Author: SeniorWomenWeb

Unheralded Government Cost Cutting Originated by Senator Cassidy: Does the EGO Act Mean No Portrait of Pres. Donald Trump Nor the First Lady?

Senator Bill Cassidy, R-La, right

We’ve discovered an interesting and perhaps little known Congressional bill while waiting for the CBO to rate the costs of the Graham – Cassidy health bill*; here are the CBO’s comments on the EGO Act:

From the Congressional Budget Office: As ordered reported by the House Committee on Oversight and Government Reform on September 13, 2017

H.R. 1701 would prohibit the use of federal funds to pay for official painted portraits of any officer or employee of the federal government, including the President, Vice President, Cabinet members, and Members of Congress. The legislation would not apply to the judicial branch.

Appropriation laws have prohibited the use of federal funds for such portraits since fiscal year 2014. CBO is unaware of any comprehensive information on spending for official portraits before 2014, but we expect that most portraits of federal officials are for those in the line of succession to the presidency, members of the legislative branch, and military service personnel. The cost of such portraits appears to be about $25,000 per portrait, based on contract awards for a few federal portraits.

Implementing H.R. 1701 could reduce future discretionary costs because the prohibition on using appropriated funds for such portraits is not in permanent law. However, those effects would be less than $500,000 annually because CBO expects that fewer than 20 portraits would be purchased with federal funds in most years.

Enacting H.R. 1701 could affect direct spending by some agencies not funded through annual appropriations; therefore, pay-as-you-go procedures apply. CBO estimates, however, that any net changes in spending by those agencies would be negligible. Enacting the bill would not affect revenues.

CBO estimates that enacting H.R. 1701 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028.

H.R. 1701 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would impose no budgets of state, local, or tribal governments.

On March 24, 2017, CBO transmitted a cost estimate for S. 188, the EGO Act, as ordered reported by the Senate Committee on Homeland Security and Governmental Affairs on March 15, 2017. The two pieces of legislation are similar, and CBO’s estimates of their budgetary effects are the same.

*It appears that the co-sponsor of the new healthcare proposal was introduced by Senator Cassidy some years ago:

“If Rep. Bill Cassidy, R-La. [Editor’s note: Now SENATOR Cassidy], has his way, taxpayer-funded oil paintings that commemorate federal officials – some at $40,000 a pop – will soon be a thing of the past. Cassidy has introduced an aptly-named Eliminating Government-Funded Oil-Painting, or EGO Act, which would prevent tax dollars from funding expensive official portraits at a time when the U.S. is facing a trillion-dollar deficit.” From Elizabeth Flock, US News and World Report, 2013

©2017 Tam Martinides Gray, Editor

September 21, 2017
Five Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk; Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know
Medicaid’s Future

By Kaiser Health News*
The Graham-Cassidy proposal to repeal and replace the Affordable Care Act (ACA) is reviving the federal health reform debate and could come up for a vote in the Senate in the next two weeks before the budget reconciliation authority expires on September 30. The Graham-Cassidy proposal goes beyond the American Health Care Act (AHCA) passed by the House in May and the Better Care Reconciliation Act (BCRA) that failed in the Senate in July. The Graham-Cassidy proposal revamps and cuts Medicaid, redistributes federal funds across states, and eliminates coverage for millions of poor Americans as described below:
1. Ends federal funding for current ACA coverage and partially replaces that funding with a block grant that expires after 2026. The proposal ends both the authority to cover childless adults and funding for the ACA Medicaid expansion that covers 15 million adults. Under Graham-Cassidy, a new block grant, the “Market-Based Health Care Grant Program,” combines federal funds for the ACA Medicaid expansion, premium and cost sharing subsidies in the Marketplace, and states’ Basic Health Plans for 2020-2026. Capped nationally, the block grant would be lower than ACA spending under current law and would end after 2026. States would need to replace federal dollars or roll back coverage. Neither the AHCA nor the BCRA included expiration dates for ACA-related federal funds or eliminated the ability for states to cover childless adults through Medicaid.
2. Massively redistributes federal funding from Medicaid expansion states to non-expansion states through the block grant program penalizing states that broadened coverage. In 2020, block grant funds would be distributed based on federal spending in states for ACA Medicaid and Marketplace coverage. By 2026, funding would go to states according to the states’ portion of the population with incomes between 50% and 138% of poverty; the new allocation is phased in over the 2021-2025 period. The Secretary has the authority to make other adjustments to the allocation. This allocation would result in a large redistribution of ACA funding by 2026, away from states that adopted the Medicaid expansion and redirecting funding to states that did not. No funding is provided beyond 2026.
3. Prohibits Medicaid coverage for childless adults and allows states to use limited block grant funds to purchase private coverage for traditional Medicaid populations. States can use funds under the block grant to provide tax credits and/or cost-sharing reductions for individual market coverage, make direct payments to providers, or provide coverage for traditional Medicaid populations through private insurance. The proposal limits the amount of block grant funds that a state could use for traditional Medicaid populations to 15% of its allotment (or 20% under a special waiver). These limits would shift coverage and funds for many low-income adults from Medicaid to individual market coverage. Under current law, 60% of federal ACA coverage funding is currently for the Medicaid expansion (covering parents and childless adults). Medicaid coverage is typically more comprehensive, less expensive and has more financial protections compared to private insurance. The proposal also allows states to roll back individual market protections related to premium pricing, including allowing premium rating based on health status, and benefits currently in the ACA.
4. Caps and redistributes federal funds to states for the traditional Medicaid program for more than 60 million low-income children, parents, people with disabilities and the elderly. Similar to the BCRA and AHCA, the proposal establishes a Medicaid per enrollee cap as the default for federal financing based on a complicated formula tied to different inflation rates. As a result, federal Medicaid financing would grow more slowly than estimates under current law. In addition to overall spending limits, similar to the BCRA, the proposal would give the HHS Secretary discretion to further redistribute capped federal funds across states by making adjustments to states with high or low per enrollee spending.
5. Eliminates federal funding for states to cover Medicaid family planning at Planned Parenthood clinics for one year. Additional funding restrictions include limits on states’ ability to use provider tax revenue to finance Medicaid as well as the termination of the enhanced match for the Community First Choice attendant care program for seniors and people with disabilities. Enrollment barriers include the option for states to condition Medicaid eligibility on a work requirement and to conduct more frequent redeterminations.
Much is at stake for low-income Americans and states in the Graham-Cassidy proposal. The recent debate over the AHCA and the BCRA has shown the difficulty of making major changes that affect coverage for over 70 million Americans and reduce federal funding for Medicaid. Medicaid has broad support and majorities across political parties say Medicaid is working well. More than half of the states have a strong stake in continuing the ACA Medicaid expansion as it has provided coverage to millions of low-income residents, reduced the uninsured and produced net fiscal benefits to states. Graham-Cassidy prohibits states from using Medicaid to provide coverage to childless adults. With regard to Medicaid financing changes, caps on federal funding could shift costs to states and result in less fiscal flexibility for states. States with challenging demographics (like an aging population), high health care needs (like those hardest hit by the opioid epidemic), high cost markets or states that operate efficient programs may have the hardest time responding to federal caps on Medicaid spending. Faced with substantially reduced federal funding, states would face difficult choices: raise revenue, reduce spending in other areas, or cut Medicaid provider payments, optional benefits, and/or optional coverage groups.

September 21, 2017
FDA Commissioner Gottlieb, MD On the Continued Efforts to Promote Safe Adoption of Medication-assisted Treatment for Opioid Addiction

Statement

Photo of FDA Commissioner, Scott Gottlieb, MD*

Medication-assisted treatment (MAT) — the use of medication combined with counseling and behavioral therapies — is one of the major pillars of the federal response to the opioid epidemic in this country. This type of treatment is an important tool that has the potential to help millions of Americans with an opioid use disorder regain control over their lives. In fact, patients receiving MAT cut their risk of death from all causes in half, according to the Substance Abuse and Mental Health Services Administration. Addressing the epidemic of opioid addiction is my highest public health priority. One element of that effort is promoting more widespread, safe adoption of MAT as a way to help more people overcome addiction.

However, healthcare providers and patients face significant challenges when determining how best to treat opioid use disorder, especially when the MAT drugs contain methadone or buprenorphine — which are also opioids. For example, many patients with opioid use disorder might abuse other substances or have a co-existing chronic condition, such as a mental health disorder. This may require separate treatment using medications that, when combined with the MAT drugs methadone or buprenorphine, may pose serious risks. Today, the FDA issued a Drug Safety Communication alerting health care providers and patients of the increased risk of serious side effects when combining these particular MAT drugs with benzodiazepines — often prescribed to treat anxiety, insomnia, or other conditions — and how to address these risks while continuing to maintain patients on MAT. In addition, the FDA also recently strengthened labeling for the MAT drug buprenorphine to emphasize that patients may require treatment indefinitely and should continue treatment for as long as they benefit and as long as the use of MAT contributes to their intended treatment goals.

As noted in the Drug Safety Communication, the co-administration of the MAT drugs methadone or buprenorphine with benzodiazepines or other central nervous system (CNS) depressants can pose serious risks, including difficulty breathing, coma, and death. The FDA’s new alert follows the agency’s warning last year of the risks of using opioid analgesics (to treat pain) or prescription opioid cough products and benzodiazepines at the same time. At that time, more consideration was needed regarding the combined use of these MAT drugs and benzodiazepines or other CNS depressants due to the unique medical needs and benefit-risk considerations for this specific patient population. As a result of that consideration, the FDA’s new advisory that we’re issuing today asks health care providers and patients to be aware of these risks. But at the same time, the agency is also reinforcing that MAT should not necessarily be denied to patients taking these other medications. The dangers associated with failing to treat an opioid use disorder can outweigh the risks of co-prescribing MAT and benzodiazepines. Instead, careful management of the patient and coordination of care is recommended.

To underscore the importance of appropriately utilizing MAT products, the FDA is requiring changes to MAT drug labels to help decrease the risks of combining these drugs, while taking steps to address situations where the MAT drugs methadone or buprenorphine might be co-administered with benzodiazepines. The new labeling recommends that health care providers develop a treatment plan that closely monitors any concomitant use of these drugs, and carefully taper the use of benzodiazepines, while considering other treatment options to address mental health conditions that the benzodiazepines might have been initially prescribed to address.

Reducing the number of Americans who are addicted to opioids and cutting the rate of new addiction is one of the FDA’s highest priorities. We must do everything possible to address the staggering human toll caused by opioid use disorders, and ensuring patients receive proper treatment for both addiction and coexisting mental health conditions is a critical step in that effort.

The FDA, an agency within the US Department of Health and Human Services, promotes and protects the public health by, among other things, assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

*Dr. Scott Gottlieb was sworn in as the 23rd Commissioner of Food and Drugs on May 11, 2017. Dr. Gottlieb is a physician, medical policy expert, and public health advocate who previously served as the FDA’s Deputy Commissioner for Medical and Scientific Affairs and before that, as a senior advisor to the FDA Commissioner.

September 20, 2017
Congressional Bills Introduced: Caregiving, Community Health Centers, Campus Sexual Assault Prevention and Response

Last week, the Senate approved in unanimous consent several human trafficking bills: S. 1311, the Abolishing Human Trafficking Act, sponsored by Sen. John Cornyn (R-TX), S. 1312, the Trafficking Victims Protection Act, sponsored by Sen. Chuck Grassley (R-IA), S. 1532, the No Human Trafficking on our Roads Act, sponsored by Sen. John Thune (R-SD), and S. 1536, the Combating Human Trafficking in Commercial Vehicles Act, sponsored by Sen. Amy Klobuchar (D-MN). The Senate Judiciary Committee passed S. 1311 and S. 1312 on June 29 (see The Source, 6/30/17); the committee approved S. 1532 and S. 1536 on August 2 (see The Source, 8/4/17).

The Combating Human Trafficking in Commercial Vehicles Act, sponsored by Sen. Amy Klobuchar (D-MN), right, United States Senate

S. 1311 would prioritize efforts to end human trafficking, while S. 1312 would require mandatory restitution for victims of commercial sexual exploitation and would continue efforts to combat sex tourism.

Individuals who commit felonies involving human trafficking would be disqualified from operating commercial motor vehicles under S. 1532.

S. 1536 would expand human trafficking prevention programs among the scope of activities authorized within the Federal Motor Carrier Safety Administration.

On September 13, the House Ways and Means Committee approved, 22-15, H.R. 2824, the Increasing Opportunity through Evidence-Based Home Visiting Act, as amended, sponsored by Rep. Adrian Smith (R-NE).

Among other provisions, the bill would extend the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and would focus on research and evaluation activities to improve program effectiveness.

Bills Introduced:

Child Care

S. 1806—Sen. Patty Murphy (D-WA)/Health, Education, Labor, and Pensions (9/14/17) —A bill to promote child care and early learning, and for other purposes.

H.R. 3773—Rep. Robert Scott (D-VA)/Education and the Workforce (9/14/17)—A bill to promote child care and early learning, and for other purposes.

Family Support

H.R. 3759—Rep. Gregg Harper (R-MS)/Education and the Workforce (9/13/17)—A bill to provide for the establishment and maintenance of a family caregiving strategy, and for other purposes.

Health

H.R. 3770—Rep. Elise Stefanik (R-NY)/Energy and Commerce (9/13/17)—A bill to reauthorize and extend funding for community health centers.

Judiciary

H.R. 3745—Rep. Brenda Lawrence (D-MI)/Judiciary (9/12/17)—A bill to amend the Fair Housing Act to establish that certain conduct, in or around a dwelling, shall be considered to be severe or pervasive for purposes of determining whether a certain type of sexual harassment has occurred under that Act, and for other purposes.

Tax Policy

H.R. 3757—Rep. Ro Khanna (D-CA)/Ways and Means (9/13/17)—A bill to modify the earned income tax credit to account for the amount by which economic growth has outpaced income growth, and for other purposes.

H.R. 3749—Rep. Al Lawson Jr. (D-FL)/Agriculture; Energy and Commerce; Ways and Means; Education and the Workforce (9/12/17)—A bill to provide for a standard medical expense deduction under the supplemental nutrition assistance program, and for other purposes.

Violence Against Women

H.R. 3734—Rep. Susan Davis (D-CA)/Education and the Workforce (9/11/17)—A bill to require institutions of higher education to have an independent advocate for campus sexual assault prevention and response.

S. 1801—Sen. Tim Kaine (D-VA)/Health, Education, Labor, and Pensions (9/12/17)—A bill to require institutions of higher education to have an independent advocate for campus sexual assault prevention and response.

September 18, 2017
That Day: Pictures in the American West By Laura Wilson; “She introduces us to westerners we might never have encountered”

A Past Exhibit at the Buffalo Bill Center of the West, March 11 – August 13, 2017

Laura Wilson, Emma, Hutterite Girl in Field, Duncan Ranch Colony Harlowton, Montana, June 17, 1994. Archival pigment print, 46 x 46 in. Private Collection

Laura Wilson, renowned photographer and author whose work has been featured in the The New Yorker, Vanity Fair and London’s Sunday Times, began photographing the American West in the 1970s. The region captivates her still.

Wilson’s work was the focus of a special exhibition at the Buffalo Bill Center of the West. That Day: Pictures in the American West ran from March 11 through August 13, 2017, in the Center’s John Bunker Sands Gallery. The exhibition, organized by the artist in collaboration with the Amon Carter Museum of American Art in Fort Worth, Texas, presents Wilson’s photographs of the American West taken over the course of three decades.

From her home in Texas, Wilson set out across the state to photograph cattle ranches, the US – Mexico border region, and rural communities. She frequented rodeo arenas, witnessed parades and preachers’ sermons, and stood sideline at six-man football games. She traveled to remote corners of the West — to a naval air station in Nevada, the Pine Ridge Indian Reservation in South Dakota, and Hutterite colonies in Montana. Camera in hand, Wilson sought images of daily life beyond the suburban and urban sprawl and composed a broader and unique vision of the modern West.

“In That Day, Laura Wilson invites us into communities to which we might not have been granted admission,” says Karen McWhorter, the Scarlett Curator of Western American Art for the Whitney Western Art Museum at the Center of the West. “She introduces us to westerners we might never have encountered.”

Laura Wilson. “Cowboys Walking, J.R. Green Cattle Company Shackelford County, Texas, May 13, 1997.” Gelatin silver print, 44 x 66 in. Private Collection

Collectively, the more than eighty large-scale images are a portrait of a region and its diverse residents. Through Wilson’s lens, the West as we have come to know it through literature, artwork, and film includes both familiar and extraordinary characters and cultures.

McWhorter notes, “Wilson’s portraits run the gamut, picturing outsiders and rebels, holdouts to history and visionaries, enforcers of the laws and those who break them or … defiantly devise their own.” Working cowboys who seem to have leaped from the silver screen share space with gritty scenes of vicious dog fights. Brawny Texas Rangers are countered by debutantes in hundred-pound ball gowns. Wilson’s West is not easily defined—it’s paradoxical and complex—and its residents are anything but one-dimensional. Her photographs suggest that some traditional elements of life in the West continue to thrive in its wide-open spaces, but also that this expansive region tolerates the coexistence of an astonishing range of lifestyles and customs.

“Wilson has said she chose her subjects because they reflect her interests and her concerns,” continues McWhorter. “She approaches people not in judgment, but with intense and authentic interest. You can tell she was committed to revealing her subject’s complexity and emotional range.”

Laura Wilson. Bill Richardson, American Indian Trader, Richardson’s Trading Company, Gallup, New Mexico, January 14, 2008. Gelatin silver print, 28 x 28 in. Private Collection

The exhibition includes photographs that grapple with difficult subjects — dogfighting, cockfighting, border-related violence — that are not always easy to look at. “This is important,” says McWhorter. “It’s stimulating and requires our full attention, and allows us at the Center of the West to broach conversations about what the West looks like in the 21st century.” But, she continues, “Others of Wilson’s images are arrestingly beautiful.” McWhorter is particularly drawn to those of Hutterite men, women, and children in Montana.

The book that accompanies the exhibition and the labels throughout it include the photographer’s personal reflections on her subjects and offer insight into her days spent in the West, from trading posts to artists’ enclaves. With friendly familiarity and a storyteller’s cadence, Wilson bears witness to everyday interactions and exceptional events.

That Day: Pictures in the American West closed August 13 at the Buffalo Bill Center of the West. For more information, contact Karen McWhorter at karenm@centerofthewest.org or 307-578-4053.

Laura Wilson. Hutterite Boy on Appaloosa, Golden Valley Colony, Ryegate, Montana, June 15, 1993. Archival pigment print, 46 x 46 in. Private Collection

Laura Wilson. Mesquite Tree with Coyotes, Lambshead Ranch, Albany, Texas, January 9, 1988. Archival pigment print, 46 x 46 in. Private Collection

Editor’s Note: We just came across this exhibit, closed in August, but thought it should be seen. Don’t overlook the Shop.

September 16, 2017
“The Secret” Revisited

By Rose Madeline Mula

Have you read The Secret by Rhonda Byrne? Are you familiar with The Law of Attraction? If you watched Oprah a few years ago, you’d know all about it. It has become her Bible. According to this theory, if you ask for — and truly believe you will receive — whatever your heart desires, your every wish will be granted. It seems that sending positive vibes out to the universe magically attracts positive results, without fail. Hey, it worked for Oprah. I haven’t heard that she’s worried about where her next mortgage payment is coming from, have you?

Above, right: Adolph Menzel, Ungemachtes Bett (1845), black chalk on paper, image via Wikipedia Commons

But as incredible as that sounds, I may have inadvertently stumbled upon an even more powerful secret to unlocking the riches of the world. It’s simply this: Make your bed every morning.

While randomly surfing the web recently, I came across a quote that asserts that making your bed in the morning — even if no one will see it but you —sets you up for a fruitful, successful day which, in turn, guarantees a productive week — followed by a bang-up month and a supercalifragilisticexpialidocious year. String enough of those together, and you achieve a successful lifetime with all the trappings — an ideal spouse, perfect children, multiple mansions, private jets, Jaguars, yachts… Just name it. The possibilities are limited only by your greedy imagination.

I really think there’s something to this! Occasionally I don’t make my bed all day; so as a result, I have none of those rewards. I (apparently mistakenly) have felt that since I live alone and any company I might have isn’t likely to try to lure me into the bedroom (darn it!) what’s the point, since I’m only going to have to remove the pillows and quilt a few hours later at bedtime. Sure, my room looks so much prettier when it’s tidy and the bed is made; but unless my condo is on the market and I have scheduled an open house, what difference does it make?

I must admit, though, that whenever I pass the bedroom door to go into the bathroom or to access my laundry, my spirits (and any drive I may have had) plummet when a glance reveals that crumpled bed. And I can’t erase that vision for the rest of the day. It remains emblazoned on my brain when I sit at my computer and try to finish that essay I started a week ago (the last time I made my bed) or go into the kitchen to cook dinner (which I hadn’t done since that day last week when I last made my bed). And the picture is still messing up my head when I pick up the phone to order take-out again.

Of course, one would think there’s a simple solution — just shut the bedroom door. But that’s when I instantaneously develop X-Ray vision. I can see that mess just as clearly as before.

When did I become so slovenly? I certainly wasn’t raised that way. My mother was like the woman in the classic joke who made the bed if her husband got up at 3:00 AM to go to the bathroom. So how come Mom never achieved fabulous wealth? There’s an easy explanation — she was the exception that proves the rule. So that leaves the road to excess free and clear for me.

Sorry to rush off, but I really have to run. I want to buy a lottery ticket before the stores close.

But in order to guaranty I buy a winner, first I have to make my bed.

©2017 Rose Madeline Mula for SeniorWomen.com

Editor’s Note: Rose Mula’s most recent book is Confessions of a Domestically-Challenged Homemaker & Other Tall Tales, available at Amazon.com and other online book sellers. Grandmother Goose: Rhymes for a Second Childhood is available as an e-book on Amazon.com for the Kindle and at BarnesandNoble.com for the Nook at $2.99; the paperback edition is available for $9.95. Her website is rosemadelinemula.com.

September 14, 2017
From the Census Bureau: Income, Poverty and Health Insurance Coverage in the United States: 2016

September 12, 2017

The US Census Bureau announced today that real median household income increased by 3.2 percent between 2015 and 2016, while the official poverty rate decreased 0.8 percentage points. At the same time, the percentage of people without health insurance coverage decreased.

A Census Bureau employee translates handwritten information on the census schedule to holes on a punch card using a card puncher; 1930

Median household income in the United States in 2016 was $59,039, an increase in real terms of 3.2 percent from the 2015 median income of $57,230. This is the second consecutive annual increase in median household income.

The nation’s official poverty rate in 2016 was 12.7 percent, with 40.6 million people in poverty, 2.5 million fewer than in 2015. The 0.8 percentage point decrease from 2015 to 2016 represents the second consecutive annual decline in poverty. The 2016 poverty rate is not statistically different from the 2007 rate (12.5 percent), the year before the most recent recession.

The percentage of people without health insurance coverage for the entire 2016 calendar year was 8.8 percent, down from 9.1 percent in 2015. The number of people without health insurance declined to 28.1 million from 29.0 million over the period.

These findings are contained in two reports: Income and Poverty in the United States: 2016 and Health Insurance Coverage in the United States: 2016. This year’s income and poverty report marks the 50th anniversary of the first poverty estimates released by the Census Bureau in the Current Population report series.

Another Census Bureau report, The Supplemental Poverty Measure: 2016, was also released today. The supplemental poverty rate in 2016 was 13.9 percent, a decrease from 14.5 percent in 2015. With support from the Bureau of Labor Statistics, the Supplemental Poverty Measure shows a different way of measuring poverty in the United States and serves as an additional indicator of economic well-being. The Census Bureau has published poverty estimates using the supplemental poverty measure annually since 2011.

The Current Population Survey, sponsored jointly by the Census Bureau and Bureau of Labor Statistics, is conducted every month and is the primary source of labor force statistics for the U.S. population; it is used to calculate the monthly unemployment rate estimates. Supplements are added in most months; the Annual Social and Economic Supplement questionnaire is designed to give annual, national estimates of income, poverty and health insurance numbers and rates. The most recent Annual Social and Economic Supplement was conducted nationwide and collected information about income and health insurance coverage during the 2016 calendar year.

The Current Population Survey-based income and poverty report includes comparisons with the previous year and historical tables in the report contain statistics back to 1959. The health insurance report is based on both the Current Population Survey and the American Community Survey. State and local income, poverty and health insurance estimates will be released Thursday, Sept. 14, from the American Community Survey.

Real median incomes in 2016 for family households ($75,062) and nonfamily households ($35,761) increased 2.7 percent and 4.5 percent, respectively, from their 2015 medians. This is the second consecutive annual increase in median household income for both types of households. The differences between the 2015 to 2016 percentage changes in median income for family and nonfamily households was not statistically significant.

September 14, 2017
Breaking the Cycle of Incarceration by Keeping Mothers and Children Together

By Rebecca Beitsch, Stateline, Pew Trusts

Stephanie Petitt holds baby Legend outside of ReMerge’s offices in Oklahoma City. The program aims to keep mothers out of prison and with their children. © The Pew Charitable Trusts

When Stephanie Petitt was arrested for violating probation for prior drug and robbery convictions, she learned two things: She was 16 weeks pregnant, and she would probably deliver her baby while incarcerated at an Oklahoma prison.

In most places, an incarcerated woman who gives birth almost immediately hands over her newborn to a social worker, who places the child with a relative or with foster parents. Petitt said she was told she would have an hour to hold her newborn.

Just a few states offer alternatives that allow mother and child to stay together longer. At least eight states have so-called prison nurseries where nonviolent female offenders live with their children for a few months to several years.

But in Oklahoma City, pregnant women who are facing imprisonment for nonviolent offenses can avoid doing time and stay with their children by participating in a program known as ReMerge. The program, which is also open to mothers who have already lost custody of their children, includes two years of intensive therapy, parenting classes and job training. Women who graduate have their charges dropped.

Similar pretrial diversion programs for expecting women and mothers are scattered across the country, many formed at the city or county level. It’s difficult to determine exactly how many there are.

But the idea behind them is clear: Diverting women from prison and keeping families together can save money and help break the intergenerational cycle of incarceration. Researchers say separating children from their mothers causes significant distress, and that children are more likely to end up in prison if they have parents there. And with the number of incarcerated women — and the cost of imprisoning them — on the rise in some states, the programs are drawing new attention.

Oregon began a pilot diversion program in 2015, basing it on a Washington state program that serves both mothers and fathers facing incarceration. This year, Oregon extended its program to pregnant women, too. Supporters say it will allow the state to avoid paying $17 million to construct a new women’s facility.

Oklahoma City launched its program in 2011, spurred by Oklahoma’s high incarceration rate for women — the highest in the nation, both then and now.

65

Incarcerated women per 100,000 in the U.S.

12

142

Source: Bureau of Justice Statistics, 2015

Copyright © 1996-2017 The Pew Charitable Trusts. All rights reserved.

Petitt was 27 and addicted to methamphetamines when she was arrested. She had already lost custody of her first two children, and planned on putting her next one up for adoption. But, she said, “as I sobered up, I felt the baby move, and I wanted to keep it.”

A judge sent her to ReMerge, and she had her baby while she was participating in the program.

“The whole time I was getting high, I wanted to stop and be a mom again, but I just couldn’t stop,” said Petitt, now 30. “This gave me a second chance at being a mom.”

Foundations interested in reducing the number of incarcerated women in Oklahoma pay for most of ReMerge, with the state covering the rest. The program serves up to 50 women at a time and costs $17,000 a woman a year. That’s a bit more than the roughly $15,000 it would cost to incarcerate each of them, but if the women were behind bars, they wouldn’t get the same level of treatment and support.

Program officials say ReMerge graduates have a 5 percent recidivism rate after three years, compared with about 13 percent for women who leave the state prison system. The low recidivism rates, however, don’t include the 30 percent of women who leave the program — many of whom end up back in custody.

Support and Rules

On one recent morning, 40 or so ReMerge participants sat in a florescent-lit conference room in the basement of a downtown building and started sharing personal details from their lives.

One woman with cherry-red hair cried as she described taking her 6-year-old son to the dentist to get several teeth pulled. Before she had custody of the boy, she urged his paternal grandmother, who was taking care of him, to make him brush his teeth. Now he’s missing so many it’s difficult for him to talk and eat. The woman next to her tried to comfort her by wrapping an arm around her shoulder.

From there participants scatter to a variety of parenting programs and therapy sessions. Women who need dental care get it. Those who smoke are enrolled in a cessation program. They also get help finding jobs.

The women aren’t permitted to own a cellphone until they’ve spent a month in the program. All of the women without a high school diploma must work toward a GED diploma, and nearly all of them spend the first 90 days in supervised housing. Participants also are barred from seeing people who aren’t vetted by ReMerge staff until they are months into the program.

Dusty Tate, a formidable woman with excellent posture, several tattoos and bright blonde hair, is the onsite probation officer for all the women. She administers random drug tests and stays in constant contact with the women, texting at all hours. Some texts are good news — “I got a job!” — others are bad news — “I’m thinking about relapsing.”

Much of the program is geared toward helping the women beat their drug addictions. Nearly 60 percent of women in federal institutions are serving time for drugs, as are a quarter of women in state facilities. Others have committed crimes such as theft or prostitution in to pay for a drug habit.

Kamber Caulkins and her 10-year-old daughter have lived together for the past year.

© The Pew Charitable Trusts

Preparing to Graduate

On Monday afternoon, after the rest of the women have gone home, about a dozen who are set to graduate from the program at the end of this month gathered for their hourlong weekly meeting. Most work full time and have regained custody of their children. Several came with them in tow.

Reuniting families is an emotional challenge as much as a legal one. Some children had to be reintroduced to mothers they had forgotten. Some mothers had to resist what they call “parenting out of guilt,” trying to make up for their absence by giving in to children’s demands.

But as they near graduation, they all say they’ve re-established bonds with their children and tasted a better life that will keep them motivated.

“I never had my own car; now I’ve got one in my name. I never had my own apartment; now I’ve got my own apartment. I went to cosmetology school. I had never had a job; now I have a career,” said Kamber Caulkins, 34. “I knew I wanted it, but I had to start accumulating enough stuff that I wasn’t willing to lose it anymore.”

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Source: Bureau of Justice Statistics, 2015

Copyright © 1996-2017 The Pew Charitable Trusts. All rights reserved.

Petitt was 27 and addicted tomethamphetamineswhen she was arrested. She had already lost custody of her first twochildren,and planned on putting her next one up for adoption. But, she said, “as I sobered up, I felt the baby move, and I wanted to keep it.”

A judge sent her to ReMerge, and she had her baby while she was participating in the program.

“The whole time I was getting high, I wanted to stop and be a mom again, but I just couldn’t stop,” said Petitt, now 30. “This gave me a second chance at being a mom.”

Foundations interested in reducing the number of incarcerated women in Oklahoma pay for most ofReMerge, with the state covering the rest. The program serves up to 50 women at a time and costs $17,000 a woman a year. That’s a bit more than the roughly $15,000 it would cost to incarcerate each of them, but if the women were behind bars, they wouldn’t get the same level of treatment and support.

Program officials say ReMerge graduates have a 5 percent recidivism rate after three years, compared with about 13 percent for women who leave the state prison system. The low recidivism rates, however, don’t include the 30 percent of women who leave the program — many of whom end up back in custody.

Support and Rules

On one recent morning, 40 or so ReMerge participants sat in aflorescent-litconference room in the basement of a downtown building and started sharing personal details from their lives.

One woman with cherry-red hair cried as she described taking her 6-year-old son to the dentist to get several teeth pulled. Before she had custody of the boy, she urged his paternal grandmother, who was taking care of him, to make him brush his teeth. Now he’s missing so many it’s difficult for him to talk and eat. The woman next to her tried to comfort her by wrapping an arm around her shoulder.

From there participants scatter to a variety of parenting programs and therapy sessions. Women who need dental care get it. Those who smoke are enrolled in a cessation program. They also get help finding jobs.

The women aren’t permitted to own acellphoneuntil they’ve spent a month in the program. All of the women without a high school diploma must work toward a GED diploma, and nearly all of them spend the first 90 days in supervised housing. Participants also are barred from seeing people who aren’t vetted by ReMerge staff until they are months into the program.

Dusty Tate, a formidable woman with excellent posture, severaltattoosand bright blonde hair, is the onsite probation officer for all the women. She administers random drug tests and stays in constant contact with the women, texting at all hours. Some texts are good news — “I got a job!” — others are bad news — “I’m thinking about relapsing.”

Much of the program is geared toward helping the women beat their drug addictions. Nearly 60 percent of women in federal institutions are serving time for drugs, as are a quarter of women in state facilities. Others have committed crimes such as theft or prostitution in to pay for a drug habit.

Kamber Caulkins and her 10-year-old daughter have lived together for the past year.

© The Pew Charitable Trusts

Preparing to Graduate

On Monday afternoon, after the rest of the women have gone home, about a dozen who are set to graduate from the program at the end of this month gathered for their hourlong weekly meeting. Most work full time and have regained custody of their children. Several came with them in tow.

Reuniting families is an emotional challenge as much as a legal one. Some children had to be reintroduced to mothers they had forgotten. Some mothers had to resist what they call “parenting out of guilt,” trying to make up for their absence by giving in to children’s demands.

But as they near graduation, they all say they’ve re-established bonds with their children and tasted a better life that will keep them motivated.

“I never had my own car; now I’ve got one in my name. I never had my own apartment; now I’ve got my own apartment. I went to cosmetology school. I had never had a job; now I have a career,” said Kamber Caulkins, 34. “I knew I wanted it, but I had to start accumulating enough stuff that I wasn’t willing to lose it anymore.”

September 14, 2017
Study: Most Prescribed Opioid Pills Go Unused and Not Disposed Of In Recommended Ways

By Chanapa Tantibanchachai

Image of Hydrocodone tablets from Wikimedia Commons

A substantial majority of patients prescribed opioids after surgery fail to use their entire prescription, and more than 90 percent of them fail to dispose of leftover pills in the recommended ways, a team of researchers from Johns Hopkins University found in a recent review of half a dozen published studies.*

Opioid abuse has been rising in the US, with some public health officials referring to the rate of opioid overdoses and deaths as an epidemic. The review highlights the need for personalizing pain management after surgeries so that physicians can avoid overprescribing opioids and patients can avoid the risks of improperly storing opioid medications in the home.

Results were published online in the journal JAMA Surgery.

“Physicians write a lot of prescriptions for patients to fill for home use after they have inpatient or outpatient surgery, but our review suggests that there’s a lot we don’t know about how much pain medication people really need or use after common operations,” says Mark Bicket, an assistant professor of anesthesiology and critical care at the Johns Hopkins University School of Medicine and the paper’s first author.

“If we can better tailor the amount of opioids prescribed to the needs of patients, we can ensure patients receive appropriate pain control after surgery yet reduce the number of extra oxycodone and other opioid tablets in many homes that are just waiting to be lost, sold, taken by error, or accidentally discovered by a child.”

The Hopkins researchers found that between 67 and 92 percent of a total of 810 patients self-reported that they had unused opioids after a surgery. A small number either did not fill their opioid prescription (up to 21 percent) or filled the prescription but did not take any of the pills (between 7 and 14 percent). Overall, Bicket says, anywhere from 42 to 71 percent of prescribed pills dispensed went unused among the patients, but a pill count was not used to independently verify the number of unused tablets.

A majority of patients reported that they stopped taking pills or didn’t take any pills in the first place because they could adequately control their pain. Between 16 and 29 percent of patients reported that they ended their opioid use because of the medication’s side effects, such as nausea, vomiting, or constipation.

Analysis of two studies — which focused on opioid storage and safety — shows that up to 77 percent of patients reported that their opioids were not stored in locked containers. Five studies looking at opioid disposal practices revealed that less than a third of patients reported that they had disposed of their unused pills or that they planned to, and a smaller portion of patients—less than 10 percent—said they had considered using or had used a disposal method recommended by the Food and Drug Administration.

Bicket notes that the review’s limitations include the number of studies reviewed and differences in the questionnaires used in each, as well as limitations related to the reliability of self-reported data and unconfirmed pill counts.

To cut down on instances of unused opioids, Bicket says doctors and clinicians should personalize prescriptions and dosing instructions for patients instead of using a one-size-fits-all approach. He cautions that the research is not meant to encourage doctors to withhold opioid prescriptions from people who are in pain.

“We need to do more research into why some people need more medication than others,” he says. “Perhaps there are some characteristics in a patient, such as whether he or she is on opioids before the surgery or has certain genetic markers, that can let me determine that one needs more pain medication than another. … We need better data and tools to ensure patients have access to adequate pain relief after surgery while reducing the risks of opioid overprescribing.”

*A New study, published online in the journal Pharmacoepidemiology and Drug Safety, draws from survey data gathered by the National Health and Nutritional Examination Survey, conducted every two years since 1999-2000. Prescription opioid use, the paper found, rose from 4.1 percent of U.S. adults in 1999-2000 to 6.8 percent in 2013-2014, an increase of 60 percent. Long-term prescription opioid use, defined as 90 days or more, increased from 1.8 percent in 1999-2000 to 5.4 percent in 2013-2014.

“What’s especially concerning is the jump in long-term prescription opioid use, since it’s linked to increased risks for all sorts of problems, including addiction and overdoses,” says study author Ramin Mojtabai, a professor in the Department of Mental Health at the Bloomberg School. “The study also found that long-term use was associated with heroin use as well as the concurrent use of benzodiazepines, a class of widely prescribed drugs that affect the central nervous system.”

This is one of the paper’s more worrisome findings, Mojtabai notes, since combining opioids and benzodiazepines significantly increases the risk of overdose, even if the patient is taking a moderate dosage of opioid medication. Combining these drugs can also cause respiratory suppression, he says.

For the paper, Mojtabai examined eight consecutive biannual surveys, each of which included more than 5,000 adults living throughout the United States. A total of 47,356 adults participated in the eight surveys, and the response rate ranged from 71 percent to 84 percent.

Despite the upward trend, there is scant evidence supporting benefits of longer-term prescription opioid use, Mojtabai says, with no randomized clinical trials that support their extended use, given the risks.

Prescription opioids were originally designed for shorter-term use, which involves fewer patient risks. Many patients who take opioid medication for weeks or months develop a tolerance that over time requires higher dosages for the medication to relieve pain. As a result, patients will take more medication to reduce their pain, setting them on the path to possible addiction. While there is no clear delineation as to when addiction kicks in, longer-term use is thought to be a risk factor.

The Centers for Disease Control and Prevention issued new guidelines last year, recommending that physicians prescribe opioids for chronic pain only after other options have been proven ineffective. The guidelines also recommend short-term use (three days instead of seven) and lower dosages. The impact of these new guidelines is not yet known, Mojtabai says.

“Given the urgency, it’s critical that we continue to try and understand what benefits, if any, exist for prescribing opioids for both short- but especially for longer-term consumption,” says Mojtabai. “There may be alternative treatments. We also need to understand what other factors contribute to the considerable risks of prescription opioid medication among different groups, especially those with other drug or alcohol use in their profiles.”

September 13, 2017
Secrets, Seductions from the Cliffs of Cornwall to the Shores of Corfu and Streets of Paris: A New Masterpiece Schedule for Fall 2017

1. New Victoria Season 2 Preview!

Watch a new preview for Victoria Season 2 on PBS January 14th, 2018. As monarchy, marriage, and motherhood propel Season 2 forward, Victoria (Jenna Coleman) and Albert (Tom Hughes) will continue their epic romance in a saga that unfolds over vital moments in history.

2. The Chaperone Casting Joining McGovern are Geza Rohrig (Son of Saul), Blythe Danner (Gypsy, Madoff), Campbell Scott (House of Cards, Damages), Victoria Hill (December Boys, First Reformed) and Miranda Otto (The Lord of the Rings, Homeland). Find yet another Downton Abbey connection to The Chaperone, get more details about the film, and learn who got the whole project off the ground.

More about The Chaperone

3. Little Women… and Also These Men

There is an exciting roster of actresses in Little Women (Angela Lansbury as Aunt March, Emily Watson as Marmee, and Maya Hawke, Willa Fitzgerald, Annes Elwy, and Kathryn Newton as the iconic March sisters).

But the list of Little Women’‘s men is now complete, too, with three actors joining Michael Gambon (Mr. Laurence) and Jonah Hauer-King (Laurie): Julian Morris (Pretty Little Liars, Man in an Orange Shirt) is Laurie’s earnest tutor, John Brooke; Mark Stanley (Broken, Dickensian) takes the role of Professor Bhaer; and Dylan Baker (The Good Wife, The Americans) joins as Mr. March, army chaplain and father to the March girls.

Explore Masterpiece’s adaptation of Louisa May Alcott’s beloved classic novel, learn who is adapting the book for the screen (Hint: Call the Midwife), and see portraits of the women — and yes, the men — who are bringing your favorite characters to life!
More about Little Women

4. Meet the Man in an Orange Shirt

In what The Guardian calls “a heartbreaking tale of happiness denied,” Oscar-winning actress Vanessa Redgrave stars in best-selling British novelist Patrick Gale’s tale of two love stories, 60 years apart, linked by a family and painting with a secret that reverberates across the generations.

Met with rave reviews upon its airing in the UK, Man in an Orange Shirt also features Oliver Jackson-Cohen (Mr. Selfridge, Lark Rise to Candleford), James McArdle (Worricker), Joanna Vanderham (The Paradise), Laura Carmichael (Downton Abbey), Julian Morris (Little Women, Pretty Little Liars).

Man in an Orange Shirt will air on Masterpiece on PBS in June, 2018, as part of Gay Pride Month.

5. Get Ready for Fall

Summer is ending, but with the new fall Masterpiece schedule, you’ll be wishing for shorter days and longer, tv-filled nights, as October and November promise secrets, seductions, and even a little slapstick, from the cliffs of Cornwall to the shores of Corfu via the avenues of Paris!

Poldark Season 3 swashbuckles back onto our screens with more romance, dark secrets, derring-do, and plenty of new characters, including Demelza’s two hunky brothers, Elizabeth’s beautiful and innocent cousin, Morwenna, a newborn of dubious parentage, and more! Don’t miss the Season 3 premiere of Poldark on Sunday, October 1, 2017 at 9/8c!

On Sunday October 8, 2017 at 10/9c, The Collection premieres, immersing viewers in the post-WWII haute-couture world of a Parisian fashion house and the two brothers who clash as romances and rivalries pit family against family and the past against the future. The cast features Richard Coyle (Coupling), Frances de la Tour (Vicious), Michael Kitchen (Foyle’s War), Tom Riley (Da Vinci’s Demons), Sarah Parish (Broadchurch), and Mamie Gummer (The Good Wife).

On Sunday, October 15, 2017 at 8/7c, the islands beckon, the kumquats ripen, and the animals bleat, bark, hoot and slither: The Durrells in Corfu returns with Season 2! Don’t miss the misadventures of the Durrell family in six new episodes replete with more animals, more eccentrics, more laughs, and more love!

The Durrels in Corfu, Season Two

September 11, 2017