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For millennials, both good and bad news In Senate’s GOP health bill



Darlin Kpangbah receives free health insurance through Medicaid and is grateful for the coverage in case of accidents, such as when she tore a ligament in her leg a few years ago. “I feel like I’m injury-prone,” said Kpangbah, 20, who lives in Sacramento, Calif. Without insurance, she said, the injury “would’ve been huge to pay for.”

Young adults like Kpangbah were among the biggest beneficiaries of Obamacare, which helped reduce the rates of uninsured millennials to record lows and provided millions of Americans with access to free or low-cost insurance as well as maternity care, mental health treatment and other services.

Now, Senate Republicans have proposed overhauling the Affordable Care Act — a move that could help some young adults by lowering the cost of their premiums in the private insurance marketplaces but could hurt others who gained insurance through a massive expansion to Medicaid. A Congressional Budget Office analysis of the bill released Monday estimated that 22 million Americans could lose coverage under the Senate bill, which could change significantly before an expected vote before July 4.

The proposed legislation also would retain a popular Obamacare provision that allowed young adults up to age 26 to stay on their parents’ insurance. But the bill in its current form also could dramatically reduce health coverage and care for other young adults, according to the bill’s many critics, which include the American Medical Association and the American Hospital Association.

“Don’t be fooled,” said Jen Mishory, executive director of the advocacy organization Young Invincibles. “This is going to be a bad deal, particularly for the most vulnerable young people.”

Mishory said one of the biggest concerns is that states could opt out of requiring insurers to provide benefits such as maternity care, mental health care and prescription drugs — all commonly used among young adults. “You will see a lot of young people not getting the kind of coverage they need,” she said.

The proposed changes in the marketplaces, however, could make coverage more attractive to young people. The Congressional Budget Office reports that the Senate bill would result in a larger number of younger people paying lower premiums to buy private plans. The proposal would allow insurers to charge older people up to five times more than others, which could mean lower premiums for younger people.

At the same time, the Senate bill shifts the amount people who qualify for subsidies must pay toward their own premiums, meaning that people under age 40 might pay a smaller portion of their income toward coverage than they do under Obamacare.

But young adults could face other cost increases because of larger deductibles and less help with out-of-pocket expenses. Some no longer would qualify for subsidies at all, because the bill would reduce the income threshold for eligibility.

Millions of young adults have enrolled in coverage through the insurance exchanges, in part because of a coordinated push to get as many healthy, young people into the marketplace to balance out older, sicker consumers who were eager to sign up right away.

About 27 percent of the 12.2 million consumers who enrolled in health insurance through the exchanges across the nation in 2017, were 18 to 34 years old. In California, 37 percent of 2017 enrollees were in that age group, according to Covered California, the state’s insurance exchange.

Steven Orozco, who lives in Los Angeles, is among them. He, his wife and 2-year-old daughter have a plan through Covered California. Orozco, who is a real estate agent, said they are all healthy so they don’t use it often, but he has it just in case of broken arms or other unexpected health needs.

Orozco, 32, said that he is concerned about what could happen in Washington and how that might affect his coverage, which currently costs about $450 a month.

Despite potential benefits to young adults in the private marketplace, the most damaging changes under the Senate proposal would be for young adults covered by Medicaid, said Walter Zelman, chairman of the public health department at Cal State-Los Angeles.

In addition to phasing out the expansion of Medicaid, the Senate bill also would result in reduced funding for the program, he said.

“The biggest impact on young people is the dismantling of Medicaid,” Zelman said.

Since the Affordable Care Act took effect, about 3.8 million young adults have gained coverage through the expansion of Medicaid, according to Young Invincibles.

In California alone, Zelman said, hundreds of thousands of young people won’t be able to access Medi-Cal, California’s version of Medicaid, if the expansion is phased out. Zelman, who worked to enroll California State University students into health coverage under Obamacare, said that historically the highest percentages of uninsured people have been young adults, low-income residents, part-time workers and Latinos.

“Those are my students,” he said. “And, more generally, those are young people overall. … Anything that threatens [their] access to health is bad for them,” he said.

It’s unclear whether the proposed Republican overhaul would result in more or fewer young enrollees.

Uninsured Sacramento resident Sydney Muns, 27, works at a nonprofit that doesn’t offer health coverage, and she earned too much money to qualify for Medi-Cal or receive Obamacare subsidies. Muns said she hopes premiums and out-of-pocket costs will decline in the future so she can get coverage.

“It’s just not affordable,” said Muns, who faces $50,000 in college loan debt. “I don’t know anyone my age who has insurance.”

But Chyneise Dailey, 24, said she plans to purchase health care whether or not she is required to do so. Dailey, who works at Sacramento State, remains on her parents’ Blue Cross health insurance plan, but knows she has only a couple of years before she has to buy her own coverage.

“You never know what can happen. You get into a car accident, you’re in the ER — do you want to pay full rate or do you want to pay your copay?” Dailey said. “I’d just rather be safe than sorry.”

Under both the Senate and House plans to overhaul Obamacare, young women who go to Planned Parenthood for reproductive health and other medical services could be hurt because of a provision to ban federal funding of the organization for a year.

That concerns Niki Kangas, 35, who frequently visits Planned Parenthood clinics even though she has job-based coverage from Kaiser Permanente. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.) Kangas, of Sacramento, said she is “pissed off” that the Senate’s proposed bill would impose a one-year ban on federal funding to the organization, which is a frequent target for conservatives.

“I’ve used Planned Parenthood a lot, either in between jobs or sometimes it’s just more convenient than going out to Kaiser, like if I just need birth control,” said Kangas, a project manager at a design agency. “I think for people who don’t have insurance through their work that it’s a resource they depend on.”

Mary Agnes Carey, Julie Appleby and Barbara Feder Ostrov contributed to this report.

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20 cities primed on the Amazon wishlist to be its next HQ



NEW YORK (AP) — Amazon’s second home could be in an already tech-heavy city, such as Boston, New York or Austin, Texas. Or it could be in the Midwest, say, Indianapolis or Columbus, Ohio. Or the company could go outside the U.S. altogether and set up shop in Toronto.

Those six locations, as well as 14 others, made it onto Amazon’s not-so-short shortlist Thursday of places under consideration for the online retailing giant’s second headquarters.

The 20 picks, narrowed down from 238 proposals, are concentrated mostly in the East and the Midwest and include several of the biggest metro areas in the country, such as Chicago, Washington and Los Angeles, the only West Coast city on the list.

The Seattle-based company set off fierce competition last fall when it announced that it was looking for a second home, promising 50,000 jobs and construction spending of more than $5 billion. Many cities drew up elaborate presentations that included rich financial incentives.

The list of finalists highlights a key challenge facing the U.S. economy: Jobs and economic growth are increasingly concentrated in a few large metro areas, mostly on the East and West Coasts and a few places in between, such as Texas.

Nearly all the cities on Amazon’s list already have growing economies, low unemployment and highly educated populations.

“Amazon has picked a bunch of winners,” said Richard Florida, an economic development expert and professor at the University of Toronto who helped develop that city’s bid. “It really reflects winner-take-all urbanism.”

Among those that didn’t make the cut were Detroit, a disappointment for those excited about progress since the city came out of bankruptcy, and Memphis, Tennessee, where the mayor said the city gave it its “best shot.” San Diego also failed to advance.

“Getting from 238 to 20 was very tough,” said Holly Sullivan, who oversees Amazon’s public policy. “All the proposals showed tremendous enthusiasm and creativity.”

Amazon said it will make a final selection sometime this year.

Besides Austin, another Texas city made the cut: Dallas. In the South, Miami and Atlanta are being considered.

Officials in cities that made the shortlist took the opportunity to further tout their locations, with Philadelphia’s mayor noting “all that Philadelphia has to offer” and officials in and around Pittsburgh citing the region’s “world-class talent pool” and other advantages.

Other contenders among the 20 include Denver; Montgomery County, Maryland; Nashville, Tennessee; Newark, New Jersey; Northern Virginia; and Raleigh, North Carolina.

“It’s a long list for a shortlist,” said Jed Kolko, chief economist at job site Indeed.

He said Amazon may use the list to pit the locations against each other and get better tax breaks or other incentives. Two metro areas, New York and Washington, have more than one location on the list, increasing the competition there, he said.

“It’s hard to say whether all these places are in play or Amazon wanted to encourage continued competition,” Kolko said.

Amazon did not immediately respond to a request for comment on whether locations would be able to change their proposals or offer better incentives, but said in a statement that it will “work with each of the candidate locations to dive deeper into their proposals.”

State and local governments played up the amenities they think make their locations the best choice. Some pulled off stunts to stand out, such as New York, which lit the Empire State Building in Amazon orange.

Some gimmicks didn’t work: Tucson, Arizona, which sent a 21-foot cactus to Seattle, did not make the list. Neither did Birmingham, Alabama, which installed giant replicas of Amazon’s Dash buttons.

The company had stipulated that it wanted to be near a metropolitan area with more than 1 million people, and nearly all of those on the shortlist have a metro population of at least double that.

Amazon also wanted to be able to attract top technical talent; be within 45 minutes of an international airport; have direct access to mass transit; and be able to expand the headquarters to as much as 8 million square feet in the next decade.

But Amazon also made it very clear it wanted tax breaks, grants and any other incentives.

Boston’s offer includes $75 million for affordable housing for Amazon employees and others. Before leaving office Tuesday, Gov. Chris Christie approved a measure to allow New Jersey to offer up to $5 billion to Amazon. Newark is also proposing $2 billion in tax breaks.

But many of the state and local governments competing for the headquarters have refused to disclose the financial incentives they offered. Of the 20 finalists, 13, including New York, Chicago and Miami, declined requests from The Associated Press to release their applications. Toronto’s mayor said Thursday that the city offered no financial incentives to woo Amazon.

Several said they don’t want their competitors to know what they’re offering, a stance that open-government advocates criticized.

Amazon plans to remain in its sprawling Seattle headquarters, and the second home base will be “a full equal” to it, founder and CEO Jeff Bezos has said.

The extra space will give the rapidly growing company room to spread out. It had nearly 542,000 employees at the end of September, a 77 percent jump from the year before. Some of that growth came from Amazon’s nearly $14 billion acquisition last year of the Whole Foods grocery chain and its 89,000 employees.


Associated Press writers Josh Cornfield in Philadelphia, Matt O’Brien in Providence, Rhode Island, and Rob Gillies in Toronto contributed to this report. Rugaber contributed from Washington.

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Tourism still booms in Cuba but Trump’s tougher stance hurting private entrepreneurs



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HAVANA (AP) — On a sweltering early summer afternoon in Miami’s Little Havana, President Donald Trump told a cheering Cuban-American crowd that he was rolling back some of Barack Obama’s opening to Cuba in order to starve the island’s military-run economy of U.S. tourism dollars and ratchet up pressure for regime change.

That doesn’t appear to be happening. Travel to Cuba is booming from dozens of countries, including the U.S. And the tourism dollars from big-spending Americans seem to be heading into Cuba’s state sector and away from private business, according to Cuban state figures, experts and private business people themselves.

The government figures show that 2017 was a record year for tourism, with 4.7 million visitors pumping more than $3 billion into the island’s otherwise struggling economy. The number of American travelers rose to 619,000, more than six times the pre-Obama level. But amid the boom — an 18 percent increase over 2016 — owners of private restaurants and bed-and-breakfasts are reporting a sharp drop-off.

“There was an explosion of tourists in the months after President Obama’s detente announcement. They were everywhere!” said Rodolfo Morales, a retired government worker who rents two rooms in his home for about $30 a night. “Since then, it’s fallen off.”

The ultimate destination of American tourism spending in Cuba seems an obscure data point, but it’s highly relevant to a decades-old goal of American foreign policy — encouraging change in Cuba’s single-party, centrally planned system. For more than 50 years, Washington sought to strangle nearly all trade with the island in hopes of spurring economic collapse. Obama changed that policy to one of promoting engagement as a way of strengthening a Cuban private sector that could grow into a middle class empowered to demand reform.

Cuba’s tourism boom began shortly after Obama and Cuban President Raul Castro announced in December 2014 that their countries would re-establish diplomatic relations and move toward normalization. U.S. cruise ships began docking in the Bay of Havana and U.S. airlines started regular flights to cities across the island. Overall tourism last year was up 56 percent over Cuba’s roughly 3 million visitors in 2014.

While the U.S. prohibits tourism to Cuba, Americans can travel here for specially designated purposes like religious activity or the vaguely defined category of “people-to-people” cultural interaction.

Obama allowed individuals to participate in “people-to-people” activities outside official tour groups. Hundreds of thousands of Americans responded by designing their own Cuban vacations without fear of government penalties. Since Cuba largely steers tour groups to government-run facilities, Americans traveling on their own became a vital market for the island’s private entrepreneurs, hotly desired for their free spending, heavy tipping and a desire to see a “real” Cuba beyond all-inclusive beach resorts and quick stops on tour buses. The surge helped travel-related businesses maintain their role as by far the most successful players in Cuba’s small but growing private sector.

Trump’s new policy re-imposed the required for “people-to-people” travel to take place only in tour groups, which depend largely on Cuban government transportation and guides.

As a result, many private business people are seeing so many fewer Americans that it feels like their numbers are dropping, even though the statistics say otherwise.

“Tourism has grown in Cuba, with the exception of American tourism,” said Nelson Lopez, a private tour guide. “But I’m sure that sometime soon they’ll be back.”

While Trump’s new rules didn’t take effect until November, their announcement in June led to an almost immediate slackening in business from individual Americans, many Cuban entrepreneurs say. The situation was worsened by Hurricane Irma striking Cuba’s northern coast in September and by a Cuban government freeze on new licenses for businesses including restaurants and bed-and-breakfasts. Cuban officials say the freeze was needed to control tax evasion, purchase of stolen state goods and other illegality in the private sector, but it’s had the effect of further restricting private-sector activity in the wake of Trump’s policy change.

Cuban state tourism officials did not respond to requests for comment.

Trump’s policy changes did not touch flights or cruise ships. Jose Luis Perello, a tourism expert at the University of Havana, said more than 541,000 cruise ship passengers visited Cuba in 2017, compared with 184,000 the previous year. Even as entrepreneurs see fewer American clients, many of those cruise passengers are coming from the United States, he said.

Yunaika Estanque, who runs a three-room bed-and-breakfast overlooking the Bay of Havana, says she has been able to weather a sharp drop in American guests because a British tour agency still sends her clients, but things still aren’t good.

“Without a doubt our best year was 2016, before the Trump presidency,” she said. “I’ve been talking with other bed-and-breakfast owners and they’re in bad shape.”

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Experts: North Korea latest ICBM test puts much of US in range



PYONGYANG, North Korea — North Korea on Friday test-fired its second intercontinental ballistic missile, which flew longer and higher than the first according to its wary neighbors, leading analysts to conclude that a wide swath of the U.S., including Los Angeles and Chicago, is now within range of Pyongyang’s weapons.

Japanese government spokesman Yoshihide Suga said the missile, launched late Friday night, flew for about 45 minutes — about five minutes longer than the ICBM North Korea test-fired on July 4. The missile was launched on very high trajectory, which limited the distance it traveled, and landed west of Japan’s island of Hokkaido.

“We assess that this missile was an intercontinental ballistic missile, as had been expected,” Pentagon spokesman Navy Capt. Jeff Davis said in Washington.

Analysts had estimated that the North’s first ICBM could have reached Alaska, and said Friday that the latest missile appeared to extend that range significantly.

David Wright, a physicist and co-director of the global security program at the Union of Concerned Scientists, said in Washington that if reports of the missile’s maximum altitude and flight time are correct, it would have a theoretical range of at least 10,400 kilometers (about 6,500 miles). That means it could have reached Los Angeles, Denver and Chicago, depending on variables such as the size and weight of the warhead that would be carried atop such a missile in an actual attack.

Bruce Klingner, a Korean and Japanese affairs specialist at the Heritage Foundation think tank in Washington, said, “It now appears that a significant portion of the continental United States is within range” of North Korean missiles. Klingner recently met with North Korean officials to discuss denuclearization, the think tank said.

Washington and its allies have watched with growing concern as Pyongyang has made significant progress toward its goal of having all of the U.S. within range of its missiles to counter what it labels as U.S. aggression. There are other hurdles, including building nuclear warheads to fit on those missiles and ensuring reliability. But many analysts have been surprised by how quickly leader Kim Jong Un has developed North Korea’s nuclear and missile programs despite several rounds of U.N. Security Council sanctions that have squeezed the impoverished country’s economy.

President Donald Trump has said he will not allow North Korea to obtain an ICBM that can deliver a nuclear warhead. But this week, the Defense Intelligence Agency reportedly concluded that the North will have a reliable ICBM capable of carrying a nuclear weapon as early as next year, in an assessment that trimmed two years from the agency’s earlier estimate.

Japanese Prime Minister Shinzo Abe called the launch a “serious and real threat” to the country’s security.

Suga, the Japanese spokesman, said Japan has lodged a strong protest with North Korea.
“North Korea’s repeated provocative acts absolutely cannot be accepted,” he said.

A spokesman for Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, said Friday that Dunford met at the Pentagon with the commander of U.S. forces in the Pacific, Adm. Harry Harris, to discuss U.S. military options in light of North Korea’s missile test.

The spokesman, Navy Capt. Greg Hicks, said Dunford and Harris placed a phone call to Dunford’s South Korean counterpart, Gen. Lee Sun Jin. Dunford and Harris “expressed the ironclad commitment to the U.S.-Republic of Korea alliance,” Hicks said, referring to the U.S. defense treaty that obliges the U.S. to defend South Korea.

Prime Minister Abe said Japan would cooperate closely with the U.S., South Korea and other nations to step up pressure on North Korea to halt its missile programs.

South Korea’s Joint Chiefs of Staff said the missile reached an estimated height of 3,700 kilometers (2,300 miles) before landing at sea about 1,000 kilometers (625 miles) away. It appeared to be more advanced than the ICBM North Korea previously launched, it said.

The “Hwasong 14” ICBM test-fired earlier this month was also launched at a very steep angle, a technique called lofting, and reached a height of more than 2,500 kilometers (1,550 miles) before splashing down in the ocean 930 kilometers (580 miles) away. Analysts said that missile could be capable of reaching most of Alaska or possibly Hawaii if fired in an attacking trajectory.

South Korea’s Joint Chiefs of Staff said the missile was launched from North Korea’s northern Jagang province near the border with China. President Moon Jae-in presided over an emergency meeting of the National Security Council, which called for an emergency meeting of the U.N. Security Council and stronger sanctions on North Korea.

There was no immediate confirmation of the launch by North Korea. The day’s broadcast on state-run television had already ended when the news broke at around midnight Pyongyang time.
July 27 is a major national holiday in North Korea called Victory in the Fatherland Liberation War Day, marking the day when the armistice was signed ending the 1950-53 Korean War. That armistice is yet to be replaced with a peace treaty, leaving the Korean Peninsula technically in a state of war.

North Korea generally waits hours or sometimes a day or more before announcing launches, often with a raft of photos in the ruling party newspaper or on the television news. Kim Jong Un is usually shown at the site to observe and supervise major launches.

Late night launches are rare. North Korea usually conducts its missile and underground nuclear tests in the morning. It’s likely the North launched the missile at night and from the remote province of Jagang to demonstrate its operational versatility. To have a real deterrent, it’s important for North Korea to prove it can launch whenever and wherever it chooses, making it harder for foreign military observers trying to detect their activities ahead of time.
Yamaguchi reported from Tokyo. Associated Press writers Robert Burns in Washington, Hyung-jin Kim in Seoul, South Korea, and Eric Talmadge in Pyongyang, North Korea, contributed to this report.

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