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Patriot Waiting Games

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Pueblo Marine Corps veteran David Jiron had a stroke this past April. Once out of the hospital he went through the Veterans Administration to seek follow-up treatment at one of its facilities. The VA scheduled the treatment for this coming October.

Rather than wait about half a year to see a medical provider about the aftereffects of the stroke, Jiron used his costly private health insurance to get treatment within the local Parkview health-care system.

The Veterans’ Choice Program is supposed to cut down on VA wait times by allowing veterans to receive treatment at community medical facilities, which in turn would be compensated for their services by the VA. In theory, a veteran making a trip to the family doctor would be no different than being treated by a primary care doctor at a VA facility.

Jiron praises the Choice program for how quickly the VA got him an eye exam (within a week) at a non-VA facility. Yet the VA would not allow him to use the program for his stroke follow-up at Parkview. Jiron also was frustrated that the program won’t pay the tab for the teeth cleaning he needs, and getting it done through a VA facility is difficult because he was told the VA was “short-staffed” when it came to routine dental work. As for wait times at VA facilities, he is still waiting to see a neurologist at an out-of-town VA facility related to his April stroke.

Veterans’ Choice

Jiron is Southern Colorado service officer for Disabled American Veterans. The national nonprofit organization supports the Veterans’ Choice Program, which was established the Veterans’ Choice, Accountability and Transparency Act of 2014. Signed into law by President Barack Obama and then extended by Congress and President Donald Trump this past April, the Veterans’ Choice Act came about after it was widely reported in 2014 that about 35 veterans died while waiting for appointments at VA facilities in Phoenix. Although the Choice Program was extended this year it is still considered a temporary benefit. The extension Trump signed in April and which took effect on Aug. 7 was for $2.1 billion to pay for Choice services nationwide, and when that money runs out, the Choice Program will need another extension from Congress to keep operating.

Andrew Grieb at the Colorado DAV’s Denver headquarters says his organization backs the Veterans’ Choice Program and sees it as playing a role in what the DAV hopes would become an “integrated VA health system.”

Jiron says the VA needs to “turn around” adding that current VA Secretary David Shulkin seems to be the person to do just that. But Jiron is not the only one with issues regarding Veterans’ Choice.

Small-town, big concerns

The town of Springfield in extreme southeastern Colorado has no VA facility making it a prime location for the Choice Program. The Southeast Colorado Hospital District serves Springfield and the towns of Pritchett, Vilas and Campo. David Engel is the CEO of the hospital district, which entices veterans on its Facebook page to take part in the Choice Program at its facilities. Yet despite the promotion Engel says the number of veterans taking part in program is “sparse” for two reasons. The first is that, he says, the VA rejects veterans for the Choice Program if they carry other pricey insurance like a private plan, a plan through work or Medicare. The other is that, once a veteran jumps through the VA hoops and uses Choice to see a primary care provider within the hospital district, that vet again has to clear VA hurdles to see a specialist that the primary care provider recommends. Engel, who’s relatively new to his position at the district, adds that staff members have told him of significant delays in getting reimbursed from the VA through Choice for the hospital district’s services.

Engel says as an alternative to VA Choice Program many veterans living in the communities served by his hospital district drive as far as Amarillo, Texas, to get treatment at VA facilities there.

Telling stats

VA wait times in southeastern Colorado are daunting. Brandy Morrison, congressional liaison and acting public affairs officer for the VA’s Eastern Colorado Health Care System reveals some eye-popping statistics, which were last updated on July 31. The AVERAGE wait time for a new patient to receive care at the VA’s PFC James Dunn Clinic in Pueblo is 69 days; at the VA clinic in La Junta, 54 days; at the VA’s PFC Floyd K. Lindstrom Clinic in Colorado Springs, 52 days; at the VA facility in Lamar, 36 days; at the VA clinic in Alamosa, 29 days. The new-patient wait times at the VA facility in Salida is relatively outstanding at a mere six days. The picture for average primary care wait times for patients already established in the VA system is much, much brighter:  13 days for Alamosa; 11 days for Lindstrom in the Springs; seven days each for Lamar and James Dunn in Pueblo; four days for La Junta; and for Salida, one day.

Morrison adds that a national VA statistics website uses an average of new patient and existing patient wait times for primary care and at least one other factor to come up with its numbers. Using those statistics, the national average VA primary care wait time is 4.9 days compared with 26.68 for La Junta, 22.38 days for Alamosa, 18.35 days for Lamar, 13.99 days for Pueblo’s Dunn Clinic, 12.95 the Springs’ Lindstrom Clinic and 2.88 days for Salida.

Choice restrictions

Morrison says regarding the Veterans’ Choice Program designed to cut down on VA wait times, veterans are eligible to use the program through three avenues. The first is that if wait times for the services they require are greater than 30 days. The second is if veterans needing care live 40 miles or greater from the nearest VA facility. The third is what Morison calls a “geo-burden” which means if a veteran is separated from a VA facility by such obstacles as mountains or bodies of water. Note that a veteran having other forms of insurance is not on Morrison’s list for a veteran being turned down for the Choice Program.

Yet Morrison says relatively few veterans in the Eastern Colorado region choose to take advantage of the Choice Program. In fact, she says, during the third quarter of federal fiscal year 2017 (which runs from Oct. 1, 2016, to Sept. 30) 71 percent of the veterans served by the VA’s Eastern Colorado Health Care System chose to stay with the VA for their primary care needs rather than go through the Choice Program.

Yet for a veteran opting to go into the community to use the Choice Program, Morrison says a VA employee will place them into the program and forward all pertinent medical information to the VA “third-party administrator” or TPA (which is a company called Health Net Federal Services) for appropriate scheduling.

“Once Health Net receives and accepts the referral,” Morrison says, “they begin their scheduling attempts to get the veteran scheduled as timely as possible with the provider of their choice. Since May of 2017, the VA is the primary insurance for all services received through the Veterans Choice Program.”

Regarding payment to Veterans Choice Program providers,

Getting paid

Morrison says she cannot speak to that because Health Net handles all payments to the providers as part of its contract with the VA.

And, as Southeast Colorado Hospital District CEO Engel previously indicated, reimbursements from the Choice Program are hard to come by. And, by way of example, Pulp has learned of one story about an eye care clinic in the Pueblo area having its reimbursement check sent to an eye clinic in Alaska.

Health Net Federal Services communications director, Molly Tuttle, gives a generic response to Pulp’s concerns about delayed Choice Program reimbursements.

“It is our honor and responsibility to serve the veteran community,” Tuttle, who is based in northern California, says. “We strive to provide excellent service to every veteran, every time. Health Net Federal Services has no higher priority than the fulfillment of our Veterans Choice Program obligations in support of our continuing and long-term commitment to the veteran community.

“We strive to address issues as they arise and continue to work with our over 14,000 community providers to service the state’s more than 80,000 Choice eligible veterans in Colorado,” she adds. “Developing a complex and consistent new program like Veterans’ Choice is a team effort, and HNFS is working closely with Congress, the Department of Veterans Affairs, the Colorado VA Medical Clinics, and local health care providers to ensure veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation.”

Congressmen respond

The office of U.S. Rep. Scott Tipton (R-Cortez) representing Colorado’s 3rd District says VA wait times and the Veterans’ Choice Program do have issues. “As the Veterans’ Choice Program has been administered, it has become clear there are problems that need to be addressed, including administrative burdens and red tape in the referral process, as well as issues with payments for Choice providers,” says Liz Payne, the congressman’s communications director, in an email.

“Despite the identified problems, there are countless examples where we have seen the Choice Program work for veterans who had no access to care prior to the program’s implementation, and Congress and the VA continue to work to ensure the programs is as efficient and as streamlined as possible. Congressman Tipton and his staff also continue to work with veterans across (his district) to help them navigate the Choice Program process. We are currently serving over 1,000 veterans on Choice Program-specific casework.”

Colorado 4th District U.S. Rep. Ken Buck (R-Greeley) has this to say in an email about the Veteran’s Choice Program: “I support giving veterans more health care options through the Veterans’ Choice Act, but I recognize the challenges faced by the act over the past few years. Congress needs to continue working to improve this act so that veterans receive the care they need, when they need it.”

Kyle Huwa, Buck’s communications director, says in an email the congressman’s staff is looking into concerns Pulp has raised about long wait times at VA facilities in southeastern Colorado and the effectiveness of the Veterans Choice Act.

“Once he has more information on the specifics of the issue,” Huwa says, “he can address that question.”

Although southeastern Colorado has obvious problems with VA wait times and the Veterans’ Choice Program, there is reason to be upbeat. Air Force Veteran Phil Andreski is pleased with the VA service he receives. “No complaints from me,” he says in an email. “Don’t use VA other than getting hearing aids, and I’m satisfied.”

Andreski is the southeastern Colorado representative for the United Veterans Committee of Colorado, a Denver-based veterans’ advocacy group. He adds that he has not received any complaints from the veterans he knows about long VA wait times or the Veterans’ Choice Program.

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The #WhatNow of #MeToo for the #COLeg

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AP Photo/David Zalubowski

When several lawmakers, lobbyists and staff at the state Legislature came forward this fall to allege they were victims of sexual harassment by lawmakers, two big questions followed: how often does this happen? What can be done to prevent more cases?

Reporters have asked state officials the first question repeatedly, returning to readers with little response from the state. The latter prompted a conversation from leadership, but as for what’s next—how the allegations, formal complaints, and legislature’s response—will impact politics under the gold dome and whether women will feel any safer is to be determined.

So far, top state lawmakers have decided to hire a human resources officer—who would be independent from the legislature—to be a contact person when incidents involving sexual harassment are brought forward. Now, leadership is tasked with handling and investigating such claims.

The group also decided to hire an independent consultant to review the legislature’s sexual harassment policy, and lawmakers, staff, and aides will undergo another round of sexual harassment training this year. Typically, those working at the Legislature are only required to go through training every two years.

Those changes are a good start, said Erin Hottenstein, executive director of Colorado 50/50, an organization that aims to get more women in public office. But the legislature stopped short of changing any current policies. And Colorado 50/50 called for an entire overhaul.

“I’m very pleased that there was a recognition that the policy needs to be improved,” Hottenstein said.

But there weren’t any specific recommendations regarding transparency, which Hottenstein said is significant in looking at what happens next.

Lawmakers and staff said they couldn’t disclose how many sexual harassment claims that leadership in each chamber have received because they were personnel issues.

“I think there’s a way to be transparent and safe,” Hottenstein said. “There should be a high- level summary document that shows on a certain date a sexual harassment complaint was made and who it was against and a date of a deposition and what the result was.”

Hottenstein said transparency becomes crucial in these cases because it leads to accountability and the public’s right to know what actions the people elected to office are taking.

In October, Pueblo Rep. Daneya Esgar broke her silence posting on Facebook that she was no stranger to sexual harassment and experienced it just a week earlier with a colleague she works with regularly as a lawmaker. The post was part of the #MeToo movement after a New York Times expose highlighted the stories of several women who said they’d been sexually harassed or assaulted by Hollywood producer Harvey Weinstein.

Then, a flood of other allegations were brought to the surface in Colorado politics. Rep. Faith Winter said fellow House member Steve Lebsock had harassed her at a legislative party in 2016. Winter and a lobbyist say they filed formal complaints against Lebsock.

An intern said Sen. Randy Baumgardner harassed her with sexually suggestive comments. The same went for Sen. Jack Tate of Centennial, who was accused of telling an intern that if she wanted to get ahead in her career, he could help.

Rep. Paul Rosenthal, who is openly gay, allegedly groped a man and used his seat to try and get a date with another.

But the case between Lebsock and Winter gained the most attention, even prompting Lebsock to take a polygraph test, which the administrator says he passed, to prove his innocence. Lebsock has hinted that the entire incident may be a case of dirty politics, alleging that Winter is the one lying.

When several lawmakers were asked if the case would mean a splintered Democratic party in the House, they were unsure, but optimistic about the session.

Still, there haven’t been any resignations over the allegations, though several, including leadership and editorial boards from across the state, said these legislators should step down from their seat. Some even called for House Speaker Crisanta Duran to step down from her position because she promoted Lebsock to a chairmanship despite knowing there was an incident between him and Winter.

The transparency piece has yet to be addressed by state lawmakers, and it’s unclear whether any policy or legislative changes will address that in the coming months. But for what it’s worth, the women who have broken their silence about sexual harassment in the Legislature are supportive of the changes leadership has discussed.

“I’m encouraged to see the direction leadership is taking when it comes to developing new and independent methods of dealing with complaints of sexual harassment at the Capitol,” said Esgar, who still hasn’t named the colleague she said grabbed her thigh at a legislative event earlier this year. “I’m hopeful that new ideas are still being formulated and considered, when it comes to ways to change the culture itself.”

The lawmaker added that a new session will certainly mean new ideas will come to light, “it’s our responsibility to lead the state in changing cultures to help make work environments safe and productive for all employees on every level.”

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

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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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