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UK officials tell migrants in France: You are being lied to by people smugglers – Sky News

Posted on September 24, 2019 by Danzig

British immigration officials have warned migrants in northern France they are being lied to by people smugglers promising them a better life in the UK.

Their intervention comes at a time when the number of migrant crossings has been increasing, partly because of camps being cleared.

There was another clearance on Tuesday, when almost a thousand migrants were removed from a gym in a Dunkirk suburb.

Invited by the French authorities, the British officials' work in France includes "countering the misinformation being spread by other sources, including organised crime groups", the Home Office said.

Migrants are being warned that people smugglers are not telling the truth about the journey, or about what awaits them if they make it to Britain.

The Home Office said it was determined to stop "this reckless and illegal activity by stopping boats from leaving French shores".

Those removed from a gym in the Dunkirk suburb of Grande Synthe included several families with young children, the charity Care4Calais said.

Another charity, Help Refugees, said about 250 children were there, 150 of who were unaccompanied.

"These evictions are about political bravado rather than humanitarian concerns," said Maddy Allen, the charity's field manager for the area.

More than 200 police officers escorted aid workers from the site early on Tuesday, before coaches arrived and migrants were escorted on to them.

They are being taken to temporary shelters and will be allowed to apply for asylum.

According to French police, the evacuation followed concerns over security and hygiene.

But Care4Calais said it had been pointless because many of those evicted would soon be back in Dunkirk and Calais in their quest to reach the UK.

"Continual forced evictions don't affect the underlying issues that cause people to risk their lives crossing the Channel," said founder Clare Moseley.

"The men, women and children that we talk to every day do not want to take these risks; all they want is for their asylum claims to be heard."

Immigration minister Seema Kennedy said: "People thinking about making the perilous journey across the English Channel in a small boat are taking a huge risk with their lives and the lives of their children."

Meanwhile, 29 arrests have been made as part of an investigation into a large migrant smuggling network, Europol said.

Last week, the National Crime Agency arrested six British men suspected of smuggling migrants.

Elsewhere, the Ocean Viking aid ship has picked up 61 people from a plastic boat off the coast of Libya.

At least two people have died and 14 are missing after a boat filled with migrants hoping to reach Europe capsized off the coast of Tunisia.

And Malta has refused to accept 90 migrants rescued by an Italian Coast Guard vessel.

UK officials tell migrants in France: You are being lied to by people smugglers - Sky News

Fewer asylum seekers arriving in Finland | Yle Uutiset – YLE News

Posted on September 24, 2019 by Danzig

Asylum seekers on the Finnish-Swedish border in 2017.Image: Riikka Rautiainen / Yle

First-time asylum applications numbered 1,750 by mid-September, a fraction of the 30,000 applications Finland received during the 2015 migrant crisis, according to Migri, the Finnish Immigration Service.

Migris asylum unit director, Antti Lehtinen, said figures from the past months indicate that Finland may not receive more than 2,200 applications for international protection this year.

Internal border checks have made it far more difficult to move around Europe, which is apparent in the smaller number of people reaching Finland, Lehtinen explained.

The number of people seeking refuge in Finland has been decreasing since 2016, with a total of 2,409 people submitting first-time asylum applications last year.

Lehtinen told Yle that it was difficult to evaluate whether any domestic polices had influenced migrants decision to seek asylum in the country.

Finland is not any more attractive than other European states, he said.

Nationals from Turkey, Russia and Iraq make up the highest proportion of new asylum applications in Finland at the moment.

Migri currently has a backlog of some 8,900 asylum applications. Lehtinen said processing times had grown due to administrative courts sending appeals back to Migri for reconsideration. Appeals cases currently account for around half of the agency's caseload.

With a downward trend of people entering Finland, Migri has decided to shutter a number of asylum seeker reception centers, cutting a total of 800 beds.

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Fewer asylum seekers arriving in Finland | Yle Uutiset - YLE News

Franciscan sister says respect for migrants under threat – Catholic San Francisco

Posted on September 24, 2019 by Danzig

Migrants who arrived across the U.S.-Mexico border are pictured on a bus to their final U.S. destination with their host families. (Photo courtesy Sister Norberta Villasenor, OSF)Sept. 23, 2019Nicholas Wolfram SmithThe truth at the heart of the immigration crisis is straightforward, says Franciscan Sister Sheral Marshall.Were either all part of one human family and everyone deserves our respect, or certain people arent and if they arent, then we can do anything we want to them, said Sister Sheral, who is pastoral associate for liturgy at St. Robert Parish in San Bruno.She spoke Sept. 8 to about 50 people in the church sanctuary about her experience at the border. From Aug. 4-12, Sister Sheral volunteered at a Catholic Charities migrant shelter in Laredo, Texas, witnessing the humanity and gratitude of newly arrived migrants and asylum seekers.Theyre just ordinary people like us who happen to be born in a different place, she said.Part of her talk was to address the general confusion around migration and asylum, Sister Sheral said, emphasizing that both are enshrined in international law.People can emigrate if theyre in danger of persecution, or torture, or starving to death, she said.Sister Sheral also criticized an asylum process that has been made deliberately more difficult.Under a new Trump administration regulation issued on July 15, U.S. ports of entry have been closed to many asylum claims. According to the new rule, any person who failed to apply for protection from persecution or torture in a third country through which they transited en route to the United States cannot apply for asylum. If Central Americans, for example, cross Mexico without applying for asylum there, they cannot be granted it by the U.S.The third country policy was a violation of international law on refugees and has led to a severe decline in the number of migrants admitted, Sister Sheral said.One shelter employee told her only 16 people had been permitted to enter the country within a two-week span at the crossing in Laredo.As a result, she said, people have turned to coyotes, or smugglers, to take them across the border into the U.S where they turn themselves in to the Border Patrol. Desperation has led to steep costs for smuggling, she said, with the price of crossing as high as $8,000.Its an unbelievable situation, Sister Sheral said. If you hear people talking about illegal aliens, all I can think of is sci-fi movies. These people arent illegal, theyre undocumented, and they cant apply at the places they should.Sister Sheral also criticized the Trump administrations decision to end the Flores agreement, which since 1997 has limited the detention of migrant children to 20 days. Indefinite detention would have lifelong harmful psychological effects, she said.That its being done in our name is the horrible thing. Its not our values as a country, she said.The factors provoking immigration drought, violence, gangs and corruption, among others make it difficult to see how it will end, Sister Sheral said.Sending people back to the nations they fled is inhumane since they used all their resources to make the trip to the U.S., she said.Sister Sheral also pointed out that the violence and instability in El Salvador, Guatemala and Honduras, where many migrants have come from, exists in part because of U.S. involvement in their national affairs.Its such a mess and they dont deserve it, she said.Sister Sheral encouraged people to keep track of political developments around immigration, as well as to pray, write letters and donate to humanitarian organizations helping migrants.As for returning to the border, Sister Sheral said, I would love to go again but I dont know if anyone will be crossing.Franciscan Sister Sheral Marshall, seen during a recent visit to a migrant service shelter in Texas, said the migrants are given the address of the closest Catholic Charities to help find a lawyer for their immigration court hearing. (Photo courtesy Sister Norberta Villasenor, OSF)

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Franciscan sister says respect for migrants under threat - Catholic San Francisco

What is the real story behind Judaism in Hungary? – JNS.org

Posted on September 24, 2019 by Danzig

(September 23, 2019 / JNS) The history of Europe and the Jewish people is one that has seen some of humanitys most remarkable triumphs and darkest periods. Despite the Jewish population nearly being wiped out in the Holocaust, the story of Judaism and Europe is still being written today. The central European nation of Hungary, home to some 120,000 Jews out of a population of nearly 10 million, has historically played a large role in this storyone that it is still grappling with today due to its complex past, tense present and uncertain future.

When this government was first elected back in 2010, we had to obey the constitution. And in this constitution, we state that we are a Christian country, and we are very proud of that and our Judeo-Christian heritage, which is very strong in Hungary, Hungarian Ambassador to the United States Lszl Szab told JNS.

Szab, who has served at his post since 2017, said, We believe that the Jewish Christian heritage that the European civilization is built upon is strong and alive in Hungary. We believe Jewish Christian culture and origin of European civilization is the strongest foundation and our countrys survival over the last millennia.

Christianity has played a significant role in Hungarys history and identity after being adopted in the 11th century, and most Hungarians today still identify as such, despite the Communist era and increasing secularization throughout Europe. Unlike elsewhere on the continent, Hungarian Prime Minister Viktor Orbn has been making the countrys Christian values and identity as a centerpiece of his government, even calling his country a Christian Democracy.

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Hungarian Ambassador to the United States Lszl Szab. Credit: Hungarian Embassy.

We believe this is something we need to preserve, and quite clearly, Israel is the torch in that battle, said Szab. We think that going back to the roots and this very foundation is the secret of a very successful society, and that is what we are trying to build.

The Judeo-Christian civilization that informs the right-wing government of Orbn has been a source of controversy throughout Europe. At a time when many Europeans have dropped their Christian roots, Orbn has embraced them, viewing himself as a defender of these values. These values seem to play a role in his embrace of Israel.

Last year, Orbn made a high-profile visit to the Jewish state and was welcomed by Israeli Prime Minister Benjamin Netanyahu as a true friend of Israel.

Israeli Prime Minister Benjamin Netanyahu holds a joint press conference with Hungarian Prime Minister Viktor Orbn at the Prime Ministers Office in Jerusalem, on July 19, 2018. Photo by Marc Israel Sellem/POOL.

Earlier this year, Hungary became the first European country in decades to open a diplomatic trade mission in Jerusalem.

This is a very exciting moment for us because its the first European diplomatic mission opened in Jerusalem in many decades, and three Hungarian diplomats are going to be assigned to this office for trade purposes, said Netanyahu. Thats important for trade, for diplomacy and for the move that Hungary is leading right now to change the attitude in Europe towards Jerusalem.

Additionally, Budapest has defended Israel on the international stage.

On the platform of the United Nations and European Union, we have strongly supported pro-Israel positions or vetoed anti-Israel initiatives, said Szab. One of the most recent ones was when the European Council wanted to declare that it was a bad idea for the U.S. to move its embassy to Jerusalem. We were one of the first countries to veto it. Earlier this year, we decided to open our diplomatic mission in Jerusalem. We have not yet moved the embassy, but I believe this is a very important step that we are one of the first countries to open a diplomatic mission after the United States and Guatemala. We hope many other countries follow that path.

Indeed, countries in Central and Eastern Europe, such as Hungary, Poland, Czech Republic, Greece and Romania, have become strong allies of Israel, defending the country against anti-Israel resolutions in the European Union, such as the battle to re-label goods from Israeli settlements, or condemning the U.S. decision to move the embassy from Tel Aviv to Jerusalem.

Hungarian Prime Minister Viktor Orbn (second from left) in the Old City of Jerusalem on the last day of a two-day official state visit to Israel. To his right is Rabbi Shmuel Rabinowitz; to the right of him is Hungarian Rabbi Shlomo Koves, July 20, 2018. Photo by Yonatan Sindel/Flash90.

Judaisms millennia-old presence in Hungary

Hungarys emergence as one of Israels staunchest defenders in Europe is a remarkable feat considering the complex history of Hungary and the Jewish people. Still, news coverage on Hungary of late seems to focus on negative moves by Orbn, who has been accused of eroding Democratic institutions, using anti-Semitic tropes against political enemies and revising history, especially Hungarian complicity in the Holocaust. Yet given this, Hungary also has remarkably low levels of anti-Semitism and a thriving Jewish community that seems at odds with the accusations against the government.

While Jews first settled in the region during the Roman era, the modern community can be traced back to the medieval period during the formation of the Hungarian state. Like other European Jewish communities during the subsequent centuries, they enjoyed periods of prosperity and peace under various leaders, followed by persecution and even expulsions under others. Nevertheless, the community continued to grow, and by the eve of the 19th century numbered about 81,000 people.

In 1867, Hungarian Jews were fully emancipated and granted the same political and civil rights as their Christian compatriots in the Austro-Hungarian Empire, allowing them to play an active role in Hungarian commercial, financial and cultural life. In subsequent decades, Hungarian Jews made enormous contributions to culture, science, industry and even sports.

A view of the Dohny Street Synagogue, also known as the Great Synagogue, in Budapest, Hungary. It is the largest synagogue in Europe and the second-largest in the world. Photo by Yossi Zeliger/Flash90.

During the 1920s and 30s, Hungarian Jews began to face the first series of anti-Semitic laws and discrimination as the situation in Europe began to destabilize. Nevertheless, on the eve of the Holocaust, the community numbered about 825,000 people. Despite facing severe persecution under dictator Adm. Milkos Horthy and feeling the ramifications of German power throughout World War II, Hungarian Jews were nearly spared the fate of their brethren until the last year of the war. It wasnt until 1944 when the Nazis began to address Hungarian Jewry in full force, occupying the country in March, and rounding up local Jews in ghettos and deporting them to death camps, mainly Auschwitz, in what was described as one of the most horrifyingly efficient operations of the Holocaust even as the German war effort was starting to fail.

In the end, approximately 255,000 Hungarian Jews survived (Nobel laureate Eli Wiesel and former Californian Rep. Tom Lantos among the more well-known), less than one-third of its prewar population.

The Jewish cemetery and memorial for victims of the Holocaust at the Dohny Street Synagogue, also known as the Great Synagogue, in Budapest, Hungary, on Jan. 1, 2019. Photo by Nati Shohat/Flash90.

For the survivors of the Holocaust, the ensuing Communist-era did not offer any sanctuary. While some Jewish communities were reconstituted, there were also a series of pogroms in the post-war period as well as the closure of Jewish institutions and arrest of activists by the communists.

Going in the right direction

In the 21st century, the Hungarian Jewish community has seen a remarkable comeback.

According to the World Jewish Congress, its population stands at about 120,000, making it one of the largest communities in Europe. Budapest, where most of the community lives, has a number of Jewish institutions, including museums, community centers and synagogues, such as the Dohny Street Synagogue, the largest in Europe. Budapest itself has more than 20 active synagogues that include the range of Jewish denominations from Orthodox to Reform, and a Chabad-Lubavitch presence. A number of Jewish organizations and youth groups are active in Hungary, and the country recently successfully hosted the European Maccabi Games in August.

Nevertheless, the modern Hungarian Jewish community faces challenges similar on the global scale, such as intermarriage, an aging population and growing anti-Semitism.

Once you are in Budapest, you realize how much fake news is going around on Hungary. We are really unjustifiably blamed for being an anti-Semitic country, said Szab. This might have been the case 70 years ago, but if you walk around Budapest today, you can see that Hungary is one of the best places for Jews in Europe.

Jews in Hungary are not considered minorities; they are considered Hungarian. It is just a feature of them that they follow the Jewish faith, and there is nothing special about them, unlike other Western countries. They feature prominently in Hungarian society and are great contributors to our culture, said Szab.

Before the war, 5 percent to 6 percent of Hungarians were Jews, but 30 percent of medals were won by Jews, he said. We clearly see the contribution from sports to Nobel prizes. We are proud of that.

The ambassador continued, We are also proud that there is an interest by Jews in Hungary from all over the world. I am happy to say in 2016, Israel was second-largest investor in Hungary, including in real estate and industry. Obviously, you put your money where your mouth is, and I believe this is a good indication that something in going in the right direction.

Israeli Prime Minister Benjamin Netanyahu and his wife, Sara, at Shoes on the Danube Bank Holocaust memorial in Budapest, Hungary, on July 20, 2017. Photo by Haim Zach/GPO.

According to Hungarian Foreign Minister Pter Szijjrt, more than 200 Israeli companies employ 5,500 people in Hungary. Trade between the two nations stood at $525 million in 2018.

We have approximately 100,000 people who claim themselves Jews, and in Hungary, there are no issues in practicing their religion. If you wear a kipah in Hungary, nobody cares, said Szab.

Much has been reported about the revival of anti-Semitism across Europe in recent years. While some has been attributed to the rise of far-right and far-left groups and parties, fingers have also pointed to the influx of Muslim migrants, particularly due to the Syrian civil war, and threat of Islamic terrorism.

This combination of Jew-hatred has become especially relevant in Western Europe, where far-left leaders like the British Labour Party leader Jeremy Corbyn have cloaked anti-Semitic views with anti-Zionism, leading to scandal in his party and fears of him becoming prime minister amid the Brexit crisis. France, with a large Muslim community from North Africa that has historically rejected nationalist inclusion, has seen brutal Islamic terror attacks on the Jewish community, causing Jews to fear for its future and even sparking emigration. Similarly, Germany, which has absorbed a massive influx of Muslim migrants, has reported an almost 20 percent rise in anti-Semitism.

Far-left groups across Western Europe are also fueling the BDS movement that targets Israel. This movement is particularly forceful in Irelandone of Europes fiercest critics of Israel and the first E.U. country to vote to boycott goods from Israeli settlements. Similarly, many towns and cities across Spain have moved to boycott Israel and its goods.

Eastern European countries like Hungary have largely closed their borders to outsiders, and have refused to take in the waves of refugees from the Middle East and Africa. Hungary has refused E.U.-mandate deals for the allocation of refugees; opinion polls show the vast majority oppose accepting refugees. As a result, Eastern Europe remains largely homogenous as compared to Western Europe.

Hungary made headlines during the migrant crisis in 2015-16, when more than a million people crossed into Europe for its refusal to absorb migrants, who hailed mainly from Muslim countries across the Middle East like Syria, to the erection of a $476 million, 100-mile border fence along its frontier with Serbia, which is not a member of the E.U., to stem the flow. Hungary built a barrier along its border with Croatia as well. Leaders in Hungary have hailed the Serbian-border fence for protecting European culture and European values.

Szab believes that the Hungarian governments strong stance on the migrant crisis is tied to his countrys positive situation for its Jewish community.

Even though in Hungary we are not perfect, we are headed in the right direction. We believe that the irresponsible immigration policies that many countries decided to support is creating this new type of anti-Semitism. The huge crowds coming to Europe come from anti-Semitic countries; this is something that the governments are shy to talk about. We have to make sure that the policies and requirements of the E.U. have to be kept.

A tour boat on the Danube River in Budapest, Hungary. Photo by Isaac Harari/Flash90.

Indeed, surveys have shown that Hungarian Jews feel both safer and face less anti-Semitic attacks than their counterparts in Western Europe. A 2018 survey by the American Joint Distribution Committees International Center for Community Development found that Eastern European Jews (including Hungary) reported higher feelings of safety (96 percent) than their Western European Jewish neighbors (76 percent).

Western European respondents were more likely to consider anti-Semitism as a threat than were Eastern Europeans, and to report deterioration in the situation from earlier surveys, the report said.

Additionally, Hungarys anti-Semitic watchdog group, TEV, reported 32 anti-Semitic hate crimes in 2018, the lowest since it started tracking in 2014. For comparison, the United Kingdom, which has about three times the Jewish population of Hungary, recorded 1,652 anti-Semitic incidents in 2018, the highest total since it began collecting data in 1984.

The prime minister zero tolerance for anti-Semitism since he was elected in 2011, Szab said. Since then you can see the numbers, but Hungary has probably become one of the safest countries for Jews in Europe.

We are very proud of that. We believe that this is not only our moral duty, but also a competitive edge when it comes to politics, the economy, and culture. We believe this is something we can build on, he said.

While Hungary may not be facing the threat of Islamic terrorism and anti-Semitism that has taken hold in Western European, Eastern European countries have been concerned over the rise of right-wing nationalism, populism and historical revisionism.

In Poland, the issue of Holocaust revisionism led to tensions with Israel last year after the country passed a law to criminalize associating Poland with crimes committed by the Nazis during World War II. After a global outcry, Poland reversed itself on the law.

Hungary has faced its own controversy regarding the Holocaust under Orbn with his praise of wartime leader Horthy as an exceptional statesmen, as well as the concern over historical revisionism with its long-delayed House of Fates Holocaust museum commissioned by Orbn back in 2013.

There is a strong trend in Hungary today to present the destruction of Hungarian Jewry during the Holocaust as an exclusively German crime and, except for a small group of Hungarian thugs, to ignore the role and responsibility of the Hungarian authorities and society, wrote the director of Yad Vashem Libraries, Dr. Robert Rozett, in a statement on the museum.

Szab dismissed the House of Fates issue, saying it is a controversy created by the left liberal press, and that the country already has a world-class Holocaust museum, established in 1999 by the government during Orbns first term as prime minister.

The controversial House of Fates Holocaust museum in Hungary. Credit: Hungarian Government.

This current government wanted to have a new approach to it [the Holocaust] and the government provided space and money for the museum. This is where the controversy started. Some accused Orbn of wanting to change the past and to whitewash history; obviously, these accusations are completely unfounded, said Szab.

After years of debate and criticism, the prime minister said, OK, you tell us what should be in that museum. We contacted Yad Vashem and many Jewish organizations, and asked them for their input.

At the same time, Orbn and his Fidesz Party have been also accused of using anti-Semitic tropes against left-wing billionaire and philanthropist George Soros, who is Jewish and was born in Hungary, during his 2018 re-election campaign. Soros runs the Open Society Foundation, which has funded many left-wing organizations, including ones that are highly critical of the Jewish state, some of whom deny its right to exist.

I believe the whole thing is being orchestrated by George Soros. He has a lot of money, and the open society foundation is funding a lot of organizations. I think that because Hungary has a strong and solid conservative government, that it creates enemies all around the world. And especially in the liberal media, there are a lot of accusations. They dont base their judgement on fact, and it makes it very hard to fight it.

Typical accusations from Brussels and Socialist governments in Europe are that we are anti-Semitic, that we are Russian-friendly or China-friendly, that we are corrupt. They are never quoting facts. If you look at facts in Hungary, it is quite the opposite. I believe those accusations are completely unfounded. When it comes to George Soros, he is a speculator. He tried to ruin the British pound, the Swedish krona. He is an enemy of the people, and he is trying to destabilize many countries in Europe. He pulled out the Jewish card, nobody cares if he is Jewish or not, he is a speculator who went against Hungary and we have defended ourselves.

The track record for the Hungarian government on fighting anti-Semitism paints a different picture.

Orbn has been involved in establishing a national Holocaust Memorial Day and recently pledged $3.4 million to fight anti-Semitism in Europe, and is staunchly defended by some Hungarian Jewish leaders as not harboring anti-Semitism.

Hungarian Prime Minister Viktor Orbn tours the Yad Vashem Holocaust Memorial Museum in Jerusalem on July 19, 2018. Photo by Hadas Parush/Flash90.

We also have mandated that all primary schools curriculums have Holocaust lessons, said Szab. All primary-school kids go through the Holocaust lessons. Hundreds of teachers have traveled to Israel to learn about the Holocaust. We believe we are on the forefront of this, and we have nothing to be shy about.

The ambassador said the world should talk to Jews in Hungary and see this for themselves. They are the best references for us, he said. If you look at their incredible culture and celebrations of Jewish life, the beautiful synagogueswe have some of the largest in the worldand even Jewish cemeteries being renovated. We are very proud of this.

Sometimes, we feel isolated from the rest of Europe and singled out by the media. But I believe the more you know about Hungary, the more you like.

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What is the real story behind Judaism in Hungary? - JNS.org

Trump administration announces the end of ‘catch and release’ – AZCentral

Posted on September 24, 2019 by Danzig

Migrants from Central America in a Tijuana, Mexico, February 2019, wait to meet with U.S. immigration officials.(Photo: Nick Oza/The Republic)

TUCSON Acting Homeland Security SecretaryKevin McAleenan announced on Monday the end ofthe practice his departmentrefers to as"catch and release," with changes coming as early as next week.

Theterm refers to the process in which the federal government must release migrant families, mostly from Central America, apprehended at the U.S.-Mexico border intothe interior of the United States to begin the process of seeking asylum. That process can take years, given themassive backlogs in the country'simmigration courts.

McAleenan made the announcement during prepared remarks before the Council on Foreign Relations in Washington, D.C.

"(The Department of Homeland Security)will no longer be releasing family units from Border Patrol Stations into the interior," McAleenan said."This means that for family units, the largest demographic by volume arriving at the border this year, the court-mandated practice of 'catch and release' due to the inability of DHS to complete immigration proceedings with families detained together in custody--will have been mitigated."

In doing so, McAleenan would be fulfilling President Donald Trump's campaign promise to end so-called "catch and release." It follows several steps the Trump administration has taken in recent monthsto restrict the ability of migrants to claim asylum in the U.S.

In a follow-up statement, the Homeland Security Departmentsaid the move is part of its"strategy to mitigate the loopholes that act as a 'pull factor'for family units seeking to cross illegally at the Southwest border."

The department said that if migrant families do not claim a fear of return, they will be "quickly" deported back to their countries of origin. But if they do express a fear of return, the families would be sent back to Mexico to await the outcome of their asylum proceedings under the policy known as the "Migrant Protection Protocols."

McAleenan noted there will besome humanitarian and medical exceptions.

There are many questions about how the program will work.

Phoenix church pastors help Central American migrants, who were dropped off by U.S. Immigration and Customs Enforcement.(Photo: Nick Oza/The Republic)

The announcementon Mondayfocused largely on Central American families processed by the U.S. Border Patrol. They've made up the bulk of border apprehensions this year.

To date, agents have processed nearly 458,000 migrants traveling as families this year, nearly all of them hailing from three Central American countries: Guatemala, Honduras and El Salvador.

But McAleenan did not say whether this change also will applyto the thousands offamilies who have spent months waiting at legal ports of entry along the U.S.-Mexico borderto present their claims with Customs and Border Protection officials at the ports.

A report earlier this year from researchers at the University of California-San Diego estimated the number of migrants waiting in Mexican border cities at nearly19,000.

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Earlier this month, theSupreme Court allowed the Trump administration to implement restrictions at the border that would allow them to reject migrants who haven't first applied for asylum at another country they'vetraveled through.

The thousands offamilies waiting to seek asylum at the border also include a surging number of Mexican migrants who are fleeing cartel violence in their home states. McAleenan's announcement didn't address thatpopulation of migrants either.

While the Homeland Security Departmenthas expanded the Migrant Protection Protocols to five border cities andhas sent back about47,000 migrants, the program is not in place at many parts of the border, including at any of Arizona's border crossings.

It's unclear if the program will expand to these areas before families apprehended there are no longer released into the U.S.

The Homeland Security Departmenthas not responded to a request for comment.

We are still at crisis levels in illegal crossings at the Southwest Border and, until we change the fundamental laws governing our immigration system, we wont solve the underlying problem

In his remarks, McAleenan said policies such asthe Migrant Protection Protocolsand the new restrictions on asylum are having their intended effect. The number of migrants apprehended at the border has decreased after peaking in May.

Still, he stopped short of claiming success.

"We cant let our progress cloud our vision," McAleenan said. "We are still at crisis levels in illegal crossings at the Southwest Border and, until we change the fundamental laws governing our immigration system, we wont solve the underlying problem."

Have any news tips or story ideas about the U.S.-Mexico border? Reach the reporter at rafael.carranza@arizonarepublic.com, or follow him on Twitter at @RafaelCarranza.

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Campus Mental Health Care Demand On the Rise – Diverse: Issues in Higher Education

Posted on September 24, 2019 by Danzig

by B. Denise Hawkins

Jacqueline L. Caskey-James

Getting in the groove with the rigors of college classes, managing newfound freedoms and relationships and jostling to fit into campus life are among the rites of passage for most freshmen. At Fort Valley State University in Georgia, these experiences were no different for Jacqueline L. Caskey-James.

They were also among the lessons she and her classmates at the historically Black institution struggled to learn if they were going to make it academically and be well mentally, in the process.

People were struggling with so many issues and behaviors, but we just didnt talk about them. We didnt know how, she says.

That was in 1979, when Caskey-James was a first-time college student and mental illness was real to most, but hushed, even if what ailed you didnt have a diagnosis or there was no one to help a young, Black person cope. The events of four decades ago sound like yesterday when Caskey-James tells how she and her friends watched day after day as their roommate crumbled and broke under the weight of college. They didnt know how to help her, or what triggered her constant crying.

In those days, we had a dorm mother who would sit and talk to her as she cried and cried and cried. The dorm mother would give her hugs and love on her, but that wasnt enough, says Caskey-James of the roommate who eventually slipped away from school and out of their lives.

The student never returned to campus. Decades later, they learned that their roommate had committed suicide, which is now the second-leading cause of death among college students.

Its a Different World

Today, Caskey-James, Fort Valley States director of Student Health and Counseling since 2010, says that roommate likely suffered from chronic sadness and depression that accompanied her to college like her trunk. She knows now that there were indicators, but no one to diagnose and treat them.

Now, Caskey-James, the professional mental health counselor and often the first line of response to a wave of students in need of support, would do for that roommate what she does every day comfort and cradle her like a caring dorm mother, get her to the campus in infirmary, contact her parents, deliver mental health counseling, connect her to treatment, sit bedside, see her through a crisis and more.

In 2019, the National Center for Education Statistics projects 19.9 million students will attend colleges and universities. With that comes an increase in the number of young adults with mental health issues. Making their way to campus with their load of boxes and books, new bedspreads and mini fridges, first-time college students are at a uniquely vulnerable stage in their lives. Most will be uprooting themselves from the familiar family, friends and support systems and doing so at a time when many mental illnesses first appear, says Annelle B. Primm, M.D., MPH, former deputy medical director of the American Psychiatric Association and the senior medical adviser to the Steve Fund, a foundation that supports the mental health and emotional well-being of college students of color. Mental illnesses that begin by age 24, during the college years, Primm adds, account for 75 percent of all lifetime cases of the disease.

Reflecting on her own college experience, Caskey-James adds: Some of the same kinds of behaviors that our students are experiencing today were happening when I was a student here. We just kept quiet about them, even when the pressure and fear that came with being the first person in the family to go to college overwhelmed and worrying about making the grade and making ends meet kept you up at night. Primm says these are the kinds of stressors, situations and behaviors that can contribute to a host of psychological and physical ailments in students.

Stress-related anxiety and depression rank as the most common mental health concerns of todays college students, according to the latest annual reports by the Center for Collegiate Mental Health (CCMH) at Pennsylvania State University. When surveyed by the American Council of Education, college presidents said they are also aware that their students are facing anxiety (84 percent) and depression (83 percent).

While these latest reports, and others published in recent years, sound an alarm about the mental health crisis that exists at U.S. colleges and universities, findings from the Steve Fund suggest that African-American college students, especially those in their first year, may be most at risk. Heres why: They are more likely than their White peers to report feeling overwhelmed most or all of the time during their first term (51 percent vs. 40 percent).

But, like African-American adults, these African-American students are less likely to help.

Dr. Annelle B. Primm

Stigma and a cultural mistrust of mental health professionals who lack cultural competence are among the barriers to mental health care. But there are consequences. Primm adds: Coping with an untreated mental illness can affect a students social experience and academic performance. And for students of color, theres often more under the surface working against them.

The fight against stigma

Students who are seeking mental health services are finding campus counseling centers straining to meet their demand. On most campuses, these are facilities that need to have the ability to treat as much as counsel.

Penn States CCMH reports found that students use of counseling centers rose an average of 30-40 percent from fall of 2009 to spring 2015, even though enrollment increased by just 5 percent during that time.

Like the rest of the nation, its been tough for Fort Valley State to keep pace with the demand from students in search of mental health services. Caskey-James and a new licensed counselor comprise the team of two that leads the effort. During the past spring semester at Fort Valley State, 516 students sought mental health services, says Caskey-James. And last fall, a record 41 students who were seen needed to be admitted for a time to an off-campus psychiatric facility or stabilizing unit.

To meet the changing needs of its students, Howard University has been constantly evaluating and redesigning how it delivers mental health services, says Dr. Ayana Watkins-Northern, who directs University Counseling Services. As a new semester begins, she says, We have reconfigured ourselves to be more focused on crisis intervention and shorter-term treatment.

Back at Fort Valley State, walk-ins to the counseling center are at a steady beat. Thats alright with Caskey-James. A decade ago, her challenge was finding a way to get students who needed and wanted mental health services just to come into the center. To students, those who visited the center had to be pregnant, have HIV, AIDS or a sexually transmitted infection or be crazy, Caskey-James learned. Such notions stopped many students in their tracks, but for the practitioner eager to change that thinking, they were a spark.

First, Caskey-James set out to disrupt the fear and stigma associated with mental illness what kept most students away. Today, her efforts are a work in progress.

For us, there was a level of personal embarrassment and stigma that came with seeing and experiencing things that people labeled as crazy. The times have changed, but those perspectives on mental illness and mental health linger and cross generations, says Primm. They dont seek help more often because of things like stigma, cultural mistrust of the medical system, racism and fear of being shunned.

Cost and accessibility to practitioners of color are also factors in whether people of color get mental health care.

Its a complex issue with roots that run deep. But on some campuses, there are signs of change. At Fort Valley State, for example, a growing group of more than 100 student peer educators is helping to reduce the mental health taboo on campus and make it okay to even be seen stepping inside the center and the infirmary for activities, information and care. It also takes tough love, sound education and getting in their face to keep students on this campus physically and mentally healthy and able to practice self-care, says Caskey-James, whose yearlong dorm talks and visits are set to kick off with the new semester.

To track attendance, which is mandatory, she said students must swipe in to the room with their identification badges.

On most days and nights, for Caskey-James, the past at her alma mater is present.

Its my goal to reduce mental healths stigma and to get our students to graduation, healthy and whole, says Caskey-James. When I needed it, I was helped by dorm mothers and others here on campus. Now, its my turn to pay it forward.

This article appears in the September 19, 2019 issue of Diverse.

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Campus Mental Health Care Demand On the Rise - Diverse: Issues in Higher Education

The bare minimum America could do to expand health coverage – Vox.com

Posted on September 24, 2019 by Danzig

There is an extremely simple and potentially bipartisan idea that could dramatically cut the uninsured rate in America: enrolling people automatically in health insurance.

A new study examined the difference in coverage rates among people who were able to automatically reenroll in their Obamacare plan in California and people who were not. They found people without the option to automatically reenroll in an insurance plan were much less likely (about 30 percentage points less likely) to stay insured through the marketplace than people with the automatic option, according to Coleman Drake at the University of Pittsburgh and David Anderson at Duke University who published their study as a research letter in JAMA Internal Medicine.

They framed their findings in the context of the Trump administrations consideration of ending automatic reenrollment (which is standard on the Obamacare marketplaces). The unavoidable implication is that more people would end up without health insurance. From Drake and Anderson:

Elimination of automatic reenrollment would likely be associated with decreases in the number of enrollees who remain insured through the marketplaces. As an opt-out policy, similar to that used in other health insurance markets such as Medicaid, automatic reenrollment may be associated with increases in continuity of coverage in the marketplaces by reducing administrative barriers to reenrollment.

While the Trump administration considers, for whatever reason, ending a policy that keeps people insured, the truth is automatic enrollment is about the bare minimum the United States could do to make sure its citizens have health coverage.

In the abstract, its a no-brainer. It crosses ideological lines. As a group of progressive and conservative health policy experts wrote in Health Affairs last year, automatic enrollment could be one useful way to replace the individual mandate (now repealed) in making sure younger and healthier people sign up for insurance and keep Obamacare premiums down.

Maryland has set one possible example for how automatic enrollment could work, with Republican Gov. Larry Hogan signing a bill this year that allows Marylanders to check a box on their tax return and get enrolled in a health insurance plan. The state estimates half of its 360,000 people are already eligible for either subsidized health insurance or Medicaid through the ACA.

Automatic enrollment is a shared feature of the Democratic health care plans, too. The more moderate proposals, like those by former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg, would start by automatically enrolling people who should be eligible for the ACAs Medicaid expansion but live in a state that refused to expand in a new government insurance plan. Other iterations, like Medicare for America, would automatically enroll newborns in a government plan.

This change would bring some logistical challenges, as Christen Linke Young wrote for the Brookings Institution think tank. Governments have to do the work to figure out what people are eligible for. It might be Medicaid, Obamacare subsidies, or nothing at all, and once they do, governments must also set up a way to collect premiums from the automatically enrolled.

There are ways around this, but people who support single-payer Medicare-for-all (where every person would have the same government insurance plan) might argue this is overly complicated.

But its also maybe the easiest way to expand insurance coverage and one that should be agreeable to politicians of both parties.

If Democrats win full control of Congress and the White House next year, then they can think about an even more ambitious health care agenda. Automatic enrollment is something that could be done no matter what. Its hard to see the argument against it, given what research like that of Drake and Anderson teaches us.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in Americas health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

Are you interested in more discussions around health care policy? Join our Facebook community for conversation and updates.

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The bare minimum America could do to expand health coverage - Vox.com

Health Net Invests $3.55 Million to Strengthen Californias Health Care Delivery System & Improve Patient Outcomes – Yahoo Finance

Posted on September 24, 2019 by Danzig

LOS ANGELES--(BUSINESS WIRE)--

Grants Will Support the Collection of Patient Health and Services Data Critical to Meeting the Health Care Needs of Most Vulnerable Patient Populations

Health Net announced today its continued commitment to strengthening Californias health care delivery system by awarding $3.55 million in grants to improve patient data collection and reporting a fundamental priority for addressing the gaps in the states health care system and improving health outcomes, especially amongst the most vulnerable patient populations.

Encounter data, the administrative information that describes health care interactions between patients and providers, must be collected by law in the state of California. The data serves as one of the most important tools in enabling healthcare providers, stakeholders, and state legislators to analyze trends in healthcare, and can help to identify best practices that improve health outcomes for patients enrolled in Medi-Cal, which serves over 13 million Californians, or close to one-third of the states population.

At Health Net, a key component of our mission to transform the health of communities is working to ensure Medi-Cal enrollees have access to high-quality care so they can live longer and healthier lives, said Carol Kim, Vice President of Community Investments and Government and Public Affairs for Health Net. The accurate collection and reporting of encounter data is a critical piece of this puzzle as this information allows us to measure health outcomes, track the needs of vulnerable patient populations and inform a stronger, better approach to care for Californias future.

Health Nets latest $3.55 million investment in encounter data is comprised of two grants. The company will award $2.55 million to assist in the implementation of solutions that improve encounter data tracking through new technology and standardized practices for 13 Medi-Cal providers. These providers are located across California from dense, urban areas including Los Angeles and San Francisco to rural, underserved regions such as Kern and Tulare counties. This work is based on a comprehensive assessment conducted in 2018, which Health Net funded last year with a $5.85 million grant.

Additionally, Health Net will award a $1 million grant to Manatt Health, a health care consulting firm, to conduct a year-long Stakeholder Engagement program. This new stakeholder engagement effort will facilitate critical conversations amongst state and industry leaders assisting in the identification of solutions to expand data collection infrastructure, implement necessary advancements in technology, and track and assess patient services.

Health Nets latest investments demonstrate our ongoing commitment toward improving encounter data collection an essential component of our states Medi-Cal care delivery system and an essential part of improving quality health care in California. We are dedicated to investing in collaborative solutions to move us one step closer toward the collective goal of a healthier California, said Kim.

Grant Recipients

About Health Net

At Health Net, LLC (Health Net) we believe every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Founded 40 years ago, we remain dedicated to transforming the health of our community, one person at a time. Today, Health Nets 3,000 employees and 85,000 network providers serve more than three million Californians. Thats one in 13 residents throughout the State. We provide health plans for individuals, families, employers, people with Medicare and people with Medi-Cal coverage for every stage of life. Health Net also offers access to substance abuse programs, behavioral health services, employee assistance programs and managed health care products related to prescription drugs. We offer these health plans and services through Health Net, LLC and its subsidiaries: Health Net of California, Inc., Health Net Life Insurance Company and Health Net Community Solutions, Inc. These entities are wholly owned subsidiaries of Centene Corporation (CNC). For more information, visit HealthNet.com.

View source version on businesswire.com: https://www.businesswire.com/news/home/20190923005851/en/

Notre Dame Health Care to host 2019 Educational Forum – Community Advocate

Posted on September 24, 2019 by Danzig

Find Your TRIESSENCE: A mindfulness journey for a joyful and fulfilling life

Worcester Notre Dame Health Care (NDHC) is hosting its annual Educational Forum on Wednesday, Oct. 16 from 5:30-8:30 p.m. at the Hogan Center at the College of the Holy Cross, 1 College St., Worcester. This special event is a fundraiser to support the educational mission of NDHC. The Presenting Sponsor is F.L. Putnam Investment Management Company and the Reception Sponsor is J. J. Bafaro Mechanical Contractors.

Community support of this initiative has helped to change lives throughout the community. Proceeds benefit the Educational Bridge Center at Notre Dame Health Care, supporting NDHCs educational mission including: adult basic education classes, individualized tutoring, scholarship support, citizenship preparation, and specialized health care skills training, including Alzheimers and dementia seminars and workshops on improving end-of-life care.

This year the keynote speaker is Tessa Todd Morgan, a mindfulness expert, personal growth coach and accredited trainer in Emotional Intelligence. As the founder and CEO of TRIESSENCE, Morgan presents nationally and has coached hundreds of individuals and organizations to achieve a balance of physical, mental and spiritual wellness.

Morgan has been privileged to work with famous keynote speakers and celebrities such as Dr. Mehmet Oz, Geena Davis, Sir Ken Robinson and Suze Orman.

Guests will also enjoy music and hear about its healing value from Notre Dame Health Cares own music therapists.

There are many ways to participate including event sponsorships, tributes and by purchasing seating to attend. Registration for individual seating is just $50 per person. Sponsorships provide additional opportunities for recognition and will highlight your partnership in supporting NDHCs educational mission. Guests will enjoy a reception with hors doeuvres, cash bar, raffles, mingling and music; followed by the speaker program, complete with dessert. Advanced registration is required; they are unable to accommodate seating at the door. Visit http://www.notredamehealthcare.org for more information or contact Paige Thayer at [emailprotected] or 508-852-5800, x2509.

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Notre Dame Health Care to host 2019 Educational Forum - Community Advocate

Health Care Delayed Is Health Care Denied – Foundation for Economic Education

Posted on September 24, 2019 by Danzig

Medicare for All (M4A), or at least some version of it, is supported by the majority of current Democratic primary candidates. The way its being pitched, it sounds great. Never worry about medical bills? That sounds amazing! Paying medical bills is one of my most despised Adult Things I Have To Do, and goodness knows I have more to pay than most people. But as Milton Friedman said, One of the great mistakes is to judge policies and programs by their intentions rather than their results.

Government-run health care service is not a novel idea. Its been tried and continues to be tried in many countries around the world, and even, to an extent, here in the United States. And if we look at the results of those programs, it tells a rather stark story of delays and shortages and deaths that could have been prevented.

Nationalizing health care into a single-payer format is a popular offering since it would mean that Americans could walk into a doctors office, clinic, or hospital, receive care, and never worry about getting a bill in the mail. But how does it work in practice?

If we insist on maintaining government control over the price and the supply, were down to rationing and waiting as our options.

First, a little basic economics. When the price of something a lot of people want, like medical care, goes down, the demand for it goes up. More people are able to afford consuming more of it, so they do. If a doctors visit costs $10 (or $0) instead of $60, people go to the doctor more often and for less severe symptoms. But there are only so many doctors and facilities and hours in the day, so now we have a supply problem.

When people want more of a thing than is available, normally the price for it will rise, indicating that its worthwhile (that is, profitable) for more of that thing to be produced, drawing more suppliersin this case, medical care providersto the market. But when the price is fixed by government forces, whats the indication (or motivation) to produce more?

Now, instead of health care just being expensive, theres simply not enough of it. If we insist on maintaining government control over the price and the supply, were down to rationing and waiting as our options. Since telling a population of over 325 million people that each of them may only receive health care X number of times a year is certainly politically impossible, all we really have left is waiting.

And wow, do people wait for nationalized health care. In Canada, for example, the Fraser Institute reports the median wait time between getting a general physicians referral and actually receiving the treatment was a little over four months in 2018 (19.8 weeks, to be exact). The report goes on to say:

There is a great deal of variation in the total waiting time faced by patients across the provinces. Saskatchewan reports the shortest total wait (15.4 weeks), while New Brunswick reports the longest (45.1 weeks). There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.

Naturally, the severity of cancer meaning a shorter wait time to begin treatment is encouraging to see, and its about on par with the US. But every week of delay before treatment begins increases the chances of mortality. Emergent, life-threatening health issues arise and should be treated with urgency. But who, then, gets to decide what qualifies as urgent and necessary? And what happens when they get it wrong?

And its not just waiting for actual procedures and treatments, either. There are long waits to even be seen in the first place. In 2017, a Canadian woman reported being told that the wait time for a new-patient appointment with a neurologist was four and a half years. Granted, thats an outlier, but the trend in Canada (as well as other countries with single-payer systems) has been toward longer and longer wait times for doctor visits, diagnostic tests, and treatments.

Lest you think these problems wouldnt plague us here in the United States, weve already gone down the road of government-run health care stateside. The Department of Veterans Affairs (the VA) offers full health care coverage to former military members. And its been a disaster for the patients whove already had their lives at risk in the armed forces.

In 2014, the VA waitlist scandal first broke around the Phoenix, Arizona, facility when it was reported that 40 veterans had died waiting for care. (I put scandal in quotation marks because its not a scandal. Getting caught with a mistress is a scandal. People dying while waiting for medical attention their government promised to give them is a gross injustice.)

Just as justice delayed is justice denied, all too often health care delayed is health care denied.

After an internal audit that same year, it was revealed that more than 120,000 veterans were either waiting for or never received their promised care. And thats people who have no choice but to go through the VA: the kind of government-run care some Democrats want everyone to have (or lack). Those veterans who managed to secure private health insurance or could afford to pay out of pocket and went elsewhere for their health care werent included in the tally. Nor are the 7,400 veterans who took their own lives that year.

Ostensibly, the VA has cleaned up its act since then, though theres some indication that might not be true.

And lets not forget the Indian Health Service (IHS) that is supposed to provide health care for Native Americans here in the US. Its the only option for those living on reservations, and it has long been plagued by shortages and long waits. And yet, in 2008 when a proposed reform would have allowed tribe members to choose from various options including purchasing private insurance, it was voted down.

If the American government cant even care for the people its systematically oppressed and displaced for centuries or the ones who risk their lives at its whim, it calls into question the ability of that same government to effectively expand its coverage to encompass the entire population. As evidenced by its own failings at small scale and the failings of other nationalized health care systems around the world, just as justice delayed is justice denied, all too often health care delayed is health care denied.

If we want to actually improve Americas health care system, what it needs is more freedom and more choice, not less. Markets work, even with health care.

Get rid of the burdensome regulations that limit the supply of providers and facilities, and the price of exams, tests, and procedures will come down. End the monopoly on approval and quality control that is the FDA so that private quality assurance providers can operate, and the price of prescription drugs will come down. Extend the tax breaks that businesses get for offering health insurance to include individuals, allow it to be sold across state lines, and stop mandating what it must cover, and the price of insurance plans will come down in addition to ending the reliance on ones employer for health coverage.

Just as you shouldnt have to depend on an employer for health care coverage, you shouldnt have to depend on a government, either.

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Health Care Delayed Is Health Care Denied - Foundation for Economic Education

How to save on health care costs, Nationwide Retirement Institute survey finds – Financial Planning

Posted on September 24, 2019 by Danzig

Welcome to Retirement Scan, our daily roundup of retirement news your clients may be talking about.

Younger clients take more risks to reduce health care costsNearly three in four younger adults have made risky moves to save for health care-related expenses, a survey by Nationwide Retirement Institute has found according to this Forbes article. These actions include deferring medical treatment, not getting appropriate care to avoid deductibles and avoiding a medical bill by skipping a scheduled appointment, the survey found. Younger adults are advised to make preventive care a priority and contribute to a health savings account to save taxes on their medical expenses.

Americans are saving more, and that isnt necessarily goodAlthough overall household saving has increased since 2007, clients continue setting aside cash many years after a downturn, contrary to what analysts expected, according to this article from Morningstar. Personal-saving rate climbed from 3.7% in 2007 to 6.5% in 2010, and it continued to increase an average 8.2% in the first seven months of 2019. That is evidence to suggest that something structural has changed, and its made the saving rate kind of sticky at higher levels, according to an economist.

1 in 3 Gen Xers made this costly mistakeNearly a third of all Gen Xers have borrowed from their 401(k)s, a survey by Schwab Retirement Services has found, according to this article in Motley Fool. Such a move is a poor decision to make, as taking a 401(k) loan comes with hidden costs, including a hefty 10% penalty if they are below the age 59. Their loan will be treated as a taxable distribution if they fail to repay the debt on time, and it will trigger a tax bill and can even raise their tax bracket.

3 times it makes sense for clients to borrow from their 401(k)s Clients are advised to only borrow from a 401(k) if they need to cover a down payment on their first home, pay off high-interest debt or are in a significant financial setback, according to this CNBC article. Before taking a 401(k) loan, clients are advised to factor in the penalties and fees, as well as determine whether they can afford to lose out on the tax-deferred growth of their savings. The loan will be considered a distribution and trigger an income tax bill and penalty if they leave their jobs and fail to repay the debt within a few months.

Satchit Balsari: Will AI help universalize health care? – The BMJ – The BMJ

Posted on September 24, 2019 by Danzig

The successful integration of AI into healthcare services must take different focuses depending on local contexts, says Satchit Balsari

Health and Wellness Centers are sprouting up across Indiain fact, there will be 150,000 of them. [1] As part of the government of Indias ambitious goal to extend insurance coverage to 500 million citizens, thousands of rural and urban clinics are getting a facelift. I visited one such clinic this July, not far from Bengaluru, Indias IT capital, where we were greeted by freshly painted walls anointed with logos depicting various services offered at the clinic. The telemedicine screen on one such logo hinted at the central role that digital services will be expected to play. The mid-level healthcare provider (MLHP) staffing the clinic, was a member of a new cadre of non-physician providers, continuing Indias long tradition of successfully task-shifting basic care delivery to community health workers. [2] She beamed as she powered on her tablet computer. It would eventually be loaded with apps to access and capture data from each of the programmes.

At its essence, this combination of task-shifting and technology is a recognizable symbol of last-mile delivery anywhere in the Global South. Providers at such clinics across Asia and Africa continue to see untenable numbers of patients, each interaction lasting no more than a few minutes. [3] And it is this fleeting visit, sometimes at the cost of a days wage, that is the patients only hope of being correctly screened, diagnosed, treated, or referred. The success of universal health coverage will depend in no small measure on the success of optimizing care during these interactions.

Frontline providers are faced with state-mandated data-entry requirements, with tablet computers, and few other resources at their disposal. Despite an explosive growth of point-of-care devices and tele-consulting services, few governments have managed to test and successfully integrate portable technologies into age-old clinical pathways. Even a reliable list of current diagnoses, medicines, and lab resultsinformation that most clinicians would consider very basicis seldom available. In a world where my Sonos app can pull songs from Apple, Amazon and Spotify, it is remarkable that most patients and physicians cannot access basic clinical data collated from disparate sources. [4] With limited time, and even less information, practitioners are left prescribing placebo combinations of anti-inflammatories, analgesics, and antibiotics in lieu of meaningful care. [5,6]

AI powered virtual assistants, predictive algorithms, customized care-plans and home-based nudges can be game-changing for delivering care to those with little to no care. [7] But in order for this vision to be rolled out globallyto reach the billions that do not have the most basic access to carewe need more than Silicon Valley hubris and Wall Street speculation. Hundreds of millions of dollars are being spent on AI solutions in anticipation of the discovery of healthcares Uber. The time has come for some somber reckoning.

Deep neural networks, the complex, multi-layered, self-teaching models that are expected to eventually aid and nudge physicians, will only be as good as the data that power them. The more structured and labelled the data, the readier they are for machines to ingest them. The most successful inroads we have therefore seen are those where the data are the cleanest, for example in radiology images or in pathology slides. [8] Algorithms attempting to predict survival, readmission, or risks for infections, are messier and highly dependent on the quality of data (and their accompanying biases) captured in electronic health records. [9]

The trouble with these context-laden algorithms is one that clinicians are very familiar with. Clinical parameters considered normal in European men should probably not have driven clinical decision-making around the world, for as many decades as they did. [10] Similarly, clinical trials are often unable to replicate their success when validation is attempted in entirely different populations. Services whose deep neural networks have been powered by data-rich populations, may similarly not be applicable or usable in low and middle-income settings. [11] While many applications may indeed transcend population heterogeneity, those that will be used to decide, deny or delay care must have contextual intelligence, to be relevant and fair. Where technology is perhaps most needed, the data simply do not exist.

An overzealous drive to elevate digitization over other aspects of care, however, will do harm. Low-resource settings can hardly afford to shackle overburdened providers with the responsibility of feeding algorithms. The clinician as data-entry operator ought to become as anachronistic as the stenographer. Companies have begun to leverage voice-recognition technologies, natural language processing, and deep neural networks to extract texts from physician-patient interactions to populate EHRs [12,13]. Making these advances accessible in local languages and dialects, to liberate hundreds of thousands of healthcare workers from their keyboards, may in fact be one of the most important contributions AI can make toward expanding access.

What is required now is a thoughtful reconnaissance in the Global South, of what problems need solving (first), what data are needed to solve them, and how best technology can be leveraged to collect these data. Clinicians should be at the forefront of this rapidly changing landscape steering developers and investors toward solving the most basic, yet pressing challenges of care delivery today. A successful example of need-driven, thoughtful, strategic application of AI technologies is the collaboration between Indias Aravind Eye Hospitals (the worlds largest network of eye care clinics), and Google, that resulted in deep learning algorithms to detect diabetic retinopathy. [14]

For most of humanity, AI powered personalization of diet recommendations based on gut biomes will remain a moonshot. But employing machines to collate a list of our patients current diagnoses, medications, and lab results will be a giant leap forward.

Competing interests:None declared

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Satchit Balsari: Will AI help universalize health care? - The BMJ - The BMJ

GM no longer paying for striking workers’ health insurance – ABC News

Posted on September 24, 2019 by Danzig

General Motors is no longer paying the health care costs for the tens of thousands of auto workers who went on strike on Monday, shifting the costs instead to a union fund.

More than 49,000 union workers walked off their jobs on Sunday night, starting a nationwide strike at General Motors. As negotiations enter their third day on Wednesday, the health coverage for striking workers will no longer be covered by GM.

Mary Kay Henry, the president of the Service Employees International Union which represents more than 2 million members slammed the news in a statement, calling it "heartless and unconscionable."

GM's decision to yank healthcare coverage away from their dedicated employees, in the dead of night, with no warning, is heartless and unconscionable. GM's actions could put people's lives at risk, from the factory worker who needs treatment for their asthma to the child who relies on their parents' insurance for chemotherapy," she said. "Thankfully these men and women have their union, which is making sure working people and their families can continue to get care."

In a statement to ABC News, GM expressed sympathy that "strikes can be difficult and disruptive to families."

"While on strike, some benefits shift to being funded by the union's strike fund, and in this case hourly employees are eligible for union-paid COBRA so their health care benefits can continue," the statement added.

Union leaders have argued that GM workers deserved a bigger slice of the company's record profits, which they say have totaled $35 billion in North America over the last three years. Union members are calling for higher wages, retention of a health insurance plan in which workers pay about 4% of the costs, an improved pension plan and assurances that GM -- the makers of Buick, Cadillac, GMC and Chevrolet -- will not close four plants in Maryland, Ohio and Michigan.

As negotiations remain at a stalemate, some on the front lines say they hope for a swift resolution.

Machinist Clarence Trinity who was picketing at a GM factory in a Detroit suburb told the Associated Press that he couldn't "see this lasting too long," adding that "both sides are losing bad."

ABC News' Bull Hutchinson and Joshua Hoyos contributed to this report.

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GM no longer paying for striking workers' health insurance - ABC News

Industry VoicesThe solution for offering ‘shoppable’ prices in healthcare is coming – FierceHealthcare

Posted on September 24, 2019 by Danzig

Hospitals are experiencing heartburn over the Centers for Medicare & Medicaid Services directive that they must post their prices for shoppable services beginning next year.

This isnt due to some sort of entrenched aversion to sharing prices with patients.

Its simply that for decades hospitals have dealt largely with insurance companies instead of patients regarding reimbursement. Almost all of their revenue cycle processes, people and systems have been designed around facilitating payment from a middle person, not directly with the patient.

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To put this into stark perspective, consider the experience of a colleague of mine whose primary care provider ordered a series of chest X-rays and tests for her through the local hospital. Because my colleague has a health plan with a large deductible, she needed an estimate of her cost of care before scheduling the services.

RELATED: CMS wants hospitals to post their rates. But hospitals aren't sure how

Once at the hospital, she was directed to the patient access department, where eventually she was summoned to a small cubicle. Inside, a woman sat behind a desk with nothing on it but a computer and a framed picture of a puppy. The latter was abruptly pushed in front of my colleague, presumably for her to think warm and fuzzy thoughts while the patient access staffer spent the next 20 minutes alternating between flipping pages in a thick binder and clicking through different computer screensall to generate a single cost estimate.

Bored, my colleague asked the woman some idle questions about where she was from and last worked, and learned shed actually come from Disney. And this is definitely not Disney, the woman said in a trembling voice.

Sound surreal? Its actually a pretty accurate representation of whats involved in generating a patient estimate in hospitals across the country. (Its also a vivid snapshot of why patient access employee turnover is so high.)

The process is clearly untenable. In terms of streamlining it, however, there isnt really another industry that hospitals can look to for examples. Just like hospitals serve patients with different levels of acuity and insurance benefits, service professionals such as electricians, mechanics, accountants and others serve customers with highly variable needs.

But here is where the clouds begin to part. Unlike these other professions, in healthcare a great deal of artificial-intelligence-driven work is being done to automate patient access transactions between hospitals and insurers. In a relevant example, robotic process information and machine learning can combine to compare a patients current insurance benefits and hospitals price for a certain service to then calculate the patients out-of-pocket cost.

Thats a very simplified description, but the output is delivered in one of two ways that are scalable for hospitals.

RELATED:Hospitals, insurers signal major fight over CMS price transparency proposal

In the first, hospitals generate the estimate in-house, but directly from an existing system like Epic. Theres no need for a patient access employee to contact an insurer or for the patient to be present. Phone calls and binders arent required, either.

Instead, a data provisioning system assesses whether the most accurate benefit information is present, either in an EDI clearinghouse or on the payers website. If the latter, robotic process automationor botslog into the payers website with the providers credentials and retrieve the patients real-time benefits. Additional bots then calculate the patients out-of-pocket costs based on what the hospital charges and what the health plan pays.

Of course, thats not the same as posting prices online, which leads us to the second way to give patients fast and accurate estimates. This option is even more scalable than the first. Hospitals can embed a self-service calculator on their websites that allows a prospective patient to enter data in just a handful of fieldsproviding an insurance plan number, the procedure name and a few other pieces of data. This generates the estimate in less than a minute, and the patient never had to contact the hospital to get it.

Thats a welcome convenience for patients (even for those of us partial to pictures cute puppies).

Its also a crucial need. As more Americans are directed to high-deductible plans with high co-insurance, patients must have faster insight into their cost of care before scheduling it. In the absence of this understanding, many patients will delay or put off care altogether. Technology that swiftly produces accurate estimates in under a minute answers both a federal mandate and the hospitals commitment to patient care.

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Industry VoicesThe solution for offering 'shoppable' prices in healthcare is coming - FierceHealthcare

Argo city council ponders new surveillance tool, amends employee health care resolution – Trussvilletribune

Posted on September 24, 2019 by Danzig

By Joshua Huff, sports editor

ARGO The addition of new surveillance cameras became a topic of discussion at the Argo city council meeting on Monday, Sept. 23, 2019. A representative from Alabama Power presented a surveillance tool that could be mounted on existing poles that track vehicle types, color and license plates.

There is no video feed, but snapshots that are uploaded into the cloud and can only be accessed by the police and never by Alabama Power. The images would be stored for only 30 days before they are deleted. Argo would pay a monthly fee of $166.67 per camera and the contract would last 24 months, thereafter, should Argo renew, the city would be given a replacement camera.

The cameras are not a speed camera, the representative said. It cannot tell how fast anybody is going. It cannot generate tickets or anything like that. All it does is it takes the license plates that are going by and puts it into a database. Since the police will have access to this, they can run it against the NCIC. If there is anybody coming into the city wanted for murder, stolen vehicles, warrants, sex offenders the police will get an alert to their car and show what theyre wanted for.

The council will research the topic further.

In other Argo news, the storm shelter behind City Hall at 100 Blackjack Road will be delivered this Thursday, Sept. 26. The shelter will house up to 100 people.

The council unanimously passed an amendment to the employee health insurance resolution wherein all full-time employees are now immediately eligible for health insurance. The city will pay 100% of single coverage and the city will pay for a portion of the cost if the employee elects to include family members with a cap of $200 per month. The employee is responsible for the remainder of the premium. The amendment passed unanimously.

The Argo city website will get a new makeover. The cost has already been included in the yearly budget. The council voted unanimously to hire ADR Business and Marketing Strategies to update the website.

Improvements to Katie Lane took a step forward as the council voted to accept the bid of Harrison Builders Inc. to shore up piping that runs under the road. That option allows for the road to remain open.

The meeting concluded with the mayor asking for $1,000 to get starting with applying to grants to get the word out about the upcoming census. The motion passed unanimously.

The county has decided to umbrella all the cities underneath the county and apply for a grant to pay for literature, signs, banners and that sort of stuff, Mayor Betty Bradley said. To help the cities out so that we can get the most accurate count that we can possibly get.

Each city gets around $1,600 per person counted in the U.S. Census.

The mayor and others have already come up with events throughout next year that will get the word out for citizens to participate in the census: A table at the Halloween candy giveaway, a Christmas parade census float, an event on the fourth of July called Police be our Valentine, and an Easter egg hunt.

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Argo city council ponders new surveillance tool, amends employee health care resolution - Trussvilletribune

David Jones, Health Care Entrepreneur Behind Humana, Is Dead at 88 – The New York Times

Posted on September 24, 2019 by Danzig

I built a nursing home, Mr. Jones said the lawyer told him. I ran back to my buddy Wendell and said, Lets build a nursing home. There was no forethought in it.

Each man borrowed $1,000, and with other investors their first nursing home got built.

Within a few years they had a chain of about 50 homes, called Extendicare, which they took public in 1968 at $8 a share. By the end of the year the share price had multiplied tenfold.

In the early 1970s after ending a losing venture in trailer parks they sold the nursing homes and started to buy and build hospitals. Even as Mr. Jones and Mr. Cherry were amassing a chain, eventually named Humana, that grew to about 100 hospitals, they saw a need to shift direction again.

Humana had been operating health insurance plans since the mid-1980s, supplying its hospitals with a constant stream of insured patients. The arrangement in some cases led Humanas insurance companies to push doctors to hold down costs, prompting the doctors to rebel by boycotting the companys hospitals.

Humana spun off the hospitals in 1993 to a new company, Galen Health Care (which later that year was sold to Columbia Health Care for $3.4 billion). Mr. Jones took control of a Humana that was dedicated entirely to health insurance.

In 1998, Mr. Jones agreed to sell the company to UnitedHealthcare for $5.5 billion. But the sale was never completed; the deal ended a few months later after United reported an unexpected $900 million charge in its second quarter, causing its stock to plunge.

Mr. Jones retired as Humanas chairman in 2005 and focused on nonprofit work on behalf of the Parklands project, the Louisville Public Libraries and the Actors Theater of Louisville.

He is survived by his daughters, Susan and Carol Jones; his sons, David Jr., Dan and Matt; 11 grandchildren; a sister, Jean Donoho; and a brother, Clarence. His wife, Betty Lee (Ashbury) Jones, died last month.

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David Jones, Health Care Entrepreneur Behind Humana, Is Dead at 88 - The New York Times

UAW workers claim they were blindsided by health insurance switch – Fox Business

Posted on September 24, 2019 by Danzig

United Auto Workers members say they feel blindsided about changes to theirhealthcare coverage after General Motorsannounced Tuesdayit would no longer pay striking workers.

UAW is holding out even though GM shifted the costs of striking workers'health insurance to the UAW for the time being.

GM pushed back againstthe narrative that benefits are lost and that the shift was unexpected.

"Medical and prescription drug benefits are continuous, and benefits are even retroactive to the beginning of the strike for those that enroll in COBRA coverage," GM said in a statement.

UAW blasted the moveas a way to "leverage unfair concessions." They had told workers they would qualify for specified healthcare benefits available through theUAW Strike and Defense Fund at the start of the strike.

Meanwhile, local news outlets have covered stories like those of longtime GM employee Dennis Urbania and GM employee spouse Laura Prater.

Urbania is waiting on a heart transplant and is desperately hoping he doesn't get "the phone call" while his insurance rolls over to the UAW.

"If I get the phone call today, I can't get the heart, I need catastrophic insurance. ...Am I upset? Yes. Am I mad? Yes, but there's a lot more stories out there than just mine," he told FOX17.

Earlier this week, Praterwoke up from stomach surgery to find she was no longer covered.

"All of a sudden I am risking getting this major hospital bill we honestly couldn't afford," Prater. aTennessee resident, told FOX17.

"We had no warning and in fact, I even verified last week before the surgery 'is this still a go?'"she said.

UAW insurance signups for members in Prater's area were scheduled foron Wednesday and Thursday, according to FOX17.

CLICK HERE TO READ MORE ON FOX BUSINESS

The longer thestrike lasts, the bigger the losses that GM will have to face. The strike could cost GM at least $77 million a day, Morningstar analyst David Whiston told FOX Business on Tuesday.

The strike was in its fourth day Thursday.

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UAW workers claim they were blindsided by health insurance switch - Fox Business

Jim Chanos: This Berkshire Hathaway-Backed Health Care Company Is an Insurance Fraud – Yahoo Finance

Posted on September 24, 2019 by Danzig

Jim Chanos (Trades, Portfolio) specializes in sniffing out fraud. In the early 2000s, he was one of the few people betting on the collapse of Enron. More recently, he has made headlines with his well-publicized short position on Tesla (NASDAQ:TSLA) and his criticism of Elon Musk. In a Sept. 19 interview with CNBC, Chanos discussed another one of his shorts - dialysis provider DaVita Inc. (NYSE:DVA).

Insurance fraud?

DaVita is notable for the fact its biggest shareholder is Warren Buffett (Trades, Portfolio)'s Berkshire Hathaway (NYSE:BRK.A)(NYSE:BRK.B). We will discuss why this seems strange in a little while; for now, let's talk about Chanos' short thesis.

"It's always ominous in my world when one of your biggest customers sues you for fraud. And this spring, Blue Cross of Florida sued Davita for a scheme."

The suit alleges (and Chanos agrees with these allegations) that DaVita has been targeting Medicare and Medicaid patients and pushing them into signing up for expensive commercial insurance through the Obamacare exchanges. DaVita promises better service and shorter waiting times to those on the more expensive insurance. Many of these patients cannot afford commercial insurance; however, the company points out that The American Kidney Fund, a charity, will cover some of the premium payments.

"They then turn around, using the VSO numbers, and charge the commercial payers, three to four times what they get for Medicare and Medicaid. Now, this is bad enough, but what really is interesting is that the two largest donors, at slightly less than 90% of the donations to the American Kidney Fund, are DaVita and Fresenius [another big player in the dialysis business]. And so they are donating to the charity, the charity is paying the premium into the Obamacare exchange and they're then charging the insurers three to four times X."

DaVita has always said it does not direct the fund's spending. However, a whistleblower from the fund recently came forward and said this was not the case, and that DaVita plays a direct role in determining where the money goes.

Where does Berkshire come in?

"Berkshire Hathaway, as you mentioned, owns over 25%. Whatever you might think, this I think is a very bad look for an insurance company like Berkshire Hathaway, to be promoting a company that I think is certainly running an insurance scam, and if the whistleblower is correct, it's actually insurance fraud. And I just can't understand why Berkshire Hathaway would be promoting a company that's gaming the insurance business is as much as DaVita is."

It's definitely odd to see a company like DaVita listed in Berkshire's holdings. For one thing, as Chanos points out, it has a history of paying large fines to the federal government, which it seems to accept as a cost of doing business. It's own 10-K filing lists many risk factors and its extreme reliance on this Medicare-sponsored model makes it vulnerable to possible legislative and regulatory challenges. With that being said, DaVita does have a strong hold on the market for dialysis, which I suppose affords it a fairly wide moat. But all the same, it seems decidedly unlike Berkshire.

Disclosure: The author owns no stocks mentioned.

Democrats biggest health care lies – New York Post

Posted on September 24, 2019 by Danzig

When it comes to health care, Democrats are selling snake oil. Americans are grappling with rising medical costs. But if they fall for the phony solutions the left is offering, theyll pay with exorbitant taxes and shorter lives.

Whopper 1: ObamaCare is affordable. Joe Bidens running a television ad in Iowa pledging to stand by ObamaCare because every American deserves affordable health care. Iowans arent going to buy that. Theyre not hayseeds.

Truth: In Iowa, 90% of ObamaCare customers who paid their own way in 2014 have dropped their coverage. ObamaCare is affordable only if you qualify for a subsidy. Middle-class people who earn too much to get taxpayer-funded help cant afford to stay enrolled.

They have taken it on the chin, reports Larry Levitt of the Kaiser Family Foundation. Why is the number of uninsured in America suddenly rising again? Blame ObamaCare for pricing the middle class out of insurance.

Whopper 2: House Speaker Nancy Pelosi has a new proposal to bring down prescription drug prices. Shed force drug companies to negotiate with Uncle Sam on the price of each medicine.

Truth: Get real, Madame Speaker. No one negotiates with the feds. Uncle Sam will dictate the price. Any drug company that refuses will get socked with a draconian penalty equal to 75% of the previous years sales of that medicine. In short, bankruptcy. Good luck getting the meds you need then.

Pelosis proposal also would bring medical innovation to a halt. Who will suffer most? Cancer patients. New cancer drugs are available sooner in the United States than in countries with drug price controls, and that has resulted in longer cancer survival rates here, according to Columbia University economist Frank Lichtenberg.

True, the public is up in arms about drug prices. In reality, though, theyre not increasing faster than hospital or doctor costs. Yet seniors especially feel the sticker shock because they pay a separate deductible for medications under Medicare Part D. That deductible should be eliminated. It would to save the system money. Medications keep patients out of the hospital and off the operating table. But a separate deductible discourages patients from taking them.

Whopper 3: At every campaign stop, presidential wannabe Liz Warren rails that insurance companies sucked $23 billion in profits from the system. As if eliminating those profits would free up money to cover the uninsured. Thats baloney.

Truth: $23 billion is a minuscule 0.65% of the $3.5 trillion Americans spend on health care. Zeroing out all insurance company profits wouldnt make a dent in the nations medical costs.

So where will the money come from? Warren backs Bernie Sanders Medicare for All plan, which Sanders estimates will cost $3 trillion to $4 trillion a year, about as much as the entire US budget. To raise that much money, all taxpayers, not just the rich, would have to hand over a gut-wrenching share of their income to Uncle Sam.

A married couple earning $165,000 a year and currently paying a 24% marginal rate would be hit with a 60% marginal rate, according to Congressional Budget Office revenue tables. Say goodbye to your standard of living.

Whopper 4: Politicians are here to help. On Friday, Bernie Sanders was approached by a Navy vet with crippling Huntingtons disease and a wad of hospital bills. The vet said Tricare a government-run program had canceled his coverage. Sanders seized the moment, later bragging that hed called a Nevada senator and members of Congress to get the vet help.

Truth: If you think getting through to an insurance company when you need help is hard, imagine having to call a member of Congress under government-run health care.

Pols are scapegoating drug companies and insurance companies. Heres what theyre not telling you: Medical costs are rising just as fast in other developed countries. Major culprits are the obesity epidemic and inactive lifestyles, not Americas capitalist health system.

Health costs are a top issue in the 2020 election, and every candidate has a plan. Yet their plans are mere shell games, shifting the costs from one group of people to another. No one wins but the pols.

Betsy McCaughey is a former lieutenant governor of New York and chairman of Reduce Infection Deaths.

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Democrats biggest health care lies - New York Post

Michigan Health Care Regulators Just Restricted Access to Promising New Cancer Treatments – Reason

Posted on September 24, 2019 by Danzig

A state commission, acting at the behest of Michigan's largest hospital chain, voted on Thursday to restrict cancer patients' access to promising, potentially lifesaving treatments.

It's another example of the problems caused by little-known state-level health care regulations known as Certificate of Necessity (or, in some states, Certificate of Public Need) laws. These laws are supposed to slow down increasing costs, but they often end up being used to restrict competition, often at the request of powerful hospital chains.

That's exactly what seems to have happened in Michigan, where the state's Certificate of Need Commission voted Thursday to impose new accreditation requirements for health care providers who want to offer new immunotherapy cancer treatments. Those treatments attempt to program the body's own immune system to attack and kill cancer cells, and they have become an increasingly attractive way to combat cancer alongside more traditional methods, such as surgery, chemotherapy, and radiation.

One particularly promising type of immunotherapy involves literally bio-engineering T-cellsthe foot-soldiers of the body's immune systemand equipping them with new Chimeric Antigen Receptors that target cancer cells. This so-called "CAR T-cell therapy" is every bit as badass as it sounds:

But under the new rules adopted by the Michigan Certificate of Need Commission, hospitals will need to go through unnecessary third-party accreditation processes before being able to offer CAR T-cell therapies. Even after obtaining that additional accreditation, hospitals would have to come back to the CON commission for another approvala process that effectively means only large, wealthy, hospital-based cancer centers will be able to offer the treatments.

The new rules were "opposed by cancer research organizations, patient advocates and pharmaceutical companies, who argue it would add an unnecessary level of regulation and deny many patients access to potentially life-saving treatment," reportsMichigan Capital Confidential, a nonprofit journalism outfit covering Michigan politics.

In favor of the new rules? The University of Michigan Health System, the state's largest hospital system, which argues that the new rules are necessary for patient safety.

To be clear: It's not a question of patient safety. In 2017, the Food and Drug Administration (FDA) approved two CAR T-cell therapies for children suffering from leukemia and for adults with advanced lymphoma. Although the technology is still being developed and other uses of T-cell therapies are yet to be approved by the FDA, the Michigan CON Commission does not do medical testing. Like similar agencies in other states, the extent of its mandate is purely economic, not medical.

Anna Parsons, a policy coordinator with the American Legislative Exchange Council, points out that the safe administration of CAR T-cell therapy does not require hospitals to make new capital investmentswhich is the only time CON laws should apply. Literally any FDA-certified hospital should be capable of offering these treatments, since all the high-tech bioengineering is done at other locations. The only thing that happens at the hospital is a simple blood transfusion.

Though the specific applications of CON laws differ from state to state, their stated purpose is to prevent overinvestment and keep hospitals from having to charge higher prices to make up for unnecessary outlays of capital costs. But in practice, they mean hospitals must get a state agency's permission before offering new services or installing new medical technology. Depending on the state, everything from the number of hospital beds to the installation of a new MRI machine could be subject to CON review.

As part of that review process, it's not uncommon for large hospital chains to wield CON laws in order to limit competition, even at the expense of patient outcomes.

From 2010 to 2013, for example, the state agency in charge of Virginia's CON laws repeatedly blocked attempts by a small hospital in Salem, Virginia, to build a neonatal intensive care unit (NICU), in large part because a nearby hospitalwhich happened to have the only NICU in southwestern Virginiaobjected to the new competition. Even after a premature infant died at the Salem hospital, state regulators continued to side with the Salem hospital's chief competitor, against the wishes of doctors, hospital administrators, public officials, and patients who repeatedly testified in favor of letting the new NICU be built.

Even when the outcomes aren't as tragic as dead babies or untreated cancer patients, CON laws have adverse consequences. In 2016, reseachers at the Mercatus Center at George Mason University found that hospitals in states with CON laws have higher mortality rates than hospitals in non-CON states. The average 30-day mortality rate for patients with pneumonia, heart failure, and heart attacks in states with CON laws is between 2.5 percent and 5 percent higher even after demographic factors are taken out of the equation.

When it comes to CAR T-cell therapy, there does not seem to be any compelling reason for Michigan regulators to use CON laws except to explicitly limit which hospitals can provide those treatments.

"We will never know how many more lives this therapy could have saved if the added time and expense these onerous regulations put in place discourage hospitals and clinics from providing treatment in the first place," Parsons wrote this week in The Detroit News.

Under Michigan law, the legislature has 45 days to review and overturn the decisions of the CON Commission. Here is one situation where that is exactly what it should do.

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Michigan Health Care Regulators Just Restricted Access to Promising New Cancer Treatments - Reason

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