[VIMS is now calculating sea level rise at 32 sites around the USA and Alaska.
- Heard on Weekend Edition Sunday
[VIMS is now calculating sea level rise at 32 sites around the USA and Alaska.
By Chris HornePublished: March 13, 2018, 6:26 pm Updated: March 13, 2018, 6:40 pm
GLOUCESTER POINT, Va. (WAVY) – A new study from the Virginia Institute of Marine Science shows how much our sea level is expected to rise in the next 30 years.
The VIMS study predicts a rise of nearly 20 inches at Sewell’s Point by the year 2050. ODU Oceanographer Larry Atkinson reviewed the study, and says its chief author is one of the best authorities on sea level rise in the world.
“It’s really been the life work of Dr. John Boon over at VIMS,” Atkinson said. “(The sea level) seems to be rising a bit faster than we thought five or ten years ago.”
That’ll mean more locations will flood, and the ones that already do will be deeper and last longer.
“When we have a large hurricane come by and there’s storm surge, or a nor’easter like right now, we’ll see more flooding,” Atkinson said. “The region is starting to take action. There will be large structures built to help mitigate some of this.”
Christy Everett of the Chesapeake Bay Foundation calls the VIMS study concerning, and talked about smaller-scale plans to address sea level rise, which she sees as more environmentally conscious.
On the campus of the Brock Environmental Center in Virginia Beach, Everett showed us what are called pervious pavers and plantings called bio-swales.
“When the rain comes through, it goes between the pavers and into the ground and back to the aquifer,” Everett said.
The pavers are designed to re-direct storm surge, and the bio-swales are designed to retain it. “So it could prevent it from flooding a parking lot, destroying cars, things like that.”
Atkinson says sea level rise comes from a number of factors, including climate change, sinking land and expanding ocean waters from ice and glacier melt.
Several agencies are working on plans to mitigate sea level rise,including the Hampton Roads Planning District Commission, the Army Corps of Engineers, and the Commonwealth Center for Coastal Flooding Resiliency, a joint collaboration among VIMS, ODU and William and Mary’s Law School.
Nearly five months after Hurricanes Irma and Maria, medical services in the USVI are still in horrible shape, with 400 seriously ill patients receiving care in the mainland, and both major hospitals (in St. Thomas and St. Croix) unable to treat a large portion of those with chronic health problems or emergencies. From National Public Radio, Sunday, 4 February 2018.
This deep analysis of gerrymandering, from a joint study by “FiveThirtyEight” and the “Cook Political Report” is from Dan Balz’s The Sunday Take political analysis column in the Washington Post.
The gerrymandering issue is front and center in the courts.
The Supreme Court has taken two cases: one challenging a Republican-drawn map in Wisconsin, the other a Democratic-drawn map in Maryland. The justices will rule later this year on the constitutionality of district boundaries that appear to unduly favor the party that drew them.
Meanwhile, the Pennsylvania Supreme Court just ruled the congressional boundaries there violate the state constitution by giving Republicans more districts than the partisan split of the state should allow. The state court ordered the lines be redrawn by early next month. In North Carolina, a federal court tossed out the boundaries there for the same reason. That ruling was stayed by the Supreme Court as the justices deliberate over the cases already before it.
Partisan gerrymandering is often seen as the root of much of what is wrong with current politics, from the lack of competitive districts to the rise of ideological extremes, particularly on the right, and the ensuing gridlock in Washington. Most Americans recoil at the contorted shape of some districts and see malevolent hands at work.
“It’s easy for opponents of gerrymandering . . . to argue what districts shouldn’t look like,” writes David Wasserman, who oversees House elections at the Cook Political Report. He adds, “But it’s much more difficult to say what districts should look like, because reformers can disagree on what priorities should govern our political cartography.”
Harry Enten of FiveThirtyEight, another member of the team that spent months on the project, writes that gerrymandering “is a far more complex topic than some analysts and partisans care to acknowledge. . . . There’s no ‘right’ way to draw a district. Prioritize one goal — competitiveness or nonwhite representation, for example — and you have to sacrifice others.”
The team set out to show how different goals produce dramatically different maps. In all they drew 258 different state congressional district maps and a total of 2,568 district maps, using a free, Web-based application. The results are all available for viewing at FiveThirtyEight.com.
They produced maps that heavily favored Democrats, with 263 districts where that party would have a clear advantage. They did another that heavily favored Republicans. In that case, there were 275 districts tilted toward the GOP. In both cases, fewer than 30 districts of the 435 were considered competitive.
But then they showed what the breakdown between the parties would look like if the mapmaking process sought to closely match the distribution of seats to the allegiances of the electorate. In another case, they drew boundaries to produce the maximum number of closely competitive districts; in another, they maximized the number of majority-minority districts. They produced one set of maps with districts that followed county boundaries as much as possible. In one case, they turned the process over to an algorithm designed to produce the most compact districts possible.
Redistricting is inherently a political process, and in most states it remains in the hands of politicians. After the 2010 elections, Republicans held the upper hand in far more state legislatures than the Democrats, which is one reason the GOP has the advantage in the House. But Democrats have not been exactly pure in their approach, either. In states where they controlled the process, they sometimes produced districts that were similarly designed to give themselves an advantage.
However, if Democrats were to control more state legislatures and governorships after the 2020 Census, and therefore have a freer hand in many states to draw new boundaries, they would face some obstacles that Republicans have not faced, according to the study.
Democratic voters are far more clustered in and around urban areas than are Republicans, making it easier to pack them into districts. Republicans are more spread out. This geography of politics favors Republicans in the construction of congressional districts.
Another factor is the role of the Voting Rights Act. Democrats can’t maneuver their voters into particular districts so easily because that could reduce the number of majority-minority districts. In the past, Republicans have worked with minority (and Democratic) legislators to create more majority-minority districts, reaping the benefit of making surrounding districts more Republican in their leanings.
When the FiveThirtyEight team sought to make districts as compact as possible — and they note that there are scores of measures of what constitutes compactness — they ended up reducing the number of majority-minority districts. When they sought to draw maps proportionate to the breakdown of the electorate, they had to engage in some partisan gerrymandering to get there.
When they sought to produce the maximum number of competitive districts, geography again became a factor. “In an era when Democrats and Republicans are choosing to live next to like-minded neighbors, drawing lots of competitive districts can be tricky,” Wasserman writes. “In fact, in some cases, it requires conscious, pro-competitive gerrymandering.”
That particular effort produced a map with 242 competitive districts: a remarkable number that would put the political parties on the edge of breakdowns and enrich a new class of political operatives. It also could result, for better or worse, in a House whose members were reactive to the mood swings of an electorate influenced by 24/7 cable news and the power of social media. The “competitive” map also ended up with non-compact districts and a reduced number of majority-minority districts.
The lack of competitiveness in House districts has come gradually and steadily and not simply as a result of partisan gerrymandering. The Cook Political Report has calculated that the number of competitive districts declined from 164 after the 1996 election to just 72 after the 2016 election. Cook’s team earlier concluded that less than a fifth of that decline was caused by redistricting.
One factor in reducing the number of competitive House districts is that fewer and fewer counties are balanced politically. Enten cites statistics showing that in the 1996 presidential election, 1,111 counties — about a third of the total nationally — were decided by margins of 10 percentage points or fewer. In 2016, “that number had plummeted to just 310.” That makes it all the more difficult to produce competitive House districts without trampling on the goal of keeping counties and communities as intact as possible.
All of this may be a bit wonky for the average person. But there’s a larger message in all the data. As people judge the current state of politics, there is more at fault than partisan gerrymandering, as distasteful as it might be. As Wasserman puts it: “Gerrymandering is a really easy practice to condemn and a really complex problem to solve. And just as there are not permanent majorities in American politics, there may never be such a thing as a perfect map.”
Correction: An earlier version of this article misstated the number of U.S. House districts. There are 435, not 538.
[Not sure that this news represents a vote of confidence in the Open Government movement or support for it by the US Government . . . At the least, the less-than-24-hours advance notice of the postponement of the meeting evinces a degree of disrespect for the “Open Government community.” . . . For other, sporadic notice of information about the Open Government movement by the US Government and a few civil society organizations and individuals, check the web site at <https://groups.google.com/group/us-open-government>
For non-US organizations and agencies that are affected by elements of the US Open Government programs (I’m thinking, for example, of disaster and international health issues, such as satellite imagery or up-to-date epidemiological reports), contact me at <firstname.lastname@example.org>, and we’ll see if we can find a channel for introducing your concerns in the formulation of version four of the US National Action Plan. . . . . bp]
We’re writing with a few updates regarding the National Action Plan for Open Government.
First, due to a combination of factors, we will need to delay tomorrow’s meeting by approximately two months. Please hold Tuesday March 27 at 10:00 am on your calendars. As stated in the United States’ official delay letter (available: open.usa.gov,opengovpartnership.org), the delayed delivery of the fourth National Action Plan and related materials is allowing USG additional time to ensure that the plan is as substantive and aligned to national priorities as possible. The delay in this month’s meeting reflects that approach. We appreciate everyone’s patience and remain committed to full participation in the partnership.
On an administrative note, we wanted to make sure that everyone saw that, as a result of the delayed delivery of the fourth National Action Plan, the Open Government Partnership has moved the United States from the “odd year” to the “even year” cohort of participating countries. The new deadline for delivery of NAP4 is August 31, 2018. You can read OGP’s official letter here.
Alycia on behalf of the Open Gov Team
U.S. General Services Administration
Office of Government-wide Policy
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[There’s a point at which I stop being bemused by the blunders and lies — which cannot be distinguished from each other, because the perpetrators themselves DO NOT KNOW the difference — of the New Regime. This report from the January 16th Washington Post is much too oblique in calling out the embedded fake stats. ]
A new Justice Department report issued Tuesday suggests that, since 9/11, 73 percent of terrorism convictions in the United States have involved individuals who were born in other countries. An expert on terrorism data, however, said that what is most alarming about the document is its math.
The survey was conducted by the Justice Department and the Department of Homeland Security in response to a specific requirement in the Trump administration’s travel-ban order issued in March. It found 549 individuals charged with terrorism. Of them, 254 were not U.S. citizens, 148 were born abroad but later received U.S. citizenship and 147 were U.S. citizens by birth, the report says.
President Trump has called for an end to the practice of letting naturalized U.S. citizens bring their relatives into the United States — critics call this “chain migration” — and for abolishing the “diversity lottery’’ for green cards. In releasing the report, administration officials said the figures underscore a need for tougher immigration standards to keep terrorists out of the United States.
Karen Greenberg, director of Fordham University’s Center on National Security, said the figures instead show there is a need for applying tougher statistical standards to government reports. [I think she means the report is wrong, by almost any standard of interpretation for its errors . . . bp]
“It’s an awfully thin report for an absolutely important topic,” she said. “There’s almost no rhyme or reason to the things they choose to include or not include — they don’t explain it.”
The report considers only those incidents motivated by international terrorist groups — so instances of domestic terrorism are not counted. Moreover, individuals captured overseas, extradited and brought to the United States to face trial are included in the same category as people who emigrated to the United States and were charged with terrorism offenses years later.
For example, Ahmed Abu Khattala, convicted in November in connection with the deadly 2012 attack on a U.S. diplomatic mission in Benghazi, Libya, is counted in the same category as someone who successfully applied for a visa to enter the United States.
“Doing that intentionally confuses the threat of domestic terrorist attack with the number of foreigners, by increasing the number of foreigners,” Greenberg said. Extradited terrorism suspects are not immigrants, she said, and should be taken out of the sample.
Trump’s executive order specifically seeks “information regarding the number of foreign nationals in the United States who have been charged with terrorism-related offenses while in the United States (or) convicted of terrorism-related offenses while in the United States.”
That would appear to exclude those, such as Abu Khattala, who were brought to the United States for the sole purpose of charging them with terrorism crimes committed overseas, but the report issued Tuesday said it includes “those who committed offenses while located abroad, including defendants who were transported to the United States for prosecution.”
A Justice Department spokesman would not say how many such extradition or overseas-capture cases were included in the report.
Greenberg, whose center at Fordham issues reports analyzing terrorism prosecutions, said there are about 80 such cases.
Greenberg also questioned the time frame examined in the report, saying that looking back to 2001 paints a misleading picture of today’s terrorist threat.
Online indoctrination and recruitment by the Islamic State and other terrorist groups over the past few years has led to an increase in the number of U.S.-born terrorism suspects. About 54 percent of those charged with supporting the Islamic State in recent years were born in the United States, Greenberg said.
Senior Democrats on two House committees accused the Trump administration of misrepresenting terrorist crimes to fit anti-immigration policy goals.
Reps. Jerrold Nadler (D-N.Y.) and Bennie Thompson (D-Miss.) called the report an attempt “to vilify the immigrant community and justify an exclusionary immigration policy,” adding in their statement, “The American people will not be fooled by such naked bigotry, and we should not allow this administration to get away with its abuse of the facts to further its extremist, xenophobic agenda.”
The top Republican on the House Judiciary Committee, Rep. Bob Goodlatte (R-Va.), said in a statement that the report “confirms what we already know: our current immigration system is broken, and it fails to protect the American people.’’
[This article is from the exemplary on-line magazine Vox, by Sarah Kliff, who is a super interpreter of public policy in the health arena. Follow her regularly, including especially her daily VoxCare column. ]
“It was a very sharp muscle pain,” Saifan, a 39-year-old engineer, remembers. “I couldn’t move or sleep in any position. I was trying laying down, sitting down, nothing worked.”
Saifan went online to figure out where he could see a doctor. The only place open at that hour was Overland Park Regional Medical Center in his hometown of Overland Park, Kansas.
The doctor checked his blood pressure, asked about the pain, and gave him a muscle relaxant. The visit was quick and easy, lasting about 20 minutes.
But Saifan was shocked when he received bills totaling $2,429.84.
The bill included a $3.50 charge for the muscle relaxant. The rest — $2,426.34 — was from “facility fees” charged by the hospital and doctor for walking into the emergency room and seeking care.
Because Saifan’s health spending is still within his plan’s deductible, he is responsible for the entire amount.
“I called the insurance company to make sure the bill was real,” he says. “They said it was a reasonable price, and gave me a breakdown.”
There are 141 million visits to the emergency room each year, and nearly all of them (including Saifan’s) have a charge for something called a facility fee. This is the price of walking through the door and seeking service. It does not include any care provided.
Emergency rooms argue that these fees are necessary to keep their doors open, so they can be ready 24/7 to treat anything from a sore back to a gunshot wound. But there is also wide variation in how much hospitals charge for these fees, raising questions about how they are set and how closely they are tethered to overhead costs.
Most hospitals do not make these fees public. Patients typically learn what their emergency room facility fee is when they receive a bill weeks later. The fees can be hundreds or thousands of dollars. That’s why Vox has launched a year-long investigation into emergency room facility fees, to better understand how much they cost and how they affect patients.
Saifan’s bill was so expensive, it turns out, because the hospital used the facility fee typically reserved for complex, intensive emergency room visits.
Emergency room facility fees are usually coded on a 1 to 5 scale, to reflect the complexity of care delivered to the patient. Saifan’s visit where he received a muscle relaxant was coded by the doctor as a level 4 visit — the second highest — and came with hefty fees as a result.
The hospital billed a separate facility fee (!) and chose level 3, typically reserved for moderately complex visits.
Saifan’s experience isn’t an anomaly: A new Vox analysis reveals that emergency rooms all across the country are increasingly using these higher-intensity codes, and that the price of these codes has increased sharply since 2009.
Vox worked with the nonprofit Health Care Cost Institute (HCCI) to analyze 70 million insurance bills for emergency room visits from between 2009 and 2015. We focused on the prices that health plans paid hospitals for facility fees, not the hospital charges (which can often be inflated well above what patients actually pay).
We found that the price of these fees rose 89 percent between 2009 and 2015 — rising twice as fast as the price of outpatient health care, and four times as fast as overall health care spending.
Overall spending on emergency room fees rose by more than $3 billion between 2009 and 2015, despite the fact the HCCI database shows a slight (2 percent) decline in the number of emergency room fees billed in the same time period.
“It is having a dramatic effect on what people spend in a hospital setting,” says Niall Brennan, executive director of the Health Care Cost Institute. “And as we know, that has a trickle-down effect on premiums and benefits.”
The HCCI data shows that prices are rising dramatically and that, increasingly, hospitals have gravitated to using the most expensive billing codes — the level 4 and 5 charges, typically reserved for the most complex visits.
The rising price of emergency room facility fees coupled with growing usage of the most expensive codes mean it’s significantly more expensive to go to an emergency room now than it was six years ago.
Hospitals argues that these increases are due to an aging, sicker population.
“If you have a monopoly — and when it comes to the ER, it’s a monopoly — you can set any price you want,” says Robert Derlet, a professor emeritus in emergency medicine at the University of California Davis, who has been critical of ER billing in the past.
“What is going to deter me from increasing my price? Who can stop me? If I’m the financial officer for the hospital, I might even get a bonus for doing this.”
David Overton knows what strep throat feels like. He comes down with it once or twice every year. He typically goes to urgent care or a drug store clinic when his achy throat and fever symptoms start.
But his most recent strep throat infection flared up on Memorial Day, and those clinics were closed. So he went to Legacy Emergency Room & Urgent Care outside of Dallas.
Overton walked in the door for urgent care, but staff there said his case was severe enough to move him to the emergency room side of the clinic.
“I felt terrible, and I wasn’t up for debating it,” he says. “So I was like okay, I guess we’ll do this.”
The emergency room performed a CT scan and used IV medications to treat Overton. He immediately felt better, and left with a prescription for antibiotics. Three days, later he saw another doctor who confirmed it was a simple case of strep throat.
But because of the complex intervention — the CT scan, the IV drugs, the long visit — the hospital coded Overton has having the most complex visit possible, a level 5. They billed him a $1,900 facility fee. Because he has a high-deductible plan, he’s responsible for all of it.
“Did I need the CT scan? No. Did I need the IV antibiotics? No,” he says. “I could have been treated with oral antibiotics.”
He’s currently paying off the bill by $50 each month. So far, he’s paid $300.
Emergency billing guidelines offered by the American College of Emergency Physicians typically reward doctors for providing a higher level of medical care. They instruct hospitals to use the more expensive billing codes for cases where they have to perform multiple scans and examinations.
Two different hospitals trips for the same condition may be treated and billed quite differently. A case of strep throat treated with oral antibiotics — a simple visit — would likely be coded as a level 1 or 2 visit. But a visit with multiple scans and an IV drip could come out to a 4 or 5.
The HCCI data set suggests that Overton’s experience may not be atypical. It shows that more and more emergency rooms are billing the severe, expensive facility fee charges.
What’s more, there are no federal guidelines on how to code even the exact same visit. This is left up to a hospital’s billing staff, meaning that if two patients receive identical care in different emergency rooms, one may be coded as a level 3 and another as a level 4.
“There are charges that people could look at differently,” says David McKenzie, reimbursement director for the American College of Emergency Physicians. “Reasonable people could disagree on severity.”
These discrepancies can be expensive for patients, as emergency rooms charge hundreds of dollars more for the more severe codes.
The HCCI database shows that the average price of a level 3 facility fee (in medical coding, this is billed as 99283) is $576. Go up to the next severity code, level 4 (or, in medical codes, 99284), and the price rises to $810.
“Hospitals can make a lot of money charging for all the extras — CT scans, MRIs, laboratory fees, even starting an IV,” Derlet, the emergency physician, says.
In 2009, 50 percent of all emergency room facility fee charges were for level 4 and 5 codes. In 2015, that number rose to 59 percent.
How to interpret that trend isn’t fully clear. Some say it could signal hospitals charging higher rates for similar care. But the current data makes it impossible to rule out the fact that emergency room visits may just be getting more serious.
The government has tried to crack down on high emergency room fees before — but ultimately was scared off by intense push back from health care industries.
In 2012, an investigation by the Center for Public Integrity showed that hospitals had earned an additional $1 billion in Medicare revenue by using the most expensive facility fees — the level 5 codes.
This meant that the public insurance program that covers Americans over 65 was suddenly spending significantly more money on these routine fees.
In response, the Obama administration proposed eliminating the facility fee levels entirely, to get rid of any incentives to bill for a higher price. It suggested one flat fee for all visits.
“A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit,” Medicare argued in November 2013.
But that rule never saw the light of day. After intense pushback from hospitals and doctor groups, the issue was dropped and the fee levels remain today.
“I remember we got an onslaught of comments, hospitals being very frustrated, emergency room doctors being upset,” one former Medicare official involved with the rule said. “It definitely got pulled, and it was just about the amount of commenting and concerns from the industry.”
At the time, Medicare issued a statement saying it “intends to consider options to improve the codes for these services in future rulemaking.” So far, the agency has taken no actions to re-regulate these codes.
Some patients, however, have had success taking matters into their own hands.
Last winter, John Shelbourne ended up with a small gash above his eye from a basketball game with friends.
“It was just big enough that it needed to be closed,” Shelbourne, 37, says. “It was probably 9 at night, so I had to head to the emergency room.”
The doctors at Swedish Covenant Hospital glued the wound shut and covered it with Steri-Strips. Shelbourne estimates the visit took about 15 minutes.
A few weeks later, he received a bill with a $899 facility fee. (Incidentally, the Steri-Strips — which cost $1.49 for a box of 12 at Target — were billed at $14.)
Shelbourne’s visit was coded level 3, a medium-intensity facility fee. He showed the bill to his father, a doctor.
“I was able to ask him what these levels were, and he asked his nurses, who knew the difference,” he says. “They said level 3 is a complex procedure, and once I found that out, I knew there was no way this was a complex visit.”
Shelbourne started calling the hospital, arguing that his visit should be coded level 2 instead of 3. He made 25 separate calls over two months. He kept records of all of them, on sticky notes around his desk at work. The hospital eventually agreed with him and lowered his visit from a level 3 down to a level 2.
That change lowered his portion of the bill from $441 down to $305.
“I’m stubborn,” Shelbourne says. “Once I found out what a level 3 visit was, I got pissed off about it. I was on a mission. I went from not knowing the difference between ER visit levels to seeing how these things could get totally slipped by you.”
Saifan, the engineer in Kansas who received the $2,429.84 bill for the muscle relaxant, is disputing his bill as well.
“We’ll see how the dispute goes, but I’m not expecting it to change,” he says. He says the hospital told him he could get a 10 percent discount if he paid the bill in full rather than installments over time, which he’ll do if his dispute is unsuccessful. His family has enough money to pay off the bill.
“It’s not easy to pay $2,500, but it won’t be life or death,” he says. “It would be a pretty frustrating disappointment.”