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Palestinian Leadership Amends UN Application For Statehood, But US Support Is Lacking
Palestinian Authority President Mahmoud Abbas gestures beneath a poster of former Palestinian leader Yasser Arafat, during a rally marking the 10th anniversary of Arafat's death, in the West Bank city of Ramallah Nov. 11, 2014. Reuters/Finbarr O'Reilly
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The Palestinian leadership pushed for statehood Monday, submitting an amended version of its U.N. draft resolution to become a sovereign state. The resolution, which is not supported by the U.S., Israel or Gaza-based Hamas, calls for a peace deal between the Palestinian leadership and Israel as well as terminating Israel's occupation of Palestinian territories by the end of 2017, Israeli media reported.
The amendments submitted Monday by the Palestinian Authority modified an existing resolution submitted by Jordan Dec. 17. That draft called for Palestinian statehood and for the city of Jerusalem to be the capital of an Israeli state and a Palestinian state. Monday's resolution submission, however, takes a harder stance. It asks for only East Jerusalem to be the capital of Palestine and calls for an end to Israeli settlement building in the West Bank and East Jerusalem, Haaretz reported. Nine Security Council votes are needed to adopt a resolution.
Arab leaders decided in November to support the Palestinian bid for statehood. Palestinian Authority President Mahmoud Abbas said at that time that he would submit a statehood bid at the U.N. Security Council and join international organizations and treaties if Israel did not respond to requests for resuming peace talks. Since then, U.S.-brokered peace talks have failed. Battles between Israel and Hamas, which controls Gaza, have killed more than 2,000 Palestinians and 66 Israeli soldiers.
U.S. State Department Press Office Director Jeff Rathke said Monday in a press briefing the U.S. does not support the draft resolution.
"This draft resolution is not something we would support," Rathke said. "We don't think it is constructive. We think it sets arbitrary deadlines. Further, we think the resolution fails to account for Israel's legitimate security needs. We don't believe this resolution advances the goals of a two-state solution." Rathke said that U.S. Secretarty of State John Kerry had been in touch with both Abbas and Israeli Prime Minister Benjamin Netenyahu.
The WAFA news agency reported Monday that Abbas told Kerry he would press ahead with the resolution despite Israeli and U.S. opposition. Abbas also told senior leaders of his Fatah party that the vote on the resolution could be delayed until 2015.
“This process will take more than a day or two, and we must be clear with our people in order to avoid a state of confusion stemming from the numerous statements, which are sometimes contradictory,” Palestinian Foreign Minister Riyad al-Maliki told the Ma’an news agency. “These procedures are unrelated to the Palestinian position, but are routine U.N. procedures in such cases.”
Hamas, which is deemed a terrorist organization by the U.S. and Israel, said Monday that the Palestinian leadership should withdraw its draft resolution from the Security Council.
"The draft resolution is unacceptable and aims to liquidate the Palestinian cause. It contains massive concessions," Hamas spokesman Sami Abu Zuhri said in a statement Sunday. "The resolution expresses the will of an influential group within the PLO and "does not reflect the national desire of our people."
AIRASIA CONFIRMS WRECKAGE FROM MISSING PLANE, CEO SAYS 'WORDS CANNOT EXPRESS SORROW'......
HOW IS THIS WHEN THEY GOT A TEXT MESSAGE SAYING EVERYTHING IS OK, AND EVERYONE IS ALIVE???..... MORE CABAL BULLSHIPE.....
William Wan, Daniela Deane and Brian Murphy
Dec. 30, 2014An unidentified object, found during a search and rescue operation by the Indonesian Air Force for the missing AirAsia plane, floats in the ocean off the coast of Pangkalan Bun, Borneo, Indonesia.Kenarel/European Pressphoto Agency
BEIJING — Recovery teams pulled wreckage and bodies from the sea off Indonesia on Tuesday after an intensive three-day search finally yielded the grim fate of a missing passenger jet that plunged from storm-laced skies with 162 people aboard. Officials from the carrier AirAsia confirmed the debris was from the plane that disappeared Sunday moments after the pilot asked to climb to a higher altitude in an apparent attempt to avoid rough weather. “We are sorry to be here today under these tragic circumstances,” said AirAsia executive Sunu Widyatmoko in a statement issued in the Indonesian city of Surabaya where the plane departed for Singapore. Indonesia’s president, Joko Widodo, thanked the international effort mobilized for the search, and then shifted his comments to the grieving families. “I feel your loss,” he said.
AirAsia confirmed Tuesday that bodies and debris seen floating in the Java Sea were from the jet that went missing on Sunday. (AP) Even as bodies and various flotsam were pulled aboard ships, experts prepared for the next step: trying to reach what was left of the Airbus A320-200 in waters up to 100 feet deep. Indonesia authorities said divers and sonar-equipped ships headed to the site, about 100 miles southeast of the coast of Borneo. The top goal was recovery of the plane’s flight recorder, the so-called black box, in hopes of gaining clues on the cause of the crash.
Indonesia’s search-and-rescue chief, Bambang Soelistyo, said the effort has been complicated by waves up to 10 feet high. A former accident investigator, John Cox, said the recorder — if found — would likely be analyzed by experts in countries such as the United States or Australia, working alongside Indonesian authorities. It could take several days to fully study the data, he added. “In those boxes will be story of what brought down the AirAsia flight,” said Cox, a former captain for US Airways and now chief executive of the Washington-based consulting firm Safety Operating Systems.
Among the critical questions is whether Flight 8501 broke up during flight or hit the water intact. “It’s important to know because that tells you whether it was a force like a storm that destroyed the airplane in air or if it was a matter of the pilots losing control and never able to recover from it,” said Australia-based aviation security expert Desmond Ross.
One possible advantage for investigators was the relative shallow seabed and its proximity to shipping lanes, which likely means extensive knowledge of currents that could carry the flight recorde which are waterproof and fitted with an electronic tracking signal. “My guess is we’ll know what happened within a week,” said David Gallo, an American oceanographer and co-expedition leader of the investigation into the 2009 crash of Air France Flight 447 which went down in the open Atlantic with 228 people aboard and sunk more than 13,000 feet. It took more nearly two years to recover the black box.
As night fell Tuesday, it was unclear how many bodies had been spotted. At least three were recovered and placed on an Indonesian warship, said the rescue operations chief Soelistyo. A spokesman for the country’s navy, Manahan Simorangkir, said an earlier report that more than 40 bodies were recovered was incorrect and blamed on a “miscommunication” by his staff, the AFP news agency reported. The lack of extensive body recoveries could mean that many remained in the cabin. In the Air France crash, the largest number of bodies found were still in the submerged fuselage, said Gallo.
Meanwhile, an array of debris was carried to Indonesian ports: A portable oxygen tank, a light blue wheeled suitcase, a portion of the inner layer of the aircraft cabin. At the Surabaya airport, about 400 miles southeast of Jakarta, relatives of those on the flight broke down in tears as television images showed the recovery a body, bloated by the sun and sea. Some hugged or collapsed in anguish. One man was carried out on a stretcher. The TV images drew strong condemnation online. The station, TvOne, quickly apologized and subsequently blurred out video of the corpse at sea. Nearly all the passengers and crew were Indonesians — some making year-end holiday trips to Singapore. “Words cannot express how sorry I am,” wrote AirAsia’s CEO, Tony Ferdandes, in a tweet.
The debris field was first spotted about six miles from the flight’s last known coordinates. In a cruel twist, some rescuers believed they saw people waving for help. It turned out to be the sea swells tossing lifeless arms. “When we approached closer [we saw] they were already dead,” said Lt. Tri Wibowo, co-pilot of an Air Force Hercules C130 involved in the search effort, according to the Indonesian newspaper Kompas.
The spotters on the plane also saw what looked like a shadow on the seabed in the shape of a plane. Indonesian authorities said Monday they believed the plane was lying at the bottom of the sea, prompting a request to the United States, Britain and France for more advanced equipment.
The Pentagon said that details of that assistance were being worked out, but it would probably include “air, surface and sub-surface detection capabilities.” In a statement issued late Monday, search officials said they have deployed 12 helicopters, 11 planes and 32 ships, including assets from Malaysia, Singapore and Australia, with more than 1,100 personnel involved. Even fishing boats were tapped in the widespread search. The U.S. Navy said the USS Sampson, a guided-missile destroyer that is already in the region, would join the search later Tuesday.
Until the discoveries Tuesday, the frustrating maritime search were eerily similar to those in the case of Malaysia Airlines Flight 370, which disappeared over the Indian Ocean in March. The whereabouts of the plane, with 239 people aboard, are still a mystery. “Reality is so cruel,” said Jiang Hui, a salesman in Beijing whose 70-year-old mother was on the Malaysia Airlines flight. “I feel so much for the families of the AirAsia flight. I have been in their place for the last 10 months.” A statement from Malaysia Airlines extended “deepest sympathies” to the families of the AirAsia passengers and crew.
For the moment, the last moments of the AirAsia flight offer the only hint of what may have happened. According to Indonesia’s state-owned navigation provider, AirNav, the pilot asked air traffic control at 6:12 a.m. on Sunday for permission to turn left to avoid bad weather. Permission was granted, the Jakarta Post reported. The pilot then asked to climb from 32,000 to 38,000 feet, but did not explain why. Jakarta’s air-traffic control conferred with Singapore-based counterparts and agreed to allow the plane to move to 34,000 feet because a second AirAsia flight, 8502, was flying at 38,000 feet. But by the time air-traffic controllers relayed the permission to climb at 6:14 a.m., there was no reply.
Deane reported from London and Murphy from Washington. William Wan is The Post’s China correspondent based in Beijing. He served previously as a religion reporter and diplomatic correspondent. Daniela Deane was a reporter in four countries in Europe and Asia and a foreign affairs writer in Washington before she joined the Post. She now writes about breaking foreign news from both London and Rome. Brian Murphy joined the Post after more than 20 years as a foreign correspondent and bureau chief for the Associated Press in Europe and the Middle East. He has reported from more than 50 countries and has written three books.
Sure, you could throw all of these things under the broad category of racism. But some of these disparities are often perpetuated by people who insist that they believe with all their hearts in racial equality.
It seeps into just about every aspect of life
There's a term for what's happening when, despite our best intentions and without our awareness, racial stereotypes and assumptions creep into our minds and affect our actions: implicit racial bias.
It seeps into just about every aspect of life, including areas like criminal justice that can have deadly consequences. Thirty years of neurology and cognitive psychology studies show that it influences the way we see and treat others, even when we're absolutely determined to be, and believe we are being, fair and objective.
That's why implicit racial bias has been called "the new diversity paradigm — one that recognizes the role that bias plays in the day-to-day functioning of all human beings."
The first step in understanding how implicitracial bias works is to understand the general concept of implicit bias, which can shape the way we think about lots of different qualities: age, gender, nationality, even height.
Two of the leading scholars in the field, Mahzarin Banaji and Anthony G. Greenwald, capture it well in the title of a book they wrote about the concept. It's called "Blindspot: Hidden Biases of Good People"
You can think of it generally as "thoughts about people you didn't know you had"
What do these "blind spots" look like, and how do they shape behavior? Well, if you have a stereotype about Asian people that labels them as "foreign," implicit bias means you might have trouble associating even Asian-American people with speaking fluent English or being American citizens. If you've picked up on cultural cues that women are homemakers, it means you might have a harder time connecting women to powerful roles in business despite your conscious belief in gender equality.
The effects aren't always negative: if you have a positive attitude about your alma mater, implicit bias could mean you feel more at ease around someone who you know also graduated from there than you do around people who went to other schools.
But there are a couple of things make implicit bias especially fascinating and potentially insidious:
First, since our thoughts often determine our actions, implicit bias can lead to discriminatory behaviors (more on those below). Second, it is impossible to detect without taking a test. In other words, you can't sit down and do introspection about your biases, and you can't just decide not to let them affect your attitudes and actions. Implicit bias lives deep in your subconscious, and it is largely separate from the biases you know you have.
How does implicit racial bias affect the way we think about race?
Implicit bias comes from the messages, attitudes, and stereotypes we pick up from the world we live in, and research over time and from different countries shows that it tends to line up with general social hierarchies.
Studies have shown that people have implicit biases that favor Germans over Turks (in Germany), Japanese over Koreans (in Japan), men over women (when it comes to career-related stereotypes), youth over elderly, and straight people over gay people.
So, it's no surprise race is a prime area for implicit bias, and if you live in America, you can probably make an educated guess about some of the ways it tends to play out: among other things, there's a widespread preference for light skinned over dark skinned and white over black.
Implicit racial bias tends to work against the same groups that are the victims of the type of overt racism that you hear from white supremacists or the more subtle bigotry of people who believe that racial minorities suffer from cultural pathology or who actively defend racial and ethnic stereotypes.
But it can also affect the minds of people who would say — honestly — that they are horrified by these types of attitudes. That's because the implicit associations we hold often don't align with our declared beliefs.
the implicit associations we hold often don't align with our declared beliefs
As Cynthia Lee, a professor at the George Washington University School of Law, has explained, "the social science research demonstrates that one does not have to be a racist with a capital R, or one who intentionally discriminates on the basis of race, to harbor implicit racial biases."
In all areas touched by implicit bias, including race, we tend to hold biases that favor the group that we belong to (what researchers call our "ingroup"). But research has shown that we can also hold implicit biases against our ingroup. So yes, white Americans generally have implicit biases against other races, but racial minorities can hold implicit biases against themselves, too. These results are rarely reflective of conscious attitudes.
How do you figure out whether you have implicit racial bias?
To evaluate implicit bias, scientists mostly use tests that measure reaction time and rely on the idea that if we closely associate two concepts in our minds, they'll be easy for us to sort together. And if we don't associate them, they'll be harder, and take more time, to sort together.
The most popular of these tests is the Implicit Association Test, or IAT. Anthony Greenwald and his colleagues invented it in the mid-1990s. An organization called Project Implicit, maintained by Greenwald, Mahzarin Banjai, and Brian Nosek, allows people to take it online. The test is basically a video game that you play on a computer, the object of which is to sort categories of pictures and words.
An image from an implicit-bias test at Project Implicit
Here's an example of how it measures implicit racial bias: in the black-white race attitude test, test takers are asked to sort pictures of white and black people's faces, and positive and negative words, by pressing one of two keys on the keyboard. It turns out that most people are able to do this more quickly when the white faces and positive words are assigned to the same key (black faces and negative words are assigned to the other key), compared with when white faces and negative words are assigned to the same key (and black faces and positive words are assigned to the other key). The difference in the time it takes a user to respond in different situations is the measure of implicit bias. Try a test yourself at Project Implicit.
"[M]y hands were literally frozen when I had to associate black with good"
Here's how Banaji explained the way taking the IAT feels, in a 2013 interview with the Boston Globe:
"So when I took the test ... it was stunning for me to discover that my hands were literally frozen when I had to associate black with good. It's like I couldn't find the key on the keyboard, and doing the other version, the white-good, black-bad version was trivial. So the first thought that I had was: 'Something's wrong with this test.' Three seconds later, it sunk in that this test was telling me something so important that it would require a re-evaluation of my mind, not of the test."
How do the implicit racial biases the IAT reveals play out in reality?
Implicit racial bias can shape our beliefs and assumptions, color the way we treat other people, and even help decide what "feels true" for us when it comes to larger social and political issues.
Banaji explained that in one version of the IAT, researchers took famous Asian Americans such as Connie Chung and Michael Chang and Kristi Yamaguchi and picked white foreigners such as Hugh Grant, Katarina Witt, and Gerard Depardieu, and asked test takers to connect them to American symbols and foreign symbols. They found it was easier to associate Hugh Grant with American symbols than Connie Chung. "That shows how deeply the category 'American' is white" in many people's minds, she said.
It was easier to associate Hugh Grant with American symbols than Connie Chung
She went on to explain what she said were the connotations of implicit bias when it comes to politics: "The reason I especially like that result is that in the first Obama election and since then, the issue has come up about these 'birthers,' and I think what we captured there was a little bit of a birther in all of us. I think this is where conscious attitudes matter. You and I say, 'I consciously know Barack Obama was born in this country, and I believe this because the evidence is there.' For some people who we might write off as the lunatic fringe, the association to be American is to be white. I can see for them that feels true."
What are the main areas in which implicit racial bias affects our everyday lives?
Implicit biases are pervasive. Researchers say everyone possesses them, even people like judges, who have avowed commitments to impartiality.
And they don't just stay tucked away in our unconscious until they're revealed by a computer game. They determine how we behave. There is increasing evidence that implicit bias — including implicit racial bias, which the IAT measures — predicts behavior in the real world. This behavior, of course, harms the people who are members of groups that are the subjects of negative implicit bias.
For example, research has shown that it can affect healthcare: in one study, despite self-reporting very little explicit bias, two out of three clinicians were found to harbor implicit bias against blacks and Latinos. And it turns out that this affected the care that black patients got: the stronger the clinicians' implicit bias against blacks relative to whites, the lower the black patients rated them on all four sub-scales of patient-centered care. It's also been connected to racial discrimination in hiring, performance evaluations, housing discrimination, and even perceptions of neighborhood crime.
Criminal justice — from arrests, to police shootings, to juries' perceptions of defendants — is such a rich area for implicit racial bias to operate that it deserves its own separate discussion.
To understand the gaping racial disparities in criminal justice, it helps to understand implicit bias. As Vox's German Lopez has explained:
Part of the problem is outright racism among some judges and cops, socioeconomic disparities that can drive more crime, and drug laws that disproportionately affect black Americans. But the other explanation is that cops, like everyone else, carry this implicit bias, which experts agree affects how they police people of different races. Since these are the people who carry out the initial steps of law enforcement, this bias might launch a cascading effect of racial disparities that starts with simple arrests and ends in prison or death.
These are a few ways implicit bias has been found to operate at every level of the criminal-justice system:
Studies have shown that a person's level of implicit racial bias predicts the amount of shooter bias — meaning, how much easier it is to shoot African Americans compared with white people in a video-game situation. And when researchers at the University of Colorado at Boulder and California State University at Northridge reviewed a decade of empirical evidence about cops and implicit bias in 2012, they found police officers seem to possess implicit bias that might make them more likely to shoot black suspects than white ones.
In a 2013 article for Court Review, Kimberly Papillion addressed the idea that well-meaning judges can have neurophysiological responses that activate implicit racial biases, concluding that "Assuming that judges can simply try harder to be fair, take more time when making decision, or utilize their egalitarian value systems to eliminate bias in their decision-making process is naïve. The solutions should be tailored to the neurophysiologic reactions that infuse bias into the sentencing decisions."
Can you get rid of implicit racial bias?
The good news is that there is some evidence that implicit biases, including implicit racial biases, are malleable.
There are studies that demonstrate that you can at least produce shifts
Counter-stereotypic training: People can be trained, using visual or verbal cues, to develop new associations that contrast with the stereotypes they hold.
Exposure to individuals who defy stereotypes: Being made aware of people who challenge the assumptions that fuel our biases — for example, male nurses, elderly athletes, or female scientists — has shown potential to decrease them.
Intergroup contact: Simply having contact with the people about whom you have bias can reduce it. But researchers have found the contact typically has to involve individuals sharing equal status and common goals, a cooperative rather than competitive environment, and the presence of support from authority figures, laws, or customs.
Taking the perspective of others: considering contrasting viewpoints and recognizing multiple perspectives can reduce automatic implicit bias.
Mindfulness-meditation techniques: new research suggests that these can reduce implicit bias by short-circuiting negative associations.
While these methods are promising, implicit biases are really tough to shake. As Banaji told the Boston Globe, "I would say we should not be naïve about how easily we can change them. On the other hand, there are studies that demonstrate that you can at least produce shifts."
Between 18 and 22, a woman is like Africa. Half discovered, half wild, fertile and naturally Beautiful!
Between 23 and 30, a woman is like Europe. Well developed and open to trade, especially for someone of real value. Between 31 and 35, a woman is like Spain, very hot, relaxed and convinced of her own beauty.
Between 36 and 40, a woman is like Greece, gently aging but still a warm and desirable place to visit.
Between 41 and 50, a woman is like Great Britain, with a glorious and all conquering past.
Between 51 and 60, a woman is like Israel, has been through war, doesn't make the same mistakes twice, takes care of business.
Between 61 and 70, a woman is like Canada, self-preserving, but open to meeting new people.
After 70, she becomes Tibet . Wildly beautiful, with a mysterious past and the wisdom of the ages. An adventurous spirit and a thirst for spiritual knowledge.
THE GEOGRAPHY OF A MAN Between 1 and 80, a man is like Iran, ruled by a pair of nuts.
"Make them cry...
You're not out there to take any prisoners... Enforce collection until they
come to their knees." -- Instructions given at a 1996 IRS training lecture
"More tax is collected by fear and
intimidation than by the law. People are afraid of the IRS." -- Former IRS
District Chief David Patnoe
For taxpayers everywhere, terror is spelled I-R-S -- but the Internal
Revenue Service is much more than just the world's most fearsome and ruthless
tax collection agency. Current and former IRS officials have described how the
agency literally considers itself to be at war with the tax-paying public.
Leaked videos of IRS employee training sessions have revealed how agents have been taught
to use unethical and illegal means to extract money from long-suffering taxpayers,
and to retaliate against anybody -- whether ordinary citizen or
conscience-stricken agency employee -- who objects.
Since at least 2011, the IRS has carried out another role -- that of harassing
and persecuting the Obama administration's political rivals, while granting
special privileges to his allies. Anybody who belonged to a group with words
like "Patriot" or "Tea Party" in its name found himself in
the IRS's cross-hairs.
This illegal harassment wasn't limited to one state, or one region -- and it
didn't end with invasive questions about finances, donors, and membership
lists. Like secret police investigators in a Communist country, IRS officials
looking into the activities of pro-life activists scrutinized the "content
of their prayers" for supposedly inappropriate political content, and even
tried to impose limits on their peaceful outreach and activism.
While the IRS
was carrying out this campaign of persecution, its employees were
spending tens of millions of dollars on extravagant employee retreats -- and
unlike common taxpayers, they weren't required to keep track of their expenses.
When they weren't busy abusing taxpayers and wasting their money, unionized IRS
employees were preparing for the most radical expansion of the agency's mandate
in its history, which will put it in charge of enforcing the new
"Obamacare" law.
That's right: Under
Obamacare, the IRS will have the power to make life-and-death decisions
affecting every U.S. citizen -- and the officials directly responsible for the
harassment of the Tea Party movement will have critical roles in administering
the new government-run health care system.
How did we end up with the IRS? What are the dangers it represents to innocent
taxpayers? What can be done to rein in that rogue agency -- and is it possible
for us to be rid of it completely? You owe it to yourself to see
"Crosshairs: The Internal Revenue Scandal" -- and to share what you
learn with your friends and family. Your lives and those of your loved ones may
literally depend on it.
Obamacare cuts Medicaid doctor pay 42 percent in 2015. Here's why.
Thousands of Medicaid doctors are bracing for a tough start to 2015: a 42 percent pay cut.
The Affordable Care Act temporarily boosted payment rates for primary care doctors who see Medicaid patients in 2013 and 2014. The idea was to make sure doctors kept participating in Medicaid — which typically has low reimbursement rates — even as the program expanded to cover millions more Americans this year.
That earlier Obamacare pay raise was big, averaging out to a 73 percent increase for primary care doctors across the country. But it was also temporary, lasting only two years, and is set to run out on December 31. That means, beginning January 1, 2015, Medicaid doctors will earn less each time they see a patient — or, they could decide to pull out of the program altogether. Nobody is totally sure which way doctors will go.
Here's a quick guide to why the raise happened, why it's running out, and what it means for the future of Obamacare.
1) Obamacare raised Medicaid's primary care payments in 2013 and 2014
It's long been true of the American health care system that Medicare (the federal insurance program that covers the elderly) pays doctors more than Medicaid (the state-federal insurance program that covers the poor).
On average, Medicaid paid doctors about two-thirds of what Medicare pays — although, as this map shows, there's lots of variation across the country.
(Kaiser Family Foundation)
Even though Medicaid paid less, it has usually done a pretty good job making sure patients can get in to see primary care doctors. But there was a worry that, after Obamacare, that might not be the case. Medicaid is one of the two big programs the law relies on to expand health insurance coverage (the other is the marketplaces). Forecasters had estimated that 13 million additional people would join the program in Obamacare's first decade, and 7 million of those people would sign up in the first year.
Research has found that doctors are more likely to accept new Medicaid patients when their payment rates are higher. And the Affordable Care Act included a provision that aimed to entice doctors to sticking with — or perhaps joining — the program as it expanded to cover millions more Americans.
Beginning in 2013, the law bumped Medicaid primary care doctors' reimbursement rates up to match those of Medicare (specialists did not get any increase). The law funded the increased payments through the end of 2014, setting up a looming cliff that we're now approaching.
That's an estimate from the Urban Institute, which ran the numbers on how payment rates will change in 2015.
The decline will vary a lot from state to state. That's because each state sets its own payment rates for primary care doctors. In a state like California, for example, which tended to pay Medicaid doctors very low rates, Obamacare has doubled their fees. But in North Carolina, where the two programs fees were more similar, the pay rate increase was much smaller.
3) The federal government will not extend the pay cut
Mostly because it's expensive: the two years of the pay-bump cost the federal government $11 billion.
Medicaid advocacy groups have lobbied Congress a bit to extend the pay cut for at least two years now. And Sens. Patty Murray (D-WA) and Sherrod Brown (D-OH) did introduce legislation that would extend the pay bump until 2016.
"We’re ready to lobby for what’s right to improve the situation," Roland Goertz, chair of the Academy of Family Physicians, had said in 2012 about extending the pay cut. "We’re ready to go to the mat for what works, and we need to be going in this direction."
But the issue hasn't gotten traction; the Murray-Brown bill has languished in committee since its introduction this past summer. And that means, barring any last minute miracle, Medicaid payment rates will decline in many states — but not all — on Thursday.
4) Fifteen states are stepping in to extend the payment raise
(Kaiser Family Foundation)
Medicaid is a joint federal-state program, with the two governments splitting the bill for patients' coverage. And, according to the Kaiser Family Foundation, 15 states will step in and provide funding to either fully or partially continue the payment increase.
What's notable about this map, however, is that the states stepping in tend to be those that were already paying Medicaid doctors pretty well in the first place. They are places like New Mexico that, before Obamacare, paid primary doctors 85 percent of the Medicare rate, or Mississippi, which paid 90 percent.
The states that have a much bigger gap between Medicaid and Medicare payments, like California, are not generally not stepping in to avert the payment cut. This is probably due to the fact that fixing the bigger gaps is so much more expensive.
5) Nobody knows what this will mean for Medicaid patients' access to care
The worry among Medicaid advocates is that lower payment rates will translate into fewer doctors being willing to see patients. This is a articulated in a recent New York Times article, citing data from Ohio:
A survey by the Ohio State Medical Association found that some Ohio doctors began accepting Medicaid patients because of the rate increase in 2013. Ohio doctors who were already participating in the program said they had accepted more Medicaid patients after the rate increase. And almost 40 percent of Ohio doctors indicated that they planned to accept fewer Medicaid patients when the extra payments lapsed.
Previous studies have shown that states that pay more for primary care in Medicaid do have more doctors accepting new patients. This chart from Health Affairs shows the correlation:
Those are the reasons for concern — but there are also reasons to think things might go okay, too. Medicaid patients tend to have just as good access to primary care as patients in private coverage. One 2012 study commissioned by the federal government found that Medicaid patients are equally as likely to have had a routine check-up in the past year as those with private insurance. The real challenges in access tend to happen when patients seek speciality care.
And it's worth keeping in mind there were thousands of doctors who saw Medicaid patients prior to the Affordable Care Act's pay bump. These are people who, even before they got a big raise, thought it made sense to see these patients at lower rates. That gives decent reason to think that these doctors will stick around after the pay increase disappears, too.
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US Supreme Court, in 1985, “Dowling v. United States”, unequivocally held that allegations of copyright infringement can be prosecuted only under copyright-specific legislation, not criminal law.
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