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Support mounts against Indian River health textbook censorship

Residents and students continue to support the inclusion of materials defining the terms lesbian, gay, bisexual and transgendered in the Indian River School District’s health curriculum.

The Monday Board of Education meeting was not as well attended as the October meeting, which drew about 100 protestors. However, this most recent meeting continued to be dominated by people speaking against board member Shaun Fink, who wants the material to be removed.

The health curriculum subcommittee has reviewed about two-thirds of the materials that could be considered controversial. At a recent meeting, officials said they would need to make a decision on the inclusion of the LGBT terms in the next few months, or else fail to meet state standards for students currently taking health class.

The most emotional speaker was Milton resident the Rev. Michael Smith, minister for the Unitarian Universalists of Southern Delaware.

“Removing language because it refers to sexuality once again casts too many back into the shadows of misunderstanding and prejudice and bigotry. It strips many of their inherent worth and dignity. It invites bullying,” Smith said. “I don’t get it. I don’t get how any of you can sit there and look at children who are victims of such bullying, knowing that this is what’s going to happen to them unless people can talk and learn about each other.”

Smith talked about the values portrayed when Indian River High School’s color guard presented the flags and the audience said the pledge of allegiance at the start of the meeting. The district’s board would not be staying true to that promise of freedom and justice for all if they cut the LGBT material, he implied.

“We put our hands over our hearts. Some warm hearts,” he said, focusing on Fink. “Some very cold hearts.”

In September, Fink said at a health curriculum subcommittee meeting that teaching students that being gay is normal is unacceptable, and has since repeated that sentiment at multiple public meetings. Fink, pastor and founder of Cornerstone Bible Church in Millsboro, said he is motivated by his Christian faith, in addition to claims that homosexual sex carries a higher risk of sexually transmitted diseases than heterosexual sex.

Fink also opposes a portion of the curriculum on STD, HIV and pregnancy prevention, supporting abstinence-only education instead.

Fink said he was happy people are coming to the meetings.

“I’m happy people are coming out to express their views. I’m saddened by the lack of biblical knowledge,” Fink said.

The importance of the separation of church and state was also stressed during public comments. A prayer, typically offered through the public comment period at the start of each meeting, was notably missing.

“The idea that someone can be in a position of power and discriminate against a group as large as that of the lesbian, gay, bisexual, transsexual and asexual community is outrageous,” Sussex Central junior Bryce Molnar said. “It not only makes the school a dangerous place for a student of the orientation to be in, but also puts that student to shame. Whatever your beliefs may be, your intentions good or bad, if they interfere with the equality amongst students, then they should not be those which influence the educational process.”

Molnar commented that “The Miseducation of Cameron Post,” a book with a homosexual protagonist that drew criticism in the Cape Henlopen School District, has been removed from the Sussex Central Library.

In October, officials said a person filed a formal materials complaint with the district asking that the book be removed. The book being removed from the Sussex Central library is related to the complaint, Superintendent Susan Bunting said.

A committee examining that complaint met last week, Bunting said. LouAnn Hudson, who led the committee meeting, said she is currently writing up the committee’s findings, which will be given to Bunting, who will make a recommendation to the board at either a curriculum meeting Dec. 8 or at the next regular board meeting.

Hudson could not comment on the committee’s decision, but Bunting said she thinks they were in favor of dismissing the complaint, therefore allowing the book in the library.

“I think the recommendation of the committee was to not object to the book,” she said.

302-537-1881, ext. 207

On Twitter @rachaelpacella

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Mass Imprisonment and Public Health

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In First Week, More Than a Million Apply for Health Insurance on Federal Website

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If Supreme Court Strikes Federal Exchange Subsidies, Health Law Could Unravel

Supreme Court police stand guard during a storm in March.i

Supreme Court police stand guard during a storm in March.

Michael Reynolds/EPA/Landov

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Michael Reynolds/EPA/Landov

Supreme Court police stand guard during a storm in March.

Supreme Court police stand guard during a storm in March.

Michael Reynolds/EPA/Landov

Exactly what would happen to the Affordable Care Act if the Supreme Court invalidates tax credits in three dozen states where the federal government runs the program?

Legal scholars say a decision like that would deal a potentially lethal blow to the law because it would undermine the government-run insurance marketplaces that are its backbone, as well as the mandate requiring most Americans to carry coverage.

In King v. Burwell, the law’s challengers argue that Congress intended to limit federal tax credits to residents of states running their own insurance exchanges. Currently only 13 states and the District of Columbia operate exchanges on their own; another 10 are in some sort of partnership with the federal government. Federal officials run the rest.

Should the justices find that subsidies in federal exchanges are not allowed, “I don’t think there are any rosy scenarios,” said Timothy Jost, a law professor at Washington and Lee University and a supporter of the law. “It’s a complete disaster.”

The immediate impact would be that the Internal Revenue Service would stop paying subsidies to those in federally run exchanges.

In 2014, more than 4.6 million people were getting those subsidies but the number is projected to grow to as many as 13 million by 2016.

Most of those who lose subsidies would no longer be required to have insurance, because they would fall into an exemption in the law for those who have to pay more than 8 percent of family income for premiums.

“Since a lot of people can’t afford insurance without the tax credits, you’re looking at a lot of people shedding coverage,” says Nicholas Bagley, a law professor at the University of Michigan.

Those who hang onto their coverage and pay the premium without help “are likely to be sicker on average than the people who shed their coverage because they’re the ones who need insurance the most,” he says.

Indeed, the insurance industry argued in a legal brief for a related case that elimination of the federal exchange subsidies could seriously undermine those markets, creating an insurance death spiral.

“A sicker pool of consumers results in higher premiums, which causes an additional relatively healthy subset of participants to drop out, which in turn results in a further increase in premiums,” the group’s trade group, America’s Health Insurance Plans, said in its brief.

Eliminating subsidies also would undermine the so-called employer mandate that seeks to require larger firms to provide coverage. That’s because it requires employers to pay a fine if their employees obtain subsidies on the exchange. If there are no subsidies, there are no employer fines and thus effectively, no mandate.

So what could be done? Some have argued that states that rely on the federal government to run their exchanges could establish their own marketplaces. But legal experts believe that’s problematic as well.

“The practical obstacle is that creating an exchange is not child’s play,” says Bagley. “They’ve got to be able to carry out a variety of functions,” including working with consumer assistance groups and overseeing plan’s compliance with the laws.

While some have suggested that states could create a “virtual” exchange on paper and then contract with the federal government to run it, Bagley says the law on the subject is pretty explicit. “States would have to do more than just the bare minimum,” he said.

Timing and financing would also pose practical problems. The final deadline for states to apply for federal funding to establish an exchange has passed. And a Supreme Court decision is likely to come in late June of next year, which is after another deadline (June 15) for states to use their own funds to establish an exchange in time for the 2015-16 open enrollment season.

The political obstacles are potentially even bigger.

In six states, even if a governor wanted to establish an exchange, the state legislature has specifically taken that authority away, according to the National Conference of State Legislatures. Georgia became the seventh state earlier this year.

That means state legislatures will have to get involved, said Bagley.

And many “are full of new members after the mid-term elections who specifically campaigned against the ACA.”

Still, not everyone is convinced all this would spell the ACA’s end.

“Congress will step in,” predicts health economist Tom Miller of the conservative American Enterprise Institute.

“We’re going to have the kind of political give and take which was abbreviated and artificially truncated when the law was passed,” he said. “It’s not a pretty process, but that’s why we have a government and we elect people.”

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

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Answers to Every Possible Thanksgiving Health Question, 2014

Previously: “Answers to Every Possible Thanksgiving Health Question, 2013.” This year, some of the questions are real.

* * *

Does turkey really make you sleepy, or does that just happen because we’re all fatties and eat too much at Thanksgiving dinner?Delaney Chambers, Washington, DC

Overeating and boredom and a paradoxical response to stress lead to sleep. The turkey-tryptophan story is one of the greatest lies ever in all of history.  

What’s all this about spatchcocking? Sam Wells, Flint, MI

It lets you cook a turkey in 45 minutes, and all you have to do is remove the spine. Why is anyone not doing this? Spatchcocking got really popular in 2012, but it’s been around a lot longer.

What’s a good recipe for  pumpkin pie if I’m on the Paleo diet? Chet Woodhaul, Hammond, IN

None. You either eat like a real caveperson or you eat pumpkin pie, but you don’t get to do both. Not this time.

I feel bad that turkeys can’t have sex, should I go “heritage”?Bourree Lam, New York, NY

Backing up for a minute just so everyone’s on the same page: Most turkeys are products of artificial insemination, but heritage turkeys are the product of good old-fashioned turkey sex. The drawback is that they cost as much as $200. It’s like I always say, if I had $200 to spend on a turkey …  I forget how the rest goes. The point is, how much do you care about the bird intercourse? Thanksgiving is nothing if not a time for reevaluating priorities.

How much turkey do I have to consume to absorb the drinks I need to survive Thanksgiving, and not get “too drunk”?Tanvi Misra, Washington, DC

The protein and fat in turkey will slow the absorption of alcohol more than carbs will. You could also just drink less and eat less? But then! It wouldn’t be a holiday, now, would it. [Cackles]

If I eat my Thanksgiving meal over the course of two hours instead of 10 minutes, is that healthier? Will I gain less weight and have fewer heart attacks?Alana Semuels, New York, NY

Yes. If you eat more slowly you’ll probably eat less. How many heart attacks are you having right now?

Has your stance on Tofurkey changed? I know the company sent you a big box of Tofurkey after you made fun of their name last year.Steve Perkiss, Hillsboro, KY

It’s just such a terrible word. I really can’t eat it without telling like 10 people “I had Tofurkey for lunch” and then laughing like a weirdo. Hearing that demon word come out of my own mouth just shakes my whole sense of who I am as a person, my sense of ease and safety in my own body. But it’s actually not terrible stuff.

For purposes of plate balancing, pumpkin pie counts as a vegetable, right? Carl Johnson, Washington, DC

For purposes of plate balancing, yes.

Are there any health concerns I should be aware of when my children cover every one of their fingers with black olives?Alan Taylor, Boston, MA

Only the health concern of that being too adorable! And the possible development of another serious health condition I won’t get into here.

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When Health Coverage Expansion Means Longer Waits for a Doctor

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1 in 10 hit snag on Mass. Health Connector site

About 5,000 people applying for health insurance have been temporarily locked out of the Massachusetts Health Connector’s website because of difficulties proving their identities online — an issue that Connector officials call inevitable and similar to experiences in other states.

Software glitches are not to blame, said Maydad Cohen, the state official overseeing the website’s reconstruction. Instead, requests for more documentation to verify identities are evidence of a necessarily rigorous process, he said.

Continue reading below

“The system is operating exactly as it was built to,” Cohen said, by trying to ascertain “that you are who you say you are when you’re applying.”

But those caught in this snag — about 10 percent of people who attempted to log into the health insurance site — find it maddening.

“It makes you go crazy. This has been very tough,” said Lesley Hausmann of Lexington, who had to mail in a copy of her husband’s driver’s license.

“It’s infuriating,” said Richard Pask of North Truro, who mailed copies of his and his wife’s passports last week and is still waiting to hear back. “It’s like a Kafka novel.”

Despite a smattering of such complaints, Cohen said the Connector had kept its promise to provide a well-performing website to Massachusetts residents who do not get health insurance from an employer.

In the Connector website’s first seven days, 51,967 signed on and learned what kind of health coverage they are eligible for — the key function that software was unable to perform last year, after it was retooled to comply with the federal Affordable Care Act. That number represents roughly a quarter of the 175,000 to 225,000 people expected to use the Connector during the three-month open enrollment period.

“To reach that milestone in seven days gives us really good hope,” Cohen said. He said the website continues to operate without lags; the average wait time at the call centers during the first seven days was just over four minutes.

Of those who determined their eligibility, 23,792 qualified for Medicaid and were immediately enrolled. The rest were found eligible for private insurance, and half of those people selected a plan. A total of 753 have already paid their first month’s premium, which is due Dec. 23.

While thousands made it through the process, 4,998 people came to a dead stop when they could not verify their identities online. Connector officials said this rate of roughly 10 percent is similar to that of the federal marketplace. Spokeswomen for the health insurance exchanges in Connecticut and Rhode Island, both among the nation’s best-functioning, reported similar estimates for identity-verification problems: 10 percent in Connecticut, 10 to 15 percent in Rhode Island.

To continue with their application, people need to provide backup documentation, such as copies of a driver’s license or passport, by mail or fax. As of Monday morning, 899 people had sent in documents and 739 accounts had been unlocked, according to Connector spokesman Jason Lefferts.

The Connector is using Experian, a credit-rating service, to check identities against information the service has in its database. Young people and new immigrants who do not have long credit histories, people who have been victims of identity theft or have had their credit history frozen, and those who have recently moved can run into this problem. But any number of quirks can cause it.

Hausmann, a 47-year-old self-employed management consultant, has no idea why the system could not verify her husband’s identity. They bought health insurance on the Connector last year.

Hausmann called it “really aggravating” to read news stories about the website’s success. “It’s not going great for everyone,” she said. “It’s nice that the technology is running better, but that doesn’t mean they have everything running well.”

Pask, 62, who is retired, feels the same way. “It’s like pouring salt in the wound when you read the paper or turn on the television and they tell you how swell everything is going,” he said.

Last year, Pask spent months trying to get coverage. He was hoping for a better experience this year, but it is not going well. He said he waited 40 minutes for service at the call center early last week. He got a mysterious error message that he believes may have been related to his abbreviating “N. Truro” instead of spelling out “North.” Then he hit the identity snag. He said he mailed out copies of his and his wife’s passports Wednesday and still hasn’t heard back.

Connector officials point to Paul Munafo’s experience as more typical.

Munafo, a 62-year-old carpenter and builder who had a liver transplant last August, is not yet able to return to work, and relies on the income of his wife, MJ Bruder Munafo, the artistic director of a theater on the Vineyard. Last year, they were never able to apply for a subsidy because of the website’s failure, and ended up buying insurance for $1,250 a month for the pair.

This year, the Munafos went to Vineyard Health Care Access, an advocacy group, where a “navigator,” trained to help people enroll, entered the couple’s information and showed them their options. In a little over an hour, they had selected a plan that, because of a $500 subsidy, cost $780 a month.

“It’s a godsend,” Paul Munafo said. “I’m so grateful.”

Eric Linzer, spokesman for the Massachusetts Association of Health Plans, said health insurers are starting to receive enrollment files from the Connector. It is too soon to tell, he said, whether the next crucial steps — getting people enrolled so they can get their insurance cards — will go smoothly.

Felice J. Freyer can be reached at

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Hookah, as Health Risk, Still Qualifies as Smoking

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Health Care Delays Lead to Ouster of Veterans Hospital Director in Phoenix

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HealthSouth to buy Texas home health company for $750M

Grinney, Jay

Jay Grinney

Alan Alexander
Reporter- Birmingham Business Journal


HealthSouth Corp. has agreed to buy Dallas-based Encompass Home Health and Hospice for $750 million.

The deal is expected to close before the end of the year.

The pending purchase marks HealthSouth’s entry into the home health industry, which has been pegged for growth due to the aging of the massive baby boomer generation.

“One of our stated strategic objectives has been to expand into home health, assuming we were able to acquire a high-quality, scalable asset that was capable of consolidating the highly fragmented home health industry. Today we are very pleased to announce the acquisition of the company we believe fits these requirements,” said Jay Grinney, CEO of HealthSouth. “Encompass’ expertise in home health complements HealthSouth’s leadership position in inpatient rehabilitation. Encompass’ exceptional management team, strong corporate culture, and track record of successfully providing high-quality, cost-effective home care services has positioned the company as a leader in the home health industry.”

Encompass has completed 45 separate acquisitions since 2005 and Grinney said HealthSouth will be able to marry its strong free cash flow with Encompass’ ability to revitalize underperforming home health companies to accelerate that growth.

Encompass is owned by Cressey Company and is the fifth-largest provider of Medicare-focused home health services in the U.S., operating in 140 locations across 13 states.

“We are thrilled to be joining HealthSouth and are confident that our mission of delivering a better way to care for our employees, patients, referral sources and all of our stakeholders will align well with HealthSouth’s mission and allow our merged organizations to continue to provide high-quality post-acute services to the communities we are privileged to serve,” said April Anthony, CEO of Encompass.

Alan Alexander covers health care, technology and education for the Birmingham Business Journal. Click here to follow him on Twitter.

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