query about when or whether McCrory’s request might be granted.
The election had been widely seen as a referendum on McCrory’s support for a state law denying transgender people the right to use the public bathroom matching their gender identities, instead forcing them to use those corresponding to the gender assigned at birth.
The law led to widespread boycotting of North Carolina by entertainers such as Bruce Springsteen and Itzhak Perlman while sports organizations such as the National Basketball Association and the National Collegiate Athletic Association moved major events out of state.
McCrory’s request came in a letter to the election board dated Friday and made public on Tuesday, citing a law entitling him to a recount as long as Cooper’s lead is less than 10,000 votes.
NORTH CAROLINA: Gov. Pat McCrory Now Contesting Results In 52 Counties, Alleges Dead And Felon Voters
The Charlotte Observer reports:
Gov. Pat McCrory’s campaign announced late Thursday that 50 more election complaints have been filed – bringing the total number of counties with contested election results to 52 of the state’s 100 counties, including Mecklenburg. The latest complaints say ballots were cast by people who were dead, were convicted felons or had already voted.
“With each passing day, we discover more and more cases of voting fraud and irregularities,” McCrory campaign manager Russell Peck said in a news release. “We intend to make sure that every vote is properly counted and serious voter fraud concerns are addressed before the results of the election can be determined.”
The expanded number of complaints will likely further delay the process of certifying election results, which currently have Democrat Roy Cooper leading McCrory by about 5,000 votes. Counties can’t finalize their election results until all complaints are resolved, according to a memo from the State Board of Elections.
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“Back when Chris Porsz was a paramedic in the 70s and 80s, he also pursued his passion for photography. He spent hours walking around the city of Peterborough, Cambridgeshire (Great Britain) taking candid shots of punks and policemen, siblings and sweethearts, traders and teenagers. Today, more than three decades later, Chris has reconnected with his subjects and recreated their photos, which he’s compiled in a new book called “Reunions.”
“Back when Chris Porsz was a paramedic in the 70s and 80s, he also pursued his passion for photography. He spent hours walking around the city of Peterborough, Cambridgeshire (Great Britain) taking candid shots of punks and policemen, siblings and sweethearts, traders and teenagers. Today, more than three decades later, Chris has reconnected with his subjects and recreated their photos, which he’s compiled in a new book called “Reunions.”
Over the weekend, North Carolina Gov. Pat McCrory filed a challenge to the voting totals in Durham County, alleging “malfeasance” by local officials. Durham County officials today declared that no irregularities were found. Tonight McCrory is challenging a second county’s vote on different grounds. Via press release from his office:
A formal protest has been filed with the Bladen County Board of Elections to challenge several hundred apparently fraudulent absentee ballots cast for Roy Cooper and other Democrats in Bladen County. Initial evidence laid out in the protest suggests a “massive scheme to run an absentee ballot mill involving hundreds of ballots, perpetrated by and through the Bladen County Improvement Association PAC,” a political action committee funded by the N.C. Democrat Party and other prominent statewide Democrats.
The protest, filed by Bladen County Soil and Water Conservation District Supervisor McCrae Dowless and corroborated by a forensic handwriting expert, notes “shocking evidence resulting from a blatant scheme to try to impact the voting results of an entire county and perhaps even sway statewide and federal elections,” including the gubernatorial race.
“With hundreds of fraudulent votes found in just one North Carolina county for a straight Democratic ticket, close examination of this election is required to make sure the true winner of the election is properly determined,” said Jason Torchinsky, legal counsel for the Pat McCrory Committee Legal Defense Fund. “The staggering evidence of voter fraud in Bladen County and the number of similar PACs that the North Carolina Democratic Party donated to shortly before the start of early vote requires close examination throughout the state.”
The fraudulent ballots were identified as problematic after Dowless brought suspicions of voter fraud in his race for Soil and Water Conservation District Supervisor to the attention of the Bladen County Board of Elections prior to Election Day.
The press release goes on to solicit donations for McCrory’s “Legal Defense Fund.” The Raleigh News & Observer notes that McCrory won Bladen County by “about 1000 votes.” The current vote totals are below. It may be another week before a winner is formally declared, although Roy Cooper has claimed victory since late on election night.
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La Tricolor firmó una de esas victorias que quedan grabadas en la retina y cargan de alegría a un país que no se empacha con las mieles del triunfo.
NORTH CAROLINA: Election Officials Find No Evidence Of Gov. Pat McCrory’s Claim Of Counting “Malfeasance”
The Charlotte Observer reports:
Durham County Board of Elections Chairman Bill Brian said Tuesday that officials have seen no evidence supporting questions raised about the accuracy of more than 94,000 votes that were counted manually on election night. “We have seen no evidence to that effect,” Brian said during a Tuesday morning press conference. “Mr. Stark may have some, but we have seen no evidence to that effect.”
Thomas Stark, general counsel for the state Republican Party, filed a formal protest Friday contending that the Durham County Board of Elections engaged in “malfeasance” with regard to ensuring the accuracy of votes counted election night. Durham County officials had to manually enter information after they were unable to upload data from six cards that saved information from ballot tabulators.
Like all county elections boards, the Durham County Board of Elections is made up of two Republicans — including Brian — and a Democrat. The governor appoints members of the State Board of Elections, which appoints members of county elections boards like Durham’s.
The Durham County Board of Elections will hold an 8 a.m. probable cause hearing Wednesday on the protest to consider whether there is any basis to the complaint. The meeting will be held in Durham County commissioners’ chambers at 200 E. Main Street. If the board determines there is any basis to the complaint, the board will hold an full evidentiary hearing at a meeting already scheduled for 11 a.m. Friday to certify the final voting totals for Durham County.
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By Leo Babauta
Whether you’re in the U.S. or not, the results of yesterday’s election can bring up some strong feelings — maybe outrage or depression, maybe elation and shock, maybe contempt for others.
In this crazy emotional time, I urge you to try a compassion practice.
Perhaps, like some people I know, you are angry about the outcome, and can’t believe your fellow Americans would elect the person they elected. Perhaps you’re feeling vindicated, and are unhappy with the way your fellow Americans have steered this country for the last eight years. Perhaps you’re not from the U.S., and you’re feeling scorn for Americans, or confusion, after the results of this election.
Whatever you’re feeling, it’s likely to come from a place of non-understanding. That’s not likely to help our community, locally or globally, nor will it help our own happiness. It can be a transformative practice to practice compassion right now.
The truth is, we each have personally experienced what the other side is going through. The results of the election represent the feelings of millions of other people — they speak in some way for our fellow human beings. We have each felt these emotions: feeling left behind, feeling frustrated, distrusting, powerless, angry, hopeful for change, disliking the change that we see.
Imagine yourself feeling those feelings, one at a time. Feel how difficult they are. Now imagine that someone from the other side is feeling those things.
See if you can feel compassion for a fellow human being for feeling them. Feel a connection to them, because you too have suffered through this difficulty. Feel a connection to all your fellow humans who are going through their difficulties right now, in the U.S. and around the world.
We are connected, even if we have immense differences. We live and work together, we feed each other and depend on each other, we support each other and share ideas, we all are going through immense change and struggle, we have struggles in our lives and feel helpless to change the world at large.
The other “side” might have a different worldview that causes them to vote a different way than you, to want different policies … but underneath, we all have the same tender hearts. And by finding this common ground, we can reconnect to each other in a compassionate way.
Humans have lived in what we now call the American Southwest for centuries, making a wide impact on the land, much of it visible from aerial and satellite photography. Nuclear detonations, housing subdivisions, oil exploration, hydroelectric facilities, solar power facilities, roads, mines, farms, ranches, cities, and towns have altered much of the land over the years. Over the past week, I took a virtual tour with Google Earth, and wanted to share some of these snapshots of the human landscape in Arizona, New Mexico, Colorado, Utah, and Nevada.
“African American Early Voting is down 8.5% from this time in 2012.” Via Daily Kos:
This morning, the NC GOP sent out a press release bragging about how successful the state party has been in suppressing the vote. As a reminder, the state “surgically” slashed the early voting methods used by most often by African Americans — including eliminating “Souls to the Polls Sunday” and radically reducing the number of early voting locations.
North Carolina GOP eliminated Sunday voting because “counties with Sunday voting were disproportionately black and Democratic” pic.twitter.com/G55KWY9EKD
— Ari Berman (@AriBerman) November 6, 2016
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The Charlotte Observer reports:
Over the last year, when companies announced plans to grow their footprints in North Carolina, state leaders have presented them with an unusual gift: An oak bowl carved from wood from the state capitol grounds.
So when PayPal unceremoniously canceled its plans for an expansion in Charlotte over opposition to House Bill 2, state officials did what any jilted ex might: Asked for their stuff back.
“We reached out to them and said, ‘Give us the bowl back.’ That is a North Carolina artifact from the North Carolina state capitol made by North Carolina artisans for companies that are coming into North Carolina,” N.C. Commerce Secretary John Skvarla told the Observer Monday during a visit to Charter Communications’ training center in Matthews.
“We got it back, gave it to a charity auction, and they raised money that is for the benefit of the state capitol.”
The origin of the bowls traces back to about a year ago, when an oak tree on the capitol grounds was struck by lightning. Crews were about to come chop up the tree and dispose it, but Skvarla called the governor’s office to implore them to keep the pieces.
— Andy Shain (@AndyShain) October 24, 2016
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The White House has really been stepping up its music game these days, organizing festivals and now inviting Chance the Rapper to perform at the National Christmas Tree Lighting Ceremony. Because if you’re on your way out and can’t do much, you might as well use holidays you’re forced to celebrate as opportunities to invite your favorite artists to perform at your house.
It makes little sense to come up with another list of “best” Chicago books. To select a “top” 10 (or 20 or 1,000) has always seemed arbitrary and destined for accusations of unjustified boosterism and hyperbole, even in a city built on a foundation of unjustified boosterism and hyperbole.
Fairly or unfairly, Chicago often serves as a general proxy for American cities. Love or hate this idea of ostensible representativeness (most Chicagoans kind of just roll their eyes), to embrace it can prove helpful in one respect: looking at ambition, failed policies, immigration, founding myths, and contemporary life in Chicago, you find resonance elsewhere in America. When thinking through issues confronted by American cities today (and maybe always) — unequal distribution of resources, violent policing, persistent de facto segregation, administrative corruption, privatization of public services, neoliberal coddling of gentrification, fallout from decades of environmental degradation, and others — Chicago serves as a vital case study.
The local commentariat here works itself into spitting rages whenever any outsider — especially if that outsider bears a New York Times business card — parachutes into the Loop for 36 hours to explain Chi-Town (seriously, stop it: no one here calls it that) to the rest of the world. So, designed as a “Chicago 101” syllabus, these books serve as starting points rather than final judgments. They place Chicago at the center of ideas about city life, in some case pressing back on prevailing narratives about American urbanism. Instead of best Chicago books, this selection focuses on books that use a Chicago-centric perspective to address challenges that other places similarly confront.
And given that I’m leaving town this fall and casting my lot with the outsiders when I transplant to — I cringe, really, it feels like betrayal — Brooklyn, I wanted to get this thing together before the movers arrive. Much is missing: I chose not to focus on novels because so many others have done so, and poetry is almost entirely absent. Nelson Algren and Carl Sandburg were not on this list because they are prerequisites for the list. But with the excuses that I don’t intend on completeness and the movers at the gates, I hope it’s acceptable to leave gaps that conversation might fill.
1. “It Really Wasn’t Much of a Place at All.”
Dominic A. Pacyga opens Chicago: A Biography, his sweeping history of the Midwest’s largest city, with Father Jacques Marquette and Louis Jolliet. The priest and explorer first came upon a portage between the Chicago and Illinois Rivers in 1673. To build a canal here would be to connect the Great Lakes to the Mississippi, creating the largest inland waterway in the world and facilitating transportation from New York Harbor to the Mississippi along the entire midsection of the continent.
There’s a lot in between and after, and the last page of Pacyga’s book makes it to Barack Obama’s inauguration as President of the United States. That Pacyga covers so much — from the fire that destroyed one third of Chicago in 1871, to the city’s subsequent explosive growth (Chicago had a 1.7 million residents by 1900), to the Haymarket riot, to the 1968 DNC — should give a sense of the book’s scope. With so much terrain to cover, it comes as little surprise that even major events get relatively little space. Pacyga does, however, provide an especially detailed account of labor upheavals that characterized Chicago around the turn of the 20th century, providing context for understanding the city’s pushback against the rampant capitalism for which it earned its reputation.
Chicago: A Biography represents an essential starting point, primarily because it tracks the evolution of the city from a mucky swamp to a “global city.”
2. “Natural Advantages”
William Cronon’s Nature’s Metropolis and Donald Miller’s City of the Century both present meticulously detailed and conceptually riveting pictures of Chicago in the 1800’s — a century of incredible expansion. Chicago’s founding hustlers (to borrow Nelson Algren’s term for his fellow Chicagoans) proclaimed as early as the 1830’s that a marsh named for stinking onions by indigenous people, seated aside gloriously fertile grasslands on the shores of an inland ocean, would one day represent “the most important point in the great west.” By the time of the World’s Columbian Exposition in 1893, the climax of Chicago’s ascendant century, that destiny had been realized.
Cronon and Miller interrogate the stakes of this transformation, asking about the lives it altered and about the enduring epistemic shifts that Chicago’s rise implied for the United States. Chicago transformed America’s relationship with the West and with capital itself, producing not only a vast urban expanse but also structuring what we would come to understand as “rural,” “suburban,” and “hinterland.” Cronon helps us understand how the city transformed goods into abstract commodities, reshaping our relationship to the food we buy and the environment we consume. He shows how rail transit didn’t just connect distant places, but rather restructured our very understanding of space and time. In notable contrast, Miller’s history dives into the enormous cast of characters that built Chicago and chronicled its rise. City of the Century’s meticulous characterization of the “hustlers” that poured concrete into Chicago’s foundations provides singular descriptions of this cast’s influence on the city’s trajectory.
3.“High Strung, Contagious Enthusiasm”
Erik Larson’s The Devil in the White City has become standard literary fare for newcomers to Chicago, and one will often find multiple copies in a transplant’s household. Larson dramatizes the planning of the aforementioned World’s Columbian Exposition, which marked the 400th anniversary of Christopher Columbus’s voyage to America. Planning required construction of an enormous classical-inspired city in Jackson Park on the South Side, involving many of the city’s (and nation’s) architectural and economic leaders, and marking Chicago’s global coming-out party.
Lurking in the crowds, H.H. Holmes — the book’s eponymous devil — became one of America’s first serial killers. He committed scores of murders silently throughout the fair, the urban anonymity afforded him by the crowds facilitating his crimes. Larson’s book has become important, not just as a document that depicts this contradiction between glorious spectacle and urban underbelly, but also because his romanticized vision of Chicago squares with how the city still views the fair. Its spectacle (and specter) looms large in Chicago’s self-conception.
Where Larson spends time examining the drama among fair planners, Chris Ware’s Jimmy Corrigan, Smartest Kid on Earth presents an imaginative — and sparely, gorgeously rendered — view of the event’s history through a child’s eyes. An emotionally paralyzed man living in present-day Chicago, Jimmy attempts to reconnect with his father. In scenes from the 1800s, the monumental fair casts similar shadows over an inter-generational Corrigan family history. Ware depicts how the tendrils of Chicago’s past reach to its present in a city with a complicated history.
Jane Addams founded Hull-House in 1889, well before the Columbian Exposition’s electric lights flickered on. Her settlement house ultimately comprised an enormous complex of buildings in one of Chicago’s poorest immigrant neighborhoods. In Twenty Years at Hull House, one gets the sense of Addams’s determination to reformulate the way that cities treated the poor and immigrant classes — with dignity and a focus on individuals. She charted a course for services and advocacy for the poor that formed the foundation of social work and emphasized that communities matter in urban development.
Concurrently, Daniel Burnham — architect of the Columbian Exposition — moved on from the fair to create an urban plan that would transform Chicago and cement the city’s status as a global metropolis. Carl Smith’s The Plan of Chicago makes it clear that Burnham’s monumental visions leave a complicated legacy. Despite “sincere” hopes that “City Beautiful” concepts would ennoble the poor, the Plan of Chicago deserves criticism for overlooking conditions of daily life for those to whom Addams ministered. As much as it marks a culmination of optimism in city planning, it lays some of the foundation for abysmal policies that would haunt public housing in Chicago and in many other cities. Moreover, it marks a kind of opening chapter in “public-private partnerships” that govern contemporary efforts to encourage markets to solve urban problems.
5. Bigger Ambitions for Chicago-Born Novels
Native Son and The Adventures of Augie March belong at the heart of any serious conversation about Chicago novels (though I find Augie difficult to get through). The ambitions of Richard Wright and Saul Bellow in these two midcentury novels rise to the level of Chicago’s ambitions for itself. Their alternatingly devastating and ennobling investigations of individual agency and social determination in two unforgettable protagonists — Augie and Bigger Thomas — make them essential to an understanding of American ideas about selfhood, race, and ambition.
It can be easy to forget that these novels take place in Chicago; they belong to us all and not to any one city. “I am an American,” Augie declares right at his beginning. “Chicago born” comes only second, though it acts as validation of his Americanness. Upon reflection, one cannot imagine either novel taking place in any other American city — one of huge immigrant classes fragmented into neighborhoods bitterly segregated along racial and ethnic lines.
Reading these novels together with a spatial understanding of Chicago deepens one’s appreciation for how wide a gulf exists between the lives of their protagonists and the populations they represent. Augie and Bigger find themselves in Hyde Park, for example (which still boasts of its veneer of racial diversity relative to other neighborhoods), but their experiences there are utterly separate. From this smallest of details — the incongruity of lives despite physical proximity — emerges persistent truths about the structure of racial dynamics in American cities.
6. Making the Most of Migration
The Warmth of Other Suns, Isabel Wilkerson’s mammoth history of the Great Migration, won the 2015 Chicago Reader’s poll of “Greatest Chicago Book.” Chicago shares billing with LA and NYC as important destinations for those whose lives Wilkerson traces from the rural south to the urban north and west, but there can be no doubt that the Great Migration wrought indelible changes in the social fabric of every region in the United States from World War I through the 1970s; and in this story, Chicago plays a central role. Unwavering in her depictions of the political and physical violence of Jim Crow and nuanced in both her telling of personal stories and descriptions of broader effects of the migration on cities and people, Wilkerson’s book is the seminal text on the largest internal migration in American history.
Meanwhile, Adam Green’s Selling the Race provides an incisive contribution to conversations about how black Chicagoans carved a place for culture in modern America. Against prevailing narratives that cast black Americans (including many new migrants to Chicago) as victims of modernity, swept up by forces that looked to capitalize on anxieties of belonging, Green argues that they became powerful agents of cultural production. Examples from Mahalia Jackson to Ebony and Jet magazine (product of the Chicago-based Johnson Publications) present a rich picture of how much of black culture was generated and packaged for sale to wide audiences in Chicago.
7. Obsessions with the Ordinary
No city values the “ordinary” so dearly as Chicago. And if Studs Terkel stands as the everyman’s greatest champion, his Division Street America best ties the city’s affection for ordinariness to American identity. It would be a mistake to suggest that Terkel shilled the myth of a “city that works” (a term coined by Richard J. Daley). Rather, his no-nonsense portrayals of everyday Chicagoans — rich, poor, Democrat, Republican, racist, gay, jag-baggy, and others — coalesce to create this affecting hodgepodge. As Alex Kotlowitz (no slouch himself in the department of spotlighting and writing movingly about injustice in Chicago) has observed, there’s always Studs in the background — curious, probing, insisting, and asking questions that prompt often-ignored individuals to tell their stories.
Vivian Maier, whose recently discovered work also transacts in Chicago’s obsession with the ordinary, may outshine Terkel decades from now. She embodies the perfect female flâneur (or, as historian Lauren Elkin has rightly insisted, flâneuse). Maier spent most of her life as a nanny in Chicago, secretly capturing some 100,000 images on the city’s streets. The domestic nature of her work all but guaranteed invisibility, given chauvinistic structures of artistic production and labor valuation. But when John Maloof was researching the Northwest Side neighborhood of Portage Park in 2007, he came upon Maier’s forgotten images. He bought and disseminated them. Vivian Maier: A Photographer Found is a great introduction and Maier now belongs in discussions about great American street photographers. Hers is an utterly Chicago story.
8. Daley’s Siege
Richard J. Daley reigned over much of 20th-century Chicago. He ruled the city from 1955 until 1971, dominated Democratic Machine politics, and earned all of his enemies. Several books on this list describe Daley, and his complicated legacy plays out differently in their assessments. For this reason, I have left out of this list any Daley biographies.
Perhaps no account of Daley proves as brutal as Norman Mailer’s Miami and the Siege of Chicago. In his run-up to descriptions of protests and Chicago police reprisals, Mailer writes, “Daley was no national politician, but a clansman.” The 1968 DNC, convened by Daley, proved a flashpoint in American political history. The chaos fragmented the Democratic Party nationally, and set the stage for Richard Nixon’s victory in November. In Mailer’s description of Chicago, his clear affection for the city makes it all the more heartbreaking (despite his intimations of inevitability) that the fractures of American society should appear on live television broadcasts from Michigan Avenue.
Algren-esque musings notwithstanding, Mailer remains a Chicago outsider. So it feels appropriate to add Chicagoan Haskell Wexler’s film Medium Cool to this list of books. Combining documentary footage of the convention protests with a fictional film, Wexler enlivens and deepens Mailer’s account. He depicts the tumult of 1968 like perhaps no other text from that stormy year. As a bonus, Medium Cool echoes experiments happening in documentary at places like Kartemquin films, which would go on to produce the now-canonical Chicago films Hoop Dreams and The Interrupters.
9. Out in Chicago
The most recently published addition to this list is Timothy Stewart-Winter’s Queer Clout. In it, Stewart-Winter troubles the dominant narrative of 20th-century gay rights activism in the United States, which typically treats New York and San Francisco as the two central cities, often to the exclusion of the Midwest. He fills this narrative with a cacophonous history of LGBTQ culture and activism in Chicago, where firings, shakedowns, police bribes, and bar raids were just as much a part of life throughout the city as anywhere else.
Effective action depended ultimately on collaborations between gay rights and black civil rights groups, and the pursuit of delicate coalitions. Queer Clout traces the fits and starts of these collaborations and coalitions. Post-Orlando, Stewart-Winter’s discussion of the importance of gay bars for LGBTQ individuals — historically and presently — seems especially valuable. Bars served ground zero for exploitation by law enforcement, but also as meeting places and (most of the time) safe havens.
Stewart-Winter cautions against readily equating the gay rights movement with the civil rights movement; the layering of race, sexual orientation, and gender identification necessitates a more complicated picture. And his affecting description of unequal access to healthcare among Chicagoans affected by AIDS creates a devastating picture of failed policies. In a city divided between a black south and white north, lack of access to educational resources, preventive care, and treatment becomes a reminder of how segregation produces injustice that communities and policymakers must continue to fight to address.
10. Humboldt Park
To understand gentrification in Chicago, head to the Humboldt Park neighborhood, where protests against rising rents, tax hikes, and teardowns took place recently on the 606. This park, built on a former rail line, echoes efforts in other cities to erase industrial infrastructure from urban landscapes. Having whetted the appetite of developers, The 606 has accelerated the pace at which Humboldt Park is becoming unaffordable for longtime residents.
Sandra Cisneros grew up in Humboldt Park. Her beloved The House on Mango Street takes place in a similar fictional neighborhood. Traditional readings peg the novella as the coming-of-age story of Esperanza, a daughter of Mexican immigrants. Cisneros experiments with form — the book is a series of short vignettes — to explore Esperanza’s struggles with sexuality, national identity, class, and the Spanish language. The poetic language of these depictions alone makes an argument for the work’s importance.
To read Mango Street alongside Chris Ware’s Building Stories widens the lens through which readers can examine the relationship between individual and community identity. Ware’s unnamed protagonist, who loses a leg in a childhood accident, lives in Humboldt Park. Her story unfolds across 14 pamphlets, broadsheets, books, and other objects. Like Cisneros, Ware’s formal cartwheels advance conversations about identity. As with Cisneros, the book’s themes center on self-description — again, a disjointed and chronologically jumbled task (there’s no “right” way to read the book). He’s also interested in the evolving neighborhood, as the heroine moves away and revisits the three-flat in which so much life happens.
11. Whose City?
What does Chicago look like today? Natalie Moore’s The South Side, published last year, combines history and memoir to describe neighborhoods in the city that are too often represented in national news media in one-dimensional stories of gun violence. Her book draws productively from her own biography of a childhood in middle-class and largely black Chatham, and feels less concerned with comprehensiveness than with augmenting and correcting the record. As the current South Side reporter for the local NPR affiliate, Moore brings a great deal of connections and numerous voices to this project.
By contrast, Larry Bennett’s The Third City offers a picture of contemporary Chicago that seems at times too rosy in its assessment of the younger Richard M. Daley’s infrastructure investments (the book was published before the first term of Mayor Rahm “One Percent” Emanuel). Visions of Chicago as a global city — one that attracts entrepreneurs to ride the next wave of innovators was for a time called “Silicon Prairie” — ring with the optimism of the 19th century. It presents a picture of Chicago that has become popular among elected officials looking to attract private money and foreign tourists. This vision of Chicago’s third incarnation (a vision of privatization premised on the notion that a city’s chief ambition should be to attract capital to its core) looks like a new version of Burnham’s century-old Plan. It has fans elsewhere.
How to square this vision with the neighborhoods that sustain Chicago, and other cities, remains an unanswered question.
12. There Are No Two Finer Words…
Among garrulous Chicagoans, most will grudgingly agree: we miss Hot Doug’s. Chicago treasure Doug Sohn’s sausage emporium was not only a celebration of encased meats, but equally a democratizing force on a desolate block on California Avenue in the Avondale neighborhood. One waited in line (often for more than an hour) whether one was Anthony Bourdain, Aziz Ansari, or even Doug’s dad. In Hot Doug’s, the coffee table book that cashed in on Doug’s decision to close the shop not long ago, local voices weigh in on The Line: when they waited, how long they waited for, who got engaged to whom while waiting, who had to rush to the hospital to deliver a baby, etc.
Doug reminded us all (always calling us “my friend”) that in Chicago, one waits in line like civilized people. The snow, cold, heat, wind, and rain be damned.
13. Coda: Next Steps
There’s so much more to read and through-lines to trace from Carl Sandburg to Gwendolyn Brooks to Aleksandar Hemon to Chance the Rapper. Those interested in extensive lists of Chicago novels should consult, all kidding aside, several best-of lists already out there. My favorite was published by the dearly departed local site Gapers Block, and it organizes novels by neighborhood. Chicago magazine published a fun list of new Chicago-centric reads for the summer. I’m excited to read Margo Jefferson’s Negroland and Darryl Pinckney’s Black Deutschland. And Curbside Splendor Publishing (a local house) recently put out The Empty Bottle Chicago: 21+ Years of Music / Friendly / Dancing, a history of one of the Northwest Side’s most-loved venues.
But now, it’s time to get to packing.
Image Credit: Pixabay.
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Public Policy Polling reports:
For the first time this entire cycle PPP finds a clear leader in the race to be North Carolina’s next Governor: Roy Cooper. Cooper’s at 46% to 41% for Pat McCrory, with Libertarian Lon Cecil at 2%. When undecideds and Cecil voters are asked who they’d pick if they had to choose between Cooper and McCrory, Cooper’s lead ticks up to 50/43.
McCrory continues to be unpopular, with only 41% of voters approving of him to 49% who disapprove. This makes 39 months in a row we’ve found his approval rating under water. Voters are generally having a positive reaction as they’ve become more familiar with Cooper, with 40% of voters rating him positively to 32% who have a negative opinion.
The story in this race is Cooper’s strength with independent voters. He leads McCrory 44-33 with them in the full field, and 50-34 with them in the head to head. By contrast, McCrory defeated Walter Dalton by a 2:1 margin with independents in 2012. But they have largely soured on him with now only 36% approving of him to 49% who disapprove.
HB2 is causing McCrory big trouble as well. By a 20 point margin voters want to see it repealed- just 32% support keeping it on the books, to 52% who think it should be overturned. Among pivotal independent voters, there’s 56/29 support for repeal. There may be one simple reason HB2 is so unpopular- it’s a bill targeting LGBT people, yet only 19% of North Carolinians say they have a negative opinion of LGBT people, to 47% with a positive one and 34% who are indifferent. A bill cutting the rights of a group of people that only a small slice of the electorate has a problem with isn’t going to be very popular.
McCrory’s taken a direct hit thanks to HB2. Only 39% of voters approve of how he’s handled the issue, to 49% who disapprove. And by an 11 point margin voters say his handling of HB2 makes them less likely to vote for him this fall- 41% say it makes them less inclined to support him to only 30% who say it makes them more likely to.
The post NORTH CAROLINA: Dem Attorney General Roy Cooper Leads Gov. Pat McCrory By Five Points In New Poll appeared first on Joe.My.God..