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By Lindsey Bomnin and Stephanie Gosk

Democrats and Republicans in the U.S. Senate have joined forces to propose a law they say will help fix a problem experienced by at least 40 percent of Americans — surprise medical bills.

Surprise medical bills are frequently the result of patients receiving treatment from a health-care provider that they didn’t know was not covered by their health insurance. In a bill they will introduce to the Senate Thursday, co-sponsors Democrat Maggie Hassan of New Hampshire and Republican Bill Cassidy of Louisiana want to make health care providers negotiate these out-of-network charges with the insurance companies before billing the patient.

Watch this story tonight on “NBC Nightly News With Lester Holt” at 6:30 p.m. ET / 5:30 p.m. CT

“What Maggie and I advocate,” said Cassidy, who was a practicing gastroenterologist before entering the Senate, “is that, okay, let’s hold the patient harmless and let these other entities work it out.”

Said Hassan, “It’s called baseball style arbitration. It’s been piloted and used well in New York.”

If the insurance company and the health care provider can’t reach an agreement, the bill stipulates that an independent arbiter would step in and choose a price for the provided service based on the market rate in the state.

“Baseball-style arbitration” got its name from Major League Baseball, where players can choose to arbitrate their salary instead of accepting what their team offers. The player and the team name their numbers, and then an arbiter picks one of the numbers.

Nicole Briggs had an emergency appendectomy. Because she didn’t know her surgeon was out-of-network, she got a surprise medical bill for almost $5,000 that resulted in a lien on her home and her salary docked by 25 percent each month.Ray Farmer / NBC News

In 2015, the state of New York passed a bill modeled on baseball’s system. It went into effect two years ago. As of March 2019, it had been used to settle about 2,000 disputes, according to Vox. A Yale study showed that both the number of out-of-network bills and the price of emergency room care had fallen in New York since arbitration was introduced. New Jersey passed a law similar to New York’s in 2018.

Four out of 10 Americans, according to a recent poll, said that they have received surprise medical bills in the past year.

Cassidy and Hassan say they have the bipartisan support to pass their bill, which has multiple sponsors from both parties. Said Cassidy, “This is not a Democrat or Republican issue. It is an American issue.”



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U.S. spy chief creates a new head of election security for intelligence agencies

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ASPEN, Colo. — The nation’s top spy has created a new job to coordinate the U.S. response to election security threats.

Director of National Intelligence Dan Coats announced Friday he has established the position of intelligence community election threats executive — and appointed a career official, Shelby Pierson, to serve in this new role.

Pierson will serve as the agency’s principal adviser on threats to elections and matters related to election security, the Office of the Director of National Intelligence said in a statement. She will coordinate and integrate all election security activities, initiatives and programs across spy agencies and synchronize intelligence efforts in support of the broader U.S. government, the statement said.

“Election security is an enduring challenge and a top priority for the IC,” Coats said. “In order to build on our successful approach to the 2018 elections, the IC must properly align its resources to bring the strongest level of support to this critical issue. There is no one more qualified to serve as the very first election threats executive than Shelby Pierson, whose knowledge and experience make her the right person to lead this critical mission.”

Coats also directed the FBI, the CIA and other spy agencies to name a single lead for election security for each agency.

Coats’ move came amid growing concern about foreign threats to the 2020 election, and little evidence that the Trump White House is engaged on the issue.

Pierson served as the DNI’s crisis manager for election security during the 2018 midterm elections and has served for more than two decades in intelligence jobs, the DNI said,

Coats also announced the creation of an Intelligence Community Election Executive and Leadership Board, chaired by Pierson. Members of this board are senior executives from across the government who will coordinate the response to election threats, Coats said.



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How Trump could lose by 5 million votes and still win in 2020

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In the wake of President Donald Trump’s tweets suggesting several nonwhite progressive congresswomen “go back” to their countries — three of them were born in the U.S. — it’s tempting for Democrats to believe the comments will backfire with an increasingly diverse electorate and seriously damage his re-election prospects.

But the cold reality for Democrats? The bulk of the nation’s demographic transformation is taking place in states that matter the least in deciding the Electoral College.

Democrats’ worst nightmare came true in November 2016 when Hillary Clinton captured 2.9 million more votes than Donald Trump but he still comfortably prevailed in the Electoral College, 306 to 232. As much as they would like to purge that outcome from memory, Democrats would be unwise to write it off as a fluke: In 2020, it’s possible Trump could win 5 million fewer votes than his opponent — and still win a second term.

The nation’s two most populous states, California and Texas, are at the heart of Democrats’ geography problem.

Both behemoths are growing more diverse at a much faster rate than the nation — owing to booming Asian and Latino populations — and are trending toward Democrats. Yet neither blue California nor red Texas would play a pivotal role in a close 2020 election, potentially rendering millions of additional Democratic votes useless.

Over the past four years for which census estimates are available, California’s population of nonwhite voting-age citizens has exploded by 1,585,499, while its number of white voting-age citizens has declined by a net 162,715. The Golden State’s GOP is in free fall: In May 2018, the state’s Republican registrants fell to third place behind “no party preference” voters for the first time. In 2016, Clinton stretched Barack Obama’s 2012 margin from 3 million to 4.2 million votes. But padding that margin by another 1.2 million votes wouldn’t yield the 2020 Democratic nominee a single additional Electoral vote.

Over the same time period, Texas has added a net 1,188,514 nonwhite voting-age citizens and just 200,002 white voting-age citizens. Texas’ economic boom has attracted a diverse, highly professional workforce to burgeoning urban centers of Dallas, Houston, Austin and San Antonio and shifted the state’s politics leftward — especially as GOP votes have begun to “max out” in stagnant rural areas. In 2016, Clinton cut Obama’s 2012 deficit from 1.2 million to just over 800,000. But again, even cutting Trump’s margin by 800,000 wouldn’t yield the 2020 Democratic nominee a single additional Electoral vote.

Democrats’ potential inefficiencies aren’t limited to California and Texas: The list of the nation’s top 15 fastest-diversifying states also includes the sizable yet safely blue states of New York, New Jersey, Massachusetts, Maryland, Washington and Oregon.

Meanwhile, demographic transformation isn’t nearly as rapid in the narrow band of states that are best-positioned to decide the Electoral College — a factor that seriously aids Trump.

In 2016, Trump’s victory hinged on three Great Lakes states he won by less than a point: Michigan (0.2 percent), Pennsylvania (0.7 percent) and Wisconsin (0.8 percent). All three of these aging, relatively white states have some of the nation’s highest shares of white voters without college degrees — a group trending away from Democrats over the long term. And the nonwhite share of the eligible electorate in each of the three has increased at only a quarter to a half of the rate it has surged in California, Texas and Nevada.

Democrats eagerly point out that they swept Senate and governors’ races in Michigan, Pennsylvania and Wisconsin in 2018. And they flipped two seats in Michigan and four in Pennsylvania on their way to taking back the House.

But Trump could lose Michigan and Pennsylvania and still win the Electoral College, so long as he carries every other place he won in 2016. And Wisconsin didn’t provide as clear a verdict in 2018. Even with favorable turnout in a “blue wave,” Democrats won Wisconsin’s governor’s race only by a point and failed to gain a House seat. If enough Trump voters who sat out 2018 — particularly white working-class men — return to the polls in 2020, the Badger State could easily stay red.

There are three other states Trump carried by fewer than five points in 2016 that could play a decisive role in 2020: Arizona (3.5 percent), Florida (1.2 percent) and North Carolina (3.7 percent).

Of the “Sun Belt” trio, Florida was the closest in 2016 yet remains one of Democrats’ biggest frustrations.

Over the past four years of census data, it had the nation’s eighth sharpest increase in the nonwhite share of voting-age citizens. But the Sunshine State’s trend lines favor Trump: The rapid influx of conservative Midwestern retirees to the Panhandle and Gulf Coast, along with Florida’s above-average Hispanic support for GOP candidates, explain why Sen. Rick Scott and Gov. Ron DeSantis, both Republicans, defied the “blue wave” in 2018.

Democrats’ strongest Sun Belt pickup opportunity in 2020 may actually be Arizona. Its electorate isn’t very rural and its share of nonwhite voting-age citizens is growing at the third-fastest rate in the country, behind only Nevada and California.

Unlike in Florida, where Democrats lost a Senate seat, Arizona Democrats picked up a Senate seat in 2018. And North Carolina looks likely to remain competitive as the Research Triangle, Charlotte and the Piedmont Triad continue to attract young, left-leaning professionals.

Together, these six states — Arizona, Florida, Michigan, North Carolina, Pennsylvania and Wisconsin — are best-positioned to decide which candidate reaches the magic 270 Electoral votes. That’s not to say that other states won’t be close: It’s possible Trump could win Maine, Minnesota, Nevada or New Hampshire, and it’s possible the Democratic nominee could win Georgia, Iowa, Ohio or Texas. But if either scenario materializes, the election will be a blowout and the victor will likely have already won the “swing six” comfortably.

Bottom line: Mired at an approval rating in the low 40s, Trump has a narrow path to re-election. But the concentration of demographic change in noncompetitive states, particularly California and Texas, threatens to further widen the chasm between the popular vote and the Electoral College, easing his path. Trump could once again win with less than 47 percent, a victory threshold far below the share of the popular vote the Democratic nominee might need.

The ultimate nightmare scenario for Democrats might look something like this: Trump loses the popular vote by more than 5 million ballots, and the Democratic nominee converts Michigan and Pennsylvania back to blue. But Trump wins re-election by two Electoral votes by barely hanging onto Arizona, Florida, North Carolina, Wisconsin and Maine’s 2nd Congressional District — one of the whitest and least college-educated districts in the country.

A scenario that divergent isn’t especially likely, but after 2016, Democrats shouldn’t discount it either.

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Activists who fought for Roe v. Wade are back to fight for reproductive rights

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Jane Fisher still remembers feeling terrified driving to New York City from her Connecticut college campus for a 3 a.m. appointment with an abortion doctor almost 50 years ago. She had heard countless horror stories of women getting sick and dying from unsafe abortions, so she decided to travel in the dead of night to a clandestine clinic in the neighboring state, which recently legalized abortion.

The procedure, which safely terminated her unwanted pregnancy, yielded a sigh of relief for Fisher, but the panic-ridden experience resonated for a long time, eventually sparking a passion in her for reproductive rights.

Jane Fisher in Concord, New Hampshire in 1979.

“Women deserved better,” she said. “I needed to do something about it.”

After college, she began protesting and working with well-known reproductive rights activist Bill Baird until abortion became legal in 1973 with the landmark Roe v. Wade Supreme Court decision.

Now at 70, the retired clinical social worker has once again felt the call for action after feeling like what she’d fought so hard for is facing a new threat.

“Abortion rights are under attack in such a deep way now,” she said, referring to the wave of anti-abortion laws recently passed. “How can you sit back? The rapidity with which some of these laws have taken place is very frightening. It’s happening way too quickly.”

Fisher belongs to an abortion-rights group comprised of women who grew up in the pre-Roe v. Wade era called Grandmothers for Reproductive Rights. The group lobbies state legislatures, has an avid presence at women’s marches and hosts educational discussions on reproductive justice.

Like Fisher, many activists who spoke out in defense of a woman’s right to choose in the ’60s and the ’70s said they have felt the call to action again, and this time they feel a greater urgency to get involved because they remember what life was like when abortions were criminal.

Jane Fisher and Judy KahrlCourtesy Grandmothers for Reproductive Rights

“We can’t go back to that,” said Karen Mulhauser, 76, who protested for reproductive justice in the ’60s. “Young people sometimes don’t believe that Roe could be reversed because they’ve grown up seeing abortion always being available, but that’s why women need to tell stories of what it was like when it wasn’t.”

Mulhauser said she was forced to self-induce an abortion at 19 years old when she had no legal way to obtain one. She still remembers standing in a “pool of blood” struggling to get back to campus afterwards.

She went on to become the executive director of the National Abortion Rights Action League, now known as NARAL Pro-Choice America, in the ’70s and the ’80s, after working as a pregnancy counselor and a volunteer for Planned Parenthood.

These days, she’s busier than ever doing voter engagement work and mentoring young women who are looking to further the abortion rights cause.

In the last year, anti-abortion advocates have made a concerted push to siphon access to the procedure by pressuring states to pass restrictive abortion laws aimed at triggering the Supreme Court to overturn more than 40 years of federal abortion protection under Roe v. Wade.

So far, nine states have passed such laws, including Alabama, whose law makes abortion at any stage of a pregnancy a felony punishable by 10 to 99 years or life in prison if it goes into effect.

Other states, such as Ohio and Louisiana, have introduced “heartbeat” bills which outlaw abortions when a fetal heartbeat is detected, which usually occurs around six weeks, before many women know they are pregnant.

Heather Booth, 73, founded an underground network as a college student out of Chicago in 1965 called “Jane” that helped women obtain abortions until they became legal.

After Roe was decided, Booth began working on a host of other social change efforts including financial reform, marriage equality and immigration policy.

But in the wake of the recent challenges to abortion, Booth has lent her voice back to women’s reproductive rights by promoting strong organization and voter mobilization in the face of what she feels is a more powerful opposition than before.

“The opposition is now more virulent, partisan, well-funded and organized for political purposes in ways that it was not quite the same before Roe,” she said. The strict and very clear partisanship surrounding this issue wasn’t the same level back then, she said.

Several other activists from the pre-Roe era echo Booth’s sentiment.

“Watching the last year or two has been absolutely agonizing,” said Sheila Spear, 78, a ’60s activist who recently joined Grandmothers for Reproductive Rights’ educational outreach branch. “In the ’60s, I don’t think many women were openly pursued by the law the way people are now. They weren’t threatened with going to jail for the rest of their lives.”

Sheila SpearCourtesy Sheila Spear

“It’s ridiculous that despite our past efforts, this next generation of women may still be denied their reproductive rights,” she said. “It’s worse this time because we know better.”

Spear feels the threat to abortion rights has reached peak level.

Abortions will not cease, even if it’s outlawed, said Norma Dreyfus, 79, a retired doctor who worked the septic abortion ward in New York City as a medical student in the mid-1960’s. She still vividly remembers the horrors of seeing women who underwent illegal or self-induced abortions, who were infected, hemorrhaging and dying.

Women will go back to doing whatever it takes out of desperation, which will lead to unsafe and dangerous outcomes, she said. “We’ve already seen it happen.”

In 1965, illegal abortions accounted for 17 percent of all deaths attributed to pregnancy and childbirth, according to the Guttmacher Institute, a group that studies reproductive rights. Although the numbers of deaths was likely higher as the data only reflected reported deaths, the institute reported.

Dreyfus feels her unique perspective on the medical side of botched abortions will help spread the cause, which is why she’s actively involved in advocacy and has even testified in front of the Maine Legislature regarding two bills on abortion rights.

Jeanne Galatzer-Levy, 68, a former member of “Jane,” had retired into a quiet life after working as a science writer in Chicago until she too felt the winds around abortion begin to shift.

Jean Galatzer-Levy in the 1960s.

“I’ve become much more active than I ever was before,” she said. “It’s important to tell our story because the story is still relevant. I wish it wasn’t, but it still is.”

She’s particularly worried about low-income women, who are almost always disproportionately affected by restrictive abortion access.

“Middle-class women are always going to be able to get abortions because there will always be places they can go that will give them safe abortions. It’ll just be harder for poor women to gain access to safe places,” she said.

According to a 1960’s study of low-income women in New York City, 77 percent said that they had attempted a self-induced procedure, the Guttmacher Institute reported.

But Galatzer-Levy is hopeful the new generation will take heed the stories of women who knew life before abortion was legal and will help move the cause forward.

“I’m really excited by what I see in the new women’s movement and the new activism,” she said. “They are moving it along,” she said.

Fisher has charged herself up for the next round of action with nothing short of the same passion she had as a young college student. She now has a new generation of women to fight for and to fight alongside, she said.

“It’s time we all get active and pay attention to reproductive justice because these rights are fundamental to all women, and we have to have each other’s backs,” she said. “We absolutely cannot go backwards.”

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