Pacific Progressive

The Payday Playbook: How High Cost Lenders Fight to Stay Legal

by Paul Kiel ProPublica

A version of this story was co-published with the St. Louis Post-Dispatch.

As the Rev. Susan McCann stood outside a public library in Springfield, Mo., last year, she did her best to persuade passers-by to sign an initiative to ban high-cost payday loans. But it was difficult to keep her composure, she remembers. A man was shouting in her face.

He and several others had been paid to try to prevent people from signing. "Every time I tried to speak to somebody," she recalls, "they would scream, ‘Liar! Liar! Liar! Don't listen to her!'"

Such confrontations, repeated across the state, exposed something that rarely comes into view so vividly: the high-cost lending industry's ferocious effort to stay legal and stay in business.

Outrage over payday loans, which trap millions of Americans in debt and are the best-known type of high-cost loans, has led to dozens of state laws aimed at stamping out abuses. But the industry has proved extremely resilient. In at least 39 states, lenders offering payday or other loans still charge annual rates of 100 percent or more. Sometimes, rates exceed 1,000 percent.

AMA President Optimistic About A Fix For Medicare’s Doctor Payment Formula

This material was published by Kaiser Health News.

By Mary Agnes Carey

Debated and despised, the Medicare physician payment formula may finally be on the way out – at least that’s what AMA President Ardis Hoven believes.

Known as the “sustainable growth rate” or SGR, the formula routinely threatens double-digit payment reduction to doctors until Congress steps in at the last minute to stop the cuts. Currently a 25 percent cut looms Jan. 1 unless Congress takes action again.

An admitted optimist, Hoven says she sees plenty of evidence to support her view that Congress is prepared to pass a permanent SGR fix this year. The AMA president points to wide bipartisan support in both chambers. She notes that the House Energy and Commerce Committee passed SGR legislation before the August break — well before the usual end-of-the-year scramble that has been the usual path to a short-term SGR fix. The House Ways and Means and Senate Finance panels are also actively working on a solution. “This is different. This is palpably different,” Hoven says in an interview.

Faith in Values: A Godsend to Reproductive Health Clinics

This article was published by the Center for American Progress.

By Sally Steenland

Two posters hang on my office wall. One says, “Jesus never shamed women.” The other says, “Pray to end sidewalk bullying.”

I got the posters from Faith Aloud, a counseling and advocacy group that connects faith with reproductive justice. It’s an important connection but one that is rarely seen in today’s political battles over women’s reproductive health, especially when the focus is abortion. Despite that invisibility on the public stage, religion is ever-present in the lives of most women who come to clinics for reproductive health care, including abortion.

More than 7 in 10 women who get an abortion in this country claim a religious affiliation such as Protestant or Catholic, according to the Guttmacher Institute. Furthermore, Catholic women have a higher abortion rate than Protestant women—22 for every 1,000 women, compared to 15 for every 1,000 women, respectively.

Faith Aloud works with health clinics across the country to provide spiritual counseling to women considering an abortion, as well as postabortion counseling for them and for their family and friends who come with them to the clinic. Through faith-specific videos, free confidential telephone counseling with clergy, events, and more, women receive compassionate and nonjudgmental care for their spirit and soul during a difficult time in their lives.

Survey: Big Business May Shift Retirees, Part-Timers To Insurance Exchanges

This material was published by Kaiser Health News.

By Jay Hancock KHN Staff Writer

Corporate America is taking a hard look at moving retirees and part-time workers into health insurance marketplaces created by the Affordable Care Act, suggests a survey by the National Business Group on Health.

To a lesser extent large companies also expect coverage for their full-time workers employee spouses to shift to the online, state-based marketplaces known as exchanges, according to the annual survey published Wednesday.

"They see the exchanges as logical places for them," NBGH President Helen Darling said in an interview, portraying the change as adding diversity and stability to the marketplaces. "These are people that public policymakers wanted to get into the pool."

The survey was done before the Obama administration delayed until 2015 the requirement that large employers offer coverage to certain workers, the group cautioned, so some plans may have changed.

Sandberg's Lean In Called For an Unpaid Intern – And That's Apparently Legal

by Blair Hickman ProPublica

Aug. 16: This post has been corrected and updated.

A top editor at Lean In, the nonprofit offshoot of Facebook COO Sheryl Sandberg's book about empowering women to achieve their goals, has come under fire for seeking an unpaid intern.

And though many online questioned the ethics of the position, it likely would have been legal for the nonprofit to do so.

Jessica Bennett, Lean In's Editor-at-Large, posted on Facebook yesterday: "Wanted: editorial intern, to work with our editor (me) in New York. Part-time, unpaid, must be HIGHLY organized with editorial and social chops and able to commit to a regular schedule through end of year. Design and web skills a plus! HIT ME UP. Start date ASAP."

The public was less than pleased. Noting that the unpaid position seemed to conflict with the organization's mission to help women "pursue their ambitions," over 200 people replied to Bennett's post, the bulk of them saying the organization should pony up:

"By restricting it to those who can afford to have done all that and live in NYC without pay on a permanent position, you excluded an awful a lot of people, namely those with less possessions and women included. Your medium and behavior does not meet the message – and that is a tremendous shame." – Sofia Diogo Mateius

Dark Money Group Spent on House Race, Then Told IRS It Didn't

by Justin Elliott ProPublica

Shortly before Election Day last year, mailers went out to Texas voters featuring pictures of a Democratic congressional candidate and a rare species of spider, whose discovery had forced stoppage of an important highway construction project.

"The same left-wing extremists who support Pete Gallego want more burdensome regulations that put the interests of spiders above our need to create more jobs," the flier declared, referring to discovery of the endangered Braken Bat Cave meshweaver. "The best way to stop left-wing extremists from killing jobs is to vote against their hand-picked candidate Pete Gallego."

The group that put out the mailer, A Better America Now, reported to the Federal Election Commission it had spent about $65,000 for the mailer and TV advertising in the hard-fought race to represent Texas' 23rd district.

But in a tax return recently filed with the IRS, the group claimed it did not spend any money at all on "direct or indirect political campaign activities."

HHS Will Allow ‘Unbanked’ People To Use Prepaid Debit Cards On Exchanges

This material was published by Kaiser Health News.

By Sarah Varney

At the urging of advocates for low-income consumers, the Obama administration said Wednesday that it is moving ahead with a rule requiring health plans accommodate households that do not have traditional bank accounts. One in four of the uninsured eligible for federal insurance subsidies does not have a bank account, according to a report released earlier this year by the tax preparation firm Jackson Hewitt.

The report dubbed people without connections to traditional banks the “unbanked.” It estimated that 8.5 million people without health coverage would have difficulty getting tax credits to help them buy insurance on the new, online marketplaces if health plans barred certain payment methods, including cashier’s checks, money orders and prepaid debit cards that have gained popularity with low-income households.

HHS Watchdog Says Rural Hospital Program Needs A Trim

This material was published by Kaiser Health News.

By Jenny Gold

The federal government’s program to help rural hospitals has grown bloated and unwieldy, according to a report released Thursday by the Office of Inspector General of the Department of Health and Human Services. The program costs the government and Medicare beneficiaries up to a billion dollars a year more than the original parameters of the law allowed, the agency found.

The critical access hospital program was intended to financially stabilize small, rural institutions by providing them with higher Medicare reimbursement rates. The hospitals in the program are supposed to have 25 or fewer beds and be at least 35 miles away from another facility (15 miles across mountainous terrain) in communities that would otherwise have limited access to health care services. The effort was a response to a spate of 360 rural hospital closures in the 1980s and 1990s.

But there was a loophole:  Until 2006, states were allowed to waive the distance requirement and designate small hospitals considered “necessary providers” as critical access hospitals as well, even if they were close to other facilities. The program grew quickly and now nearly one in four acute care hospitals are getting the extra payments. Congress got rid of the loophole in 2006, but hospitals that already had the exemption were grandfathered.

ACOs’ Coordinated Care Savings May Be Contagious

This material was published by Kaiser Health News.

By Jenny Gold

Accountable care organizations (ACOs) may actually be the unicorns we’ve been waiting for, spreading their cost-saving magic throughout the health system.

An early cost-sharing program in Massachusetts designed to cut costs for private Blue Cross Blue Shield patients also lowered costs for Medicare patients who were seen by the same providers, according to a study published Tuesday in the Journal of the American Medical Association.

An ACO is a network of doctors and hospitals that shares responsibility for providing care to a specific group of patients. The idea is to pay the providers for the quality of the services they provide, rather than the volume – in other words, to veer away from the fee-for-service system. The ACO is offered a bonus for giving patients high quality care at a reduced cost. But if they fail to hit certain quality targets or do not manage to reduce the cost of care, they will be paid less.

There are already more than 428 ACOs in the US, serving an estimated 14 percent of the population, including both Medicare and private-insurance patients.

The Gender Wage Gap Differs by Occupation

This article was published by the Center for American Progress.

By Sarah Jane Glynn and Nancy Wu |

The median wage gap between genders fell since 2000, but progress is currently stalled. Women still earn less than men in nearly every occupation, though some suffer from greater wage disparities than others. The following is a list of the top 10 occupations with the largest and smallest gender wage gaps.

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

This article is from the Henry J. Kaiser Familhy Foundation. 6/12/13

 Gretchen Jacobson, Patricia Neuman and Jennifer Huang

While much of the health policy world is focused on the health coverage developments in store as the Affordable Care Act of 2010 (ACA) is implemented, private insurers are also gearing up for the next Medicare Advantage open enrollment season. Four months from now, just as exchange enrollment swings into action, Medicare beneficiaries will have the option to enroll in a Medicare Advantage plan (or switch plans) during the annual open enrollment period. And, earlier this month, each of the insurers participating in the Medicare Advantage program submitted what is known as a “bid” to the federal government that essentially indicates whether they will offer more or fewer Medicare Advantage plans in 2014 than in 2013and how they will change their plans’ benefits and premiums, which could ultimately affect how many Medicare beneficiaries enroll in Medicare Advantage plans in 2014 and future years.

During the debate about the ACA, there was much discussion about whether and to what extent reductions in federal payments to Medicare Advantage plans would affect seniors. Some questioned whether plans would pull out of markets across the country leading to a drop in Medicare Advantage enrollment, as occurred after Congress reduced payments for Medicare plans as part of the Balanced Budget Act (BBA) of 1997 (see Exhibit 1).

Exhibit 1. What is the future outlook for Medicare Advantage?

Judging the High Court Justices

This article was published by the Center for American Progress.

By Billy Corriher

Unlike every other federal judge, the justices of the U.S. Supreme Court are not governed by a code of judicial ethics. Chief Justice John Roberts has defended the justices’ decision to exempt themselves from the ethical rules. Because the justices are members of the highest court in the federal system and are exempt from the rules other federal judges must adhere to, the question arises: Who judges the justices?

This question also arises with respect to state supreme courts, but in a number of states, the need for strong judicial-ethics rules is of the utmost urgency. Because state court judges are elected and many justices must raise large campaign contributions to keep their jobs, the ethical rules that prevent conflicts of interest are crucial to ensuring that the public views the judicial process as fair and legitimate. Justice cannot be seen as having a price tag.

North Carolina has managed to address this problem by creating a system in which complaints against its high court justices are heard by a panel of judges from the North Carolina Court of Appeals. But a bill recently passed by the state legislature—H.B. 652—would transfer the authority to investigate the justices away from the panel of judges to the high court justices themselves. At the same time, another bill passed by North Carolina lawmakers—H.B. 589—will open the floodgates to campaign cash from corporations and lawyers who may want the justices to rule a certain way, which will certainly raise more questions about conflicts of interest.

IRS Ruling On Same-Sex Couples Has Implications For Health Law

This material was published by Kaiser Health News.

By Mary Agnes Carey

Thursday’s announcement that the federal government will give the same tax treatment to legally married same-sex couples as they do to heterosexual couples may have ripple effects for the 2010 health care law.

The decision from the Treasury Department and the Internal Revenue Service means that the income of legally married same-sex couples will be considered in determining eligibility for enrollment in the health law’sMedicaid expansion and for subsidies to purchase coverage in the law’s online marketplaces, orexchanges.

The tax ruling applies regardless of whether the couple lives in a state that recognizes same-sex marriage, the agencies said.

After a Possible Strike in Syria: Planning Ahead for Potential Responses and New Threats to U.S. Security Interests

This material was published by the Center for American Progress.

By Rudy deLeon, Brian Katulis, and Peter Juul

A U.S.-led military strike against President Bashar al-Assad’s regime in Syria could begin soon in response to the Assad regime’s large-scale use of chemical weapons on its own people last week. The reported elements of this proportionate response are designed to respond to the Assad regime’s chemical-weapons violation and to avoid enmeshing the United States more deeply in Syria’s multisided conflict.

In response to the first reports of small-scale chemical-weapons use in Syria last April, theCenter for American Progress advocated a multifaceted approach to guide a U.S. response. This response included three major components:

1. Demand an emergency U.N. Security Council meeting on the Assad regime’s likely chemical-weapons use to help validate the facts.
2. Engage NATO and regional partners in planning the U.S. response, which would aim to destroy “appropriate military targets, including delivery systems, logistics, and applicable command and control.

Scarlet Letters: Getting the History of Abortion and Contraception Right

This article was published by the Center for American Progress.

By Ranana Dine

If recent legislation passed in Arkansas and North Dakota is allowed to stand, it will be harder for women to get an abortion in those states than it was in New England in 1650. Legislators in Little Rock and Bismarck have passed new restrictions that ban abortions according to when a fetal heartbeat is detected, which can occur as early as six weeks into a pregnancy. Federal judges have blocked the new restrictions until legal challenges to their constitutionality are settled. But the six-week deadline contrasts starkly with early American abortion law, where the procedure was legal until “quickening”—the first time a mother feels the baby kick, which can happen anywhere from 14 weeks to 26 weeks into pregnancy.

Abortion was not just legal—it was a safe, condoned, and practiced procedure in colonial America and common enough to appear in the legal and medical records of the period. Official abortion laws did not appear on the books in the United States until 1821, and abortion before quickening did not become illegal until the 1860s. If a woman living in New England in the 17th or 18th centuries wanted an abortion, no legal, social, or religious force would have stopped her.

That, however, is not the way the anti-abortion movement likes to paint the history of abortion in the United States. Anti-abortion organizations such as the National Right to Lifespin a narrative in which legal abortion is a historical anomaly and an unnatural consequence of modern America’s loose moral standards. On the National Right to Life’s website, for example, a page titled “Abortion History Timeline” describes “a few rogue doctors and midwives” performing abortions in early America, only “as far back as the 1850s.” In reality, trusted midwives and medical practitioners performed abortions from the beginning of American colonial life and throughout world history. Fox News also falsifies American abortion history on its website. On a page titled “Fast Facts: History of U.S. Abortion Laws,” it claims that abortion in the American colonies “was ruled a misdemeanor if performed prior to quickening.”