Order aims to reveal true costs for care

WASHINGTON (AP) — President Donald Trump signed an executive order Monday that calls for upfront disclosure by hospitals of actual prices for common tests and procedures to help keep costs down.

The idea is to give patients practical information that they can use to save money. For example, if a hospital charges your insurer $3,500 for a type of echocardiogram and the same test costs $550 in a doctor’s office, you might go for the lower-price procedure to save on copays.

But insurers said the idea could backfire, prompting hospitals that now give deeper discounts to try to raise their own negotiated prices to match what high earners are getting. Hospitals were skeptical of the move.

Trump’s order also requires that patients be told ahead of time what their out-of-pocket costs like deductibles and copays will be for many procedures.

Little will change right away. The executive order calls for a rule-making process by federal agencies, which typically takes months or even years. The details of what information will have to be disclosed and how it will be made available to patients must be worked out as part of writing the regulations. That will involve a complex give-and-take with hospitals, insurers and others affected.

Consumers will have to wait to see whether the results live up to the administration’s promises.

“For too long it’s been virtually impossible for Americans to know the real price and quality of health care services and the services they receive,” Trump said at the White House. “As a result, patients face significant obstacles shopping for the best care at the best price, driving up health care costs for everyone.”

Health and Human Services Secretary Alex Azar told reporters earlier that the order “will put patients in control by increasing choice and competition.”

Lack of information on health care prices is a widespread problem . It’s confusing for patients, and experts say it’s also one of the major factors that push up U.S. costs. The same test or procedure, in the same city, can cost widely different amounts depending on who is performing it and who is paying the bill. Hospital list prices, which are available, don’t reflect what they are paid by insurers and government programs.

The health insurance industry said disclosing negotiated prices will only encourage hospitals that are now providing deeper discounts to try to raise their rates to match the top-tier facilities. “Publicly disclosing competitively negotiated proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers,” Matt Eyles, head of the industry group America’s Health Insurance Plans, said in a statement.

The Federation of American Hospitals, representing for-profit facilities, warned that if the Trump administration regulations take the “wrong course,” they may “undercut the way insurers pay for hospital services, resulting in higher spending.”

While the prices Medicare pays are publicly available, private insurers’ negotiated rates generally are not. Industry officials say such contractual information is tantamount to trade secrets and should remain private.

Azar pushed back against that argument, saying insurers do ultimately disclose their payment rates when they send individual patients an “explanation of benefits.” That’s the technical term for the form that patients get after they’ve had a procedure or seen the doctor.

“Every time any one of us goes to a doctor or a hospital, within a couple of weeks in our mailbox arrives an explanation of benefits. (It) contains the list price … the negotiated rate … and what your out-of-pocket is,” Azar said. “This is not some great state secret out there.”

Patients should have that information ahead of time to help them make decisions, he added.

Trump’s executive order also calls for:

—expanded uses for health savings accounts, a tax-advantaged way to pay health care bills that has long been favored by Republicans. Coupled with a lower-premium, high-deductible insurance plan, the accounts can be used to pay out-of-pocket costs for routine medical exams and procedures.

—a plan to improve the government’s various health care quality rating systems for hospitals, nursing homes and Medicare Advantage plans.

— more access by researchers to health care information, such as claims for services covered by government programs like Medicare. The data would be stripped of details that could identify individual patients.

Government moves migrant kids after report

The U.S. government has removed most of the children from a remote Border Patrol station in Texas following reports that more than 300 children were detained there, caring for each other with inadequate food, water and sanitation.

Just 30 children remained at the station outside El Paso Monday, said Rep. Veronica Escobar after her office was briefed on the situation by an official with Customs and Border Protection.

Attorneys who visited Clint last week said older children were trying to take care of infants and toddlers, The Associated Press first reported Thursday. They described a 4-year-old with matted hair who had gone without a shower for days, and hungry, inconsolable children struggling to soothe one another. Some had been locked for three weeks inside the facility, where 15 children were sick with the flu and another 10 were in medical quarantine.

“How is it possible that you both were unaware of the inhumane conditions for children, especially tender-age children at the Clint Station?” asked Escobar in a letter sent Friday to U.S. Customs and Border Protection acting commissioner John Sanders and U.S. Border Patrol chief Carla Provost.

She asked to be informed by the end of this week what steps they’re taking to end “these humanitarian abuses.”

Lawmakers from both parties decried the situation last week.

Border Patrol officials have not responded to AP’s questions about the conditions at the Clint facility, but in an emailed statement Monday they said: “Our short-term holding facilities were not designed to hold vulnerable populations and we urgently need additional humanitarian funding to manage this crisis.”

Although it’s unclear where all the children held at Clint have been moved, Escobar said some were sent to another facility on the north side of El Paso called Border Patrol Station 1. Escobar said it’s a temporary site with roll-out mattresses, showers, medical facilities and air conditioning.

But Clara Long, an attorney who interviewed children at Border Patrol Station 1 last week, said conditions were not necessarily better there.

“One boy I spoke with said his family didn’t get mattresses or blankets for the first two nights, and he and his mom came down with a fever,” said Long, a senior researcher with Human Rights Watch. “He said there were no toothbrushes, and it was very, very cold.”

Vice President Mike Pence, asked about the unsafe, unsanitary conditions for the children on “Face the Nation” on Sunday, said “it’s totally unacceptable,” adding that he hopes Congress will allocate more resources to border security.

Long and a group of lawyers inspected the facilities because they are involved in the Flores settlement, a Clinton-era legal agreement that governs detention conditions for migrant children and families. The lawyers negotiated access to the facility with officials and say Border Patrol knew the dates of their visit three weeks in advance.

Many children interviewed had arrived alone at the U.S.-Mexico border, but some had been separated from their parents or other adult caregivers including aunts and uncles, the attorneys said.

Government rules call for children to be held by the Border Patrol in their short-term stations for no longer than 72 hours before they are transferred to the custody of Health and Human Services, which houses migrant youth in facilities around the country through its Office of Refugee Resettlement while authorities determine if they can be released to relatives or family friends.

Customs and Border Protection has referred AP’s questions to the Office of Refugee Resettlement, which said Monday that 249 children who had been held at Clint would be moved to the agency’s network of shelters and other facilities by Tuesday.

“(Unaccompanied children) are waiting too long in CBP facilities that are not designed to care for children,” ORR spokeswoman Evelyn Stauffer said. “These children should now all be in HHS care as of Tuesday.”

Report: Hackers using telecoms like ‘global spy system’

LONDON (AP) — An ambitious group of state-backed hackers has been burrowing into telecommunications companies in order to spy on high-profile targets across the world, a U.S. cybersecurity firm said in a report published Tuesday.

Boston-based Cybereason said the tactic gave hackers sweeping access to VIPs’ call records, location data and device information — effectively turning the targets’ cellular providers against them.

Cybereason Chief Executive Lior Div said that because customers weren’t directly targeted, they might never discover their every movement was being monitored by a hostile power.

The hackers had turned the affected telecoms into “a global surveillance system,” Div said in a telephone interview ahead of the report’s launch.

“Those individuals don’t know they were hacked — because they weren’t.”

Div, who is presenting his findings at the Cyber Week conference in Tel Aviv, provided scant details about who was targeted in the hack, saying that Cybereason had been called in to help an unidentified cellular provider last year and discovered that the hackers had broken into the firm’s billing server, where call records are logged.

The hackers were using their access to extract the call data of “around 20” customers, Div said.

Who those people were he declined to say, describing them as mainly coming from the world of politics and the military. He said the information was so sensitive he would not provide even the vaguest idea of where they or the telecom were located.

“I’m not even going to share the continent,” he said.

Cybereason said the compromise of its customer eventually led it to about 10 other firms that had been hit in a similar way, with hackers stealing data in 100 gigabyte chunks. Div said that, in some cases, the hackers appeared to be tracking non-phone devices, such as cars or smartwatches.

Risking their lives to tell the story

Last week started with our colleague and friend, Tom Fox, suddenly finding himself in the midst of a violent assault on the judiciary. Rather than flee, he took up his camera and shot the suspect with something other than bullets. As he has done tens of thousands, hundreds of thousands of times, before he lifted his camera. And in its eye, Fox captured the suspect in the thrall of his attack.

This is first stunning — who has the courage, the habit, the skill and the quickness of mind in such a moment other than a professional deeply dedicated to his craft? Second, the moment is also reflective of the larger public service that is reporting to a community what is happening and why — or, in the case of an opinion section like ours, what might be done about it to shape our common trajectory.

Reporters and photographers across the globe do this every day. Journalists don’t always get it right, and not every person purporting to be a journalist takes with them the approach of letting the facts shape the story. But there is an importance to having professionals out there, on the streets, in the rooms of power, telling the rest of us what is happening that is too often overlooked. Too often we forget that our public debate is what determines the success of our society, and too often we take for granted that even basic facts are widely known about what is happening.

Repressive regimes understand the power and importance of a free press, perhaps at times better than those in free societies. After all, there is a reason why journalists in Russia, Venezuela, and China (to pick just a handful of oppressive countries) are either on the run from state control or outright under the influence of the very powers that society needs to come under the scrutiny of honest, fair reporting.

Repressive regimes understand that to allow an unfettered media — even a lone photographer who feels free to memorialize on film whatever is before him or her — is to open the gates to self governance. A society that is well informed is a society that can determine its own destiny.

This is why journalists are often targeted for killing across the world, and why free speech itself is an essential ingredient to our society. We met recently with a group of journalists visiting from South America. We asked them a simple question: After visiting our newsroom, what is the biggest difference between journalists in the United States and the press in your home countries? The answer for more than a half dozen journalists was the same. Some of it came through in fragmented English and other comments were translated. But the message was the same, in the United States there is a level of freedom of the press that is impressive, important, and not as freely felt elsewhere in the world.

Journalists elsewhere might publish freely, but they often do so with a feeling that they need to look over their shoulders.

That doesn’t mean there isn’t danger. To paraphrase something Fox said after Monday’s terrifying event: stay in this business long enough and at some point you will be in the line of fire. That’s especially true for photographers and reporters whose work sends them to dangerous places, even in our own city.

We are grateful for Tom Fox. We are so grateful he and others were spared in Monday’s violence. We should all be grateful for the press freedoms he was exercising.

And we are thinking today of all those who take risks — often risking everything — just to capture an image or otherwise tell the world what is happening around us.

— The Dallas Morning News

A look back in time (June 1982(

Thirty-seven years ago

June 1982

PIQUA — Along about the end of July, Ed and Elizabeth Niemann will close their grocery store here one evening just like they’ve been doing for the past 43 years, but they won’t open it the next morning. That will mark the first time since 1884 that there won’t be a Niemann store in Piqua. “I thought we’d stay open long enough for the business to be 100 years old,” Niemann, who is 81, said, “but the tornado and high utility bills took care of that.” The tornado in March damaged the Niemann store roof and it hasn’t been repaired. The couple haven’t missed a day’s work to illness in more than 43 years.

*****

A special supplemental food program for women, infants and children, called WIC, is now available in Iola through the Southeast Kansas Community Action Program. The WIC program is designed to meet supplemental nutritional needs of low- and moderate-income pregnant women, nursing mothers, babies and children up to six years of age. Funds for the program are distributed by the Department of Agriculture to state health departments which in turn contract with local agencies to provide the services. A voucher system is used in exchange for the indicated foods from local grocery stores.

*****

Bob Huskey was picked at a Republican Party caucus last night to be appointed to fill a vacancy on the Allen County Commission from the Third District to replace Bob Garver, who resigned effective June 15. 

*****

TOPEKA (AP) — Mary Alice Lair, Piqua, vice chairman of the State Republican Committee, automatically assumes the chairmanship with the resignation of the chairman, Morris Kay, who is running for Congress in the 2nd District.

*****

A new barn and education building at the Allen County Community College farm, five miles north of Iola, has just been completed and will be handed over to the college by the contractor later this week. The metal building is 104 feet long and 54 feet wide. It will also be used to house livestock and equipment and will be used in the agriculture teaching program at the college. The old brick dormitory-style building at the farm is about halfway razed and should be completely removed by fall.

*****

New laws come into effect tomorrow, July 1. For the first time in 44 years, the penalties will change for conviction of driving while under the influence of alcohol or other drugs. The new law requires a jail term and has set fines five times higher than previously. Moped operators under 18 years of age will be required to wear a helmet and eye protection. All moped operators are required to wear some type of eye protection. 

All motorcycles and mopeds manufactured after Jan. 1, 1978, will be required to have lighted head and tail lights at all times.

*****

Ed and Betsy Varner are the new managers of the restaurant at the Best Western Inn. Varner, who has managed the Allen County Country Club for the past year, leased the eating establishment, which they have renamed The Greenery, last week.

State to allow trans residents to change birth certificates

TOPEKA, Kan. (AP) — Kansas will allow transgender people to change their birth certificates so the documents reflect their gender identities under a legal settlement that Democratic Gov. Laura Kelly’s young administration and LGBTQ-rights advocates announced Monday.

The agreement ends a federal lawsuit filed in October by four transgender individuals and the Kansas Statewide Transgender Education Project against officials at the state Department for Health and Environment, which issues birth certificates. U.S. District Judge Daniel Crabtree issued an order Friday to make the agreement binding.

The agreement reverses a policy imposed under conservative Republican Gov. Sam Brownback that gave Kansas among the toughest rules in the nation for changing a gender on a birth certificate. Lambda Legal, a national LGBTQ-rights group that represented the individuals and group suing Kansas, said only Ohio and Tennessee have similar policies in place and that they’re being challenged in court too.

The Kansas lawsuit argued that the state’s policy violated the right of transgender people to due legal process and equal protection under the law. It also said refusing to allow changes conveyed “an ideological message” and forced transgender people to identify with the sex “incorrectly assigned to them” at birth, violating their free speech rights.

“It was time for Kansas to move past its outdated and discriminatory anti-transgender policy,” said Kelly, who took office in January. “This decision acknowledges that transgender people have the same rights as anyone else, including the right to easily obtain a birth certificate that reflects who they are.”

The Brownback administration policy prevented transgender people from changing their birth certificates even after they transitioned, changed their names legally and obtained new driver’s licenses and Social Security cards, according to the lawsuit. Critics said the policy made it harder for transgender individuals to register to vote and even enroll their children in public schools.

Also, LGBTQ-rights advocates said, once a conflict between a birth certificate and other documents became known, transgender individuals faced discrimination.

“This judgment makes me feel safer and like my state finally recognizes me and respects me as a woman,” said plaintiff Nyla Foster, a 30-year-old Kansas City-area resident born in Kansas.

Tom Witt, executive director of the LGBTQ-rights group Equality Kansas, said transgender individuals had been changing their birth certificates for years until Brownback’s administration stopped the practice in 2012. The state health department then issued a formal rule in 2016.

“This is absolutely a huge step forward for transgender Kansans,” Witt said of the agreement ending the Brownback administration policy.

Supporters of the Brownback administration’s policy said at the time that birth certificates are historical records that document the information known at the time. Brownback’s spokeswoman added that Kansas law allows only minor corrections in birth certificates and “changing the sex designation is not a minor change.”

Brittany Jones, executive director of the conservative Family Policy Alliance of Kansas, said of Kelly, “She demonstrates she’s willing to compromise documents and data that are critically important to every Kansan for the sake of a political agenda.”

In 2015, Brownback, an opponent of same-sex marriage, rescinded an executive order issued previously by Democratic Gov. Kathleen Sebelius to ban anti-LGBTQ discrimination in state hiring or employment decisions. He argued that the Republican-controlled Legislature — led by social conservatives at the time — should set such policies.

Kelly not only issued a new anti-LGBTQ discrimination order on her second day in office, but hers covered companies that have contracts with the state. She issued a proclamation recognizing June as LGBTQIA+ Pride Month, and Lt. Gov. Lynn Rogers is the keynote speaker for a Pride Unity Rally on Saturday in Wichita.

Omar Gonzalez-Pagan, a senior Lambda Legal attorney, said when Brownback’s administration enacted its 2016 policy on birth certificates, 46 states gave transgender people an opportunity to correct them, though their policies varied.

Federal judges last year struck down restrictive policies in Idaho and Puerto Rico, so Lambda Legal was confident it would prevail in Kansas if its lawsuit went to trial, Gonzalez-Pagan said.

He praised Kelly’s administration for taking “a fresh look” at the issue and moving to save taxpayers money by avoiding litigation.

Tension builds between cities, states over opioid lawsuit

CLEVELAND (AP) — Tension is emerging between lawyers representing state and local governments over the path forward in a set of lawsuits seeking to hold the drug industry accountable for the toll of the nation’s opioid crisis.

A federal judge scheduled a hearing today in Cleveland on a plan pitched by for lawyers for local governments on distributing money to nearly 25,000 municipal and county governments across the country. The plan would take effect if companies that make and distribute the powerful prescription painkillers agree to one or more legal settlements.

Attorneys general for most states said Monday in a pair of letters to Judge Dan Polster that such an arrangement could hurt their ability to reach a national settlement.

One of the letters warned that the deal would give communities elsewhere “functional veto power” over any settlement a state reached. The attorneys general said that is not acceptable for states.

Drug distribution companies and pharmacies are opposing the arrangement. They say it would make a settlement impractical and they raised concerns about whether the proposal is legal.

Drug makers haven’t raised such concerns yet. Purdue Pharma, the company that makes OxyContin, put out a statement that didn’t take a side in the issue.

“The company is committed to working with all parties toward a resolution that helps bring needed solutions to communities and states to address this public health crisis,” Purdue officials said.

Purdue has said it’s considering declaring bankruptcy.

Judge Dan Polster, based in Cleveland, is presiding over most of the more than 2,000 lawsuits filed by local and tribal governments over opioids.

Forty-eight states have also taken legal action against at least one drug firm, but all but one of their claims are being handled in state courts.

Still, Polster has invited state governments to be part of settlement negotiations. The Centers for the Disease Control and Prevention found opioids, including prescription drugs and illicit versions such as heroin and fentanyl, played a role in nearly 48,000 deaths in the U.S. in 2017 — making them the nation’s leading cause of accidental death.

Conservation program signup returns

Farmers and ranchers with expiring Conservation Reserve Program (CRP) contracts may re-enroll in certain CRP continuous signup practices or, if eligible, select a one-year contract extension. 

USDA’s Farm Service Agency (FSA) also is accepting offers from those who want to enroll for the first time in one of the country’s largest conservation programs.

The CRP signup session runs through Aug. 23, according to a USDA press release.

The Farm Service Agency stopped accepting offers last fall for the CRP continuous signup when 2014 Farm Bill authority expired. The 2018 Farm Bill reauthorized the program this past December, and FSA has carefully analyzed the bill’s language and determined that a limited signup prioritizing water-quality practices furthers conservation goals and makes sense for producers while FSA works to fully implement the program.

This year’s CRP continuous signup includes such practices as grass waterways, filter strips, riparian buffers, wetland restoration and others.

Continuous signup enrollment contracts last for 10 to 15 years

 

Producers with Expiring CRP Contracts

Letters are in the mail to all producers with expiring CRP contracts, describing possible options.  

A one-year extension is being offered to those with expiring CRP contracts of 14 years or less that have practices not eligible for re-enrollment under this CRP signup.

Alternatively, producers with expiring contracts may have the option to enroll in the Transition Incentives Program, which provides two additional annual rental payments on the condition the land is sold or rented to a beginning farmer or rancher or a member of a socially disadvantaged group.

 

CRP Continuous CREP Signup

This signup also enables producers to sign up under existing Conservation Reserve Enhancement Program (CREP) agreements. CREP targets high-priority conservation concerns identified by a state, and federal funds are supplemented with non-federal funds to address those concerns. 

 

Other Future CRP Signup Options

FSA is still planning a CRP general signup in December, with a CRP Grasslands signup to follow. Those who extend their contracts may be eligible for one of these signup types or another continuous signup in the future.

 

Iola’s FSA office is in the USDA Service Center, 202 W. Miller Rd. Additional information is available at www.farmers.gov and at www.fsa.usda.gov/crp.

Market events on tap

Thursday is Sunflower Member Day at the Allen County Farmers Market in downtown Iola.

Sunflower Health Plan KanCare members will receive a $10 voucher to purchase fruits and vegetables during Thursday’s market, from 5:30 to 7 p.m. on the east side of the square. To receive a voucher, members must show their ID cards when they arrive.

The vouchers are valid Thursday only.

Farmers Market sessions also are planned from 8 to 11 a.m. in Humboldt’s downtown square, and from 1 to 4:30 p.m. next Tuesday at the parking lot at 700 N. State St.

Vendors at all three markets accept EBT, Debit cards and participate in the Double Up Food Bucks Program.

State grapples with growing abandoned wells

EUDORA, Kan. (AP) — Kansas residents and environmentalists are calling on oil and gas regulators to address the growing number of abandoned wells over the past five years.

The state is home to 22,000 deserted oil and gas wells, with more than 19,000 of those residing in a 32-county area in eastern Kansas, the Topeka Capital-Journal reported.

Judith Wells bought property in Douglas County without being informed the land had unplugged wells. Since then, she’s been calling on the energy sector’s oversight agency, the Kansas Corporation Commission, to deal with operators who abandon wells.

She said some idled wells aren’t even listed on the commission’s reports submitted to the Legislature. Wells also said the state hardly has the funds to finance the plugging of deserted wells.

“If taxpayers aren’t tapped for these problems, the wells will truly sit open and unattended,” Wells said.

The state has capped 10,100 wells, as of 2018. But year-to-year plugging has dropped since 2002, when it peaked at 750 wells. From 2015 to 2018, the number fell to less than 300. That’s in addition to the number of abandoned wells in the state’s inventory growing by 3,000 in 2017.

The Kansas Corporation Commission’s annual reports show that a fund established in 1996 to provide money for well plugging isn’t adequately keeping pace with the demand.

Commission Chairman Dwight Keen said the agency doesn’t have the resources to hold every absconder accountable. Keen said it’s difficult to determine who’s responsible for some abandoned wells that were drilled decades ago.

Keen added that there aren’t many contractors eager to bid on well plugging work in the state.

“It’s a difficult challenge, but it is one that we will master. We have to,” Keen said. “We’re trying as many unique avenues to protect our freshwater resources.”

Joe Spease, of the Kansas Sierra Club, said the issue has worsened because of the oil and gas industry’s influence in the Legislature and on the commission. He’s demanding that regulators hold oil and gas companies accountable for the cost of plugging any well they use. Spease also recommended halting a company’s business in the state until its idle well is plugged.

“That can and must be stopped,” Spease said.