Showing posts with label grim. Show all posts
Showing posts with label grim. Show all posts

Thursday, February 27, 2014

Grim scenario for Hawaii"s Obamacare plan: The numbers don"t add up

As the Hawaii Legislature weighs bills that would make sweeping changes to the state’s Obamacare program, the interim director of Hawaii’s healthcare exchange on Wednesday laid out a grim financial picture facing the agency.



With anemic enrollment by individuals and little interest among small-business employers, the state’s nonprofit exchange — known as the Hawaii Health Connector — is unlikely to have enough money to pay its bills, even under the best of circumstances, when federal grant money dries up in 2015.   


The exchange had originally planned to stay afloat by collecting a 2% fee on every plan sold through the exchange, but with the slow pace of enrollment and changing federal rules — delaying the employer mandate and allowing canceled plans to continue — Interim Director Tom Matsuda said Wednesday that the math simply does not add up.


Last week, Matsuda and the Health Connector’s board members used expected enrollments by 2016, as well as the average premium costs, to calculate how much the exchange could collect by exacting its 2% fee on each plan.


“That revenue figure is far below what we think our expenses are going to be,” said Matsuda, who has estimated that the agency will need about $ 15 million a year starting in 2015. Health Connector board members also looked at the best-case scenario for enrollment, and “even then, we’re still short on having enough revenue to cover projected expenses,” he said.


When the Affordable Care Act passed, Hawaii appeared to be one of the states best-positioned to benefit. Because of a 40-year-old state law requiring employers to provide coverage, its uninsured population is among the lowest in the nation at 100,000 people, or 8%. But even with $ 205 million in federal grants, the state’s exchange has been mired in technical problems that have kept enrollment the lowest among the 50 states — just 4,300 as of mid-February. Beyond those problems, Matsuda said that low demand for health insurance in Hawaii would make it difficult for the exchange to stay afloat over the long term.


Of the 100,000 uninsured in Hawaii, about half are expected to be eligible for Medicaid — meaning just 50,000 people would buy individual plans through the Health Connector under the best-case scenario. And while Hawaii hoped to sell thousands of plans through the exchange’s small-business marketplace, Matsuda said so few small businesses are eligible for tax credits that officials are simply not seeing the demand. “What people can get on the Connector versus outside the Connector is the same, so there isn’t really a strong incentive for small employers to use the Connector,” he said.


Further complicating matters, only two insurers offer plans on Hawaii’s exchange, so many companies are continuing to rely on their longtime brokers (who, having essentially been cut out of the process, have no incentive to help Hawaiians buy plans on the exchange).


“This is not a problem of the operations,” Matsuda told lawmakers, who have been demanding more information about how the nonprofit has operated. “It’s a problem with the market not fitting exactly what the [Affordable Care Act] mandate is all about.”


Health Connector officials are pleading with officials at the federal government’s Centers for Medicare and Medicaid for a waiver that would give them more time to spend the $ 205 million in federal grant funds that must be used or allocated by the end of the year.


That flexibility, Matsuda says, would allow the Health Connector to try to fix some of the technical problems that have stifled enrollments. One major source of the problems is a communication breakdown between the two systems that a consumer must navigate to get signed up for a health insurance plan. Every Hawaiian must get a denial of Medicaid eligibility through the state system — built by one contractor — before they can apply for tax credits to help buy a plan through the Health Connector’s system — built by a second contractor.


Nearly 20,000 applications have been caught between the two systems.


If federal officials agreed to give the Health Connector more time to spend the grant money, Matsuda said, the agency could work on streamlining and integrating those two systems, among other things. 


“We’re just going to assume right now that that’s not going to happen,” Matsuda said of the waiver, “but we’re just going to keep pushing to see if we can get a decision.”  


As Hawaii healthcare officials try to find a solution for its financial problems, lawmakers are revising a series of bills intended to improve accountability for the Health Connector, which as a private nonprofit does not directly report to legislators. 


House Bill 2529, a measure introduced by Health Committee Chairwoman Della Au Belatti and 19 of her colleagues, would have dissolved the nonprofit and brought the healthcare plan under the control of the state. At a legislative hearing in early February, Belatti proposed placing the Health Connector temporarily under control of the governor’s office beginning in 2015.


But lawmakers on the House Commerce and Consumer Protection Committee backed off that change because of concerns that the state would then absorb the exchange’s financial and legal liability problems. Instead they drafted changes that would give a legislative committee the right to monitor the Health Connector’s finances and operations, and would require that the agency submit a detailed budget and sustainability plan to lawmakers each fiscal year.


Legislators are also considering adding a “sustainability fee” to every health insurance plan sold in the state, with the money going to pay for the Health Connector’s operations.


“Maybe in the long run, the market just never will be big enough to sustain this,” Democratic State Rep. Angus L.K. McKelvey said at the end of a two-hour hearing Wednesday. “We need to get these numbers; we need this information. We need to talk about IT and all these other things so we can address them now and have good understanding to work with you and others to create the most responsible, transparent and accountable system.”


maeve.reston@latimes.com


Twitter: @MaeveReston




WHAT REALLY HAPPENED



Grim scenario for Hawaii"s Obamacare plan: The numbers don"t add up

Thursday, November 28, 2013

Sandy Hook Shooting Investigation Report: Grim Details, No Motive

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Sandy Hook Shooting Investigation Report: Grim Details, No Motive

Tuesday, November 12, 2013

VA Stops Releasing Data On Injured Vets As Total Reaches Grim Milestone


US Veteran Disabled Texas Pic #2 Getty ImageInternational Business Times – by Jamie Reno



The United States has likely reached a grim but historic milestone in the war on terror: 1 million veterans injured from the fighting in Iraq and Afghanistan. But you haven’t heard this reported anywhere else. Why? Because the government is no longer sharing this information with the public.



All that can be said with any certainty is that as of last December more than 900,000 service men and women had been treated at Department of Veterans Affairs hospitals and clinics since returning from war zones in Iraq and Afghanistan, and that the monthly rate of new patients to these facilities as of the end of 2012 was around 10,000. Beyond that, the picture gets murky. In March, VA abruptly stopped releasing statistics on non-fatal war casualties to the public. However, experts say that there is no reason to suspect the monthly rate of new patients has changed.  


VA ceased to disclose this data despite President Obama’s second-term campaign pledge that his administration would be open and transparent. Absent information about the number of soldiers that have sought government medical help and about the types of injuries they had, policymakers, Capitol Hill and health care professionals may be hamstrung in making decisions about funding for crucial veterans’ health programs and the treatments and diagnostic tools that should be researched and targeted. The reliability of future military strategies could be in jeopardy as well.


VA’s actions are “a gross injustice to veterans and the taxpaying public,” says Anthony Hardie, a Gulf War veteran and veterans’ advocate who has testified before the House Veterans’ Affairs Subcommittee on Oversight and Investigations. Hardie suggests that Congress should tackle the problem, perhaps even legislatively, noting that withholding the data “reflects a VA pattern of abuse and lack of transparency.”


Rep. Jeff Miller, R-Fla., the chairman of the House Committee on Veterans’ Affairs, stopped short of making such a harsh assessment, but just barely. VA’s records on veterans from Afghanistan and Iraq, he says, “were a valuable resource for the committee, and it’s unfortunate that VA has decided to discontinue them for now. We have asked VA to explain what security concerns led to its decision and provide an estimate as to when it will resume production of the reports.”


Miller added: “I hope VA will resolve this issue quickly, because with more than 100 outstanding requests for information from the committee currently pending, the department already has more than enough issues with transparency.”


Previously, Veterans Affairs published reports four times a year on how many patients that had served in Afghanistan’s Operation Enduring Freedom and Iraq’s Operation Iraqi Freedom and Operation New Dawn were seen for the first time in VA health care system. The most recent report was released in March 2013, reflecting numbers from the previous December. Nothing in June. Nothing in September.


VA stopped preparing and releasing these reports on health care use and disability claims involving the 2.6 million U.S. service members who have been deployed to Iraq and Afghanistan without warning, claiming unspecified “security” reasons.


A statement buried on an unpublicized VA web page reads, “VA and the Department of Defense are currently enhancing their existing security arrangements for the delivery of the data VA uses for these reports. At this time, it is unknown when the next reports will be released.”


[Update: hours after our story was published on Friday, the statement was updated to: "VA and the Department of Defense have enhanced their existing security arrangements for the delivery of the data VA uses for these reports. The 2nd Quarter FY 2013 reports should be released in November 2013."] 


Some believe privately that the enormity of the 1 million injured figure, which advocacy groups like the Veterans for Common Sense say has already been surpassed, is responsible for the reticence of VA and the Obama administration, both of whom are hoping to avoid a public relations fiasco. And several veterans advocates including Michael Zacchea, a director at the Veterans for Common Sense, suggest that there may have been some sort of data transition compromise between DoD and VA — two agencies that have never communicated very effectively. It’s even possible that VA was hacked. But no one who would know is talking.


Phil Budahn, a VA spokesman, says the department was “unable to get an answer” for this story. But veterans’ advocates, lawmakers and others agree that the information VA is currently withholding is important information that Americans have a right to know. And it isn’t just a matter of acknowledging — or refusing to acknowledge — a shocking numerical milestone: It could also influence the treatment programs, for which funding must be quantified, and provide useful data for reducing future injuries.


Zacchea sees the potential for disrupting veterans’ programs as unacceptable. “VA must release information about patients and claims among our newest generation of veterans for the year 2013 so Congress makes sure VA has enough funding,” he says.


Linda Bilmes, a Harvard professor and author of ”The Three Trillion Dollar War,” who has testified before Congress about the cost of war, agrees.


“We need accurate data on casualties in order to make decisions about treatment, research, operations and budget,” she says. “But we also need to know how much of our medical effort should be devoted to specific conditions such as psychiatric, pain relief, physiotherapy, substance abuse, etc. And regionally, we need to know where the demand for services is outstripping supply.”


Bilmes adds that in addition to helping determine how much money the government should spend and where it should be spent, these reports help the nation study and draw conclusions from the current war effort.


“Sadly, this is unlikely to be our last war,” she says. “Those of us who study the long-term effects of conflict depend on the government to collect and make available these reports that will help us to analyze what happened during this one.”


Veterans photo2 Car stickers commemorating U.S. military service in Vietnam, Afghanistan and Iraq are seen on a recruiter’s table at a veterans job fair in Los Angeles.  REUTERS/Lucy Nicholson


A House Veterans Affairs Committee staffer who asked not to be named because he is unauthorized to speak to the press said, however, that while the reports are important and should be shared by VA with the public, they are “not essential” for budgetary submissions.


“The committee has information within VA’s budget on the number of users of the health care system broken down by era, etc.,” says the staffer. “Further, there are stats on OIF/OEF [Operation Iraqi Freedom and Operation Enduring Freedom] claims activity in the budget submissions as well.”


Does that mean there is enough information in these budget submissions? In 2005, Veterans Affairs officials testified before Congress that the department was doing just fine, that it had enough money. Just a few months later, then-VA Secretary James Nicholson went back to Congress, hat in hand, and asked for billions more in emergency funding to keep the department’s doors open. This was due in part to the flood of Iraq and Afghanistan patients. Zacchea, a retired Marine lieutenant colonel who fought in Iraq, says that could easily happen again. He notes that in 2007, Veterans for Common Sense sued VA, alleging the department was unprepared to handle the tidal wave of patients and claims. The case made it all the way to Supreme Court, where the court announced in January, without further comment, that it would not hear arguments in the lawsuit. It died.


“We [VCS] are suspicious that VA’s reports on patients and claims ceased shortly after the Supreme Court’s action early this year,” Zachea says.


Whatever the reason, VA’s reluctance to share this non-fatal war casualty information raises questions. How many patients has Veterans Affairs treated in 2013? How many more disability compensation claims does it expect to need processing? Does VA need more funding to hire doctors and nurses to treat veterans suffering from traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD)?


The department’s lack of transparency has generated frustration and even anger among lawmakers on both sides of the aisle. Congress recently held hearings on the issue of VA transparency and even created a website that keeps a running record of outstanding information requests made to the department by both Democrat and Republican members of the House Veterans Affairs Committee, commonly referred to as HVAC.


“The leisurely pace with which VA is returning requests – and in some cases not returning them – is a major impediment to the basic oversight responsibilities of the committee,” the site notes.


VA’s woeful track record persists despite a memo sent by President Obama to federal agencies shortly after taking office for a second term promising, “We will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration.”


VA is also under fire for its backlog of veterans’ disability claims. The House passed a bill this week calling for the establishment of a 15-member commission that would examine ways to expedite the painfully slow claims process.


According to VA numbers, 1.4 million new, reopened and appealed claims were pending as of October 28. The average time for VA to process a claim is one year, and the department makes mistakes in 30 percent of claims. The average time for processing an appealed claim is four years.


The House also passed a bill this week that would limit the amount VA can spend on executive bonuses each year, mandating a 14 percent cut to the department’s performance awards.


And a House panel is examining VA spending on extravagant conferences. The Washington Post reported this week that the department held two events in Orlando near Walt Disney World that cost taxpayers at least $ 6.1 million, according to VA inspector general (IG). The expenses included $ 50,000 for a 15-minute video spoofing the Oscar-winning movie “Patton.”


Five VA officials involved have resigned or retired since the IG faulted their roles the training events in Orlando, according to a newly released congressional report.


But VA’s biggest and most important challenge remains caring for the onslaught of veterans returning from 12 years of war. At the end of last year, the department reported a staggering 56 percent health care usage among 1.6 million recent war veterans eligible for VA treatment.


If the same 56 percent rate is applied to the remaining 1 million service members who went to war and are expected to be discharged and become eligible for VA care in the coming years, VA may eventually treat 1.5 million Iraq and Afghanistan war veteran patients.


Among these veterans, some sources revealed last year that the PTSD rate exceeds 30 percent, and one Stanford University study puts the PTSD rate at 35 percent. If accurate, that means a total of between 780,000 and 910,000 Iraq and Afghanistan war veterans may return home with PTSD, which is often debilitating.


This week, legislators and several veterans’ service organizations called for VA programs to be funded one year in advance to improve planning and avoid service disruptions in any future government shutdowns.


“As we saw earlier this month, in the event of a prolonged shutdown, VA would not have been able to issue disability compensation, pension payments, or education benefits,” said Senate Veterans’ Affairs Committee Chairman Bernie Sanders, I-VT, at a news conference on Wednesday. “That outcome would have been reprehensible.”


Congress currently funds only the medical care portion of VA’s discretionary budget – about 86 percent of the total – one year in advance. VA hospitals and clinics continued operating without interruption during the 16-day partial government shutdown earlier this month but other VA programs and services, including claims processing, scaled back operations.


In Sanders view, the lack of casualty data could be mitigated through better collaboration between the Pentagon and Veterans Affairs, particularly by integrating electronic health records to provide real-time access to relevant military medical and personnel files. “It’s no secret that the exchange of personnel and medical records between the departments of Defense and Veterans Affairs has faced a number of challenges,” Sanders told IBTimes.


On Thursday, as this article was being prepared for publication, Sanders spokesman Michael Briggs offered a telling footnote. After being contacted by IBTimes, Briggs said, Sanders’ office got in touch with VA, and the department “told us they’re going to start putting up these numbers again soon. We raised the question with them, and they told that they will be forthcoming. The senator believes VA should be transparent about these numbers, and he now has assurances that they will be.”


It remains to be seen whether VA will follow through with the promised release, explain why the information was withheld in the first place, and clarify whether any plans or programs have been affected by the lapse.


Veterans photo U.S. Veterans Affairs Secretary Eric Shinseki (L) and Defense Secretary Chuck Hagel (R) appear a news conference on efforts to eliminate VA claims backlogs, at the U.S. Capitol in Washington, May 22, 2013.  Reuters/Jonathan Ernst


http://www.ibtimes.com/va-stops-releasing-data-injured-vets-total-reaches-grim-milestone-exclusive-1449584






VA Stops Releasing Data On Injured Vets As Total Reaches Grim Milestone

Sunday, May 19, 2013

Syria"s grim reality: Neither side can "win"


SANA via EPA



Syrian army soldiers taking position in the Jarba area in rural Damascus, Syria, in this photo released May 13 by the official Syrian Arab News Agency.




By Bill Neely, International Editor for ITV News, NBC News’ international partner


News analysis


DAMASCUS, Syria – It’s early Friday morning, a holy day in Syria’s capital. But war is no respecter of dawn or devotion; dense smoke is rising from several suburbs and the birdsong is punctured by the thud of falling artillery shells.


This is Damascus today; a city filled with the noise of war. MiG warplanes swoop overhead en route to rebel targets, mortars land amid dense housing, tanks rumble through suburban streets and, now and again, suicide bombers detonate their vehicles in the hope of killing President Bashar Assad’s men. 


But there is a difference in the war here today, from when I last visited four months ago.


Assad’s men appear to be winning, in Damascus at least.


I walked through a suburb where the front line has been pushed back 600 yards by government troops. That may not seem much, but when every 50 yards can cost scores of men’s lives, even a modest advance can be significant. 


The smoke from the shelling is further away from the city than before. Rebels are less able to launch attacks on the city center. In their stronghold of Jobar, a suburb of Damascus, which they have held for months, there are now around 200 rebels who are surrounded by government forces pounding them relentlessly.


Much of the fighting on Assad’s side is now being done by the militia men of the National Defense Force. They are part time soldiers, trained and armed in 40 days. Their motivation is simple and strong: to defend their districts and to drive out rebels they see as Islamist extremists.


It’s thought there are around 50,000 militia soldiers. They know their ground and are proving more adept at urban, street fighting than a regular army trained in national warfare and tank battles.    


Syria’s Deputy Foreign Minister Faisal Mekdad tells me “momentum is absolutely on our side…We have new tactics, new ways of dealing with armed groups. Now we know the art of fighting them.”


It’s a pattern repeated in many areas of Syria. In the country’s third largest city, Homs, a key suburb, Wadi Sayeh, was retaken by Assad’s men. In the South, rebels withdrew hundreds of men from one town because they couldn’t be resupplied with ammunition from Jordan. In areas of the North, rebels are running low on arms and ammunition because some donors can’t afford to keep paying for munitions two years into the war.



Loud explosions echo across Damascus as the Syrian Army continues operations to push rebels further from the capital. As the fighting rages footage has emerged of President Assad making a rare public appearance and being cheered by supporters. It’s not clear exactly when or where it was filmed.  ITV’s Bill Neely reports from Damascus.



So is this a tipping point in the war?


No.


Does it mean Assad will win?


No.


It all depends on what you mean by winning. 


‘Winning’ by not losing
The former U.S. Secretary of State Henry Kissinger once said that rebels in a guerrilla war only have to avoid losing to win. But in Syria that maxim might equally apply to the government. 


After Tunisia’s leader fell in days, Egypt’s in weeks, Libya’s in months, the world assumed Assad would fall quickly. It’s now been years. And he’s still there.


He’s there partly because of Russian and Iranian help. He receives a steady supply of weapons from both. 


The latest report in the New York Times suggests Russia has now given Syria advanced anti-ship cruise missiles, in order to deter the West from mounting a blockade or no-fly-zone against the country. Russia is also gathering a flotilla of warships near Syria in a show of strength and support for its ally, before next month’s planned peace talks in Geneva. Russia’s more conventional weapons stocks have been supplying the guns of the government for two years.


Syria’s armed forces are also being bolstered by men from the Lebanese organization Hezbollah, men trained and in many cases, practiced in urban warfare. 


Ward Al-Keswani/Reuters



Free Syrian Army fighters carry their weapons while walking down a debris-filled street in the al-Ziyabiya area in Damascus on May 5.




Rebels losing propaganda war
There is an ebb and flow to most wars. At the moment the government has the flow and rebels are on the ebb. 


They are losing ground in the propaganda war, too. Several times this week they have posted brutal videos on the Internet, demonstrating their ruthlessness.


In one, an Islamist fighter, from the Jabhat al-Nusra group that is affiliated with al-Qaeda, appears to publicly executes 11 men kneeling in front of him. Before shooting each of them once in the head, he accuses the men of being soldiers responsible for a massacre. It’s one of two brutal execution videos posted by the Al-Nusra group in recent days. Another,video widely circulated in Syria, appears to show a rebel fighter from Homs cutting a hole in a dead soldier’s chest, removing the heart and appearing to take a bite.  


It may be an ancient tactic of war, to dehumanize and terrify your enemy, but the rebels are making many in the outside world queasy and ready to question whether they are worthy of further support. Memories of smiling, flag waving, peaceful pro-democracy demonstrators have dimmed.


And the opposition’s lack of organization is becoming a real problem.


There is, arguably, no such thing as the Free Syrian Army. Aid organizations say they have to deal with around 300 different rebel groups, many loosely grouped under the umbrella of the FSA. Many others are rivals of the FSA, like the al-Nusra group. An “army” is usually something with a command structure and a unified organization. The FSA appears to be nothing of the kind.


As for a political opposition to Assad, the Syrian National Coalition is far from a united coalition. Politicians in the West are frustrated by the apparent inability of the “opposition” to provide a credible alternative to the Assad government.


What international ‘policy’?
All those issues have left supporters of Syria’s initial revolution in a quandary.



/



A look back at the conflict that has overtaken the country.




The U.S., Britain, France and others are now seriously considering sending weapons to certain, vetted, rebel groups. But which ones? Would the apparent heart-eater’s group qualify? How can Europe or America guarantee that the arms they ship will not end up in the hands of Islamists who later turn them against the West? Just remember Benghazi and the murder of a U.S. Ambassador happened in a Libyan city the West began a war to save.


The American administration seems to be indecisive in the face of a seemingly insoluble crisis, haunted by intervention in Iraq, talking about an ever thickening red line on the use of chemical weapons, but concerned about arming the wrong people a year too late. 


Britain and France are pushing for the arming of rebels, while Germany and Austria are pointing to what they see as the folly of doing so. 


Qatar and Saudi Arabia are pouring arms into Syria, money that is making the Islamists of al-Nusra the most effective fighting force on the rebel side. The Gulf States have no interest in the victory of “freedom and democracy” in Syria. As Sunni Muslim states, they want to weaken Shia-dominated nations like Syria and Iran. For many in Saudi Arabia, the advance of a Salafist-Islamist group like the black flagged Nusra Front is an added bonus.


More losers, than winners
Syria’s is now more than a sectarian conflict. It’s a regional conflict in microcosm, where Iran and Saudi Arabia face off, where Russia and the West arm wrestle, where Israel and Turkey spar for regional dominance and where Syrians die in the tens of thousands.


My old notebook records a death toll of 8,000. That seemed astonishingly high to me, just a year ago. Now it is ten times that and I’m no longer surprised. In fact the Syrian Observatory for Human Rights, a U.K. based organization that tracks the death toll, now puts it at more than 90,000.


Syria’s story today is one of massacres and executions, gruesomely recorded for history on video, of ruthless attacks by both sides, of MiG warplanes bombing men with mortars and machine guns, a chronicle of death foretold, everywhere.


President Assad may be “winning” the war now, whatever winning means. Rebels may “win” in the end by seeing him leave office. But nobody is really winning.


This is, and has been for months, an unwinnable war, deadlocked and deadly. Neither side can break through and neither side will give up. 


Today in Syria, there are only losers.


Related links: 


‘Sheer savagery’: Syrian rebel rips out soldier’s heart, Human Rights Watch says


Syria denies blame for Turkish border bomb blast that killed at least 46


NBC News coverage of Syria 






Syria"s grim reality: Neither side can "win"