Media

Warnings from whistleblowers past

CJR Daily - November 6, 2013 - 1:50pm
Following Edward Snowden's leaks to the press about the scope of NSA surveillance, public opinion polls have posed questions like, "Do you think Snowden is a whistleblower, or a traitor?" Regardless of the polls' results, the fact that a distinction is being made between the two terms is progress, according to Dana Gold, a senior fellow at the Government Accountability...
Categories: Media

David Miranda challenges his UK detention

CJR Daily - November 6, 2013 - 11:40am
David Miranda, Glenn Greenwald's partner, was in a UK court today challenging the legality of his nine-hour detention at Heathrow under anti-terror laws in August and requesting the return of confiscated material. Under tough questioning from a three-judge panel, Miranda argued that the UK government illegally detained him and that the materials he was carrying were protected. The reigning Lord...
Categories: Media

Loyal Obama Supporters, Canceled by Obamacare

Pro Publica - November 6, 2013 - 8:57am

San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are “cradle Democrats.” They have donated to the liberal group Organizing for America and worked the phone banks a year ago for President Obama’s re-election.

Since 1995, Hammack and Brothers have received their health coverage from Kaiser Permanente, where Brothers worked until 2009 as a dietitian and diabetes educator. “We’ve both been in very good health all of our lives – exercise, don’t smoke, drink lightly, healthy weight, no health issues, and so on,” Hammack told me.

The couple — Lee, 60, and JoEllen, 59 — have been paying $550 a month for their health coverage — a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act. The couple would need to find another one. The cost would be around double what they pay now, but the benefits would be worse.

“From all of the sob stories I’ve heard and read, ours is the most extreme,” Lee told me in an email last week.

I’ve been skeptical about media stories featuring those who claimed they would be worse off because their insurance policies were being canceled on account of the ACA. In many cases, it turns out, the consumers could have found cheaper coverage through the new health insurance marketplaces, or their plans weren’t very good to begin with. Some didn’t know they could qualify for subsidies that would lower their insurance premiums.

So I tried to find flaws in what Hammack told me. I couldn’t find any.

Hammack recalled his reaction when he and his wife received a letters from Kaiser in September informing him their coverage was being canceled. “I work downstairs and my wife had a clear look of shock on her face,” he said. “Our first reaction was clearly there’s got to be some mistake. This was before the exchanges opened up. We quickly calmed down. We were confident that this would all be straightened out. But it wasn’t.”

I asked Hammack to send me details of his current plan. It carried a $4,000 deductible per person, a $40 copay for doctor visits, a $150 emergency room visit fee and 30 percent coinsurance for hospital stays after the deductible. The out-of-pocket maximum was $5,600.

This plan was ending, Kaiser’s letters told them, because it did not meet the requirements of the Affordable Care Act. “Everything is taken care of,” the letters said. “There’s nothing you need to do.”

The letters said the couple would be enrolled in new Kaiser plans that would cost nearly $1,300 a month for the two of them (more than $15,000 a year).

And for that higher amount, what would they get? A higher deductible ($4,500), a higher out-of-pocket maximum ($6,350), higher hospital costs (40 percent of the cost) and possibly higher costs for doctor visits and drugs.

When they shopped around and looked for a different plan on California's new health insurance marketplace, Covered California, the cheapest one was $975, with hefty deductibles and copays.

In a speech in Boston last week, President Obama said those receiving cancellation letters didn’t have good insurance. “There are a number of Americans — fewer than 5 percent of Americans — who've got cut-rate plans that don’t offer real financial protection in the event of a serious illness or an accident,” he said.

“Remember, before the Affordable Care Act, these bad-apple insurers had free rein every single year to limit the care that you received, or use minor preexisting conditions to jack up your premiums or bill you into bankruptcy. So a lot of people thought they were buying coverage, and it turned out not to be so good.” 

What is going on here? Kaiser isn’t a “bad apple” insurer and this plan wasn’t “cut rate.” It seems like this is a lose-lose for the Hammacks (and a friend featured in a report last month by the public radio station KQED.)

I called Kaiser Permanente and spoke to spokesman Chris Stenrud, who used to work for the U.S. Department of Health and Human Services. He told me that this was indeed a good plan. Patients in the plan, known as 40/4000, were remarkably healthy, had low medical costs and had not seen their premiums increase in years. “Our actuaries still aren’t entirely sure why that was,” he said.

While many other insurance companies offered skimpier benefits, Stenrud said, “our plans historically have been comprehensive.”

Kaiser has canceled about 160,000 policies in California, and about one third of people were in plans like Hammack’s, Stenrud said. About 30,000 to 35,000 were in his specific plan.

“In a few cases, we are able to find coverage for them that is less expensive, but in most cases, we’re not because, in sort of pure economic terms, they are people who benefited from the current system ... Now that the market rules are changing, there will be different people who benefit and different people who don’t.”

“There’s an aspect of market disruption here that I think was not clear to people,” Stenrud acknowledged. “In many respects it has been theory rather than practice for the first three years of the law; folks are seeing the breadth of change that we’re talking about here.”

That’s little comfort to Hammack. He’s written to California’s senators and his representative, House Minority Leader Nancy Pelosi, D-Calif., asking for help.

“We believe that the Act is good for health care, the economy, & the future of our nation. However, ACA options for middle income individuals ages 59 & 60 are unaffordable. We’re learning that many others are similarly affected. In that spirit we ask that you fix this, for all of our sakes,” he and Brothers wrote.

Consumer advocate Anthony Wright said it’s important to remember the way the insurance market worked before the act was passed, when insurers could deny coverage based on pre-existing conditions. “It’s impossible to know what the world would have looked like for these folks in the absence of the law,” said Wright, executive director of the group Health Access.

“We certainly had an individual market, especially in California which was the Wild Wild West, where there was huge price increases, cancellations, a range of other practices.

“That doesn't mean that there were certain people who lucked out in the old system, who wound up in a group with a relatively healthy risk mix and thus lower premiums,” he added. “The question is: Is health insurance something where people get a rate based on the luck of the draw or do we have something where we have some standards where people who live in the same community, of the same age, with the same benefit package are treated equally?”

Wright said discussions should focus on how to provide consumers like Hammack with assistance if they barely miss qualifying for subsidies.

So what is Hammack going to do? If his income were to fall below four times the federal poverty level, or about $62,000 for a family of two, he would qualify for subsidies that could lower his premium cost to as low as zero. If he makes even one dollar more, he gets nothing.

That’s what he’s leaning toward — lowering his salary or shifting more money toward a retirement account and applying for a subsidy.

“We’re not changing our views because of this situation, but it hurt to hear Obama saying, just the other day, that if our plan has been dropped it’s because it wasn’t any good, and our costs would go up only slightly,” he said. “We’re gratified that the press is on the case, but frustrated that the stewards of the ACA don’t seem to have heard.”

Like this story by health care reporter Charles Ornstein? You may also want to read “Why Health Insurance Cancellations Shouldn’t Be a Surprise” and “The Affordable Care Act’s Most Important Date: Not What You Think.”

Categories: Media, Politics

Where, oh where are all those poor people?

CJR Daily - November 6, 2013 - 5:50am
Unless you've been under a rock for the past two weeks, odds are you've heard the unhappy tale of at least one "Obamacare loser" or "rate shock" victim or "poster child." (On Monday, I traced one Deborah Cavallaro's media-go-round--CBS 2, NBC News, CNBC, MSNBC, Marketplace, Fox News--telling the world about her health insurance cancellation letter and her inability to find...
Categories: Media

The NYT paywall plugs the hole

CJR Daily - November 6, 2013 - 5:50am
Felix asks what my graph of New York Times digital revenue would look like including print ads. Here's the original chart, which shows the paywall doubling NYT digital revenue in just over two years: Now here's the chart Felix requested, which adds in print ad revenue. Let me note that the non-2013 numbers in this post are based on my...
Categories: Media

A lot: that's how many

CJR Daily - November 5, 2013 - 1:48pm
On Monday the University of California, Berkeley released the results of the kind of awe-inspiring study that makes for excellent space journalism. Using data from NASA's Kepler spacecraft, a team of scientists deduced that there are numerous "Earth-like" planets in the Milky Way, with temperatures in the "Goldilocks zone"--meaning not too warm, or too cold, to host liquid water (and...
Categories: Media

Why Health Insurance Cancellations Shouldn’t Be a Surprise

Pro Publica - November 5, 2013 - 1:40pm

There seems to be no letup of bad news on the Affordable Care Act. Yesterday, Healthcare.gov, the problem-plagued federal health insurance marketplace, crashed again. And a pile of news reports focused on citizen anger over policy cancellations prompted by the law.

Last night, President Obama addressed the situation. Passing the act 2010 “was the easy part,” he said. Though he’s done campaigning for office, Obama said, "I’ve got one more campaign in me – the campaign to make sure that this law works for every single person in this country."

To get behind the headlines, we reached out to a leading expert on the law: Kip Piper, who advises large health care organizations on Medicare, Medicaid, and health reform policy, finance and business strategy.

Among other roles, Piper has worked as senior adviser to the administrator of the Centers for Medicare and Medicaid Services (CMS), Wisconsin state health administrator, director of the Wisconsin Medicaid program, a senior Medicare budget officer at the White House Office of Management and Budget.

"The fact that ACA would effectively nuke most of the existing commercial individual health insurance market was never in question," Piper told us.

In the interview below, which was edited for length and clarity, Piper discusses cancellations, the apparent surge in Medicaid enrollments under Obamacare and whether more transparency would have helped the rollout.

Q. What’s your take on the coverage cancellations arriving in mailboxes around the country?

A. It was always known that the ACA would outlaw millions of existing individual or non-group health insurance policies.  From a policy wonk perspective, that was a no-brainer.  It was self-evident in the law in March 2010 and confirmed in subsequent rules and analyses.  Also obvious all along was that consumers would face a very different marketplace under the ACA, with some seeing lower premiums (including me), some seeing larger premiums, and most everyone seeing higher deductibles, higher co-pays, and a narrower choice of providers. 

Quantifying the impact of ACA on the individual — estimating the number of people affected — was always tough.  Whether it would cause 60 percent or 80 percent of individual plans to be cancelled was hard to estimate because data on individual coverage is hard to come by, rules and products varied by state, the ACA grandfathering rules came out slowly and in pieces, and even things like the essential health benefit package varies a bit by state.  Also, not all these policies expire on December 31.

What’s frustrating is how it took three and a half years, the failed launch of the federal exchange, and the news media starting the question the administration’s core talking points for anyone to focus on this. Whether you like or dislike the ACA policies, the 19.4 million Americans in the various parts of individual market deserved a heads up.

Q. Could this have been prevented?

A. From a regulatory perspective, health insurers in the individual market have no choice but to discontinue non-compliant policies and, if they wish to keep business, offer new, compliant policies.  Health insurance is a binding contract.  Insurers can’t merely transfer people.  They have to cancel policies that no longer meet federal and state law, give notice, and then try to sell people into the new one policies. Having said this, the new policies will generally be more expensive.  The ACA requires people to buy a richer benefit package – it only permits sale of the richer benefit packages.  You can argue that this is better for society but there is no free lunch and it does eliminate choices many consumers were fine with. 

The higher cost sharing – deductibles and co-payments – that many are seeing (including me) is an inevitable byproduct of the ACA insurance market rules, the brave new actuarial risks of the post-ACA marketplace, and competition based on premiums and brand.

Q. Is Medicaid a success story here?

A. Medicaid enrollment data from the states with their own exchanges certainly suggests a surge in Medicaid.  It’s still early but it appears that the surge is a combination of ACA Medicaid expansion and the woodwork effect – bringing in individuals already eligible but not enrolled.  Medicaid rolls will also increase somewhat as individual commercial polices are cancelled, high-risk pools end, and some small and mid-size employers drop coverage.

Today, Medicaid covers about 74 million Americans.  Given all the unknowns, including economic conditions, projected Medicaid enrollment by 2020 ranges from 85 million to 102 million. Regardless, the role of Medicaid in the marketplace and impact of Medicaid on federal and state budgets will only grow. 

Q. Should the contractors behind healthcare.gov be penalized?

A. Determining accountability for the healthcare.gov mess is very tricky.  Both the CMS and the multitude of contractors were responsible for the project, with a maze of interdependencies.  Parsing out responsibility for the many failed parts of the federal systems for Obamacare will be difficult, will take months, and an independent party such as GAO or the Inspector General.  Overall, it appears that there will be considerable finger pointing in all directions, with plenty of blame to go around. 

CMS made several significant strategic blunders, most notably the decision to manage the project in-house rather than hiring a systems integrator.  Hiring a systems integrator to honcho the project, serve as a super general contractor, make the disparate pieces work together, and oversee testing and problem solving was essential.  CMS simply does not have the experience or capabilities to do this in-house.  Retaining an integrator would have been expensive, probably at least $75 million on a project this size.  Perhaps they didn’t have the budget, but otherwise the decision to handle system integration in-house is inexplicable and proved disastrous.

The Obama administration decided to avoid making decisions during the 2012 election year.  Given the nature of elections and the array of winners and losers under the ACA – most of whom still are unaware they are winners or losers – this is perhaps understandable.  However, CMS had no choice but to follow orders and avoid making decisions or revealing information about the controversial law during the election.  That meant countless critical decisions that should have been made in 2011 and 2012 were not made until well into 2013, leaving little time for problem solving, system integration, and testing. To this day, nearly 44 months since the law was signed, not all ACA-related decisions have been made, with many less critical rules deferred.

In the end, whether in the form of reasons or excuses, the contractors have plenty to point in minimizing their share of responsibility.  It appears they have covered themselves with a paper trail of warnings to CMS.

Q. You’ve been particularly critical of the administration’s transparency and follow-through on its own rules.

A. Presidential executive orders have long required cost estimates and impact analyses for every major proposed or final rule.  In Executive Order 13563, President Obama reiterated the longstanding requirement and further directed each federal agency “… to use the best available techniques to quantify anticipated present and future benefits and costs as accurately as possible.” A Regulatory Impact Analysis (RIA) must be prepared for rules with economically significant effects — anything with an impact of $100 million or more in any one year.  Obviously, every ACA rule had an impact of over $100 million.

However, early on CMS stopped providing cost estimates for rules implementing the Affordable Care Act.  Most were omitted entirely, others watered down to be meaningless statements the analytical equivalent of saying, “The hell if we know what will happen.”  They even started explicitly saying in ACA rules — including the massive Medicaid expansion rule — that the rule didn’t have an impact of over $100 million because, in effect, everybody expected it. 

My understanding is that CMS was directed by the White House Office of Management and Budget (OMB) to stop publishing the cost estimates and impact analyses with the ACA rules.  They were concerned the information, coming from the CMS Office of the Actuary, would be used as ammunition by the House and other critics of Obamacare. That is certainly true but no excuse for ignoring 30 years of executive orders and the President’s own stated commitment to open government. 

Read more of Kip Piper’s exchange with ProPublica’s Charles Ornstein here.

Categories: Media, Politics

Evidence for the hard-to-prove assertion

CJR Daily - November 5, 2013 - 1:28pm
Jean Eaglesham had a nice get—an exit interview with the outgoing enforcement chief of the Commodity Futures Trading Commission, who complains the agency is underfunded. Right. Aren't we all? That's usually the problem with stories like this. The question of appropriate funding levels for a regulator is not only esoteric, it's necessarily murky and impossible to demonstrate. How much is...
Categories: Media

6 Months After Obama Promised to Divulge More on Drones, Here’s What We Still Don’t Know

Pro Publica - November 5, 2013 - 1:23pm

November 6: This story has been updated to reflect new developments.

Nearly six months ago, President Obama promised more transparency and tighter policies around targeted killings. In a speech, Obama vowed that the U.S. would only use force against a “continuing and imminent threat to the American people.” It would fire only when there was “near-certainty” civilians would not be killed or injured, and when capture was not feasible.

The number of drone strikes has dropped this year, but they’ve continued to make headlines. On Friday, a U.S. drone killed the head of the Pakistani Taliban. A few days earlier came the first drone strike in Somalia in nearly two years. How much has changed since the president’s speech?

We don’t know the U.S. count of civilian deaths

The administration says that it has a count of civilian deaths, and that there is a “wide gap” between U.S. and independent figures. But the administration won’t release its own figures.

Outside estimates of total civilian deaths since 2002 range from just over 200 to more than 1,000.  The Pakistani government has given three different numbers: 400, 147, and 67.

McClatchy and the Washington Post obtained intelligence documents showing that for long stretches of time, the CIA estimated few or no civilian deaths. The documents also confirmed the use of signature strikes, in which the U.S. targets people without knowing their identity. The CIA categorized many of those killed as simply “other militants” or “foreign fighters.” The Post wrote that the agency sometimes designated “militants” with what seemed like circumstantial or vague evidence, such as “men who were ‘probably’ involved in cross-border attacks” in Afghanistan.

The administration reportedly curtailed signature strikes this year, though the new guidelines don’t necessarily preclude them. A White House factsheet released around Obama’s speech said that “it is not the case that all military-aged males in the vicinity of a target are deemed to be combatants.” It did not say that people must be identified. (In any case, the U.S. has not officially acknowledged the policy of signature strikes.)

Attorney General Eric Holder confirmed only that four Americans have been killed by drone strikes since 2009: Anwar al Awlaki and his sixteen-year-old son, Abdulrahman, Samir Khan, and Jude Kenan Mohammed. Holder said that only the elder Awlaki was “specifically targeted,” but did not explain how the others came to be killed.

Although Obama said that this disclosure was intended to “facilitate transparency and debate,” since then, the administration has not commented on specific allegations of civilian deaths.

We don’t know exactly who can be targeted

The list of groups that the military considers “associated forces” of Al Qaeda is classified. The administration has declared that it targets members of Al Qaeda in the Arabian Peninsula, and “elements of Al Shabaab, but there are still questions about how the U.S. determines that an individual belonging to those groups is in fact a “continuing and imminent threat.” (After the terror alarm that led to the closing of U.S. embassies this summer, officials told the New York Times they had “expanded the scope of people [they] could go after” in Yemen.)

This ties into the debate over civilian casualties: The government would seem to consider some people legitimate targets that others don’t.

Amnesty International and Human Rights Watch conducted in-depth studies of particular strikes in Pakistan and Yemen, respectively. They include eyewitness reports of civilian deaths. (Most of the deaths investigated happened before the Obama administration’s new policies were announced, although the administration has not said when those guidelines went into effect.) The reports also raised questions of the legality of specific strikes, questioning whether the deaths were all unavoidable casualties of legitimate attacks.  

It does not appear that the U.S. plans to expand strikes against Al Qaeda to other countries – officials have reportedly told Iraq, for example, it won’t send drones there. But the U.S. has established a surveillance drone base in Niger, and fed information from drones to French forces fighting in Mali.

We don’t know if the U.S. compensates civilian casualties

CIA director John Brennan suggested during his confirmation hearing that the U.S. made condolence payments to harmed families. But there is little evidence of it happening. U.S. Central Command told ProPublica that it had 33 pages related to condolence payments – but wouldn’t release any of them to us.

We don’t always know which strikes are American

While unnamed officials sometimes confirm that strikes came from U.S. drones, other attacks may be from Pakistani, Yemeni, or even Saudi planes.

(It’s also worth noting that the U.S. has also used cruise missiles and Special Forces raids. But the bulk of U.S. counterterrorism actions outside Afghanistan in recent years appear to rely on drones.)

We don’t know the precise legal rationale behind the strikes

Some members of Congress have seen the legal memos behind targeted killing of U.S. citizens. But lawmakers were not granted access to all memos on the program. Legislation pending in the Senate would require the administration to give the Intelligence Committees a list of such legal opinions.

Other congressmen have introduced bills with more reporting requirements for targeted killings. (Proposals for a “drone court” for oversight have not gotten very far.)

It’s far from clear that any of that additional oversight would lead to public disclosure.

The government and the American Civil Liberties Union and the New York Times are still locked in court battles over requests for drone documents. While a judge has ruled the CIA can no longer assert the “fiction” that it can’t reveal if it has any interest in drones, the agency hasn’t been compelled to release any information yet. The government has also so far fought off disclosure of legal memos underpinning targeted killings.

 

And here are some things we’ve learned through leaks and independent reporting:

How the U.S. tracks targets: Documents provided by Edward Snowden to the Washington Post detailed the NSA’s “extensive involvement.” Lawyers in a terrorism-related case also uncovered reports that government surveillance of their client may have led to a drone strike in Somalia. The Atlantic published a detailed account of Yemen using a child to plant a tracking chip on a man who was killed in a U.S. strike.

What people in the countries affected think: The Pakistani government’s cooperation with at least some U.S. drone strikes – long an open secret – has now been well-documented. Public sentiment in the country is vividly anti-drone, even when violent Taliban commanders are killed, and politicians continue to denounce them as American interference. Limited polling in the region most affected by drones is contradictory, with some saying that at the very least, they prefer drones to the Pakistani military campaigns. Life in those areas is between a drone and a hard place: Residents told Amnesty International of the psychological toll from drones, and they also face reprisals from militants who accuse them of spying.

Yemen’s president continues to openly embrace U.S. strikes, though the public generally opposes them – particularly those strikes that hit lower-level fighters, or those whose affiliations with Al Qaeda aren’t clear. Foreign Policy recently detailed the aftermath of an August strike where two teenagers died. Their family disputes they had any link to terrorism.

The physical infrastructure: More of the network of drone bases across the world has been revealed – from the unmasking of a secret base in Saudi Arabia to the fact that drones had to be moved off the U.S. base in Djibouti, in the Horn of Africa, after crashes and fear of collision with passenger planes.

The CIA’s role: The administration had reportedly planned to scale back the CIA’s role in targeted killing, moving control of much of the drone program to the military. But the CIA reportedly still handles strikes in Pakistan and has a role in Yemen as well. Officials told Foreign Policy yesterday that the transition won't happen anytime soon

The history of the programs: Revelations continue to change our understanding of the contours of the drone war, but two books published this year offer comprehensive accounts – The Way of the Knife, by Mark Mazzetti of the New York Times, and Dirty Wars, by Jeremy Scahill.

Categories: Media, Politics

Audit Notes: Potshots at Snowden, News Corp. snake pit, Jamie Dimon

CJR Daily - November 5, 2013 - 10:00am
Bloomberg Businessweek deputy editor Romesh Ratnasar takes to the pages of the magazine to criticize the "unbearable narcissism of Edward Snowden." In his letter to Ströeble, however, Snowden strikes the pose of a man being framed for crimes he didn't commit at all. He refers to his leaks as a "public service" and "act of political expression" and contends that...
Categories: Media

50 Years After the Community Mental Health Act, the Best Reporting on Mental Health Care Today

Pro Publica - November 5, 2013 - 9:57am

Fifty years ago last week, President John F. Kennedy signed the Community Mental Health Act. The law signaled a shift in thinking about how we care for the mentally ill: instead of confining them into institutions, the act was supposed to create community mental health centers to provide support.

But studies on the prevalence of mental illness among inmates and the homeless (PDF) show many patients are ending up on the street or in jail, instead of served by the treatment centers envisioned in the law. The homes that do exist are often subject to loose laws and regulations, leaving already fragile patients vulnerable to further abuse and neglect.

How far have we come? Here are some important reads on the state of mental health care today. Additions? Tweet them with the hashtag #MuckReads, or leave them in the comments below.

Milwaukee County mental health system traps patients in cycle of emergency care, Milwaukee Journal Sentinel, June 2013

In Wisconsin, psychiatric patients are often put through a revolving door of treatment: Experience a breakdown. Get arrested and brought to the emergency ward. Be released just a few days later. Repeat. Overall, “one of every three persons treated at the [psychiatric] emergency room returns within 90 days.”

Schizophrenic. Killer. My Cousin., Mother Jones, May 2013

When a parent is faced with an ill, potentially violent child, where can they turn? Journalist Mac McClelland details how community outreach in the 1970s and 1980s allowed her aunt to stay “independent until the very end." Thirty-four years and billions of dollars in mental health cutbacks later, her cousin’s battle with schizophrenia came to a much more tragic conclusion.

Nevada buses hundreds of mentally ill patients to cities around country, Sacramento Bee, April 2013

Psychiatric patient James Flavy Coy Brown got off a bus in Sacramento with no money, no medication, and no idea why he was there. He’d been sent to the California capital from a hospital in Las Vegas, who had regularly been discharging patients and busing them across the country. Patients are only supposed to be sent to other states when there’s a clear plan for their care. But stories like Brown’s show how many patients fall through the cracks.

‘Boarding’ mentally ill becoming epidemic in Washington state, Seattle Times, October 2013

The number of available psychiatric beds in Washington state is shrinking. When those few spots are full, the state is increasingly turning to its emergency rooms and hospitals to “warehouse” the mentally ill. Patients are forced to wait an average of three days, but sometimes up to several months, without any psychological treatment.

Breakdown: In rural Minnesota, mental health safety net is in limbo, Minneapolis Star Tribune, October 2013

Minnesota ranked last in 2010 for psychiatric beds per capita. “The safety net is pretty much gone,” said one mental health worker. And a Star investigation found that the few community mental health centers that are available are often ill-equipped to cope with severe disorders.

At homes for the mentally ill, a sweeping breakdown in care, Miami Herald, February 2013

Even if Miamians struggling with mental illness avoid arrest, the county’s homes for the mentally ill can “still feel like a jail.” The Herald’s investigation revealed a wide range of abuse and neglect, from staff who were beating and raping residents to ignoring their severe medical needs. And like other assisted living facilities, a patchwork of lax oversight and regulation has allowed even repeat offenders to remain in operation.

Dallas psych ER staff accused of violence were kept on duty, Dallas Morning News, November 2011

Instead of emergency care, psych patients admitted to Parkland Memorial Hospital reported receiving beatings at the hands of staff. The Morning News found many staff members were hired despite a history of abuse, and allowed to keep their jobs even after the alleged beatings. “It’s supposed to be a safe place,” said one patient. “I felt like I was in prison.”

Walter Reed and Beyond: A Soldier’s Officer, Washington Post, December 2007

Anne Hull and Dana Priest spotlighted systemic mistreatment and neglect at Walter Reed Army Medical Center, and several other veterans health facilities across the country. Vets seeking psychological care faced dizzying bureaucracy and an under-resourced system buckling under high demand. Though Walter Reed was home to the army’s largest psychiatric department, there was no specific PTSD center, and patients rarely received individual attention. For more the treatment of US vets battling the traumas of war, see these key reads on PTSD.

The New Asylums, Frontline, May 2005

Frontline documents the movement of America’s mentally ill away from closing psychiatric hospitals, and into the nation’s jails and prisons. The result is a massive strain on the minds of afflicted inmates, and on the strapped prison system tasked with treating them. Check out our MuckReads roundup for more important coverage of mental illness behind bars.

Broken Homes, New York Times, April 2002

Adult homes for the severely mentally ill were meant to be an improvement over New York’s long-shuttered psychiatric wards. But a year-long investigation by the Timesfound a for-profit system neglecting vulnerable residents. The Timesinvestigation found nearly 1,000 deaths at 26 adult homes across the city from 1995 to 2001, including cases of suicide, death at the hands of other residents, death from treatable ailments, and patients left to die after “roasting in their rooms during heat waves.”


Categories: Media, Politics

Can a Reprieve and a Lawsuit Reverse Health Insurance Cancellations?

Pro Publica - November 5, 2013 - 8:25am

As the number of health insurance cancellations continues to grow, surpassing 3.5 million by one count, an insurance company was forced to reverse course — at least temporarily.

Blue Shield of California, under threat from California Insurance Commissioner Dave Jones, confirmed Monday night that it would delay for up to three months 115,000 cancellations planned for Dec. 31, according to a report in the San Francisco Business Times. It’s the first such report I’ve seen.

"We had a disagreement with the state over the 90-day notice we gave to ... policyholders, and we were faced with a lawsuit if we did not agree to their requirement for the 90-day extension," [Blue Shield spokesman Steve] Shivinsky clarified. He said 80,000 policyholders are being notified of the new course of action that regulators are requiring.

The deal has the look and feel of a political retreat by Democratic officeholders worried about the recent outcry about cancelled individual policies.

According to the Business Times, the insurance commissioner has scheduled a news conference for early today to announce the development.

Separately, the Los Angeles Times reported Monday night that two consumers are suing Anthem Blue Cross over their cancellations, alleging they were misled into giving up their health plans.

In separate lawsuits filed Monday, Paul Simon, 39, of Sherman Oaks, and Catherine Coker, 63, of Glendale sought to pin some of the blame on Anthem Blue Cross, a unit of WellPoint Inc.

The two plaintiffs are asking the courts to block any policy cancellations unless Anthem customers are allowed to switch back to their previous grandfathered health plans.

In their Los Angeles County Superior Court suits, Simon and Coker allege that Anthem pressured them in 2011 to give up their grandfathered status, a position that would have shielded them from changes under the healthcare law.

People who bought their individual policy before March 2010, when the healthcare law was enacted, and kept it in place aren’t affected by the current changes in the market. In California, nearly half of the 2 million individual policyholders are expected to lose their current coverage and must find a new plan by Jan. 1.

Anthem told the Times that it hadn’t seen the lawsuit and couldn’t comment on it.

The Associated Press reported Monday that the issue of insurance plan cancellations is becoming a major challenge for President Obama, who repeatedly pledged that consumers could keep their insurance plans if they liked them.

The Obama administration insists nobody will lose coverage as a result of cancellation notices going out to millions of people. At least 3.5 million Americans have been issued cancellations, but the exact number is unclear. Associated Press checks find that data is unavailable in a half the states.

Mainly they are people who buy directly from an insurer, instead of having workplace coverage. Officials say these consumers aren’t getting “canceled” but “transitioned” or “migrated” to better plans because their current coverage doesn’t meet minimum standards. They won’t have to go uninsured, and some could save a lot if they qualify for the law’s tax credits.

Speaking in Boston’s historic Faneuil Hall this past week, Obama said the problem is limited to fewer than 5 percent of Americans “who’ve got cut-rate plans that don’t offer real financial protection in the event of a serious illness or an accident.”

But in a nation of more than 300 million, 5 percent is a big number - about 15 million people. Among them are Ian and Sara Hodge of Lancaster, Pa., in their early 60s and paying $1,041 a month for a policy.

It’ll be worth watching the legal system and state insurance departments as cancellation notices continue to arrive.

Categories: Media, Politics

Sounding the alarm

CJR Daily - November 5, 2013 - 5:55am
Earlier this year, when the UN's Intergovernmental Panel on Climate Change released reports showing that the rate of surface temperature increase had slowed, some publications interpreted the information as a global warming "pause"--evidence that scientists had been alarmist about the impact of human emissions on the environment. Others argued that if the coverage of the "pause" demonstrated anything, it was...
Categories: Media

The NYT paywall don't get no respect

CJR Daily - November 5, 2013 - 5:50am
I wrote Friday about a landmark for The New York Times: Its paywall revenue has overtaken its digital ad revenue—just two years after the paper bucked conventional wisdom and asked readers to pay. GigaOm's Mathew Ingram spins that news as negatively as possible, writing on Twitter that "'the Times's paywall revenue has soared past its digital ad revenue'... because ad...
Categories: Media

A failure to 'ask the questions'

CJR Daily - November 4, 2013 - 3:10pm
Deborah Cavallaro, a real estate agent in suburban Los Angeles, sure became a minor media celeb last week. Cavallaro, a 60-year-old blonde, emerged as a face of a story to which reporters came inexcusably late: Some people in the individual insurance market are receiving cancellation letters from their insurance providers, along with offers to buy often pricier Obamacare-compliant policies. Cavallaro...
Categories: Media

Don't tread on me

CJR Daily - November 4, 2013 - 2:08pm
The requirement of the Affordable Care Act that employers provide access to free contraceptives "trammels the right of free exercise" of religion, a federal judge wrote. A reader asked: "Didn't the judge mean trample, as in 'trample on the rights'?" No, the judge meant "trammel." The difference between the two words is important. As a verb, "trammel" means to constrain...
Categories: Media

NIST to Review Standards After Cryptographers Cry Foul Over NSA Meddling

Pro Publica - November 4, 2013 - 2:05pm

The federal institute that sets national standards for how government, private citizens and business guard the privacy of their files and communications is reviewing all of its previous recommendations.

The move comes after ProPublica, The Guardian and The New York Times disclosed that the National Security Agency had worked to secretly weaken standards to make it easier for the government to eavesdrop.

The review, announced late Friday afternoon by the National Institute for Standards and Technology, will also include an assessment of how the institute creates encryption standards.

The institute sets national standards for everything from laboratory safety to high-precision timekeeping. NIST’s cryptographic standards are used by software developers around the world to protect confidential data. They are crucial ingredients for privacy on the Internet, and are designed to keep Internet users safe from being eavesdropped on when they make purchases online, pay bills or visit secure websites.

But as the investigation by ProPublica, The Guardian and The New York Times in September revealed, the National Security Agency spends $250 million a year on a project called “SIGINT Enabling” to secretly undermine encryption. One of the key goals, documents said, was to use the agency’s influence to weaken the encryption standards that NIST and other standards bodies publish.

“Trust is crucial to the adoption of strong cryptographic algorithms,” the institute said in a statement on their website. “We will be reviewing our existing body of cryptographic work, looking at both our documented process and the specific procedures used to develop each of these standards and guidelines.”

The NSA is no stranger to NIST’s standards-development process. Under current law, the institute is required to consult with the NSA when drafting standards. NIST also relies on the NSA for help with public standards because the institute doesn’t have as many cryptographers as the agency, which is reported to be the largest employer of mathematicians in the country.

“Unlike NSA, NIST doesn’t have a huge cryptography staff,” said Thomas Ptacek, the founder of Matasano Security, “NIST is not the direct author of many of most of its important standards.”

Matthew Scholl, the deputy chief at the Computer Security Division of the institute, echoed that statement, "As NIST Director Pat Gallagher has said in several public settings, NIST is designed to collaborate and the NSA has some of the world’s best minds in cryptography." He continued, "We also have parallel missions to protect federal IT systems, so we will continue to work with the NSA."

Some of these standards are products of public competitions among academic cryptography researchers, while others are the result of NSA recommendations. An important standard, known as SHA2, was designed by the NSA and is still trusted by independent cryptographers and software developers worldwide.

NIST withdrew one cryptographic standard, called Dual EC DRGB, after documents provided to news organizations by the former intelligence contractor Edward Snowden raised the possibility that the standard had been covertly weakened by the NSA.

Soon after, a leading cryptography company, RSA, told software writers to stop using the algorithm in a product it sells. The company promised to remove the algorithm in future releases.

Many cryptographers have expressed doubt about NIST standards since the initial revelations were published. One popular encryption library changed its webpage to boast that it did not include NIST-standard cryptography. Silent Circle, a company that makes encryption apps for smartphones, promised to replace the encryption routines in its products with algorithms not published by NIST.

If the NIST review prompts significant changes to existing encryption standards, consumers will not see the benefit immediately. “If the recommendations change, lots of code will need to change,” said Tanja Lange, a cryptographer at the University of Technology at Eindhoven, in the Netherlands. “I think that implementers will embrace such a new challenge, but I can also imagine that vendors will be reluctant to invest the extra time.”

In Friday’s announcement, NIST pointed to its long history of creating standards, including the role it had in creating the first national encryption standard in the 1970s — the Data Encryption Standard, known as DES. “NIST has a proud history in open cryptographic standards, beginning in the 1970s with the Data Encryption Standard,” the bulletin said. But even that early standard was influenced by the NSA.

During the development of DES, the agency insisted that the algorithm use weaker keys than originally intended — keys more susceptible to being broken by super computers. At the time, Whitfield Diffie, a digital cryptography pioneer, raised serious concerns about the keys. “The standard will have to be replaced in as few as five years,” he wrote.

The weakened keys in the standard were not changed. DES was formally withdrawn by the institute in 2005.

The announcement is the latest effort by NIST to restore the confidence of cryptographers. A representative from NIST announced in a public mailing list, also on Friday, that the institute would restore the original version of a new encryption standard, known as SHA3, that had won a recent design competition but altered by the institute after the competition ended. Cryptographers charged that NIST’s changes to the algorithm had weakened it.

The SHA3 announcement referred directly to cryptographers’ concerns. “We were and are comfortable with that version on technical grounds, but the feedback we’ve gotten indicates that a lot of the crypto community is not comfortable with it,” wrote John Kelsey, NIST’s representative. There is no evidence the NSA was involved in the decision to change the algorithm.

The reversal took Matthew Green, a cryptographer at Johns Hopkins University, by surprise. “NIST backed down! I’m not sure they would have done that a year ago,” he said.

Update: A NIST spokesperson responded on Monday afternoon (this story initially stated that NIST declined to comment).

Categories: Media, Politics

Podcast: What Happens to Those Losing Health Coverage Under Obamacare?

Pro Publica - November 4, 2013 - 12:21pm

We’re now a month in to the launch of Healthcare.gov, and the problems – both technical and political – only seem to be mounting for the federal health insurance marketplace.

In particular, the Obama administration has faced backlash for repeatedly stating that those who like their current individual health insurance plans will be able to keep them when that’s proven not to be the case. But is that necessarily a bad thing?

ProPublica’s Charlie Ornstein and Steve Engelberg return to the Storage Closet Studio to discuss the real-life winners and losers of Obamacare, what consumers can expect starting in 2014, and how this change will help redistribute the risk in individual health coverage:

“…if you put the burden on people who are sick to pay the full cost of their coverage, the system collapses under its own weight,” Ornstein says. “We don’t ask elderly people to pay the full cost of Medicare. We as a society help underwrite that. We don’t ask poor people who are disabled to pay the full cost of their health insurance. That’s why we have Medicaid. And so the idea is that up until this point the individual insurance market has been sort of crippled by insurers being able to deny people based on pre-existing conditions, insurers being able to really set benefits that once you’re in it, and if you do get sick, you realize it doesn’t provide you with much of anything.”

You can listen to this podcast – as well as our previous episode, “Why Is Healthcare.gov So Flawed?” – on iTunes and Stitcher. And for more of Ornstein’s reporting on the Affordable Care Act, read his latest posts:

Categories: Media, Politics

Beacon of hope in St. Louis?

CJR Daily - November 4, 2013 - 10:05am
FAIRWAY, KS -- So much for Midwestern reserve. The St. Louis Beacon, a digital news startup founded in 2008, and St. Louis Public Radio are not quite household names in the halls of big media. But with the two outlets headed toward a merger soon, their leaders are not being shy about airing their ambitions. By merging, the organizations "will...
Categories: Media

Why Healthcare.gov Broke: Two Competing Story Lines

Pro Publica - November 4, 2013 - 9:31am

This weekend brought more than a modicum of clarity to what happened behind the scenes in the run-up to the Oct. 1 launch of Healthcare.gov.

In a devastating story, Amy Goldstein and Juliet Eilperin of The Washington Post dissected how politics trumped policy when it came to the Affordable Care Act. In two key paragraphs, they wrote:

Based on interviews with more than two dozen current and former administration officials and outsiders who worked alongside them, the project was hampered by the White House’s political sensitivity to Republican hatred of the law — sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition. Inside the Department of Health and Human Services’ Centers for Medicare and Medicaid, the main agency responsible for the exchanges, there was no single administrator whose full-time job was to manage the project. Republicans also made clear they would block funding, while some outside IT companies that were hired to build the Web site, HealthCare.gov, performed poorly.

These interwoven strands ultimately caused the exchange not to be ready by its Oct. 1 start date. It was not ready even though, on the balmy Sunday evening of March 21, 2010, hours after the bill had been enacted, the president had stood on the Truman Balcony for a champagne toast with his weary staff and put them on notice: They needed to get started on carrying out the law the very next morning. It was not ready even though, for months beginning last spring, the president emphasized the exchange’s central importance during regular staff meetings to monitor progress. No matter which aspects of the sprawling law had been that day’s focus, the official said, Obama invariably ended the meeting the same way: “All of that is well and good, but if the Web site doesn’t work, nothing else matters.”

The Post also posted online a May 2010 letter written by David Cutler, a Harvard professor and health adviser to Obama’s 2008 campaign, to Larry Summers, director of the White House’s National Economic Council. In it, Cutler wrote:

My general view is that the early implementation efforts are far short of what it will take to implement reform successfully. For health reform to be successful, the relevant people need a vision about health system transformation and the managerial ability to carry out that vision. The President has sketched out such a vision. However, I do not believe the relevant members of the Administration understand the President’s vision or have the capability to carry it out.

Another piece worth a read: “What’s Really Obstructing Obamacare? GOP Resisters,” by Michael Tomasky of Newsweek/Daily Beast. Tomasky writes that while media reports have focused on the problems of Healthcare.gov, not enough attention has been paid to the efforts by Republicans to obstruct the law. He wrote:

All across the country, Republican governors and insurance commissioners have actively and directly blocked efforts to make the law work. In August, the Obama administration announced that it had awarded contracts to 105 “navigators” to help guide people through their new predicaments and options. There were local health-care providers, community groups, Planned Parenthood outposts, and even business groups. Again—people and groups given the job, under an existing federal law, to help people understand that law.

What has happened, predictably, is that in at least 17 states where Republicans are in charge, a variety of roadblocks has been thrown in front of these folks. In Indiana, they were required to pay fees of $175. In Florida, which under Governor Rick Scott (who knows a thing or two about how to game the health-care system, you may recall) has been probably the most aggressive state of all here, the health department ruled that local public-health offices can’t have navigators on their premises (interesting, because local public health offices tend to be where uninsured people hang out). In West Virginia, Utah, Pennsylvania, and other states, grantees have said no thanks and returned the dough after statewide GOP elected officials started getting in their faces and asking lots of questions about how they operate and what they planned to do. Tennessee issued “emergency rules” requiring their employees to be fingerprinted and undergo background checks.

America, 2013: No background checks to buy assault weapons. But you damn well better not try to enroll someone in health care.

I suspect in the weeks ahead, we will see more reporting on both story lines: how the administration mismanaged the rollout of the law and how Republicans have tried to ensure its failure. But let’s not lose sight of consumers, whose lives will be directly affected by the act and what’s happening now.

Categories: Media, Politics
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