Moving From Oil to Electric Power Not Always the Greener Choice, Study Says

Yale Environment 360 - 12 hours 46 min ago
Transitioning from fossil fuels to electric-powered technology is widely believed to be an effective way to lower carbon emissions. However, as a new Nature Climate Change report explains, that calculus changes significantly if the electricity is produced by burning coal or oil. For electrification to lower emissions, a region must produce its electricity with less than 600 tons of carbon dioxide equivalent per gigawatt hour (GWh), the report says. If a region's electricity production exceeds this 600-ton threshold — as it does in India, Australia, and China, for example — moving to electricity may increase carbon emissions and accelerate climate change. "You could speculate that incorporating electrified technologies such as high speed rail in China may not lower overall emissions," says Chris Kennedy, a University of Toronto engineer who authored the study. "It might even be more carbon friendly to fly."
Categories: Environment, Health

NPR and ProPublic provide reality check on US workers’ comp system

Pump Handle - 13 hours 57 min ago

A quick way to lose someone in a conversation is to mention workers’ comp.  No doubt I’ve already lost readers because my headline included the phrase. But you’ll think differently about the topic if you take a look at this week’s reporting by ProPublica and National Public Radio. Read just the first 400 words of “The Demolition of Workers’ Comp” and you’ll be hooked on the story.

Yesterday morning, investigative reporters Michael Grabell and Howard Berkes discussed their reporting with NPR host David Greene. In the interview they noted:

  • “Since 2003, more than 30 states have passed laws that either reduce benefits, created hurdles to getting medical care or simply made it harder for workers to qualify.”
  • “Employers are actually paying the lowest cost for workers’ compensation insurance since the 1970s. And insurers are doing fairly well too. In 2013, they had an 18 percent profit – their best year since the 1990s.”

In the full ProPublica piece, they describe the degeneration of workers’ comp protections over the last 40 years:

  • “Only seven states now follow at least 15 of the [19] recommendations made during the Nixon administration [for minimum standards for workers compensation benefits.] Four states comply with less than half of them.”

Most importantly, Grabell and Berkes introduce us to several injured workers. In different ways, each are dealing with the consequences of their states’ successes in creating business-friendly ‘reforms’ to their workers’ compensation system. John Coffell , 30, Joel Ramirez, 48, and Dennis Whedbee, 53—and their families—are on the dirt-side-down of those policy changes.

There are consequences for taxpayers, too. Grabell and Berkes report that Social Security, Medicare and Medicaid are filling the gap for costs that should be paid by workers’ compensation. It’s a hefty $30 billion price tag.

When NPR host David Greene kicked off his interview yesterday, he invited listeners to:

“…imagine you’re on the job and you suffer a serious injury. Your expectation is that workers’ compensation is going to serve as your safety net.”

NPR’s listeners and ProPublica’s readers will be learning that the safety net is in tatters.

Categories: Health

Perennial Rice: In Search of a Greener, Hardier Staple Crop

Yale Environment 360 - 16 hours 23 min ago
Scientists have long sought to create a perennial rice that would avoid the damage to the land caused by the necessity of planting annually. Now, Chinese researchers appear close to developing this new breed of rice, an achievement that could have major environmental benefits. BY WINIFRED BIRD
Categories: Environment, Health

Congress squeezes Obama’s reg czar about lack of transparency

Pump Handle - March 04, 2015

It’s a rare thing on Capitol Hill when a member of the Administration is on the hot seat from both sides of the aisle. But that’s what happened on Tuesday when President Obama’s regulatory czar, Howard Shelanski, JD, PhD, testified at a joint hearing of two subcommittees of the House Committee on Oversight & Government Reform.

The Republican Chairman Mark Meadows (R-NC) and Ranking Member Gerry Connolly (D-VA) and other subcommittee members, peppered him with questions about OIRA’s lack of transparency in numerous arenas. Their motivations were different, but they were equally tough in their questioning. Republicans don’t think OIRA is doing enough to reign in regulatory agencies, while Democrats want OIRA to complement, not impede, agencies’ work.

I could relate to Chairman Meadows when he pressed Shelanski about releasing documents related to OIRA’s review of an agency regulation. That’s a topic that is close to my heart as I’ve filed numerous FOIA requests—during both Democratic and Republican Administrations—to obtain such records.

Meadows read from Executive Order 12866 (EO) which directs OIRA’s activities.

“OIRA shall make available to the public all documents exchanged between OIRA and the agency during the review by OIRA under this Section.”

I’ve referred to that exact language when I’ve filed my FOIA requests. I did so, for example, when the Labor Department proposed a regulation for workers aged 15 years or younger to be prohibited from doing some of the most dangerous tasks on farms. OIRA’s review lasted more than 9 months and child safety advocates suspected that Tom Vilsack’s USDA, on behalf of the agriculture industry, was trying to stop the rule. We wanted to see the emails and other correspondence written during that time by OIRA, USDA, Small Business Administration and other agencies about the proposal. We wanted to know which agencies were trying to quash a regulation design to protect young workers’ lives?

I agree with Meadows that the language “shall make available to the public all documents exchanged…” is pretty darn clear.

Shelanski responded to Meadows, saying:

“That executive order has been interpreted across all Administrations –Republic and Democrat—to embody the deliberative process exception of staff level communications and we do not disclose those to the public. It is to protect the integrity of process.”

Obama’s guy was not budging on this one.

Ranking Member Connolly and Cong. Matt Cartwright (D-PA) were well prepped for the hearing. It was clear to me that they’d read some of the work by the Center for Progressive Reform (CPR) on OIRA’s improper influence over decision-making by our public protection agencies (e.g.,  Behind Closed Doors at the White House: How Politics Trumps Protection of Public Health, Worker Safety and the Environment.) At one point in the hearing, Shelanski bristled when a Democrat referred to a CPR report. He responded with a scowl:

“I’m familiar with the Center’s criticism.”

Connolly raised concerns about OIRA’s bad track record on completing reviews within 90 days as prescribed in the EO. The congressman noted that the OIRA website allows the public to see how long a proposed or final regulation has been with OIRA for review, but

“there’s no explanation for why the delay. Why not? And are you working on that?”

Shelanski responded:

“…one of the things that happens very early in the review process is that the rule goes out for inter-agency comment. And we unfortunately do not have the authority to compel that commentary on as fast a timeline as we would often like, and when you’ve got a lot of agencies commenting on a particular rule, it can take some time to get that feedback.  Moreover, once we incorporate that feedback and re-transmit it back to the rulemaking agency, we have no control over how long that agency takes to bring the rule back to us.

So, to be perfectly frank, long periods of time can go by when the rule, in fact, is not at OIRA. it is under review, but it has been passed back for further work, consideration and analysis by the agency.”

The section I highlighted is something I’d not heard previously. When I want to track the status of OIRA’s review of an agency regulation, I go to this page at It shows which rules are being reviewed by OIRA and when they were submitted for review. It says “submissions under review.”

Is Mr. Shelanski saying that there may be regulatory actions on that list that are no longer under review because they’ve been retransmitted back to the agency? If that’s the case, why doesn’t the Administration just indicate that on the website?

Congressman Connolly seemed satisfied with Shelanski’s explanation of how the review process works. He said:

“That’s a perfectly rational explanation. So post it.   …Saying ‘agency X is still reviewing it’ …you put a little pressure on them to maybe accelerate their review because they are now under scrutiny.”

“When I was chairman of my county, I started a multi-year transportation plan for spot improvements. I put up [on a website] every project we were going to fund, I put up how much it was going to cost, I put up when we were proposing to have it done, and if there was a delay, we posted why, to make myself accountable.  And you know what? You’d be amazed at how quickly the bureaucracy moves when there is that public accountability.”

During the hearing, two OIRA staffers were sitting behind Shelanski and diligently taking notes. I hope they put a big star next to Cong. Connolly’s recommendation. If an agency rule has been “passed back for further work, consideration and analysis by the agency,” the website should indicate that. It could say:

“Returned to agency for further analysis. To be resubmitted again for review.”

Likewise, if the ball is in OIRA’s court, that’s what should be reflected for the public on the website. It is “under review.”

As someone who has complained here about OIRA’s failure to meet its publication deadlines for the Administration’s semi-annual regulatory agenda, I chuckled when Chairman Meadows’ staff displayed a graphic. It show the publication dates for the last five regulatory agendas. Here’s what it showed:

  • Fall 2012 agenda: published the Friday before Christmas
  • Spring 2013 agenda: published the day before July 4th
  • Fall 2013 agenda: published the day before Thanksgiving
  • Spring 2014 agenda: published Friday of Memorial Day weekend
  • Fall 2014: published the Friday before Thanksgiving

Meadows said:

“If you truly want transparency, why are you rolling this out at a time when people wouldn’t really be focusing on it?  That’s what we call the Friday afternoon data dump, but it is really what you are doing with the unified agenda. Why would you do that?”

Shelanski: “With all respect sir, the agenda remains posted.”

Meadows: “I understand, but when it comes out, it is newsworthy.”

I liked the chart with the holiday time releases, but Meadows failed to mention something else. The agendas are supposed to be published in April and October. None of them met that deadline.

James Goodwin with the Center for Progressive Reform offers some of his own views about Tuesday’s hearing. He observed the much-needed attention by Cong. Connolly and Cong. Cartwright on what James calls

“the absurdity of OIRA’s ‘open door’ meeting policy.”

I couldn’t agree more with James that the hearing was worthwhile, but only scratched the surface of the problems with OIRA—problems that have real consequences for people’s lives and health.

Categories: Health

PEPFAR, abstinence, and evidence

Pump Handle - March 04, 2015

Stanford medical student Nathan Lo reportedly caused a stir at the Conference on Retroviruses and Opportunistic Infections (CROI) last week when he presented a new finding: After analyzing surveys completed by 800,000 people in 22 sub-Saharan African countries, Lo and his colleagues found “no evidence to suggest that PEPFAR funding of abstinence and faithfulness programs results in reduced high-risk sexual behavior.”

Using data from the US-funded Demographic and Health Survey, the Stanford researchers analyzed responses to questions about the number of sexual partners, age of first sexual experience, and teen pregnancy. They then compared trends in 14 PEPFAR-funded and eight non-PEPFAR-funded countries, and found no evidence to suggest PEPFAR abstinence and faithfulness programs were associated with significant reductions in numbers of sexual partners, lower age of first sexual experiences, or fewer teen pregnancies. The New York Times’ Donald G. McNeil Jr. reports on the audience’s response to Lo’s presentation:

Global health specialists came to the microphone to congratulate Mr. Lo. Advocates who had long opposed the American policy that sought to prevent AIDS by promoting abstinence and faithfulness applauded.

“That was fantastic,” said Dr. Gilles van Cutsem, medical coordinator for Doctors Without Borders in South Africa.

Staff members from the government program that Mr. Lo had accused of wasting money — Pepfar, the President’s Emergency Plan for AIDS Relief — came up afterward to quietly congratulate him. When they realized a reporter was present, they nervously asked that they not be named.

President George W. Bush’s global AIDS plan was enacted in 2003 and marshaled billions of dollars to treat Africans who had AIDS with lifesaving drugs. Conservative Republican leaders in the House of Representatives successfully included a provision that one-third of AIDS prevention money go to programs to encourage abstinence and fidelity. That campaign — known as ABC, for abstain, be faithful and use condoms — was part of the bargain made when Christian conservatives joined with liberals to pass the law.

Keith Alcorn reports at AIDSmap that abstinence funding accounts for a smaller portion of PEPFAR money than it used to:

In 2008, the legislative requirement changed: since then, programmes have been required to justify to Congress why they spend less than 50% of prevention funding on these programmes.

Funding for the programmes peaked at $200 million a year in 2008, but declined to around $50 million in 2013, as money has been directed to other measures with stronger evidence of effectiveness.

Programmes aimed to delay sexual debut in order to reduce the period of high risk during adolescence, especially for girls, and to reduce partner numbers. Although there may be epidemiological grounds for thinking that delaying sexual debut and reducing sexual activity might reduce opportunities for acquiring HIV, evidence for effective interventions was lacking when Congress earmarked funding.

PEPFAR has done a lot of good. If health advocates faced a choice between no global AIDS program and a global AIDS program with one-third of funding going to abstinence, supporting the compromise was the right choice. Changing funding priorities based on emerging evidence of effectiveness (or non-effectiveness) is something government-funded programs should do. Ideally, the legislation creating new public-health interventions will always contain requirements and funding for studying programs’ effectiveness, as well as mechanisms for altering programs in response to new evidence. We shouldn’t let the perfect be the enemy of the good, but we should also work quickly to perfect good programs.

Categories: Health

Hurricanes Help Spread Invasive Marine Species, Researchers Find

Yale Environment 360 - March 04, 2015
Hurricanes can accelerate the spread of invasive marine species — in particular the lionfish, a hardy invader that

An adult lionfish can overrun ecosystems and devastate native biodiversity — according to research published in the journal Global Change Biology. Researchers found that hurricanes, by forcing changes in strong ocean currents, have helped lionfish spread from the Florida Straits to the Bahamas since 1992, increasing the spread of the species by 45 percent and their population size by 15 percent. Normally the currents pose a barrier to the transport of lionfish eggs and larvae, the researchers say, but as a hurricane passes, the current shifts and carries lionfish larvae and eggs from Florida to the Bahamas. Scientists say climate change may increase the frequency or intensity of future storms, which could further accelerate the spread of marine invasives.
Categories: Environment, Health

Researchers: Beyond social justice and fairness, income inequality is a matter of health

Pump Handle - March 03, 2015

The public health literature is pretty clear when it comes to income status and poverty and their profound effects on health, disability, disease and life expectancy. But what about income inequality? Does a rising gap in wealth and resource distribution affect people’s health too?

In a commentary published last week in the American Journal of Public Health, two researchers posit that growing income inequality is a contributing factor to poorer health among American workers. In “Squeezing Blood from a Stone: How Income Inequality Affects the Health of the American Workforce,” authors Jessica Allia R. Williams and Linda Rosenstock write that “because income inequality is inexorably linked to employment, a more complete picture of the effects of inequality on health emerges when analyzed through the lens of the working population.” In particular, the authors write that the characteristics of growing income inequality within the workforce and specifically among low-wage workers — such as less job security, fewer employment benefits and little control over one’s work — do pose adverse risks to workers’ health. They write:

Even though the data available to understand the relation between income inequality and health are limited, we believe there is enough evidence to demonstrate the need for concern beyond issues of fairness, social justice, and health care costs. There is a particular need for concern when the effects of inequality on adults spill over and affect their children. Moreover, changing patterns of work organization and divergent psychosocial working conditions put additional stress on workers whose work organization is changing. Income inequality can be seen as yet another social determinant of health, and when it is addressed much can be done to improve health status beyond access to health care.

The commentary cites research showing that income inequality is growing in the United States: In 2013, the top 5 percent of households accounted for more than 22 percent of all income, whereas the bottom 20 percent accounted for only little more than 3 percent of all income. Compare those statistics to 1980, when the top 5 percent accounted for 16.5 percent of all income and the bottom 20 percent accounted for 4.2 percent of income. Other measures of income inequality include wages, which have stagnated, as well as the wage gap between workers and CEOs. The commentary noted that the ratio of CEO cash compensation to average worker pay was 25 to 1 in 1970; 30 years later and that ratio is now 90 to one.

How work is structured and organized has changed dramatically as well, with many more people working more than 40 hours a week in multiple part-time or full-time jobs or working nonstandard shifts. Many such workplace and employment characteristics have been linked to poorer health, Williams and Rosenstock write. For example, they cited studies showing that poor psychosocial working conditions and long hours have been linked to heart disease and cardiovascular events, while job insecurity and job strain have been associated with increased mortality risk.

To illustrate the effects of income inequality and its associated working conditions, the commentary highlighted the health care workforce, in which there is a substantially large gap between the lowest earners, such as nurses aides, and the highest earners, such as surgeons. As the demand for efficiency increases in the health care industry, many low-wage health care workers are being asked to do more with less, even as they experience some of the nation’s highest work-related injury rates, higher health insurance premiums and pressures to work additional overtime. The workforce is also largely female and from communities of color, so they already face disparities in health care access and disease rates.

The example is a “microcosm” of the larger problem of income inequality and shifting workplace demands, the commentary stated. Williams, a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard Center for Population and Development Studies, and Rosenstock, dean emeritus of the UCLA Fielding School of Public Health, write:

Workers in health care are also likely to work nonstandard shifts, to work overtime, and to face psychosocial hazards such as violence in the workplace that further contribute to poor health. The health care workforce faces a broad array of health problems directly related to work, but, as the vast majority of this workforce earns low wages, they face the increasing pressures of income inequality.

Williams told me that the big difference in studying health and its association with income status as opposed to income inequality is that the former exposes effects at an individual level, while the latter exposes the effects of income differences across a population and whether those differences impact certain groups more than others.

“We wanted to look at how income inequality and changes in work structures both hurt the health of the workforce and reinforce each other,” she said. “If you think about low-paying jobs, the patterns of income match up pretty closely with certain job characteristics. …It’s not just income inequality that matters, it’s also other pressures — these are (workplace) trends that tend to squeeze people from many angles.”

Income inequality is yet another social determinant of health, Williams said, and so understanding its impact may be another key to putting adults and children on a healthier trajectory. She said public health practitioners can help bring this issue to light, especially the nuances of low-wage working conditions that aren’t always considered. For example, Williams said asking a worker if she or he has access to proper safety equipment and training is only one part of the picture. To reveal a more complete picture, also ask the worker whether he or she feels pressure to overlook safety in favor of efficiency. For instance, Williams noted that a health care worker might have access to the type of patient-lifting equipment that prevents worker injuries, but the strains of understaffing create a workplace culture in which safety isn’t a priority.

“Over the past few years, we’ve seen growing attention to the issue of income inequality — people instinctively realize that it’s a problem related to many other issues we face,” Williams said. “Public health (practitioners) can help us in realizing that this is also an issue about health.”

To request a full copy of the income inequality commentary, visit the American Journal of Public Health. Read some of our recent stories on the experiences of low-wage workers and their efforts to organize for better working conditions here, here and here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Photographs of Amazon Forest Added to Google Street View Collection

Yale Environment 360 - March 03, 2015
Detailed views of the Amazon rainforest, its rivers, and indigenous communities are the latest additions to Google's


Boaters on the Rio Negro "Street View" collection, the company announced this week. The imagery — captured while boating down 500 kilometers of rivers, walking along 20 kilometers of trails, and ziplining through dense forest — reveals stunning views of the Amazon from the top of its canopy to the forest floor. The photos also capture daily life in 17 communities of local people who live deep within the rainforest and along the Rio Mariepauá, one of the Amazon River's largest tributaries. The images were collected in partnership with the conservation organization Amazonas Sustainable Foundation, which hopes that sharing in-depth photographs of the area will help promote conservation efforts.
Categories: Environment, Health

Interview: How Climate Change Helped Lead to Conflict in Syria

Yale Environment 360 - March 03, 2015
Before Syria devolved into civil war, that country experienced its worst drought on record. The consequences of this disaster Colin Kelley included massive crop failures, rising food prices, and a mass migration to urban areas. In a new study in the Proceedings of the National Academy of Sciences, researchers suggest the drought and its ensuing chaos helped spark the Syrian uprising. They make the case that climate change was responsible for the severity of the drought. Colin Kelley, a climatologist at the University of California, Santa Barbara, was the study’s lead author. In an interview with Yale Environment 360, Kelley explains that long-term precipitation and soil temperature trends in Syria and the rest of the region correlate well with climate change models, demonstrating, he says, that the record-setting drought can’t be attributed to natural variability.
Read the interview.
Categories: Environment, Health

History, art and prevention: European workplace safety posters

Pump Handle - March 02, 2015

The European Trade Union Institute (ETUI) published a book last month featuring a collection of 50 workplace safety and health posters. They were designed for or developed by agencies and advocates between 1925 and 2004.

The book’s author, Alfredo Menendez-Navarro, MD PhD, organized the selections into three time periods: the years between WWI and WWII, after WWII, and the post 1960’s. Menendez-Navarro is a professor of the history of science at the University of Granada and an expert in the history of occupational health.

This poster from Poland was one that really caught my eye. No matter how much the agricultural industry wants to romanticize farm work, too many hazards are not controlled and it is dangerous.

Central Institute for Labour Protection, Poland Designer/Artist: Golonka, Jerzy (2004)


I’m going to have to keep in mind this one from Denmark. It will come in handy when business interests object to designing out the hazards of a job and instead just want to require that workers wear personal protective equipment.

How much should we put up with? Ask your safety reps, Danish Metalworkers’ Union, Denmark (1950-1974)


ETUI’s General Director Philippe Pochet wrote the forward to The art of preventive health and safety in Europe. He comments on the posters’ common themes:

“Some of the posters convey messages referring to the responsibility and, potentially, the culpability of workers. They urge workers to comply with the rules and to be careful, meticulous and tidy. Others, by contrast, highlight the dangers lurking in the workplace. They allude to the figure of death hiding in the shadows of machine gears or they point to the presence of toxic substances. Others know and call on workers to heed their advice. Two images reject this often patronising approach to prevention. A trade union poster from the early 1980s soberly announces ‘Our health is not for sale.’”

This one from Paris in 1968 could be used today by Steelworkers, some of whom have been on strike since February 1.

Down with hellish production schedules, Atelier Populaire, Paris (1968)


Among the USW’s chief concerns are excessive work hours. “Down with hellish production schedules.”

The American Petroleum Institute issued recommendations for petrochemical plants to address the hazard of worker fatigue, but they are voluntary and full of loopholes. The USW reports that it’s not unusual for some workers to be required to work a month of consecutive 12-hour workdays. This poster with the stopwatch was used during general strikes in Paris during May and June of 1968. Those protesters were also looking beyond higher wages, explains Menendez-Navarro, and demanding changes in their abusive work schedules.

Check out The art of preventive health and safety in Europe and leave a comment about your favorite poster in the collection.



Categories: Health

Emperor Penguins Had FewRefuges During Last Ice Age, Study Finds

Yale Environment 360 - March 02, 2015
The Ross Sea and certain other Antarctic waters likely served as refuges for the three emperor penguin populations that

Emperor penguins survived during the last ice age, when large amounts of ice made much of the rest of Antarctica uninhabitable, according to a new study published in the journal Global Change Biology. The findings suggest that extreme climatic conditions on the continent during the past 30,000 years created an evolutionary "bottleneck" that is evident in the genetic material of modern-day emperor penguins, a species known for its ability to thrive in icy habitats. But during the last ice age, the Antarctic likely had twice as much sea ice, the researchers say, leaving only a few locations for the penguins to breed — distances from the open ocean (where the penguins feed) to the stable sea ice (where they breed) were too great. The three populations that did manage to survive may have done so by breeding near areas of ocean that are kept free of sea ice by wind and currents, the researchers suggest.
Categories: Environment, Health

Along Cuba’s Coast, The Last Best Coral Reefs in the Caribbean Thrive

Yale Environment 360 - March 02, 2015
Decades of communist rule and a U.S. embargo have stifled coastal development in Cuba, which has had the beneficial effect of leaving many of the country’s coral reefs intact. In this gallery, photographer Robert Wintner documents the exquisite beauty and biodiversity of Cuba’s coral reef ecosystems.
Categories: Environment, Health

King v. Burwell: Supreme Court case could wreak havoc on working families, state governments and health providers

Pump Handle - February 27, 2015

“Established by the state.” Those are the four words at the center of an upcoming Supreme Court case that could strip affordable health insurance coverage from millions of working families and result in billions of dollars in uncompensated care costs.

The case is known as King v. Burwell and at its core is the question of whether residents who live in states with federally administered health insurance marketplaces, versus state-run marketplaces, are eligible to receive insurance subsidies. The plaintiffs in the case claim that those four little words in one section of the entire Affordable Care Act — “established by the state” — mean that Congress never intended for federal subsidies to be available to people living in states where the feds set up the health insurance exchange. (A little background: As authorized in the ACA, the federal government will set up an exchange in a state where state lawmakers choose not to do so on their own.)

However, legal observers and advocates argue that the plaintiffs are simply taking the words out of context and if one looks at the ACA as a whole, it’s clear that Congress intended all Americans to have access to federal subsidies and thus, affordable health insurance. The Supreme Court is scheduled to hear arguments in the case next Wednesday.

“The motivation is to undermine the ACA and the system that sets it up,” Sarah Somers, managing attorney at the North Carolina office of the National Health Law Program and an attorney with the Network for Public Health Law, told me. “This was a legal theory that was designed to bring this litigation. …It doesn’t make any sense that Congress would put that kind of poison pill in the legislation. Why would they do that?”

This is the language that’s in question — it’s known as Section 36B of the Internal Revenue Code as authorized by the ACA: the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act…

But in examining references to the exchanges within the ACA’s thousands of pages, it’s clear that the concepts of a state-administered exchange and the federal exchange are interchangeable, Somers said. In an amicus brief that the National Health Law Program signed onto along with AARP, Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, and the National Council On Aging, the authors noted:

Petitioners’ acontextual interpretation of a single phrase in one provision of the Act—if accepted—will make insurance unaffordable in the 34 states that use the Federally Facilitated Exchanges, harming low- to moderate-income residents of those states. It would also render meaningless other key provisions of the ACA designed to increase access to affordable health insurance for all.

Somers said a Supreme Court ruling in favor of the plaintiffs could have a “massive impact — it’ll affect millions of people and will cause incredible difficulty, if not chaos, for federal governments, state governments and the insurance companies.” So, just how many people are at risk for losing subsidies in the 34 states that now depend on federally facilitated health insurance marketplaces? According to a map from the Kaiser Family Foundation, more than 13 million Americans estimated to benefit from subsidies in 2016 could be impacted, with the numbers ranging from about 32,000 residents in Alaska to more than 784,000 residents in Georgia to more than 1.7 million in Texas.

“It’s amazing to think what a wreck this would be,” Somers told me.

Earlier this month, the Urban Institute released a report on what a ruling for the plaintiffs would mean for uninsured rates and health care spending. That report estimated that a ruling for the plaintiffs — a ruling that would prohibit federal subsidies in 34 states — would result in 8.2 million more uninsured people, including thousands of children, who would have otherwise spent more than $27 billion on health care in 2016. Without federal subsidies that enable people to buy affordable health coverage, the reports estimates that those newly uninsured would spend only $5.3 billion on health care, with another $12 billion provided in uncompensated care. (The uncompensated care estimate is based on the assumption that governments would fund such care and health care providers would make in-kind contributions at the same rates they had previously.)

However, the ACA was specifically designed with the assumption that demand for uncompensated care would go down — for example, the law reduced certain Medicare and Medicaid hospital payments that had historically gone to cover uncompensated care. Those types of funding reductions coupled with additional revenue losses resulting from a rise in the uninsured rate could be disastrous for providers. In addition, losing health insurance and the opportunity to access preventive care as well as care in the earliest stages of an illness has tragic effects on people’s health and mortality risks. In an amicus brief in support of the defendants, the American Public Health Association along with a host of deans, chairs and faculty within schools of public health write:

Because of the interrelationship between insurance coverage, health care access, and population health, a decision striking down the IRS rule (on federal subsidies) can be expected to lead to a loss of improvements in access to care, worsening health, and more preventable deaths. Applying the results of a prior study estimating mortality declines linked to the first four years of health reform in Massachusetts, a loss of health insurance by estimated 8.2 million persons can be expected to translate into over 9,800 additional deaths annually.

‘Sucker-punch to the gut of the middle class’

Linda Blumberg, an economist and senior fellow at the Urban Institute, described the plaintiffs’ arguments as “very flimsy,” as it seems clear that they’re taking the four words at the center of the case out of context. Blumberg was involved in the process of providing technical assistance to states as they decided whether to set up state-run exchanges or let federal officials take over. She told me that the question of whether that decision would jeopardize the availability of federal insurance subsides never came up — not once. If Congress had intended to use federal insurance subsidies as a way to pressure states into setting up their own exchanges and ultimately punish states that chose not to — as the plaintiffs argue — it’s incredible that no state took notice, she told me.

“You can’t create this coercive situation with very substantial consequences for a state without it being noticed,” said Blumberg, who also co-authored the Urban Institute report cited above. “It’s kind of impossible to have been part of the conversation around reform and believe that there’s legitimacy to this case. Having been a part of the policy process, I just don’t see any legitimacy in their argument whatsoever.”

In addition to an increase in the uninsured rate and uncompensated care, Blumberg explained how a ruling for the plaintiffs could upset the very foundation of the ACA, much of which builds off the premise of a mixed insurance pool of healthy and sick people. She said that if insurance subsidies disappear in states that depend on federally administered exchanges, the rise in some residents’ monthly insurance bills would exempt many from the ACA’s individual insurance mandate. That means some people could drop insurance coverage without facing a penalty. Blumberg said in that scenario, it’s likely that the first people who drop coverage will be healthy people — people who use the least amount of health care. That means that sicker people who use more health services remain in the insurance pool, which pushes premiums up. From there, it can be a domino effect — as premiums go up, more and more healthy people leave the insurance market and a primary mechanism for controlling health care costs starts to disappear.

“We have a situation in which we’ve created all these consumer protections that let everyone (access the insurance market), but if the only people coming in are sicker and more costly, you have a very bad dynamic,” she told me.

Regarding the four words at the core of King v. Burwell, Blumberg argued that for all intents and purposes, every exchange is established by the state — “regardless of the semantics over who’s doing the administrative role, all of these are exchanges established by the state by either the state setting it up themselves or by choosing to let the federal government set it up for them.”

“The legal folks that I listen to and trust seem cautiously optimistic and feel the case against the plaintiffs is incredibly strong on its merits,” Blumberg said.

Jane Perkins, legal director for the National Health Law Program, told me that the plaintiffs have to prove that the “statute is unambiguous on its face” and as a result, the IRS regulations about federal subsidies are beyond the agency’s authority. However, Perkins said that a hallmark of statutory construction is to determine the meaning of words by looking at the statute as a whole — in other words, you don’t untether a small group of words from its statutory context.

“The intent and wording throughout (the ACA) is to extend coverage to as many Americans as possible and the whole statute is set up to do just that,” Perkins said. “I think if the court ruled for the plaintiffs, it would not only upset (the entire) ACA, it would be reworking the rule of statutory constructions that has applied in cases for generations.”

Regarding the ruling’s potential impact, Perkins said “it would be a sucker-punch to the gut of the middle class if this ruling came down in favor of these politically driven plaintiffs.” She noted that the great majority of those affected if subsidies go away would be working people. However, she also said that if the Supreme Court rules in the plaintiffs’ favor, Congress could still step in to fix the law’s language or help states convert as seamlessly as possible to state-operated insurance exchanges.

“But it would be a very bumpy road,” Perkins said.

To learn more about King v. Burwell, visit SCOTUSblog. To learn more about the conservative architects behind the case, read this piece by Sarah Kliff.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Not an “accident”: John P. Stoll, 58, suffers fatal work-related injury in Madison, WI

Pump Handle - February 27, 2015

John P. Stoll, 58, suffered fatal traumatic injuries on Friday, February 20, 2015 while working at a construction site in the 1100 block of John Nolen Dr. in Madison, Wisconsin. reports:

  • EMS was called to the scene at 7:38 am to respond to “an entrapment”
  • Firefighters said a crew was “working on a stairwell when it collapsed”
  • When completed, the construction project will be the site of the Watermark Lofts, an apartment and retail space scheduled to open this summer.

The Daily Reporter says Mr. Stoll was an employee of Badgerland Metal Building Erectors, but their story does not name the project’s general contractor.

Badgerland Metal Building Erectors was subject to two OSHA inspections in 2013, one at a site in Cudahy, WI and the other in Mequon, WI. Those inspections resulted in citations for three serious violations, including improperly erected scaffolding and inadequate examination of the workplace for hazards. OSHA proposed penalties totally $13,200 for the violations. In settlement agreements, the company paid $4,800.

Each year, about 100 workers in Wisconsin are fatally injured on-the-job. The Bureau of Labor Statistics reports 96 work-related fatal injuries in Wisconsin during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.

The AFL-CIO’s annual Death on the Job report notes:

  • Federal OSHA has 36 inspectors in Wisconsin to cover more than 138,000 workplaces.
  • The average penalty for a serious OSHA violation in Georgia is $2,207.

Federal OSHA has until mid- August 2015 to issue any citations and penalties related to the incident that stole John P. Stoll’s life. It’s likely they’ll determine that Stoll’s death was preventable. It was no “accident.”

Categories: Health

Growing Risks to India's Water Supply Mapped With New Online Tool

Yale Environment 360 - February 26, 2015
A new online tool could help water users in India understand the risks to their water supply, which is dwindling and increasingly


Groundwater levels polluted, recent analyses show. The tool, created by 13 organizations including the World Resources Institute, allows users to see where the competition for surface water is most intense, where groundwater levels are dropping significantly, and where pollution levels exceed safety standards. Northwest India, for example, faces extremely high surface water stress as well as low groundwater levels, as this map shows. Overall, 54 percent of India is under high or extremely high water stress, an equal portion is seeing declining groundwater levels, and more 130 million people live where at least one pollutant exceeds national safety standards, according to the World Resources Institute.
Categories: Environment, Health

Highs and lows of Labor Department websites

Pump Handle - February 26, 2015

This week the differences between OSHA’s and MSHA’s websites were oh so obvious. The Mine Safety and Health Administration (MSHA) released a new on-line tool to allow users to compare a mining operation’s violations of selected safety standards to the national average. For years, mine-specific violations, penalties, injury reports, exposure sampling results, and other data have been available on MSHA’s website, but this new tool offers something different.  It focuses on a subset of safety violations which most frequently cause or contribute to fatalities and serious injuries.

While MSHA continues to make its vast trove of enforcement data available to the public—not just available, but easily searchable and accessible—OSHA’s website has been floundering. For at least the last month, the simplest query of OSHA’s “Establishment” or “Specific Inspection” search tool results in the message “Temporarily Unavailable.”

The system is especially annoying because it teases you. You don’t know from one hour to the next whether the system is working or still in disrepair. I can conduct a search at one moment, and it might spit out the data I requested.  Yeah! I think the programming glitches have finally been fixed, but only minutes later, I’m frustrated again. The next query ends with the message “Temporarily Unavailable.” It feels a little like fall 2013. That’s when I was attempting, night after night, to get onto the original Obamacare website.

I realize that OSHA’s and MSHA’s core function is enforcing safety and health regulations and helping employers comply with them. It’s not about having a splashy website or data search tools that have all kinds of bells and whistles. But the public, especially reporters, have come to rely on getting basic inspection data from the agencies’ websites. Users have become accustomed to finding out whether a particular establishment has had previous OSHA inspections, and if so, whether citations and penalties were proposed and the disposition of them.

Now that I’ve grown used to getting OSHA inspection data, it’s frustrating to get the error message “Temporarily Unavailable.”  I’m not sure the phrase “Temporarily Unavailable” really communicates what users should expect. After weeks and weeks of this problem, “Temporarily Unavailable” really doesn’t cut it. How about a message to users:

“Data will only available intermittently. Upgrades expected to be completed by X date.”

Maybe the agency could provide users a bit of information to manage their expectations. Is it a problem with the dataset, the interface between the dataset and the website, or the website platform?  Should we start to see incremental improvements in the site, or will there be a master unveil? Is the problem unique to OSHA or should we be dreading the same fate in the future for MSHA’s on-line search tools? (I’ve got my fingers crossed to stave off the latter.)

As for the subset of violations featured in MSHA’s new on-line data tool, it includes standards such as keeping workers away from suspended loads of material or equipment, ensuring machinery is not used beyond its intended design, and locking out equipment during repair or maintenance. MSHA calls them the “Rules to Live By” standards. Companies are just asking for trouble—and gambling with workers’ lives—when they disregard these important protections.

This morning, I checked out this new MSHA on-line data tool. I queried the system for Newmont USA’s gold mine in Leeville, NV.  A contract worker, Brian Holmes, 53, was fatally injured there on January 11, 2015. Plugging the mine’s unique identification number into the system, I learned something troubling: From 2012 through 2014, the rate of violations (per MSHA inspections hours) at this mine of the “Rules to Live By” standards was 2.38 compared to the national average rate of 0.77 for this type of operation. Gambling with workers’ lives indeed.

This data tool and the others available on MSHA’s website can provide valuable information to current and prospective workers, contractors, investors, competitors and the public about a specific mining operation or a group of mines owned by a particular company. It’s data that can help users make informed decisions.

Kudos to MSHA for developing new ways for miners, employers and the public to access the agency’s data. I hope your agency has a vaccine to avoid whatever is troubling OSHA’s website.

Categories: Health

For First Time in Nature Scientists Measure Heat-Trapping Effects of CO2

Yale Environment 360 - February 26, 2015
Scientists have long understood how carbon dioxide traps heat in the atmosphere and contributes to global warming, but the phenomenon had not been directly documented at the earth's surface outside of a laboratory — until now. Writing in the journal Nature, researchers present 11 years of field data on carbon dioxide's capacity to absorb thermal radiation emitted from the surface of the earth. The results agree with theoretical predictions of the greenhouse effect associated with fossil fuel combustion, researchers say, and provide further confirmation that calculations used in climate models are on track when it comes to representing the impact of CO2 emissions. "We see, for the first time in the field, the amplification of the greenhouse effect because there's more CO2 in the atmosphere to absorb what the earth emits in response to incoming solar radiation," says Daniel Feldman, a scientist at Berkeley Lab and lead author of the study.
Categories: Environment, Health

In Kenya’s Mountain Forests, A New Path to Conservation

Yale Environment 360 - February 26, 2015
Kenya’s high-elevation forests are the source for most of the water on which the drought-plagued nation depends. Now, after decades of government-abetted abuse of these regions, a new conservation strategy of working with local communities is showing signs of success. BY FRED PEARCE
Categories: Environment, Health
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