#health insurance is so important in the United States

[reasonsforhope]

"Sanofi on Thursday said it’s planning to cut the U.S. price of its most popular insulin drug by 78% and cap monthly out-of-pocket costs at $35 for people who have private insurance starting next year. 

In addition to its widely prescribed Lantus, the French drugmaker will reduce the list price of its short-acting insulin Apidra by 70%. Sanofi already offers a $35 monthly cap on insulin for uninsured diabetes patients.

The company is the last major insulin manufacturer to try to head off government efforts to cap monthly costs by announcing its own steep price cuts for the lifesaving hormone. 

Eli Lilly and Novo Nordisk made similar sweeping cuts earlier this month after years of political pressure and public outrage over the high costs of diabetes care. The three companies control over 90% of the global insulin market. 

... The change takes effect Jan. 1.

President Joe Biden’s Inflation Reduction Act capped monthly insulin costs for Medicare beneficiaries at $35, but it did not provide protection to diabetes patients who are covered by private insurance.

Sen. Bernie Sanders, a Vermont independent and the chairman of the Senate Health, Education, Labor and Pensions Committee, introduced a bill earlier this month that would cap the list price of insulin at $20 per vial.

Both the president and Sanders on Tuesday directly called on Sanofi to slash its prices after Novo Nordisk announced its own cuts that day.

Roughly 37 million people in the U.S., or 11.3% of the country’s population, have diabetes, according to the Centers for Disease Control and Prevention. Approximately 8.4 million [U.S.] diabetes patients rely on insulin, the American Diabetes Association said."

-via CNBC, 3/16/23

[intheholler]

On Appalachian and Southern Stereotypes

After seeing some people leap at the opportunity to insult and further harm us under my posts, even by obviously leftist accounts, I wanted to address some of the most popular stereotypes of our region.

Not as an excuse. There are many negative, violent and otherwise harmful features of the American South. We have a horrific history especially in terms of the violence we inflicted and continue to inflict upon the Black community that cannot be forgotten, and, as a culture, we do need to pay our dues.

But maybe this will help y’all apply some nuance to the situation and understand that we aren’t all your enemy.

Stereotype 1: Everyone is a Republican Racist

Absolute horse shit, my friends. There are people like me all over the south and in the hollers. We just get drowned out by the fascists, and it is all by design. 

In my home state of North Carolina alone, they are working tirelessly to make it impossible for young, often liberal (if not outright leftist) voices to be heard. They specifically target regions with heavy POC populations.

As recently as May of this year, the North Carolina Supreme Court overturned their own previous ruling which once made gerrymandering illegal. This allows Republicans free range to draw their congressional lines wherever benefits them most. 

Meanwhile, Roy Cooper, our Democratic governor, has been in office since 2017.

Gerrymandering is a real problem, and it reflects the worst of us. But it does not reflect all of us.

We are a working class, pro-union people.

We are coal miners and mill workers and farmers.

We took up arms against the government and fought for our labor rights during the Coal Wars as recently as the 1920s.

We bled for labor rights at the Battle of Blair Mountain.

It’s a myth that you keep perpetuating that we are all closed minded, bigoted regressionists. It diminishes the efforts of everyone from the coal miners to people like me while we try to make the region a better place.

It actually only worsens what you say that you wish you could “saw off into the ocean.” 

That's my home you're talking about.

Stereotype 2: Everyone is Obese

36.3% of the overall population of the Southeast is obese. This is true.

Have you considered why that may be? For starters, Southerners are more likely to be uninsured compared to individuals living in the rest of the country.

"Among the total nonelderly population, 15% of individuals in the South are uninsured compared to 10% of individuals in the rest of the country."

Partially because they didn't even expand the same Medicaid benefits to us. and partially because we are just so fucking poor. 

17% of the American South is below the poverty line, compared to 13% in the Midwest, 13% in the West, and 13% in the Northeast.

Percentages under 5% may not seem like much, but when you consider 1% of the total United States population is around 3,140,000 people, yeah, that adds up real quick.

How does this relate? Well...

Mississippi has 19.58% of its residents below the poverty line, and a 39.1% obesity rate.

West Virginia has 17.10% of its residents below the poverty line, and a 40.6 % obesity rate.

Kentucky has 16.61% of its residents below the poverty line, and a 40.4% obesity rate.

Are you seeing the trend?

We, generally speaking, are more likely to be unable to afford to feed ourselves wholesome foods, and we are less likely to be able to afford medical insurance--two things that are obviously important to maintaing good health and a "healthy" weight.

By the same token... 

Stereotype #3: We're All Uneducated 

The South and Appalachia are some of the lowest ranked in terms of educational funding and spending per pupil in the entire country. We don't even break the top 30 on the list, y'all.

49. Tennessee at $8,324 per pupil 47. Mississippi at $8,919 per pupil 45. Alabama at $9,636 per pupil 42. Kentucky at $10,010 per pupil 36. North Carolina at $10,613 per pupil 35. South Carolina at  $10,719 per pupil 33. Georgia at $10,893 per pupil 32. West Virginia at $10,984 per pupil

The top three best-funded states, by comparison, receive between $18k and $20k per pupil.

In terms of higher education, student loans are a death sentence for everyone but especially impoverished kids just looking for a way out. It just isn't feasible for most of us. And that's if we even tested well after going to shitty schools our whole lives. If we had better education, we'd have better literacy in all things, including critical thinking, allowing us to better see through the bullshit we are taught. But we don't. And you aren't helping the ones who are trying in spite of that.

Stereotype 4: Bad Teeth

Quickly going to touch on this one--when we consider a lack of access to affordable, healthy food, shitty medical insurance in general and our poverty rate, this one is kind of obvious. Even so:

“Dental coverage was significantly lower than the national average in the South Atlantic (45.6%), East South Central (45.6%), West South Central (45.9%), and Pacific (48.0%) regions.”

Every time you make a toothless hillbilly joke, ask if poverty is really the butt of the joke you want to be making.

These are just the most pervasive of them, imo. And they can all be underlined by extreme poverty which is absolutely by design.

It also contributes to why it isn’t so easy to “just leave” as we are so often dismissively told to do. Moving is expensive.

And why should we have to, anyway? Why should we have to flee our homes?

Why, for those who feel safe enough and/or have no other choice, should we not stay and fight to better the region?

And why can’t you other leftists get behind us and help us in our fight instead of perpetuating harmful stereotypes? We're your people, too.

Just some food for thought. And I hope some of y’all take a big ol bite.

[whilomm]

from wikipedia:

A national identification number, national identity number, or national insurance number or JMBG/EMBG is used by the governments of many countries as a means of tracking their citizens, permanent residents, and temporary residents for the purposes of work, taxation, government benefits, health care, and other governmentally-related functions. The ways in which such a system is implemented vary among countries, but in most cases citizens are issued an identification number upon reaching legal age, or when they are born. Non-citizens may be issued such numbers when they enter the country, or when granted a temporary or permanent residence permit. Many countries issued such numbers for a singular purpose, but over time, they become a de facto national identification number. For example, the United States developed its Social Security number (SSN) system as a means of organizing disbursing of Social Security benefits. However, due to function creep, the number has become used for other purposes to the point where it is almost essential to have one to, among other things, open a bank account, obtain a credit card, or drive a car.

so basically: do you kno the One Government Number that kinda gets used for everything off the top of ur head? Sometimes linked to stuff like social security (hence "social security number" in the U.S.) but they end up just bein used for like, Fuckin Whatever. im just curious how many ppl got that shit memorized

i was gonna be ha ha funnee "put your social security number your credit card number and those three wacky digits in the tags" but no someone would maybe do it. so. dont do that. please. I'm not 100% sure if every country has a system where writing your number on the internet is Bad (in the U.S. thats how u get your identity stolen) but still like. just in case. dont. thx.

but DO tell me if like. your parents or whoever made u memorize it. my mom did for some reason and now i kno it. maybe i dont need to bc i can find it easily but its in my noggin so. And also if u feel like it say how important the numbers are in your country. In the U.S. theyre Important but dont come up super super often, mostly if ur like. opening a bank account. dealing with Government Forms. taxes. insurance. occasionally medical stuff. but also if someone Gets Yours they can kinda destroy your life a bit w identity fraud. sucks a bit.

[charmedhypno]

Charmed! 2025 Covid Policy Update

Charmed! 2025 Covid-19 Policy

Charmed! is committed to hosting the safest event we possibly can as the world continues to navigate the COVID-19 pandemic. In light of this, the Convention Committee (“ConCom”) will continue to require up to date Covid vaccinations as well as masking for our attendees, staff, and volunteers at Charmed! 2025.

In addition, hand sanitizer stations will be available throughout Convention Space (“Con Space”) and our Dungeon Monitors (“DMs”) will be extremely proactive in reminding people to clean their equipment - if you need help please ask and it will be provided!

Please read the following policies carefully! They contain several important dates and deadlines – ignorance of these policies will not result in any exemptions.

Vaccination Policy

The newest Covid-19 vaccine update has been evaluated and released for use in the United States to people aged 6 months and older for Fall 2024. People can get the vaccination if it has been at least 2 months since their last vaccination for Covid-19. People who have not previously been vaccinated for Covid-19 are considered “up to date” with their vaccinations after receiving this single dose.

This vaccine update is free under most insurance plans in the United States (including Medicaid and Medicare), but is no longer offered for free by the United States government.

Free vaccinations may be available on a state-by-state basis; so check whether or not your state has a free adult vaccination program if you require a free option. People based in the United States can search for their local Health Department here: https://www.naccho.org/membership/lhd-directory

People who have been diagnosed with Covid-19 may wait 3 months before getting the updated vaccine.

In order to attend Charmed! 2025 in-person you must be up to date with your Covid vaccination: a person who is “up to date” with their vaccinations beginning September, 2024 is a person who has received the latest updated vaccine, released in September, 2024.

Vaccinations typically take around two weeks to reach full efficacy; therefore for the purposes of Charmed! 2025 vaccinations will be considered valid if they are received by or before Monday, January 6th, 2025.

In-person attendees of Charmed! 2025 will be required to show proof of “up to date” vaccination received in good time – that is, they must show proof that they have received the Fall 2024 vaccine update by or before January 6th, 2025. Proof may be in the form of one of the following: official paper vaccine card, electronic vaccine card, photocopy or digital representation of official vaccine card, website listing your name/vaccination date, dated email for an applicable vaccination appointment, a photograph of some part of the vaccination process (eg. the vial of serum), or other applicable media. If you are unsure that your form of proof will be valid, please contact us before arriving at the event. Proof of vaccination will be verified at badge pick-up.

You can contact us using one of the following ways: Email us at: Covid@Charmedhypno.org Contact us through Charmed! social media: Twitter: https://twitter.com/CharmedHypno Fetlife: https://fetlife.com/groups/121240?sp=1 Tumblr: https://www.tumblr.com/charmedhypno Bluesky: https://charmedhypnocon.bsky.social/ Discord: DM @Noelle - I have answers!

People who are unable to get the updated Covid-19 vaccine for a three month period ending with the final day of Charmed! 2025 (January 26th, 2025) due to a previous Covid-19 infection will be considered “up to date” for the purposes of in-person attendance. Please contact ConCom if you become Covid-positive within this window.

IMPORTANT: if you have a Covid-19 infection that results in you being able to get the updated vaccine within the two week time period before Charmed! 2025 begins – that is, January 8th through January 22nd – you will not be considered “up to date” with your vaccination and will be ineligible to attend Charmed! 2025 in person.

PLEASE NOTE: the three month waiting period is a CDC recommendation and it may be possible for people to get the updated vaccine within that time period.

In-person attendees at Charmed! 2025 will be required to show proof of a negative Covid-19 test taken within 48 hours of badge pick-up, (over-the-counter test is okay), in picture form in order to pick up their badge. Please do not bring a physical test with you to badge pick up - a picture on your phone is sufficient.

Mask Policy

In-person attendees at Charmed! 2025 will be required to wear well-fitting, high quality masks, such as N95s, KN95s, and FFP2s (or equivalent) at all times while in official convention space. This includes both the private convention area and Con Suite, as well as semi-public areas such as registration and the hallway outside of the upstairs classrooms.

If you are unable to acquire an N95 or similar mask, then pleated surgical masks are acceptable as a last resort.

Examples of unacceptable masks include: bandanas, gaiters, and scarfs.

Presenters and demo-bottoms may choose to remain unmasked only while actively presenting.

There are no mask exceptions for evening social events and dungeon play.

Masks may be raised, but not removed, in order to sip water and/or eat small snacks in Convention Space as needed.

A small number of masks may be available via Convention Operations for people who need them; however, we cannot guarantee this so please do your best to procure your own.

Testing Policy

In 2024, we did not require that attendees test daily but did highly recommend that they do so. For 2025, we are again highly recommending that people test daily before entering convention space. Over the counter tests are excellent at detecting a viral load in someone who is contagious, and are currently the best way for people to determine if they need to isolate themselves.

Convention Operations may have a small number of tests available for people who need them; please do not count on this and do your best to procure your own.

Policy Exemptions

Residents of countries that do not offer updated Covid-19 vaccines to the general population may be considered exempt from the requirement to be up-to-date by United States standards as long as they have received and can show confirmation that they received the primary course of vaccinations; that is, the original shot plus the two follow up shots.

We ask that people in non-U.S. countries who are eligible to receive updated vaccines continue to do so.

Attendees who are offered exemptions to the 2025 Covid-19 policy will be required to test daily while in attendance in person at Charmed! 2025 and to send verification of their negative test result to a member of ConCom before they are allowed entrance into official con space.

Failure to follow this policy may result in that person’s badge being pulled and them no longer being able to attend Charmed! 2025 in person.

We will continue to assess the status of attendees with possible medical exemptions on a case by case basis. If you are affected by this policy, please contact us as soon as you can via email at Covid@charmedhypno.org or dm Noelle_8033 on Discord.

There are no exemptions to the masking policy.

Covid Infections & Isolation Policy

Attendees, including all staff members, volunteers, presenters, etc, will be required to report and self-isolate if they test positive for Covid-19 while attending Charmed! 2025.

For the purposes of Charmed! 2025, an attendee who is “self-isolating” will remain in their private room as much as possible and will not enter any shared hotel spaces with convention members, including but not limited to: official Convention Spaces (areas past our security check points), shared convention spaces (eg. the badge pick up area, the hallway outside of upstairs classrooms), and the Charmed! 2025 Consuite (the enclosed room outside of regular Con space that is across from the public fireplace seating area.)

ConCom reserves the right to expand this list during the Convention in order to accommodate the number of in-person attendees present at Charmed! 2025.

Out of an abundance of caution, an initial positive test result will be taken as confirmation of infection, regardless of subsequent testing.

**The identity of anyone that contracts Covid-19 while at Charmed! 2025 will be kept anonymous unless otherwise unavoidable, unless that person wishes to share their identity.

Failure to report and self-isolate will result in the infected attendee’s badge being pulled and potentially a ban from Charmed! in the future.**

Reporting & Contact Tracing Policy

Anyone becoming positive for Covid-19 while attending Charmed! 2025 will be required to report and self-isolate. They will need to identify to ConCom classes/areas where they have been, including private spaces, and ConCom will inform the attendee population that they may have been exposed to Covid-19.

**The identity of anyone that contracts Covid-19 while at Charmed! 2025 will be kept anonymous unless otherwise unavoidable, unless that person wishes to share their identity.

Failure to report and self-isolate will result in the infected attendee’s badge being pulled and potentially a ban from Charmed! in the future.**

Charmed! 2025 is committed to providing as safe an environment as possible for our attendees. This may mean that our vaccination/mask requirements are stronger/stricter than those of other events or organizations. We understand that this can be frustrating, and we appreciate your adherence to these policies that are for the benefit of every attendee at Charmed! 2025.

[jmdbjk]

Jimin's mail

I would like to take this opportunity to address the Jimin's "stolen" mail incident and perhaps dispel some misinformation circulating about it in this day and age of shouting sabotage for everything.

This whole topic might be boring to everyone, but my brain won't let go of it so here it is:

This incident occurred early 2022.

For reference: Jimin purchased his apartment at Nine One Hannam in May 2021. It was a brand new building and he is the first owner of his unit. He paid in cash approx. $4.5 million USD.

In January 2022 this apartment unit was seized temporarily by the South Korea National Health Insurance agency (NHI) due to unpaid insurance premiums.

Boring but important: South Korea provides universal healthcare which is funded several ways including citizens paying a percentage of their monthly income. These premiums also fund the Medical Aid program for those who cannot pay.

The controversy: According to the NHI, Jimin was sent four notices by registered mail of his unpaid insurance premiums. But somehow, this correspondence from the NHI never made it to Jimin. BigHit took full responsibility for this "mishandling of the mail". A portion of the BigHit statement reads:

"Regarding this matter, the company is the first to receive all mail that arrives at the artists’ dorms, and in the process of relaying it to the artist, a portion of the mail was omitted by mistake. Due to Jimin’s activities abroad starting at the end of last year, his extended period of rest, and his scheduled activities abroad after that, he was unaware of matters such as [his premiums] being overdue. As soon as he found out, he paid the arrears in full, and at present, the situation has been resolved. We apologize for the fact that we have given the artist and fans cause for concern due to our company’s negligence."

Another source stated that some mail does go directly to members' homes and is retrieved by company staff where it is included with mail sent in care of the company which is then distributed to the respective member if necessary. This corroborates with the above statement by Bighit.

In an artist/agency relationship, one of the things the agency (company) provides are staff/managers who MANAGE their day-to-day business. Managers make it so artists can lead the crazy lives they live. Makes sense as the members are too busy to take care of mundane things like paying bills.

Was REGISTERED mail taken/intercepted/stolen four times from the mail room at BigHit/HYBE? I don't have clarification on that. But seems like taking someone's registered mail would be a punishable crime.

What was going on during this time: The group was on a winter break that began early December 2021 after their activities in Los Angeles concluded. Jin, Jimin and Jungkook returned to Korea almost immediately and entered self-quarantine for ten days before they were free to do what they wanted within the scope of Covid restrictions.

Refreshing everyone's memory about Bangtan and Covid: Dec. 24: Yoongi tests positive for Covid. Dec. 25: Jin and Namjoon test positive. Jan. 30: Jimin's Covid happens simultaneously with appendicitis. Feb. 15: Tae tests positive. Mar. 24: Hobi goes down for the count. Mar. 27: last but definitely not least, JK AFTER arriving in Vegas.

The members, including Jimin, were starting to post on their individual Instagrams in December. Between Dec. 21 to Jan. 9, Jimin posted photos of himself on both Instagram and Weverse at various places from his visit to Jeju Island. We don't know about the timing of the photos, whether they were posted immediately after he snapped them or posted them days/weeks later.

He posted Jan. 7 on Instagram and then his next post, this time on Weverse, wasn't until Feb. 2, immediately following his emergency appendectomy. He was in the hospital between Jan. 30 and Feb. 5 so he posted a message from his hospital bed (sweet baby).

If he did not get his apartment back until April, then he did not know about his apartment situation while he was in the hospital.

But the NHI sent four notices. So backing up further chronologically, if they seized his apartment on January 25, that means the first overdue payment notice was possibly sent in September 2021?

Sept. 13: receiving diplomat passports.

Sept. 20: UN visit and speech in New York

Oct. 24: online PTD concert

Preparations were then focused on PTD LA. They departed Seoul for Los Angeles on November 16, 2021.

They were busy. They depended on their staff to take care of their personal business.

All that time, Jimin was not aware that there was a lapse in his insurance payments. When he was made aware of the situation, he paid it all immediately.

I have no source that states exactly when this payment was received by the NHI or when it was processed.

They left March 28, 2022 for Las Vegas and returned to Seoul on April 18. There are conflicting media stories about exactly when the apartment seizure was resolved. Some say April 22.

When he was still in Seoul and not traveling to the States, where was Jimin sleeping between January 25 and April 22? Where did he recuperate when he was released from the hospital? Where was he watching "The Notebook" for the nth time? Whose sofa was he laid up on? Hmmmmmm? Did he still have access to his apartment even though it was seized? What's the point of seizing it if he still had access to it? Did he even live there? Maybe that's why he didn't know anything about the seizure because he didn't even live there to begin with? But if he did live there and couldn't access his apartment to sleep there because it was seized, why didn't it get resolved sooner than April 22?

I have so many questions.

We also need to remember that it is said during their time in Las Vegas is when Jimin confided in the members about his challenges. And he's said that these feelings ended up being expressed in the songs on his Face album. Maybe he didn't learn about the apartment mess until he was in Las Vegas and that was the catalyst that made him spill his guts to the members. Still doesn't answer a lot of the above questions....

Media broke with the news about the apartment seizure on the day that "With You," an OST for the TV drama "Our Blues," was released, April 24. Despite all this, "With You" became the fastest song in history to reach #1 on iTunes in 100 total countries, breaking the record held by "Dynamite". It is well known that even negative publicity is publicity. Personally, I don't think it had much effect on the success of the song. But Jimin's character did take a hit. Also in my opinion, he has since recovered well from all that crap. Just me talking about this is probably reminding people that this even happened. Sorry. Just forget I said anything. Ha ha. What apartment? Ha.

Whether the timing of the media breaking the story was on purpose or coincidental... we don't know. Stating purposeful sabotage of Jimin's song is speculation. A news outlet will break a story if its titillating enough regardless of timing. Jimin losing his apartment due to unpaid bills is intriguing and high drama involving a member of BTS, of course they were going to push that story out ASAP.

If the apartment seizure was resolved 2 days before the story broke, we don't know how this information got to the media. THAT is the big question. Is there some sort of process that allows this information to be released somewhere accessible to the public (and therefore the media). If so, what is the timing of that? Or did a news media outlet learn about the incident on April 22 and hold on to the information until April 24? We don't know.

Saying the media sabotaged Jimin's OST "With You" is not the full truth. It is misinformation at this point.

With the information I know of, I do not believe there was a break-in at Jimin's apartment. I can't find a reliable source to confirm anything about a break-in, suspicions of a break-in or any mention of one. Nine One is very locked down and secure so a break-in is unlikely. You cannot waltz into the apartment complex and snoop around. Unlike Hannam The Hill, Nine One is surrounded by a high wall with security stations at the entrances. However, someone who had access to his apartment such as a personal assistant or housekeeping could very well have entered without his permission. But we don't know.

If someone was determined to intercept his mail, they may not have needed access to his apartment but only to his mailbox. Where ever that is. We are told all mail is collected by staff or it is sent directly to the company... it is possible it was a mistake but what kind of idiot was handling the mail and "misplaced" registered mail four times? I do not have a reliable source confirming anyone was formally accused of stealing the mail at BigHit. They most likely dealt with it internally. At the time of the incident, I blogged that people were fired and security protocols were reviewed. I stand by that declaration. Since then, Jimin has been unyielding in maintaining his privacy. Only very recently have we seen him relaxing enough to show us glimpses of his matching gaming chairs, ceiling and edges of his television. We even got a quick view of some decor above the tv.

I am still unclear about the doxxing but I myself disturbingly did see an image online of some documents that seemed to have Jimin's personal information on them. I think this information is included in the NHI documents that never made it to Jimin. If those images were really his information and still exist on the internet, I cannot find them. These documents would have his resident registration number on them. I am assuming it's a total pain in the ass to be issued a new one.

I do not have a reliable source confirming that a news media entity is responsible for stealing the mail and also revealing Jimin's personal information. Saying news media broke into the HYBE building during this incident is misinformation.

All of these things that can't be confirmed can only be called hearsay and speculation.

Everything I have stated here is my opinion from information I witnessed as it unfolded in real time, as well as information available if you search for it.

If you lean toward conspiracy theories regarding sabotaging of everything Jimin does you will come to certain conclusions. And if you just take things at face value without speculating beyond that then you will come to a different conclusion. We won't all agree as to what exactly went down. If I come across information that is new to me regarding what happened, I may modify my opinion depending on what the new information is.

What I've stated is all I have to go on. I have questions. But I won't say someone broke into his apartment. I won't say someone stole his mail but I am still skeptical because I have too many other collateral questions about the whole incident.

If anyone else has any confirmed information about the incident and you want to talk about it, my DMs are open, asks are open, or you can discuss in the comments of this post as long as everyone stays respectful. I would love to learn about anything else if you have links to sources with new information.

And apologies for the long ramble because my brain is constantly including details that might not be pertinent but who knows...

[dontmeantobepoliticalbut]

Last week, the Supreme Court heard oral arguments in what could end up being its most consequential abortion decision since Dobbs. In a case pitting Idaho’s extreme abortion ban against a federal law known as EMTALA—that since 1986 has required hospitals to provide emergency care—conservative justices seemed to embrace the idea that states can deny crisis medical treatment to pregnant patients, even if doing so means those patients suffer catastrophic, life-altering injuries. “My reaction can be summed up as ‘appalled,’” says Sara Rosenbaum, emerita professor at George Washington University who is one of the country’s foremost experts in health policy issues affecting women and families. “Will [the court] really say it is fine [to enforce] a law that costs women their organs as long as they don’t die?”

It’s hard to think of a piece of progressive American health care policy since the late 1970s in which Rosenbaum hasn’t played a pivotal role conceptualizing, enacting, or improving. That includes the federal statute that guarantees the right of every American to go to a hospital emergency room and receive medical treatment before being sent somewhere else. The Emergency Medical Treatment and Labor Act requires hospitals to screen and stabilize anyone who arrives at the emergency room, including women in active labor. Narrow in scope yet vast in impact, the law has been a “force field around hospital emergency departments,” Rosenbaum says, protecting pregnant patients for four decades. Now, with the Dobbs decision, SCOTUS has “blown up medical care for childbearing people,” she says—and EMTALA could be the next major health care protection that the court decides to explode.

To more fully understand the implications of the case before the Supreme Court, we reached out to Rosenbaum to discuss the history of this unique statute and why it has become even more vital since the end of Roe v Wade.

You’ve called EMTALA “revolutionary” and “the most important American health care law that we have.” Why? What makes this law so special? 

It’s the only American law we have that guarantees access to care. For everybody. It doesn’t matter who you are—whether you have insurance or don’t have insurance, what color you are, how much money you have, whether or not you’re disabled. If you come to a hospital emergency department and you believe you have an emergency, they have to screen you. If it is an emergency, they have to stabilize you. The definition of an emergency isn’t that you’re in danger of dying; it includes situations that could lead to severe, long-lasting physical harm. And the decision about what is required to stabilize you—it’s up to the doctor’s medical judgment.

I would say EMTALA is really our only universal health care law.

This law is from 1986. What was happening in the ’70s and ’80s that made EMTALA seem so necessary?

A few things were going on. Back in the early ’80s, a decision was made that the United States was spending too much on hospital care. So Congress changed the payment structure for Medicare [the single largest payer for health care services in the US] to incentivize shorter stays. Pretty soon there were stories emanating from the press about a phenomenon they called “sicker and quicker,” where patients who actually had been admitted to the hospital were getting discharged too soon, when they were still unstable.

Another major problem was that indigent people were not able to get emergency care at all. There were a lot of stories of women being sent away in labor—not just pregnant patients, although that was the story that got the most play. In those days, many fewer women were eligible for Medicaid than are today and it wasn’t as generous. Only very, very indigent women could get Medicaid coverage.

Later in the 1980s, you also helped persuade Congress to vastly expand Medicaid for pregnant women, making it a federal requirement.

There’s no question that poor people bore the brunt, but they were not the only ones. For example, one of the most famous EMTALA cases from that period involved a patient with HIV—nobody would touch him. There have been many cases of fully insured people who, for whatever reason, hospitals just chose not to treat. People who were in a drunk driving accident and were out of control, for example, or mental health patients who were disruptive. Even if the patient was well insured, if they were a handful they would get sent over to the public hospital.

Hospitals are very good at getting rid of people they don’t want. And so, while indigent people were the immediate focus, there’s nothing in EMTALA that limits it to uninsured people. That’s the important thing.

Tell me about one of your pregnancy cases from this era.

One of the cases I worked on in the mid-’70s involved a Black woman named Hattie Mae Campbell who went into premature labor at her home near Holly Springs, Mississippi. She had Medicaid, but the local hospital refused to treat Medicaid patients. The baby was coming out. And the nurse stood at the door of the hospital with her arms spread wide, blocking the entrance, refusing to let her set one foot inside, because once a patient crossed over the line, there were legal arguments to be made that the hospital had begun the admission process. So she gave birth in the parking lot.

And we know that after the birth, the staff still refused admission. They provided a sheet to wrap the baby, then they transferred Campbell and her newborn to another hospital 30 miles away. How much of a factor was racism in these situations?

Race is always a factor—a combination of racism and the fact that people of color were even more poorly insured than white people.

Were there regional differences in how patients were being treated?

There were hospitals all along the Texas-Mexico border that would dress up [security] guards as immigration officials. They would station personnel at the door so you couldn’t come in. But this was going on everywhere. Rich states, poor states, affluent communities, not-so-affluent communities, racist communities, not-such-racist communities. It was happening everywhere because [private] hospitals felt that public hospitals or community hospitals should take care of patients they didn’t want.

You should understand that hospitals were set up to accept only the patients they want. That has been tempered a bit. In the case of emergency care, they can’t do that anymore. But it hasn’t changed that much. A hospital might want me for elective surgery but not my neighbor down the street who’s a Latina who has Medicaid coverage. I mean, they have all kinds of ways to avoid patients they don’t want, right? The type of insurance they take, the doctors they give admitting privileges to, deciding what networks to be part of.

That’s why EMTALA was enacted using Medicare, which is a national program, as the stick. If you as a hospital want to participate in Medicare, and you run an emergency department, then you must do these things as a condition of participation.

Even despite all these horror stories, I still have a hard time imagining how you and other public health advocates managed to get EMTALA passed.

There was no resistance in Congress. None. A Republican Senate, a Democratic House, virtually identical language in both bills. Signed by Ronald Reagan. It really was a different era in the life of the United States.

And then what happened?

Oh, then there was huge hospital resistance. Even though hospitals were very involved in designing EMTALA, it’s a pretty heavy-duty regulation. Over the years, there’s been a lot of resistance both to the requirement that hospitals have to do an initial screening and to the requirement that they have to stabilize the patient before discharging or transferring. There have been thousands of EMTALA cases. The federal government has brought them, private individuals have brought them.

There was a lot of resistance from attending doctors as well. The very first enforcement action was a birth case out of Texas. An OB-GYN who was supposed to be on-call went duck hunting, and when the hospital got a call that a woman had presented in labor, he said, basically, “I’m not coming in for her.”

In 1989, the language of the statute was tweaked to clarify that EMTALA didn’t just apply to the pregnant person, but also to the “unborn child.” Nowadays that goes right to the “personhood” argument of abortion opponents—indeed Justice Alito invoked it during oral arguments. Why was that language necessary then and how is it different from how it is being deployed today?

Because women were still giving birth in parking lots. Women in labor were still being spurned. That language is in there because women who literally had babies coming out of them were being sent away. Everybody understood that you had two medical crises going on here, the crisis of the mother and the crisis of the baby. Everyone, apparently, except the noncompliant hospitals. The concern was not just the pregnant woman, the way it is with some of the emergencies we’re hearing about post-Dobbs, where the fetus is utterly non-viable and the focus is rightly on the pregnant woman.

So the language was clarified: The baby was also a patient. Here on Planet Earth, there are two concerns in labor and delivery, the mother and the baby.

Was there any worry that at some point in the future, anti-abortion people might point to that language and say, as Idaho and Texas are arguing now, “See, EMTALA actually means we can’t do abortions because we have to care for the unborn child”?

That really was not ever the intent. No, no, no, no. We didn’t put that language in there because we were suddenly creating embryonic fetal rights. It’s just a complete misunderstanding of EMTALA.

The pro-choice world crabbed about the language but didn’t fight it tooth and nail because everyone understood the context was labor and delivery. And they were going to lose that [battle]—no member of Congress was willing to listen to nonsense at that point about “clean up your language.” I’ve litigated abortion cases since the Hyde Amendment [the 1976 law banning the use of federal funds for abortion under most circumstances], and I was completely not troubled by that language.

Was it always understood that in some situations, EMTALA might require doctors to do emergency abortions?

This issue of abortion as an emergency procedure has been grounded in EMTALA for a long, long time. There were already cases in the early ’90s of women coming to the hospital with a terrible pregnancy emergency where an abortion had to happen. Or they’d had an abortion that failed, or an incomplete miscarriage that needed an abortion procedure. So this issue [of whether EMTALA requires hospitals to perform emergency abortions] is not new. What’s new is Dobbs. What’s new is what the Supreme Court unleashed when it overturned Roe v Wade.

Pregnancy-related complications that might lead to emergency abortions—for example, when the embryo implants in the fallopian tube instead of the uterus, or when a woman’s water breaks too early for the fetus to survive—are a lot more common than many people realize. But pregnant people end up in the emergency room for all kinds of other reasons, too.

Pregnant people are frequent users of emergency departments. About one in 500 pregnancies goes to an emergency department at some point. Most of the attention has rightly been placed on emergencies where something terrible has happened to the pregnancy itself. But there’s a whole other group of emergencies that aren’t pregnancy-related—it could be appendicitis, it could be a car accident, it could be domestic abuse, it could be COVID.

The tendency when somebody is pregnant is to send them to the emergency department right away because you don’t want to take any chances. And sometimes in these situations, you need anesthesia, you need surgery. Sometimes, unfortunately, as a consequence of treatment you may have a demise. What Idaho has done is to make every pregnant person coming to an emergency department radioactive.

As someone who has spent your whole career steeped in health policy and health law, did you see this moment coming? When hospitals turn away pregnant patients with life-threatening emergencies? When a law as important as EMTALA seems on the verge of being gutted?

It was very evident, from the moment that the Dobbs decision was leaked, that there was just a total, fundamental clash between what states like Idaho with these terrible abortion bans thought they had the license to do and what EMTALA required.

When the Dobbs decision finally came down, my daughter called, incredibly upset. All of her friends were incredibly upset. I said, “Here’s my one piece of advice. You have friends all over the country. The ones who live in any one of the states that are going to impose a complete ban, tell them that they must not get pregnant. And if they do want to be pregnant, they must move away. Because a lot of things can go wrong in a pregnancy, and if anything goes wrong, they’re not going to be able to get emergency care.”

The other thing that I realized right away is that it would be impossible for doctors to practice in these places, and there would be a huge exodus of providers. And in Idaho that has happened. So people like me, who are steeped in health policy, understood immediately what was coming. But where we are now is worse than I could have even imagined it was going to be.

[dee-the-red-witch]

The Monthly Roundup

Okay, normally, this is just a free monthly post over on my Patreon, but I figured I should push this out into the wild as well, because this kind of stuff's always needed. Want this, and a bunch of weekly readings from a cursed tarot deck, media reviews, and other content including fiction and the occasional build post? Maybe consider adding me over there as well. Anyways, like I said, it's a monthly roundup- in this case a bigass collection of links and resources for folks interested in pursuing gender transition one way or another. And while a bunch of it is transfem specific and sometimes medical transition specific, because it's stuff I dug up while hunting down things for myself, there's also things in there good for anyone of any gender, and resources for legal/social transition as well. And this is long enough to deserve a cut for once, so...

Hey! What If *I'M* trans?

The Gender Dysphoria Bible- https://genderdysphoria.fyi/en Wondering if you're experiencing Gender Dysphoria? This may be a good place to start. Realize the GDB is slanted largely towards transfem folks, so it doesn't necessarily apply evenly to everyone, but it does cover a lot of ground that folks may identify with.

Trans Medical Resources

DIY HRT- https://diyhrt.cafe/index.php/Main_Page (for legal reasons, I'm going to tell you to at least try to see a licensed physician or endocrinologist before starting to DIY your own hormones, but keep in mind, I'm not your responsible adult, and if you don't choose to listen, that's on you) This is the main, best hub for sourcing and getting info on doing your own hormone therapy. Keep in mind, it's once again slanted towards feminizing methods, because testosterone is still a controlled substance in most of the world (which is bloody fucking stupid, but that's a rant for another time).

GALAP- The Gender Affirming Letter Access Project- https://thegalap.org/ While we may have new WPATH guidelines with the Soc 8 updates that dropped a little bit ago, most providers and insurers are still on outdated requirements that insist on letters from mental health providers for transgender-related care. Which can affect access to surgeries, HRT, and more. GALAP exists to connect folks with providers who'll give those letters,m in some cases free of charge even.

Gynecologist List- https://docs.google.com/spreadsheets/d/1Djia_WkrVO3S4jKn6odNwQk7pOcpcL4x00FMNekrb7Q/htmlview This one's more for uterus-owners in general and less trans-specific, but giventhe number of folks with uteri who'd can end up with a hard time finding a willing doctor for some procedures, it's important for everyone. This is a Google database of hundreds of gynecologists, listed by location, willing to perform sterilization procedures with informed consent, without secondary authorization from anyone else. The list is patient-vetted, so your mileage may vary, but for those seeking sterilization and/or hysterectomies as part of their transition it may prove to be invaluable as a resource, because doctors willing to do this work can be few and rare in some areas.

Transfeminine Science- https://transfemscience.org/ Articles, journals and all sorts of researching into, well, just what the name says, transfeminizing science. A lot of medical professionals simply don't have knowledge in the field and are acting on what they learned in med school, which may be way out of date. If they're willing to listen, there's stuff in there to help bring them up to speed. Better yet, it;'s also a great resource to educate yourself so you can advocate for your own care a bit better.

Other Transition resources (legal, social, etc)

NCTE's ID GUIDE- https://transequality.org/documents The National Transgender Center for Equality's guide to changing your legal identity, in a handy format that lets you break it down by state or territory, or even federal documents (United States only, sorry.) and links to the right paperwork to use. Rainbow Passage- https://rainbowpassage.org/ It sucks that we need organizations like this in these times, but I'm glad to see there's people already stepping up to the task. Rainbow Passage is an organization dedicated to helping trans youth get out of trans-hostile states and relocate to safer areas. And if you can, volunteering for them is a great way to help improve safety for trans folk in general.

Seattle Voice Lab- https://www.seattlevoicelab.com/ if you've seen me on social media much lately, then you've seen me talking about this place. This is who I'm (through February and March at least) taking voice lessons through to feminize my own voice more. They also have a bunch of online resources, a discord server, and other help if you need to figure your own vocal chords out a bit better.

Strands For Trans- https://strandsfortrans.org/ Need a haircut, or color or other beauty services you're using for the first time ever as an out trans person and you're not sure where's going to be safe to go? Strands For Trans is the first comprehensive database of Aesthetics businesses for hair and everything, AND THEY VET THE BUSINESSES, to ensure your safety and comfort.

TLC's Life-Planning Guide- http://transgenderlawcenter.org/wp-content/uploads/2020/04/TLC_Life-Planning-Documents-Transgender.pdf The Transgender Law Center put this guide together specifically for planning end-of-life details. Yes, it's a depressing and tragic thing, but protecting and making sure our identities are still properly preserved after we die is still just as an important part of what we're fighting as anything else is. This guide will help you with establishing a Living Will, controlling hospital visits, and setting up proper Powers of Attorney, so that nothing potentially falls back into the hands of people who might refuse to recognize who you truly are. (In many states, you can designate someone other than your next of kin to take charge of your body when you die (next of kin is defined by law, not by preference). If you need to do that, go to nolo.com and look up article on "[your state] funeral law" to get a rundown on if and how to do this.

Trans Media

The Digital Transgender Archive- https://www.digitaltransgenderarchive.net "The purpose of the Digital Transgender Archive (DTA) is to increase the accessibility of transgender history by providing an online hub for digitized historical materials, born-digital materials, and information on archival holdings throughout the world." (In short, this is one of several free libraries of trans history.)

Totally Trans- https://www.patreon.com/totallytrans/posts Hey, look at that, it's another Patreon! Except, no, wait, it's a podcast! Totally Trans looks at media both historical and modern with a transgendered lens. Sometimes it's silly fun, other times, it's great insights into queer and trans history, and all around it's a great show to add on whatever service you're already getting podcasts through- or you can hit the link above to help support them at the same time for early access.

Trans News, Blogs, and Notes

Erin In The Morning: https://www.erininthemorning.com/ Erin's newsletter runs almost daily these days, mostly with updates regarding trans legislation all around the US. It's a good way to stay up to date, but it can also be a drag these days, largely because it's practically just a constantly expanding list of bad news thanks to the GOP right now.

Stained Glass Woman: https://stainedglasswoman.substack.com/ aka Doc Impossible/Zoe. I first discovered her work and writing when WPATH released their new SOC 8 guidelines, because she was one of the few people that could make the thing actually make sense in non-legalese. But I subscribed andkeep following here for regular updates both because she presents a trans coming out narrative that was just a joy to read, and also covers interesting  news in the field of trans medicine from time to time. Definitely worth adding to your feed.

A Self Defense Study Guide for Trans Women and Gender Non-Conforming / Nonbinary AMAB Folks: https://www.silversprocket.net/2021/09/13/a-self-defense-study-guide-for-trans-women-and-gender-non-conforming-nonbinary-amab-folks/

This is, quite honestly, one of the best self-defense guides I've seen for gender-nonconforming folks (and one of the few, to be honest), short of private defense instruction. AND it's available to read in full for free at that link, or in print for just a 5$ donation. Go check it out.

Other general roundups

Grassroots GAC Resources- https://docs.google.com/spreadsheets/d/19kSzBLo_hjpiBjHN8tvK73sVHU25NKWjMau2vNl8uuM/edit#gid=778305468 Google spreadsheet of links in general, from therapy help and hrt assistance, to all sorts of other info, some of which are repeats from here, but there's also a bunch of others I haven't had time or opportunity to vet yet.

[generallemarc]

What's actually in the Ukraine bill-a breakdown

Military Assistance

Military Personnel(no, this does not mean troops are being deployed) to respond to the situation in Ukraine and for related expenses: $238,190,000, subdivided into

Army: $207,158,000

Marine Corps:$3,538,000

Air Force: $23, 302,000

Space Force: $4,192,000

This is literally what it sounds like: paying for people to do things, as opposed to the next item...

Operations and Maintenance: $34,243,729,000, subdivided into

Army:$4,877,581,000

Navy:$976,405,000

Marine Corps$69(nice),045,000

Air Force: $371,475,000

Space Force:$8,443,000

Defense-wide(bolded for being important): $27,930,780,000. Of this, $13,772,460,000 is directly for aid to Ukraine, and $13, 414,432,000 is for replacement and reimbursement for both physical aid and service aid(ie training) given to Ukraine. In other words, only the first half is actually going to Ukraine(mostly in the form of physical things like vehicles, guns, ammo and equipment and not just money) while the second half never leaves America.

Procurement:$13,276,910,000, subdivided into

Missile Procurement, Army:$2,742,757,000

Ammunition Procurement, Army:$5,612,900,000,

Other Procurement, Army: $308,991,000

Weapons Procurement, Navy:$706,976,000

Other Procurement, Navy:$26,000,000

Marine Corps:$212,443,000,

Missile Procurement, Air Force:$366,001,000

Other Procurement, Air Force:$3,284,072,000

Defense-wide:$46,780,000,

Research Programs

Research and Development:$633,387,000, subdivided into

Army:$18,594,000

Navy:$13,825,000

Air Force:$406,834,000

Defense-wide:$194,125,000

Other Military Aid

Office of the Inspector General(this is funds for oversight): $8,00,000.

Related Agencies

Intelligence Community Management Account:$2,00,000

Energy Programs

Science for the production of medical, stable, and radioactive isotopes(no idea why this is here): $98,000,000

Atomic Energy Defense Activities

Defense Nuclear Nonproliferation for etc etc:$143,915,000

Federal Salaries and Expenses for etc etc: $5,540,000

Health and Human Services

Refugee and Entrant Assistance: $481,000,000. This provision specifically allows the relevant agencies to use this money for grants or contracts with nonprofits, which imo means it's likely that most of this will go towards aiding Ukrainian refugees in Europe, and thus that this isn't just money for moving Ukrainians to America.

Department of State

Diplomatic Programs to respond to the situation in Ukraine and countries affected by said situation: $60,000,000

United States Agency for International Development

USAID operating expenses appropriated to the President for response to etc etc: $39,000,000

USAID Office of Inspector General: $10,000,000

Bilateral Economic Assistance

Transition Initiatives(meaning transition to democracy): $25,000,000

Economic Support Fund(for Ukraine's government): $7,899,000,000. A provision states that none of this money may be used for pensions(as an anti-corruption measure) and that at least $50,000,000 of this amount must be used to respond to food insecurity caused by the war.

Assistance for Europe, Eurasia, and Central Asia(for Ukraine's private sector):$1,575,000,000

International Security Assistance

International Narcotics Control and Law Enforcement(for Ukraine and other countries affected by the invasion):$300,000,000

Nonproliferation, Antiterrorism, Demining and Related Programs(for Ukraine and other countries affected by the invasion): $100,000,000

Foreign Military Financing Program(for Ukraine and other countries affected by the invasion): $1,600,000,000

Some of the more impactful general provisions of the act:

The transfer of long-range ATACMS to Ukraine was required by the act, and that appears to have already happened. The President was given the option to not do so if he determined it would be detrimental to America's national security interests, but it appears he didn't.

The Secretary of State was directed to insure as much in-person monitoring as possible for funds appropriated for Economic Support, Assistance for Europe, Eurasia and Central Asia, International Narcotics Control and Law Enforcement, and Nonproliferation, Anti-terrorism, Demining and Related Programs

The amount of money spent out of the total amounts budgeted for Economic Support and Assistance for etc etc may not exceed half the total amount of funds given by all donors to Ukraine. This basically means that, in terms of economic assistance, Europe has to do at least as much spending as we do.

The two headings for economic assistance mentioned above(totaling to $9,474,000,000) are loans that the President may only forgive in the following circumstances: up to 50% of the debts incurred by these loans may be cancelled by the President at any time after November 15th, 2024, while the remaining 50% may be cancelled at any time after January 1st, 2026. Both cancellations would be subject to Congressional approval.

[sukimas]

Kela (in total, not just college; Finland's social security program) costs ~16.9 billion euros per year. Finland has ~5.6 million people. Therefore, Kela costs about 3015 euro (or 3285 dollars) per person. A United States equivalent of Kela (properly managed) would cost 1.09 trillion dollars per year.

The total cost of the US Social Security program for the year 2021 was $1.145 trillion or about 5 percent of U.S. GDP.

Even assuming scaling administration costs, US Social Security provides nowhere near the number and amount of benefits Kela does. There is no reason that its cost should be 105% of what Kela's is (scaled for size).

The United States isn't impossible to make into a welfare state because the money is not available. The United States is impossible to make into a welfare state because its administration should be the laughingstock of the world for how poorly it is managed and run. We can only manage to stop paying more for less if we actually realize this and start taking steps to reduce the administrative bloat that is present in all of our institutions, from the local high school to the Federal Reserve.

A better world is possible! Know this: it is only so if you know the causes of this world's failures, instead of shadowboxing against Elon Musk. Billionaires should not exist- but neither should a Social Security system that costs 105% the price of one that also provides health insurance and university. This isn't just from employee number scaling, either- the Social Security Administration of the US has 60,000 employees. Kela has 6,000. The US has a population 59.3x the size of Finland, with a social security administration only 10x larger. By all accounts, Kela should cost more per head!

The United States is not a "failed state"- that means something very different- but the things it has achieved in the past (interstate highway system, post office, incredible freight rail, scientific innovations) are not achievable now. Institutions drag their feet and chase ghosts instead of looking to their more successful contemporaries. The US is not a failed state, but it is certainly a failure of a state.

I'll leave the post on this anecdote: The Washington DC Metro's Silver Line- connecting the capital of the nation to the international airport regularly used by the President of the United States, and arguably the singular piece of publicly funded infrastructure of most import to Congress- received a funding contract for line completion in 2014. The line was scheduled to open in 2018.

In actuality, the line opened in November of 2022.

[withaharmonica]

Marriage Equality for Most

Marriage in the United States is inconsistent. In 45 states adults can marry minors, same-sex marriage only became federally protected two years ago, and unlike every other couple, couples on Supplemental Security Income (SSI) receive no financial benefit. A recent opinion article in WaPo “Marriage has a monopoly on legal benefits. It shouldn’t.” by Rhaina Cohen, asserts that marriage is the only way to have a relationship be recognized as important and deserving of any protections and benefits if the people are not relatives. This is true, unless you are an SSI recipient, and you lose your benefits after marriage.

Marriage calls for vulnerability, so why are our most vulnerable not getting married? Those under 65 years-old who receive SSI are one of the most vulnerable populations: people with disabilities who have little to no income or assets. People on SSI get married less, and get divorced more, than people who do not receive SSI. This is not for a lack of love or desire, but for the penalties people on SSI receive when they get married.

To receive SSI because you have a disability is to have your income and assets restricted. The maximum, which has not been updated in 35 years, you would get is $943 a month and you cannot have more than $2000 in assets. If an SSI recipient has an increase to their income or assets, they will either lose some or all their SSI and no longer have insurance. If both people in a marriage are on SSI, they will lose 25% of their income and assets. The maliciously naïve thinking is that there are shared costs, like living expenses, when you are married means you do not need as much to survive. The outdated limits the Social Security Administration (SSA) has on the people with disabilities who receive SSI restrict most opportunities to make their lives better. The SSA want to limit their spending regardless of the pain it causes those who will suffer without SSI. It is hard to get on SSI, and it is far too easy to lose. Qualifying for SSI automatically qualifies a person for Medicaid, tying their insurance coverage to their source of income.

When I consider marriage, I imagine a couple so in love getting a happily ever after. When people on SSI consider marriage, they think about if they will be able to afford to lose their benefits, if they can live with their spouse and have health insurance. There are too many stories of people with disabilities being so in love, getting married, losing their benefits, and then while still being so in love, needing to get divorced because without health insurance they will suffer and/or die.

Other couples are holding out on marriage, waiting for the day that the U.S will recognize the cruelty of the SSI limits. This is at the expense of the legal protections’ spouses have. A person with a disability is more likely to need medical care, and in an emergency, of course they want their loved one with them. Those who hold out on marriage risk not being allowed to help make medical decisions in an emergency, or even to visit their partner in critical condition since they would not be family. Inconsistent once more, holding out for marriage does not guarantee keeping SSI status. Regardless of state laws about common-law-marriage, if someone on SSI lives with their partner who contributes household income, they can lose their insurance and income.

To be clear, people who receive SSI are stuck in poverty limbo. They cannot acquire wealth beyond $2,000 in assets, and when they are married no more than $3000. The monthly stipend has not been updated in 35 years and has not been adjusted to the cost of living. At its inception, a quarter of SSI was spent on rent, and 5 years ago 83% went towards rent. To have a part-time job to supplement their supplemental income to cover their living expenses would cost them their SSI and their health insurance. Love can overcome many things, but can it overcome the hardship of losing your only means of survival?

Congressman Jimmy Panetta (D-CA) introduced the Marriage Equality for Disabled Adults Act, a bill aimed to secure the equal right to marry for people with disabilities. Dying in committee last year, this is the second time this bill has been introduced. With the current state of the country, it is ripe to die again. However, if passed, over 7.5 million Americans would no longer be forced to choose between their income and health, and their loves. Congress and the SSA need to update SSI to ensure that all adult Americans can get married without penalty. Most is not enough; the United States needs marriage equality for all.

[reasoningdaily]

‘We’re hemorrhaging money’: US health clinics try to stay open after unprecedented cyberattack

For more than two weeks, a cyberattack has disrupted business at health care providers across the United States, forcing small clinics to scramble to stay in business and exposing the fragility of the billing system that underpins American health care.

“We’re hemorrhaging money,” said Catherine Reinheimer, practice manager at the Foot and Ankle Specialty Center in the suburbs of Philadelphia. “This will probably be the last week that we can keep everybody on full-time without having to do something,” she told CNN. The center is considering taking out a loan to keep the lights on.

The cyberattack disrupted the computer networks of Change Healthcare, which serves thousands of hospitals, insurers and pharmacies nationwide. It prevented some insurance payments on prescription drugs from processing, leaving many care providers footing the bill up front and hoping to get reimbursed.

Change Healthcare, part of UnitedHealth, is one of handful of companies that make up the central nervous system of the US health care market. Its services allow doctors to look up patients’ insurance, pharmacies to process prescriptions, and health clinics to submit claims so they can get paid.

Health care groups have pleaded with the Department of Health and Human Services (HHS) to offer medical practices a financial lifeline. The department on Tuesday said it was taking extraordinary steps to help get claims processed, but some care providers say it’s not nearly enough.

Mel Davies, chief financial officer of Oregon Oncology Specialists, told CNN she is worried that the private clinic that treats 16,000 cancer patients annually could be forced to close if she doesn’t get financial relief soon.

Cash flow has dropped by 50% in the two weeks since the cyberattack, she said. “The magnitude of this is off the charts for us.”

On Thursday night, half a month since the saga began, Change Healthcare announced plans to have its electronic payment platform back online by March 15 and its network for submitting claims restored the following week.

But the financial wreckage caused by the cyberattack will take a lot longer to clean up, health providers and analysts say.

“The prospect of a month or more without a restored Change Healthcare claims system emphasizes the critical need for economic assistance to physicians, including advancing funds to financially stressed medical practices,” Jesse Ehrenfeld, president of the American Medical Association, said in a statement Friday.

Reinheimer, who works at the foot treatment center, said Change Healthcare’s plan to bringing systems back online was a “light at the end of the tunnel … However, it doesn’t solve the immediate issue, which is lack of money today, tomorrow and next week.”

The chaos caused by the cyberattack is prompting a reckoning for senior US cybersecurity officials about the vulnerabilities in hugely important companies that underpin the health care system.

The Change Healthcare hack “is an evolution beyond” other ransomware attacks on individual hospitals “that shows the entire system is a house of cards,” a senior US cybersecurity official told CNN.

Health care executives have been sounding the alarm for several days that the cyberattack is causing severe financial strain on the sector.

The Medical Group Management Association, which represents 15,000 medical practices, has warned of the “devastating” financial fallout from the hack and of “significant cash flow problems” facing doctors. The ransomware attack has “had a severe ongoing impact on cancer practices and their patients,” the nonprofit Community Oncology Alliance said this week.

A week ago, Change Healthcare announced plans for a temporary loan program to get money flowing to health care providers affected by the outage.

But Richard Pollack, head of the American Hospital Association representing thousands of hospitals nationwide, slammed the proposal as “not even a Band-Aid on the payment problems.”

The cyberattack could end up costing Change Healthcare billions of dollars in lost revenue and clients, said Carter Groome, chief executive of cybersecurity firm First Health Advisory.

“This is a huge, huge moneymaker being essentially the middleman or the intermediary between the insurance companies,” Groome told CNN.

Change Healthcare has blamed the hack on a multinational ransomware gang called ALPHV or BlackCat that the Justice Department says has been responsible for ransomware attacks on victims around the world.

A hacker affiliated with ALPHV this week claimed that the company had paid a $22 million ransom to try to recover data stolen in the hack. Tyler Mason, a spokesperson for Change Healthcare, declined to comment when asked if the company had paid off the hackers.

Private experts who track cryptocurrency payments said the hacking group had received a $22 million payment, but it was unclear who made the payment. “A cryptocurrency account associated with ALPHV received a $22 million payment [on March 1],” Ari Redbord, global head of policy at blockchain-tracing firm TRM Labs, told CNN.

For Joshua Corman, a cybersecurity expert who has focused on the health sector for years, the Change Healthcare cyberattack is clear evidence that the US health sector is not as resilient as it needs to be in a crisis.

Acquisitions that have merged multibillion-dollar healthcare companies have accentuated the problem so that “a single point of failure can have outsized, cascading reach and consequences,” said Corman, who helped lead a federal taskforce to protect coronavirus research from hacking.

If federal officials “don’t identify the systemically important entities proactively, our adversaries will continue to do it for us … while we burn,” he told CNN.

[intheholler]

Appalachia & Southeastern USA LGBTQ+ Resource Masterpost

Under the cut, you'll find queer-focused resources sorted by state.

I have a sister post with donation links for those outside of the region who'd like to help us grow.

If you aren't from the region, I encourage you to find the organization that speaks to you the most, put your money where your mouth is and help us be better.

If you are from the region, I sincerely hope this can help you or someone you know in some way.

This list is inexhaustive as Tumblr is only permitting 100 links (which is also what necessitates the sister post and is why you may not see your contribution unfortunately).

Disclaimer: I do not (necessarily) personally endorse these organizations, nor have I vetted them thoroughly. If I have included anything you know to be detrimental or harmful in any way, please DM immediately me so I can rectify it.

General Regional Resources

Appalachian Outreach organizes events and provides access to resources for the queer community all across Appalachia.

STAY (Central Appalachia) is a youth-led activist organization in central Appalachia.

Trans in the South is a directory for gender-affirming healthcare in the south.

Southerners on New Ground (SONG) is a queer liberation group funding projects, protests, and campaigns to build a queer-friendly south.

Southern Trans Youth Emergency Project (STYEP) connects trans youth affected by anti-trans legislation with gender-affirming healthcare providers in the southeast; they offer grants up to $500 to individuals for emergency support.

Trans Health Project helps trans folks understand, access and utilize their medical insurance. They provide grants for gender-affirming surgeries.

Campaign for Southern Equality provides funding, training and resources for/to queer individuals and activists.

Not region specific, but important all the same: Help suspected transgender John and Jane Does regain their identities.

Resources by State

Alabama

AIDS Alabama helps provide housing to vulnerable individual and families, including helping queer youth find housing.

ALTGO’s list of local resources for gender-affirming care, legal services and generally queer-friendly physical/mental healthcare.

The Knights & Orchids Society provides housing, healthcare, and general support to the Black queer community.

Based in Birmingham, Magic City Acceptance Center offers supportive safe spaces and direct support to 52 counties in Alabama.

Medical Advocacy and Outreach in southern Alabama provides HIV+ care, as well as HIV & hepatitis C testing.

Prism United funds free therapy and hosts gatherings for queer individuals along the Gulf Coast.

Shoals Diversity Center is a Florence-based group that offers mental health services, support groups and other resources for the queer community in the Shoals area.

T.A.K.E. Resource Center provides direct support, grants, housing advocacy and other services for trans women of color in Alabama.

Thrive Alabama facilitates access to queer-focused healthcare services in North Alabama.

Georgia

Carollton Rainbow organizes queer-focused social events in West Georgia and provides tools for advocacy in the community.

Emmaus House is a soup kitchen in Savannah also providing laundry and shower facilities.

Emory is an Atlanta-based, queer-focused law firm.

Feminist Women’s Health Center (I know the name isn’t necessarily ideal, sorry) in Atlanta offers trans-inclusive, affordable medical care. They also provide access to abortions.

First City Network in Savannah provides referral services for healthcare, advocacy, education and mutual aid for queer Georgians.

List of housing assistance in the Savannah area

Stonewall Bar Association of Georgia serves the queer community’s legal needs in Georgia.

Kentucky

AIDS Volunteers of Lexington (AVOL) provides housing and assistance to low-income people living with HIV/AIDS.

Arbor Youth Services provides emergency shelter to queer youth in Louisville, up to age 24.

Berea Human Rights Commission offers free investigations into claims of housing or employment discrimination with a focus on queer folks.

Kentucky Health Justice Network provides referrals to gender-affirming providers, as well as financial assistance for trans healthcare and abortions.

Kentucky Youth Law Project provides free representation to queer youth.

Massive Kentuckian LGBTQ resource list provided by Lexington Pride Center, broken down into easy-to-browse categories.

Louisville Youth Group strives to give queer youth the tools and skills they need to grow personally and facilitate positive change in their communities.

Sweet Evening Breeze helps queer young adults in Kentucky between the ages of 18-24 obtain emergency housing.

Trans Kentucky’s list of gender-affirming healthcare providers across the state

Guide on changing your name following gender-affirming surgeries in Kentucky, and a tool to help you do so.

Louisiana

AcadianaCares supports folks living with HIV/AIDS while providing support to houseless and impoverished individuals.

ACLU Louisiana website.

Community resources in New Orleans, Baton Rouge and Lafayette (much of it only provides addresses and emails, so it’s hard to link individually here).

Directory of trans-focused healthcare providers

List of in-person and online queer support groups. In-person groups are based in Monroe, Lafayette and Baton Rouge.

Mutual aid in Shreveport

Out of the Closet provides clothing for the queer community with multiple locations throughout the state.

OUTnorthla is a queer film-festival hosted by PACE Louisiana.

Queer-forward healthcare in Louisiana.

QUEERPORT is a grassroots org offering a platform for queer creatives.

Tulane Drop-In Clinic provides free medical and social services to runaway and otherwise houseless youth.

Guides for legal name changes in Louisiana.

Mississippi

Capital City Pride hosts pride events, meet-ups and book clubs for the queer community around Jackson.

Gulf Coast Equality hosts drag shows, food drives and other events for the Gulf Coast area.

The Spectrum Center in Hattiesburg offers a community closet, short-term emergency housing, free HIV testing and scheduled support groups/events for the queer community in Hattiesburg.

Violet Valley Bookstore is a queer feminist bookshop owned by a published lesbian author in Water Valley.

Guide for name changes in Mississippi.

North Carolina

Charlotte Transgender Healthcare Group (CTHCG) connects trans folks with gender-affirming care.

Down Home NC helps rural working class communities organize to advocate for their rights.

Guilford Green Foundation & LGBTQ Center provides financial support to queer nonprofits and activist groups in NC to fight anti-queer legislation.

Ladies of the T is provides resources and support to trans and gender non-conforming women of color in the Tri-City area. .

North Carolina Gay and Lesbian Attorneys (NCPMB) provides attorney referrals, visibility, and support for the queer community.

Pitt County Aids Service Organization (PICASO) provides HIV prevention and testing services in Eastern NC, as well as support for individuals living with HIV/AIDS.

Asheville-based Tranzmission’s compilation of trans-focused medical, social and legal resources in WNC.

Triad Health Project provides free HIV testing, contraceptives, prevention outreach, daycare and access to their food pantry in Guilford County.

Durham-based Triangle Empowerment Center provides the queer community with emergency housing, access to PrEP, as well as support groups and other events.

South Carolina

Harriet Hancock Center is a community center offering social support for queer individuals in the Midlands area.

Free gender-affirming gear to South Carolinians!!!

Alliance for Full Acceptance (AFFA), a queer-focused social justice group

List of queer-friendly medical providers across the state

Uplift Outreach provides safe spaces for queer youth in Spartanburg.

Charleston Black Pride serves the queer POC community in the low country area.

We are Family Charleston’s community center hosts support groups and provides direct support to the queer community around Charleston. They offer microgrants to trans individuals in the state as well as in-person support groups and aforementioned free stuff for trans folks.

Closet Case is a thrift store by and for queer individuals, operated by We Are family, offering safe and affordable clothes shopping.

T-Time holds support groups for trans individuals, based in Myrtle Beach.

Palmetto Community Care provides confidential HIV testing and support as well as free contraceptives.

South Carolina based community support network for the trans community

Legal assistance in Columbia, SC/Midlands area

Guide on changing your name in South Carolina

List of queer-safe, gender-affirming care providers in Columbia, SC

Tennessee

CHOICES provides low-cost LGBTQ healthcare, among other services, such as abortions.

Emergency housing in Tennessee for those living with AIDS

Launch Pad helps queer youth among others obtain emergency shelter in the Nashville area.

Metamorphosis provides transitional housing and other emergency support for queer youth between 18 - 24.

Mountain Access Brigade provides abortion funding across the state.

My Sistah’s House in Memphis provides emergency housing and support for queer people of color, as well as access to health services for sex workers.

The Seed Theatre in Chattanooga provides free resources such as binders for the trans community and hosts safe, social spaces.

Tennessee HIV Prevention & Care

Trans Empowerment Project provides support to trans and gender-nonconforming folks around Knoxville.

Youth Villages provides emergency housing for youth under 18.

List of trans-focused healthcare providers across the state.

Virginia

Counseling, free hygiene products, temporary housing and more provided by Side by Side VA

Virginia Home for Boys and Girls partners with Pride Place to provide temporary housing for queer young adults (18-25).

Side by Side VA provides temporary housing for queer youth for up to 6 months.

Nationz, based in Henrico, provides free STI/HIV testing, food pantry, PrEP, and notary services for the queer community.

Justice 4 All provides legal aid for low-income Virginians.

Virginia Rural health Association’s list of gender-affirming healthcare providers

General rural healthcare resources in Virginia

West Virginia

Dr. Rainbow connects folks with queer-friendly care in the state.

Fairness West Virginia’s list of gender-affirming care providers.

Harmony House West Virginia provides queer-friendly shelter for houseless people.

Holler Health Justice is a queer- and POC-led mutual aid organization based in WV, though they seem open to serving all Appalachians.

Holler Health Justice also provides financial/logistic support to West Virginians seeking abortions.

WVFREE connects West Virginians with birth control providers.

Nearby gender-affirming care for trans youth at the Cincinnati Children’s Hospital Transgender Health Center.

[lacangri21]

Op got me blocked for some damn reason but this is important so I’m putting it on my blog for me.

I'm actually quite disgusted by the current Disk

Horse that feminists cause the "no drag shows"

bill in Tennessee.

In the US in the last few years, women have lost

the right to an abortion, the Supreme Court

decreed birth control isn't real health care that

government can force insurance companies to

cover, every girl and her sister is joking about

starting an OnlyFans when they turn 18, women

faced massive losses in the workforce with

Covid 19 school and daycare closures, every

misogynist with a microphone is making money

telling men how to be better at negging women,

and a woman who was abused during her

marriage was made a public laughingstock for

months and now everytime a rape victim

comes forward the conversation turns to "she's

a fucking liar and deserves to be in prison for

ruining a beautiful man's life."

And you think feminists caused drag shows to

be banned. In a conservative state.

Ok.

Point me to even One Single Radical Feminist

on the Tennessee legislature. Point me to a

single radical feminist who's on a board of

education in the entire state. Show me a radical

feminist Governor, or Judge. Point me to a

single radical feminist in the entirety of US

congress, maybe you'll find one there, but I

doubt it.

I'm sorry but a tweet is not power. Having an

Instagram account is not legislative power.

Having a small tumblr circle of mutuals is not

power. Show me a radical feminist in power,

who has the ability to influence a bill in the

United States. I want to see her. I want you to

show me this radical feminist woman in the

United States who's drafting and passing these

bills.

I stand firm on this post. Radical feminists do

not have the power you ascribe to them. This is

the work of conservatives.

[genderqueerdykes]

hey i got kicked out and i think I'm gonna be ok in terms of where I'm staying for the next week or so but i don't have access to a phone and i wont until i get back to my house (hopefully after this week) any idea what i should do

oh my goodness, i'm so sorry for not seeing this sooner, i hope you're doing okay so far

i am so sorry to hear that, i have been kicked out before and it's scary regardless of the reason. it depends on how old you are, and what kinds of resources you have nearby and what kind of situation you're in right now- even if you're staying with friends, you are able to access homeless resources in your area because sleeping on friends' couches is considered homelessness. you may want to contact a shelter in your area if you can. if you are a minor, sometimes there are shelters and homelessness programs specifically for youths, especially queer youth. Casa Q provides services like that in Albuquerque, for example

shelter, food, and a place to use the restroom are your priorities, so if you have those covered, you can work on getting the rest of your support network established. i understand if you're not able to get a job, however, finding a way to get some type of income will be crucial as it can be hard to couch surf for long. most folks aren't very patient when it comes to a friend or roommate that can't pay rent. not saying that to be mean, it's the truth unfortunately

try to figure out independent transportation if you do not have a car right now- see if there are busses, trains, metro stations, etc. near where you are and see if you are able to get around independently. Uber and Lyft are a options but they get pricy.

public libraries have free computers you can use as well as wifi, and often times have a lot of resources for local programs and centers in your area that might be able to help you. either way it's internet access and a way to charge your phone/devices if you need it.

if you are mentally ill, i suggest trying to look into getting a case/social worker if you don't have one, they can help you navigate the more overwhelming parts of life. those can be accessed through mental health services like therapy and medication management. if you do not have any form of insurance, check to see if medicaid is available where you are(if you're in the united states), and if not, look for other low income insurance, sometimes medical services can be very broad, and life saving.

try to not weigh yourself down by carrying around a bunch of stuff you don't truly need. it sucks to get rid of your stuff but weighing yourself down and having to pay a bunch to store and move a ton of possessions will work against you. figure out what the most important items are and stick to those for the time being. you can pay for a storage unit but if you don't have a car you'll have to pay for movers and these things can add up quick

if you are having a mental health crisis right now (which I would not blame you for), you have the option of attempting to stay at a crisis center or psychiatric hospital, which can give you 3+ days in a bed with prepared meals and medications. you can also gain access to resources in the community this way, as they have social workers.

transgender, queer & LGBTQ resource centers often have programs for homeless queer people and queer people struggling with housing, or at the very least can help direct you to some programs that might be able to help you figure out what to do

keep your friends and anyone else who is there for you up to date on what's happening and where you are, as well. keeping tabs with people is super important right now

if i can think of anything else, i'll let you know- i really hope you are doing okay. stay safe out there. it is very hard to navigate the world when your housing is unstable. hope you will be alright

[claxonmedicalcodinginstitute]

Best Medical Coding Training Institute in Hyderabad

Medical Coding is a standard operative procedure documented in a coded format it is coded with 3 standard books which include standard procedure guidelines called medical coding.

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Medical coding involves assigning standardised codes to medical diagnoses and procedures that are helpful in billing insurance companies and ensuring the accuracy of medical records. Medical coders typically work in hospitals, clinics, medical billing, and medical coding companies.

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Claxon is the best medical coding training institute in Ameerpet, Hyderabad. Claxon offers you the best coding training, which Madhusudhan Reddy and Snigdha Reddy started.

Madhusudhan Reddy, who was the founder of Claxon medical coding training institute, and himself a pharmacy graduate, has 10 years of experience in teaching and has been an expert at teaching medical coding.

Snigdha Reddy, herself completed her master’s in pharmacy and has 8 years of experience in teaching medical coding.

Students under their teaching and guidance have cleared the CPC examination on their first attempt and got placed in well-known MNCs like Core Health, VEE technology etc.

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Claxon offers you two courses. They are

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Evaluation Management (E&M)

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Hierarchical Condition Category (HCC)

Surgery

For more details.

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Uses of certification: Better placements, better hierarchical level jobs at entry-level, more chances to get into MNCs, more pay,  Readmore.

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Other Important FAQs About Claxon Medical Coding Institute:

Q: What is the mode of conducting classes?

Ans: The classes will be in online and offline modes.

Q: How Frequently do you conduct exams for students?

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Q: How many classes will be conducted in a week?

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Q: What is the Fee Structure of your institute?

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Q: What is the duration of the course?

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[health-insurance-struggles]

Introduction

Hello! If you've found your way to this blog, congratulations! Or condolences, if the circumstances that brought you here suck. Either way, welcome!

I am someone who works in the health insurance field (and will be remaining anonymous due to my obligations to my employer), so I've got some insider tricks. Not only that, I have multiple chronic conditions which means I've dealt with insurance from both ends.

The purpose of this blog is to help people (Americans, mostly) understand health insurance, how it works, and how to make it work for you.

All this to say, I see a lot of bullshit in my day to day life. I watch people pay more than they should or not receive the care they need because of a lack of understanding and knowledge.

I want to change that, one person at a time.

Below the cut are important posts and resources for basic information. Always feel free to write an ask if you don't see your question answered or want more detail.

**Disclaimer: No information on this blog is legal or medical advice. This is meant to be a resource for common questions or problems people run into. All information on this blog is generalized, and may not apply to your health insurance policy. This is based solely on my experience and is not binding information. The information here does not reflect the opinions or policies reflected by my employer. Always consult a medical professional for health questions, your insurance policy for benefit/claims questions, or a lawyer for legal advice.**

Basic Terminology

Types of Insurance Plans

Calling Your Insurance

So you want to make a doctor appointment...

Preventative vs Routine Services

Investigate Your Providers

Medical Malpractice/Lawsuits

What the &$#* is a claim?

My claim got denied...now what?

How to Pay Your Bill

Collections Agencies and Credit Scores

Medical Binder

HIPAA Part One

Resources:

United States Preventative Services Task Force

Healthcare.gov Preventative Services